Can spinal cord injury patients show a worsening in ASIA impairment scale classification despite actually having neurological improvement? The limitation of ASIA Impairment Scale Classification.

BACKGROUND

In our clinical training program, which includes probable American Spinal Injury Association impairment scale (AIS) grade changes in the event of recovery, we have noticed some confounding results regarding the AIS grading in spinal cord injury (SCI) patient case examples who are expected to recover. We also observed an individual case that showed a conflict between AIS grade conversion and neurological changes in European Multicenter Study on Human Spinal Cord Injury study.

STUDY DESIGN

The analysis of SCI case examples for the probable AIS grade changes in the event of recovery.

OBJECTIVES

To demonstrate the possible problems with AIS classification in SCI cases involving presumed motor and sensory changes, and to clarify the possible causes of the inverse relationship between the motor/sensory changes and AIS conversion in certain conditions.

SETTING

Ankara, Turkey.

METHODS

We studied the case examples of reference from the 2011 revision of International Standards for the Neurological Classification of Spinal Cord Injury.

RESULTS

We encountered the same unique problem of deteriorating AIS grades within the critical zones of conversion when presumed neurological improvement took place, and vice versa.

CONCLUSION

When recovery occurs without observing any motor or sensory changes while taking only the AIS into account, it would be possible to make an incorrect conclusion. This is most likely an indication of a limitation of the AIS. To enlighten this paradox, the large amount of data in SCI databases should be reanalyzed.