Although spinal cord injury (SCI) is often obvious, sometimes the extent of the injury to the spinal column is not. That is why it is important to dial 911 first, keep the patient still to avoid further spine or spinal cord damage, and use a rolled up blanket or thick towels placed on either side of the neck (body) to help immobilize and stabilize the area.

When in the hands of medical care, the doctor or emergency room staff quickly assesses the patient's condition. Quick assessment may include:

• Asking questions
• Noting the level of consciousness
• Complaints of neck or back pain
• Inability to move extremities
• Difficulty breathing

The American Spinal Injury Association (ASIA) Impairment Scale was adapted from the Frankel Classification System. ASIA helps to classify neurologic problems affecting movement (motor) or feeling (sensory).

ASIA Impairment Scale¹
A = Complete; no sensory or motor function exists in the fourth and fifth sacral elements (S4 and S5).

B = Incomplete; sensory, but not motor, function is still working below the neurologic level of injury and extends through S4-S5.

C = Incomplete; motor function is still working below the neurologic level. Most key muscles below the neurologic level of injury have muscle grade less than 3 (muscle grades are explained in the next section).

D = Incomplete; motor function is still working below the neurologic level. Most key muscles below the neurologic level of injury have muscle grade greater than or equal to 3.

E = Normal; sensory and motor functions are normal.

Muscle and Sensory Grades
Part of the ASIA Impairment Scale refers to muscle grade. This means muscle strength against resistance. It is graded on a scale from 0 to 5. For example:

• 0 = no strength
• 1 = minimal
• 4 = moderate
• 5 = normal strength

Ten different areas may be tested, such as the elbows (biceps, triceps), hip flexors, and knee extensors.

Light touch and pinprick are used to test sensation. It uses a 0 to 2 scale:

• 0 = no feeling
• 1 = feeling is impaired or highly sensitized
• 2 = normal feeling

Diagnostic Studies
SCI evaluation includes x-rays, a CT, and / or MRI. Although injury (e.g., fracture) may be visible on a x-ray, CT and MRI scans provide more structural information valuable for assessing soft tissues in the spine, such as the spinal cord. A myelogram may be performed to further evaluate the spine.