Physiotherapeutic theory for neurorehabilitation
of SCI
Background SCI
ISNCSCI (ASIA): International Standards for Neurological Classification of Spinal
Cord Injury
Motor level
The motor level is the lowest myotome with a key muscle that has a grade of at least 3, provided that
the muscle function in the key muscles above this level are normal (MMT = 5)
à C6
For myotomes that are not clinically testable (C1-4, T2-L1, S2-S5), the motor level is defined as the
same level as the sensory level
à T3
Sensory level
The sensory level is the most caudal level with normal light touch and pinprick sensation
• Sensory function tested by sensitivity to light touch and pinprick on both sides of body at key
dermatomes
• Scoring of sensation: 0 = absent, 1 = impaired, 2 = normal
, à T1
Neurological level
The neurological level of injury is defined as the most caudal level of the spinal cord with normal
motor and sensory function on both the left and right sides of the body
,AIS: ASIA Impairment Scale
A vs B: sensory function at S4-5
B vs C: motor function at S
C vs D: less/more than half of muscles have grade > 3
Example
AIS: D (motor incomplete)
- S4-5: some sensory function à incomplete
- At least half of key muscle functions below single NLI have a muscle grade > 3
Functional expectations based on complete injuries
Depending on
• Lesion level
• AIS
• Other factors: age (older), concomitant injury, pre-existing health conditions (diabetes),
secondary complications (pneumonia, UTIs, pressure injuries), BMI, psychosocial factors
à Use these expectations to establish goals and outcomes
,
of SCI
Background SCI
ISNCSCI (ASIA): International Standards for Neurological Classification of Spinal
Cord Injury
Motor level
The motor level is the lowest myotome with a key muscle that has a grade of at least 3, provided that
the muscle function in the key muscles above this level are normal (MMT = 5)
à C6
For myotomes that are not clinically testable (C1-4, T2-L1, S2-S5), the motor level is defined as the
same level as the sensory level
à T3
Sensory level
The sensory level is the most caudal level with normal light touch and pinprick sensation
• Sensory function tested by sensitivity to light touch and pinprick on both sides of body at key
dermatomes
• Scoring of sensation: 0 = absent, 1 = impaired, 2 = normal
, à T1
Neurological level
The neurological level of injury is defined as the most caudal level of the spinal cord with normal
motor and sensory function on both the left and right sides of the body
,AIS: ASIA Impairment Scale
A vs B: sensory function at S4-5
B vs C: motor function at S
C vs D: less/more than half of muscles have grade > 3
Example
AIS: D (motor incomplete)
- S4-5: some sensory function à incomplete
- At least half of key muscle functions below single NLI have a muscle grade > 3
Functional expectations based on complete injuries
Depending on
• Lesion level
• AIS
• Other factors: age (older), concomitant injury, pre-existing health conditions (diabetes),
secondary complications (pneumonia, UTIs, pressure injuries), BMI, psychosocial factors
à Use these expectations to establish goals and outcomes
,
