{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:57:37Z","timestamp":1789520257235,"version":"build-2803163510"},"reference-count":46,"publisher":"American Spinal Injury Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Successful utilization of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) requires a comprehensive understanding of its rules, terminology, and several complex concepts. There have been no studies investigating classification accuracy since the newest ISNCSCI revision (2019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate classification accuracy of SCI professionals using the 2019 ISNCSCI edition, identify common mistakes and areas of confusion, and assess associations between experience in ISNCSCI classification and performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Members of the International Spinal Cord Society (ISCoS) and attendees of the ISCoS Annual Scientific Meeting 2021 were invited to complete an online survey that included six ISNCSCI cases to classify.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 107 persons completed the survey, with overall classification accuracy of 74.6%. Accuracy was highest for injury completeness (95.3%) and sensory level (91.1%) and lowest for motor zone of partial preservation (ZPP; 54.7%) and ASIA Impairment Scale (AIS) grade (57.3%). Newer concepts, including the appropriate documentation of non-SCI conditions and classification of ZPP in incomplete injuries, contributed to several common errors. There was a significant association between overall classification accuracy and self-rated experience in the ISNCSCI classification (\n                      <jats:italic>p<\/jats:italic>\n                      = .017). Experience with the ISNCSCI examination, experience in SCI medicine, and occupation were not found to be significantly associated with overall classification accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Classification accuracy of an international cohort of SCI professionals was modest but greater than previous reports. Knowledge deficits about the 2019 ISNCSCI updates are prevalent and contribute to common classification errors. Further training in the utilization of the ISNCSCI is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.46292\/sci22-00036","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T17:36:26Z","timestamp":1676482586000},"page":"1-15","source":"Crossref","is-referenced-by-count":23,"title":["The International Standards for Neurological Classification of Spinal Cord Injury: Classification Accuracy and Challenges"],"prefix":"10.46292","volume":"29","author":[{"given":"Brittany A.","family":"Snider","sequence":"first","affiliation":[{"name":"Kessler Institute for Rehabilitation, West Orange, New Jersey"},{"name":"Kessler Foundation, West Orange, New Jersey"},{"name":"Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Eren","sequence":"additional","affiliation":[{"name":"Kessler Foundation, West Orange, New Jersey"},{"name":"Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald K.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine, Department of Physical Medicine and Rehabilitation, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"Rupp","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Kirshblum","sequence":"additional","affiliation":[{"name":"Kessler Institute for Rehabilitation, West Orange, New Jersey"},{"name":"Kessler Foundation, West Orange, New Jersey"},{"name":"Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"key":"i1945-5763-29-1-1-b1","series-title":"Standards for Neurological Classifications of Spinal Injured Patients.","year":"1982","unstructured":"American Spinal Injury Association.\n          \n          \n            Standards for Neurological Classifications of Spinal Injured Patients.\n          \n          Chicago, IL:\n\t\t\t\t\tAuthor;\n\t\t\t\t\t1982."},{"issue":"6","key":"i1945-5763-29-1-1-b2","series-title":"J Spinal Cord Med","first-page":"684","article-title":"Challenging questions regarding the international standards","volume":"41","year":"2018","unstructured":"Solinsky\n              R,\n            \n            \n              Kirshblum\n              SC.\n            \n          \n          Challenging questions regarding the international standards.\n\t\t\t\t\tJ Spinal Cord 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      \n              Clark\n              JM,\n            \n            \n              Ho\n              DT,\n            \n          \n          .\n\t\t\t\t\tAchieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2017;\n\t\t\t\t\t55(\n\t\t\t\t\t11):\n\t\t\t\t\t994\u2013\n\t\t\t\t\t1001."},{"issue":"4","key":"i1945-5763-29-1-1-b6","series-title":"Spinal Cord","first-page":"324","article-title":"International standards for neurological classification of spinal cord injury: Classification skills of clinicians versus computational algorithms","volume":"53","year":"2015","unstructured":"Schuld\n              C,\n            \n            \n              Franz\n              S,\n            \n            \n              van Hedel\n              HJA,\n            \n          \n          .\n\t\t\t\t\tInternational standards for neurological classification of spinal cord injury: Classification skills of clinicians versus computational algorithms.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2015;\n\t\t\t\t\t53(\n\t\t\t\t\t4):\n\t\t\t\t\t324\u2013\n\t\t\t\t\t331."},{"issue":"5","key":"i1945-5763-29-1-1-b7","series-title":"J Spinal Cord Med","first-page":"538","article-title":"International standards for neurological classification of spinal cord injury: Training effect on accurate classification","volume":"31","year":"2008","unstructured":"Chafetz\n              RS,\n            \n            \n              Vogel\n              LC,\n            \n            \n              Betz\n              RR,\n            \n            \n              Gaughan\n              JP,\n            \n            \n              Mulcahey\n              MJ.\n            \n          \n          International standards for neurological classification of spinal cord injury: Training effect on accurate classification.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2008;\n\t\t\t\t\t31(\n\t\t\t\t\t5):\n\t\t\t\t\t538\u2013\n\t\t\t\t\t542."},{"issue":"8","key":"i1945-5763-29-1-1-b8","series-title":"Spinal Cord","first-page":"554","article-title":"A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury","volume":"36","year":"1998","unstructured":"Cohen\n              ME,\n            \n            \n              Ditunno\n              JFJ,\n            \n            \n              Donovan\n              WH,\n            \n            \n              Maynard\n              FMJ.\n            \n          \n          A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t1998;\n\t\t\t\t\t36(\n\t\t\t\t\t8):\n\t\t\t\t\t554\u2013\n\t\t\t\t\t560."},{"issue":"4","key":"i1945-5763-29-1-1-b9","series-title":"Spinal Cord","first-page":"282","article-title":"Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury","volume":"51","year":"2013","unstructured":"Schuld\n              C,\n            \n            \n              Wiese\n              J,\n            \n            \n              Franz\n              S,\n            \n          \n          .\n\t\t\t\t\tEffect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2013;\n\t\t\t\t\t51(\n\t\t\t\t\t4):\n\t\t\t\t\t282\u2013\n\t\t\t\t\t288."},{"issue":"Suppl 1","key":"i1945-5763-29-1-1-b10","series-title":"J Spinal Cord Med","first-page":"S146","article-title":"Rater agreement on the ISCSCI motor and sensory scores obtained before and after formal training in testing technique","volume":"30","year":"2007","unstructured":"Mulcahey\n              MJ,\n            \n            \n              Gaughan\n          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Classification skills of clinicians versus computational algorithms","volume":"53","year":"2015","unstructured":"Schuld\n              C,\n            \n            \n              Franz\n              S,\n            \n            \n              van Hedel\n              HJA,\n            \n          \n          .\n\t\t\t\t\tInternational standards for neurological classification of spinal cord injury: Classification skills of clinicians versus computational algorithms.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2015;\n\t\t\t\t\t53(\n\t\t\t\t\t4):\n\t\t\t\t\t324\u2013\n\t\t\t\t\t331."},{"issue":"5","key":"i1945-5763-29-1-1-b7","series-title":"J Spinal Cord Med","first-page":"538","article-title":"International standards for neurological classification of spinal cord injury: Training effect on accurate classification","volume":"31","year":"2008","unstructured":"Chafetz\n              RS,\n            \n            \n              Vogel\n              LC,\n            \n            \n              Betz\n              RR,\n            \n            \n              Gaughan\n              JP,\n            \n            \n              Mulcahey\n              MJ.\n            \n          \n          International standards for neurological classification of spinal cord injury: Training effect on accurate classification.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2008;\n\t\t\t\t\t31(\n\t\t\t\t\t5):\n\t\t\t\t\t538\u2013\n\t\t\t\t\t542."},{"issue":"8","key":"i1945-5763-29-1-1-b8","series-title":"Spinal Cord","first-page":"554","article-title":"A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury","volume":"36","year":"1998","unstructured":"Cohen\n              ME,\n            \n            \n              Ditunno\n              JFJ,\n            \n            \n              Donovan\n              WH,\n            \n            \n              Maynard\n              FMJ.\n            \n          \n          A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t1998;\n\t\t\t\t\t36(\n\t\t\t\t\t8):\n\t\t\t\t\t554\u2013\n\t\t\t\t\t560."},{"issue":"4","key":"i1945-5763-29-1-1-b9","series-title":"Spinal Cord","first-page":"282","article-title":"Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury","volume":"51","year":"2013","unstructured":"Schuld\n              C,\n            \n            \n              Wiese\n              J,\n            \n            \n              Franz\n              S,\n            \n          \n          .\n\t\t\t\t\tEffect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2013;\n\t\t\t\t\t51(\n\t\t\t\t\t4):\n\t\t\t\t\t282\u2013\n\t\t\t\t\t288."},{"issue":"Suppl 1","key":"i1945-5763-29-1-1-b10","series-title":"J Spinal Cord Med","first-page":"S146","article-title":"Rater agreement on the ISCSCI motor and sensory scores obtained before and after formal training in testing technique","volume":"30","year":"2007","unstructured":"Mulcahey\n              MJ,\n            \n            \n              Gaughan\n              J,\n            \n            \n              Betz\n              RR,\n            \n            \n              Vogel\n              LC.\n            \n          \n          Rater agreement on the ISCSCI motor and sensory scores obtained before and after formal training in testing technique.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2007;\n\t\t\t\t\t30(\n\t\t\t\t\tSuppl 1):\n\t\t\t\t\tS146\u2013\n\t\t\t\t\t9."},{"key":"i1945-5763-29-1-1-b11","series-title":"International Standards for Neurological Classification of Spinal Cord Injury.","year":"2019","unstructured":"American Spinal Injury Association.\n          \n          \n            International Standards for Neurological Classification of Spinal Cord Injury.\n          \n          Richmond, VA:\n\t\t\t\t\tAuthor;\n\t\t\t\t\t2019."},{"issue":"1","key":"i1945-5763-29-1-1-b12","series-title":"Spinal Cord","first-page":"11","article-title":"Classification challenges of the 2019 revised International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)","volume":"60","year":"2022","unstructured":"Kirshblum\n              S,\n            \n            \n              Schmidt Read\n              M,\n            \n            \n              Rupp\n              R.\n            \n          \n          Classification challenges of the 2019 revised International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2022;\n\t\t\t\t\t60(\n\t\t\t\t\t1):\n\t\t\t\t\t11\u2013\n\t\t\t\t\t17."},{"issue":"2","key":"i1945-5763-29-1-1-b13","series-title":"Top Spinal Cord Inj Rehabil","first-page":"1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","year":"2021","unstructured":"Rupp\n              R,\n            \n            \n              Biering-S\u00f8rensen\n              F,\n            \n            \n              Burns\n              SP,\n            \n          \n          .\n\t\t\t\t\tInternational Standards for Neurological Classification of Spinal Cord Injury: Revised 2019.\n\t\t\t\t\tTop Spinal Cord Inj Rehabil.\n\t\t\t\t\t2021;\n\t\t\t\t\t27(\n\t\t\t\t\t2):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t22."},{"issue":"3","key":"i1945-5763-29-1-1-b14","series-title":"Phys Med Rehabil Clin N Am","first-page":"319","article-title":"Updates of the International Standards for Neurologic Classification of Spinal Cord Injury: 2015 and 2019","volume":"31","year":"2020","unstructured":"Kirshblum\n              S,\n            \n            \n              Snider\n              B,\n            \n            \n              Rupp\n              R,\n            \n            \n              Read\n              MS.\n            \n          \n          Updates of the International Standards for Neurologic Classification of Spinal Cord Injury: 2015 and 2019.\n\t\t\t\t\tPhys Med Rehabil Clin N Am.\n\t\t\t\t\t2020;\n\t\t\t\t\t31(\n\t\t\t\t\t3):\n\t\t\t\t\t319\u2013\n\t\t\t\t\t330."},{"issue":"1","key":"i1945-5763-29-1-1-b15","series-title":"Spinal Cord","first-page":"1","article-title":"Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury","volume":"60","year":"2022","unstructured":"Franz\n              S,\n            \n            \n              Heutehaus\n              L,\n            \n            \n              Weinand\n              S,\n            \n            \n              Weidner\n              N,\n            \n            \n              Rupp\n              R,\n            \n            \n              Schuld\n              C.\n            \n          \n          Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2022;\n\t\t\t\t\t60(\n\t\t\t\t\t1):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t10."},{"key":"i1945-5763-29-1-1-b16","unstructured":"Available from: https:\/\/www.isncscialgorithm.com."},{"issue":"5","key":"i1945-5763-29-1-1-b17","series-title":"J Spinal Cord Med","first-page":"504","article-title":"International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02\/13) on classification performance","volume":"39","year":"2016","unstructured":"Schuld\n              C,\n            \n            \n              Franz\n              S,\n            \n            \n              Br\u00fcggemann\n              K,\n            \n          \n          .\n\t\t\t\t\tInternational standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02\/13) on classification performance.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2016;\n\t\t\t\t\t39(\n\t\t\t\t\t5):\n\t\t\t\t\t504\u2013\n\t\t\t\t\t512."},{"key":"i1945-5763-29-1-1-b18","series-title":"Reference Manual for the International Standards for Neurological Classification of Spinal Cord Injury.","year":"2003","unstructured":"American Spinal Injury Association.\n          \n          \n            Reference Manual for the International Standards for Neurological Classification of Spinal Cord Injury.\n          \n          Chicago, IL:\n\t\t\t\t\tAuthor;\n\t\t\t\t\t2003."},{"issue":"1","key":"i1945-5763-29-1-1-b19","series-title":"Top Spinal Cord Inj Rehabil","first-page":"85","article-title":"International Standards for Neurological Classification of Spinal Cord Injury, Revised 2011","volume":"18","year":"2012","unstructured":"Burns\n              S,\n            \n            \n              Biering-S\u00f8rensen\n              F,\n            \n            \n              Donovan\n              W,\n            \n          \n          .\n\t\t\t\t\tInternational Standards for Neurological Classification of Spinal Cord Injury, Revised 2011.\n\t\t\t\t\tTop Spinal Cord Inj Rehabil.\n\t\t\t\t\t2012;\n\t\t\t\t\t18(\n\t\t\t\t\t1):\n\t\t\t\t\t85\u2013\n\t\t\t\t\t99."},{"issue":"4","key":"i1945-5763-29-1-1-b20","series-title":"J Spinal Cord Med","first-page":"346","article-title":"2009 review and revisions of the international standards for the neurological classification of spinal cord injury","volume":"33","year":"2010","unstructured":"Waring\n              WP\n              3rd,\n            \n            \n              Biering-Sorensen\n              F,\n            \n            \n              Burns\n              S,\n            \n          \n          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Cord.\n\t\t\t\t\t2022;\n\t\t\t\t\t60(\n\t\t\t\t\t1):\n\t\t\t\t\t37\u2013\n\t\t\t\t\t44."},{"key":"i1945-5763-29-1-1-b22","series-title":"Clin Ophthalmol","first-page":"2305","article-title":"Survey of the American Glaucoma Society Membership on current glaucoma drainage device placement and postoperative corticosteroid use","volume":"16","year":"2022","unstructured":"Yonamine\n              S,\n            \n            \n              Ton\n              L,\n            \n            \n              Rose-Nussbaumer\n              J,\n            \n          \n          .\n\t\t\t\t\tSurvey of the American Glaucoma Society Membership on current glaucoma drainage device placement and postoperative corticosteroid use.\n\t\t\t\t\tClin Ophthalmol.\n\t\t\t\t\t2022;\n\t\t\t\t\t16:\n\t\t\t\t\t2305\u2013\n\t\t\t\t\t2310."},{"issue":"8","key":"i1945-5763-29-1-1-b23","series-title":"Orthopadie (Heidelberg, Ger","first-page":"652","article-title":"[Reality of care of patella stabilizing operations 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