ISNCSCI / ASIA examination
/ IZ-nik-see / AY-zhuh /
When someone injures their spinal cord, the first thing the team needs is a precise, agreed-upon map of what still works and what does not. The ISNCSCI examination (the International Standards for Neurological Classification of Spinal Cord Injury, often just called the ASIA exam after the American Spinal Injury Association that publishes it) is exactly that map: a careful, standardised head-to-toe test that turns a confusing pattern of numbness and weakness into clear numbers and grades that any clinician anywhere can read the same way.
The exam has two halves. The sensory half tests light touch and pin-prick at 28 specific points on each side of the body, called key sensory points, each one matching a single spinal segment (a dermatome). The motor half tests the strength of 10 key muscles on each side — five in the arms, five in the legs — each scored from 0 (no movement) to 5 (normal), each matching a single segment (a myotome). The examiner also checks sensation at the lowest sacral level around the anus and whether the person can squeeze the anal sphincter — these tell whether the very bottom of the cord is connected, which decides complete versus incomplete. From all this the team derives the sensory and motor levels (the lowest segment that still works normally on each side), the single neurological level, and the AIS grade.
In rehabilitation this exam is the foundation document. It pins down the starting point, lets two hospitals across the world compare the same patient, drives realistic goal-setting, and — when repeated over weeks — measures real neurological recovery rather than guesswork. It is detailed and easy to do slightly wrong, so it must be done by trained examiners, off sedation, and not during spinal shock when reflexes are switched off. Done well, it is the single most useful piece of information about a new SCI.
A physiatrist tests each key muscle and key sensory point, finds normal strength and sensation down through the C6 segment but loss below, confirms no sensation or squeeze at the anus, and records a right motor level of C6, a sensory level of C6, and AIS grade A — a single line that another team can fully understand.
The exam converts a complex pattern of loss into standardised levels and a grade everyone reads the same way.
Performing the ISNCSCI during spinal shock, under sedation, or by an untrained examiner gives misleading results. Because the first detailed exam anchors all later comparisons, the classification is usually confirmed once spinal shock has resolved.