View source for American Spinal Cord Injury Association (ASIA) Impairment Scale

=== Reliability  ===
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Sensory and Motor examinations are reliable when conducted by a trained examiner.<ref name="Marino et al">Marino R, Jones L, Kirshblum S, Tal J, Dasgupta A. Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med 2008;31(2)166-170.</ref> Both interrater and intrarater reliability were found to be excellent.<ref>Clifton G, Donovan W, Dimitrijevic M ''et al.'' Omental transposition in chronic spinal cord injury. ''Spinal Cord 1996;'' 34:193–203.</ref><ref>Savic G, Bergström EM, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444-51.</ref> Formal training in the administration of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Standards has been shown to improve the accuracy of the examiner’s classification.<ref name="Schuld et al">Schuld C, Wiese J, Franz S, Putz C, Stierle I, Smoor I, Weidner N, EMSCI Study Group, Rupp RR. Effect of formal training in scaling, scoring and classification of the international standards for neurological classification of spinal cord injury. Spinal Cord 2013;51(4):282-8.</ref> Use of the 2013 Worksheet Revision provides significantly better classification performance and a reduction in misclassification of Motor Level and Neurological Level of Injury since its introduction, except at C2 - 4 Level, which has been suggested may be linked to the body-side based grouping of myotomes and dermatomes on the same horizontal alignment. As such it is recommended that any future revision of the worksheet should maintain the same graphical aspect in the layout.<ref>Schuld C, Franz S, Brüggemann K, Heutehaus L, Weidner N, Kirshblum SC, Rupp R. International Standards for Neurological Classification of Spinal Cord Injury: Impact of the Revised Worksheet (Revision 02/13) on Classification Performance. The Journal of Spinal Cord Medicine. 2016 Sep 2;39(5):504-12.</ref>