ASIA impairment scale

Dr Owen Kang and A.Prof Frank Gaillard et al.

The American Spinal Injury Association (ASIA) 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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