{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:51:51Z","timestamp":1774425111362,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,25]]},"group-title":"Public Health and Healthcare","reference-count":0,"publisher":"MDPI AG","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,24]]},"abstract":"<jats:p>The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) are widely used to classify spinal cord injuries, with the absence of deep anal pressure and voluntary anal contraction defining complete injury (AIS A). However, growing evidence challenges the reliability and validity of anorectal examination as the sole determinant of injury completeness. Several studies demonstrate that individuals clinically classified as AIS A may retain residual sensory or motor conduction detectable through neurophysiological methods, such as somatosensory and motor evoked potentials. These findings question the clinical and prognostic value of the complete versus incomplete distinction and highlight limitations in current classification approaches.This paper argues for a more integrative assessment framework that combines standard clinical examination with neurophysiological data and patient-reported outcomes. Such an approach may improve sensitivity in detecting residual neural function, enhance prognostic accuracy, and support more individualized rehabilitation strategies. Furthermore, shifting toward a model that emphasizes preserved function and neuroplastic potential may provide a more meaningful understanding of spinal cord injury. Ultimately, refining rather than replacing existing standards could lead to a more comprehensive and clinically relevant classification system.<\/jats:p>","DOI":"10.20944\/preprints202603.1996.v1","type":"posted-content","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:03:14Z","timestamp":1774418594000},"source":"Crossref","is-referenced-by-count":0,"title":["Anorectal Examination Can Be Crucial in Classifying Spinal Cord Injuries, but There Is Much More to Explore\u2014It Is One Piece of the Puzzle, but Not the Entire Puzzle"],"prefix":"10.20944","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-1326","authenticated-orcid":false,"given":"Alfredo A.","family":"Lopes","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5018-6905","authenticated-orcid":false,"given":"Augusta","family":"Silva","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Luz","sequence":"additional","affiliation":[]}],"member":"1968","container-title":[],"original-title":[],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:06:01Z","timestamp":1774418761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.preprints.org\/manuscript\/202603.1996\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":0,"URL":"https:\/\/doi.org\/10.20944\/preprints202603.1996.v1","relation":{},"subject":[],"published":{"date-parts":[[2026,3,25]]},"subtype":"preprint"}}