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    ISNCSCI Calculator

Welcome to EMSCI's ISNCSCI calculator

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The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most well established assessment to characterize the neurological impairment after a spinal cord injury (SCI). It is a widely accepted communication tool for clinicians and researchers. ISNCSCI consists of two major parts (neurological evaluation and a subsequent classification). The classification part of ISNCSCI is supported with this web application, which consist of rules for the determination of the location (levels), severity (ASIA Impairment Scale) and extent (zones of partial preservation) of a SCI. The classification is performed on the basis of the sensory examination of light touch appreciation and pin prick discrimination along 28 dermatomes per body side, as well as the manual muscle test for 10 "key" muscles per body side and an anorectal examination for deep anal pressure sensation and voluntary anal contraction.


The purpose of this web application is twofold: First, EMSCI uses this application as a check for internal quality control. Second, it is intended to train an individual's ISNCSCI classification skills by comparing the classification results of this computer algorithm with the manual classification made by an examiner. We encourage everybody to perform classifications manually and afterwards use this application for educational purposes and quality control.
Ideally, an ISNCSCI examiner is performing a preliminary manual classification at the conclusion of the examination. This helps to avoid misclassification of non SCI-related issues above the level of injury and to identify the most crucial dermatomes and myotomes for classification. The latter include those segments, where motor function is preserved more than three levels below the motor level, which is important for the accurate classification of AIS B versus an AIS C/D. As a consequence, the examiner can focus on these dermatomes and myotomes to ensure conclusive scoring results. Relying exclusively on computer classification skills might result in a loss of very important diagnostic skills.


This ISNCSCI calculator has been developed within the framework of the European Multicenter Study on Human Spinal Cord Injury (EMSCI). EMSCI is an internationally recognized scientific and clinical spinal cord injury network, which was initiated in 2001 to provide the clinical basis for future interventional trials in SCI. Patients with a traumatic or ischemic SCI are documented in five distinct time frames within the first year after onset of SCI. Core assessments are ISNCSCI, the Spinal Cord Independence Measure (SCIM) and walking tests [10 meter walk test, 6 minute walk test, timed up and go (TUG) test and the walking index for SCI (WISCI)].
As of August 2014, the EMSCI database contains 3193 patients from 22 European SCI centers. Maintaining a high level of quality of ISNCSCI examinations and classifications is of utmost importance within networks like EMSCI. The idea to accurately classify ISNCSCI datasets by a computer program emerged from the ESMCI quality assurance initiative. Please see the History page for a more detailed description of the background and the history of the EMSCI-ISNCSCI calculator.
The computational ISNCSCI classification approach was one of the prerequisites for the successful ISO-9001 certification process performed on an annual basis since 2010.


ISNCSCI is developed and maintained by the American Spinal Injury Association (ASIA). ASIA's International Standards Committee is responsible for the continuous review and improvement of ISNCSCI. This includes their International Standards Training E-learning Program (InSTeP), the Autonomic Standards Training E-learning Program (ASTeP) and WeeSTeP, which is the pediatric equivalent of InSTeP. We highly recommend these programs for all investigators to learn and to maintain their SCI assessment skills. ASIA also provides additional educational resources like the ISNCSCI motor examination guide, the sensory examination guide and of course the latest approved version of the ISNCSCI examination scoresheet. Please visit their Learning Center for a full list of resources.


You will need JavaScript to use all the new features for input acceleration and the new graphical features. It will run in modern HTML5 enabled browsers like Google Chrome (all versions), Apple Safari (all versions), Mozilla Firefox (version 21+) and Mircosoft Internet Explorer (version 10+). This hand-crafted implementation is proudly made without the use of PHP, Java, Perl, MySQL or any other frameworks and is only using the standard libraries of C, C++ and JavaScript.


The information provided on this web site is for educational and informational purposes only. You use this website and the information it provides on an "as is" basis. No representations or warranties are made as to its accuracy. This information should not be regarded as complete or a source of medical or diagnostic information or used as a substitute for clinical judgment of professional medical instruction.
This computer calculator application is designed to produce a spinal cord injury classification consistent with ISNCSCI as developed and copyrighted by ASIA. No representation or warranty with respect to the content is being made by ASIA. In no event shall EMSCI or ASIA be liable to you or any other entity for any direct, special, consequential, incidental, or indirect damages, liabilities, losses, costs, expenses, claims, fines, penalties, demands, or legal proceedings, however caused.
The calculator cannot produce conclusive results, if classification relevant information is placed into the comment box. This includes lesions with multiple spinal injury levels and non SCI-related impairments. In these cases the classification must be performed by a SCI professional. Please consult Kirshblum2014 et al. for guidelines regarding these issues.
You must respect all laws governing data protection, privacy and security of patient related data in your country. This includes the anonymity of any patient and examiner data and the appropriate uses of either a patient or examiner identifier. The owners and managers of this website and EMSCI are also not liable for any intentional or unintentional use of this calculator with identified patient data (see above paragraph).