ASIA Scale (American Spinal Injury Association)
International gold standard for assessing and classifying the level of spinal cord injury. Examining the motor and sensory domain based on myotomes and dermatomes and anorectal examination, classifying the neurological level of the lesion and the type, complete or incomplete (Neves et al. 2007)
The tactile sensory examination uses a brush and a painful pin. It assesses and records 28 specific dermatomes bilaterally. A score of 0 denotes absent sensation, 1 denotes impaired or altered sensation, and 2 denotes normal sensation. In the motor examination, the major cervical and lumbar myotomes are assessed, being elbow flexors and extensors, wrist extensors and flexors, finger flexors and abductors, hip flexors, knee extensors, ankle dorsiflexors, plantar flexors, and toe long extensors. Motor strength is rated using the universal six-point scale rated 0-5, where 0 = total paralysis; 1 = palpable or visible contraction; 2 = active movement, complete arc of motion with gravity eliminated; 3 = active movement, complete arc of movement against gravity; 4 = active movement, complete arc of motion against moderate resistance; 5 = (normal) complete arc of motion against resistance; NE = not examined. Motor strength is recorded for each muscle group bilaterally. Anorectal examination, digitally examined to assess voluntary sphincter motor contraction and bulbocavernosus reflex, both rated 0 for absent and 1 for present, important to determine the integrity of the lesion and assess the presence of spinal shock. The ASIA restraint scale uses the findings of the neurological examination to classify injury types within five categories: A = Complete Injury, no motor and sensory function exists in the spinal cord segments below the injury, including sacral segments; B = Incomplete Injury, sensibility (totally or partially) preserved with extension through sacral segments S4-S5, no motor function below neurological level; C = Incomplete Lesion, motor function preserved below the level of injury with most key muscles below the neurological level showing a degree of muscle strength less than 3; D = Incomplete injury, preserved motor function below the level of the lesion with most of the key muscles below the neurological level presenting a degree of muscular strength greater than or equal to 3; E = Normal, motor and sensory function. To determine motor level, the lowest key muscle should be grade 4 or 5, as this muscle will have both segments innervating it intact (Roberts et al. 2017, Kirshblum et al. 2014).
Modified Ashworth Scale (MAS)
It is a primary clinical measure of spasticity that makes it possible to measure the level of impairement (Santos et al. 2016). The scale has 5 categories ranging from normal tone to spasticity, according to muscle resistance against passive movement of the affected segment(s): 0 being normal tone; 1: slight increase in muscle tone with minimal resistance at the end of the movement; 1+: slight increase in muscle tone with minimal resistance in less than half the movement; 2: more marked increase in muscle tone for most of the movement, but passive mobilization is carried out with ease; 3: considerable increase in muscle tone, but passive movement is carried out with difficulty; 4: rigid affected segment in flexion or extension (Picon et al. 2013).
Thoracic-Lumbar Control Scale
It includes 10 items that evaluate: trunk extension in prone position, pelvis elevation, trunk flexion in dorsal decubitus, trunk rotation, sitting to supine, supine to sitting, sitting posture, trunk extension in sitting position, sitting balance and standing balance. The tasks are scored according to the patient's capacity to carry them out with minimum effort, varying from 0 to 5 points. The scores decrease as the use of compensatory strategies increases. In the first seven tasks, to obtain five points, the patient must be capable of carrying out the task in the proposed position with no evident effort and without assistance; the patient scores 4 if, when carrying out the task, some sign of effort is observed. If it is necessary for the patient to change position to carry out the task, the scores range from 3 to 0. If some contractile activity is detected or if therapist assistance is given for most of the movement, the task is scored 1. In the absence of movement and muscle contraction, or assistance given to perform the task fully, the patient's score is 0 (Pastre et al. 2011).
The Spinal Cord Independence Measure III (SCIM III)
It specifically assesses a person with spinal cord impairment on levels of independence to perform the individuals' activities of daily living and mobility. It is divided into three complementary subscales: "self-care" (scored from 0 to 20) assesses six tasks ; "breathing and sphincter control" (score from 0 to 40) with four tasks and "mobility" (score from 0 to 40) with nine tasks. The final score ranges from 0 (most dependent) to 100 (most independent) (Riberto et al. 2014).