A suggested method is to use the American Spinal Injury Association Classification of Nerve Roots and Spinal Reflexes. This is standard and published by a reputable source to allow clear communication between clinicians and Neurosurgical units.
The ASIA Standard Neurological Classification of Spinal Cord Injury Is Shown Below
![](https://medicaleducator.co.uk/wp-content/uploads/2024/05/image-1.png)
Figure 1. The ASIS Standard Classification of Spinal Cord Injury Image 1 of 2
Courtesy of the American Spinal Injuries Association, Accessed on 1/8/08 from the ASIS Website, with thanks
Inspect from the end of the bed
Inspection
- Posture
- General health
- Deformities / contractures
- Muscle wasting
- Fasciculations
- Abnormal movement – chorea etc
- Around the bed – walking aids
Tone
- Normal / reduced / increased. Unilateral / bilateral
- Cog-wheeling
- Check for clonus (UMN lesion)
- Spasticity (UMN)
Power
MRC Grade (Medical Research Council) | Movement (e.g. in hip extension/ ankle dorsiflexion etc) |
0 | No movement |
1 | Flicker of muscle movement |
2 | Movement In the plane of gravity |
3 | Movement against gravity |
4 | Reasonable but reduced power against some resistance |
5 | Normal for that person |
Coordination
Check finger –nose testing. Heel to shin movement in lower limbs.
Remember intention tremor of cerebellar disease – (cerebellar signs are ipsilateral i.e. right sided cerebellar problem eg tumour would give right sided intention tremor).
Sensation
Neurotips: Light /fine touch
Dermatomes etc are covered separately: See above classification.
Reflexes
Normal / brisk (UMN)/ reduced(LMN)
Gait
Antalgic/ broad based
Important to just look slick. Do this through practice
The Second Page of the ASIS Standard Classification of Spinal Cord Injury is shown below in figure 2
![](https://medicaleducator.co.uk/wp-content/uploads/2024/05/image-2.png)
Figure 2. The ASIS Standard Classification of Spinal Cord Injury Image 2 of 2
Courtesy of the American Spinal Injuries Association, Accessed on 1/8/08 from the ASIA Website, with thanks