The ASIA Impairment Scale (AIS) is based on the comprehensive ISNCSCI neurologic exam, identifying the exact level and completeness of SCI.
Neurological Sentinel Probe
Input the neurological grade established by the ISNCSCI sacral mapping exam to determine the AIS classification and associated recovery profile.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Classification of Traumatic Spinal Cord Injury (tSCI).
Standardizing neurological exams across the trauma care continuum.
Prognosticating potential for recovery of motor or sensory function.
Determining candidates for early surgical decompression.
Section 2
Formula & Logic
Classification Tiers
Grade
Category
Description
A
Complete
No sacral (S4–S5) motor or sensory function.
B
Sensory Incomplete
Sensory preserved at S4–S5; no motor below NLI.
C
Motor Incomplete
Motor preserved; > 50% key muscles < Grade 3.
D
Motor Incomplete
Motor preserved; ≥ 50% key muscles ≥ Grade 3.
E
Normal
Motor and sensory testing is normal.
Section 3
Pearls/Pitfalls
The Importance of S4-S5
The entire AIS grade rests on the S4–S5 examination (sacral sparing). If a patient has a "complete" motor loss at T4 but maintains sensation at S4–S5 or deep anal pressure, they are technically "Incomplete" (AIS B). This drastically changes their recovery prognosis compared to a true AIS A.
Section 4
Evidence Appraisal
Primary Reference
International standards for neurological classification of spinal cord injury (Revised 2011)
Kirshblum SC et al. • J Spinal Cord Med. 2011;34(6):535-546
Developed through international collaboration among the American Spinal Injury Association (ASIA), the International Spinal Cord Society (ISCOS), and the International Medical Society of Paraplegia. Adopted in 1982 and revised in 2011, it remains the gold standard for spinal cord injury documentation worldwide.
