ASIA impairment scale

The American Spinal Injury Association impairment scale is part of the ASIA spinal cord injury classification. It divides spinal cord injuries into 5 categories, with optional clinical syndromes.

  • A: complete
  • B: incomplete: sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5
  • C: incomplete: motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3 strength
  • D: incomplete: motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more strength
  • E: normal

Optional clinical syndromes

Muscle strength grading

  • 0: total paralysis
  • 1: palpable or visible contraction
  • 2: active movement, full range of motion, gravity eliminated
  • 3: active movement, full range of motion, against gravity
  • 4: active movement, full range of motion, against gravity and provides some resistance
  • 5: active movement, full range of motion, against gravity and provides normal resistance
  • 5*: muscle able to exert, in examiner’s judgement, sufficient resistance to be considered normal if identifiable inhibiting factors were not present

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