Classification The American Spinal Injury Association (ASIA) first published an international c lassification of spinal cord injury in 1982,

called the International Standards for Neurological and Functional Classification of Spinal Cord Injury. Now in its sixth edition, the International Standards for Neurological Classification of S pinal Cord Injury (ISNCSCI) is still widely used to document sensory and motor i mpairments following SCI.[4] It is based on neurological responses, touch and pi nprick sensations tested in each dermatome, and strength of ten key muscles on e ach side of the body, including hip flexion (L2), shoulder shrug (C4), elbow fle xion (C5), wrist extension (C6), and elbow extension (C7).[5] Traumatic spinal c ord injury is classified into five categories on the ASIA Impairment Scale: A indicates a "complete" spinal cord injury where no motor or sensory functi on is preserved in the sacral segments S4 -S5. B indicates an "incomplete" spinal cord injury where sensory but not mot or function is preserved below the neurological level and includes the sacral se gments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, i.e. ASIA C or D. C indicates an "incomplete" spinal cord injury where motor function is p reserved below the neurological level and more than half of key muscles below th e neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity. D indicates an "incomplete" spinal cord injury where motor function is p reserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more. E indicates "normal" where motor and sensory scores are normal. Note tha t it is possible to have spinal cord injury and neurological deficits with compl etely normal motor and sensory scores.[4] Dimitrijevic[6] proposed a further class, the so-called discomplete lesi on, which is clinically complete but is accompanied by neurophysiological eviden ce of residual brain influence on spinal cord function below the lesion.[7]