American Spinal Cord Injury Association (ASIA) Impairment Scale

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), usually called the ASIA exam, is the standard physical exam for mapping what sections of the spinal cord a spinal cord injury impacts A clinician tests light touch and pinprick at a key point in each of 28 dermatomes on both sides of the body, then tests the strength of 10 key muscles on each side, grading each from 0 to 5.

Those findings establish a sensory and motor level for each side, a single neurological level of injury, and whether the injury is complete or incomplete. Function in the lowest sacral segments is the deciding factor. The result is an ASIA Impairment Scale grade from A (complete) through E (normal), which shapes prognosis, goal setting, and research eligibility.

• ASIA worksheet and permissions page

Licensing Notes: The ISNCSCI worksheet is free to download from ASIA and is licensed under a Creative Commons license: it may be copied freely for non-commercial use, but it may not be altered without ASIA's permission

Learn More: Scoring is easy to get wrong by hand. ASIA's e-Learning Center (InSTeP) offers training, and the ISNCSCI algorithm at isncscialgorithm.com will compute the levels and AIS grade from entered scores.