ISNCSCI Resources

International Standards for Neurological Classification of SCI (ISNCSCI) Worksheet
(Download & Print)

Click here to access the ISNCSCI worksheet in other languages. (Chinese, French, German, Greek, Italian, Japanese, Portuguese, Spanish, Swedish, and Ukrainian)

(NEW) ISNCSCI 2026 9th Edition Booklet – Order Here

References

An open-access publication of the 2019 ISNCSCI revision:
Rupp R, Biering-Sørensen F, Burns S, et al. International Standards for Neurological Classification of Spinal Crod Injury: Revised 2019. Top Spinal Cord Inj Rehab. 2021;27(2):1-22.

Details and examples of the non-SCI taxonomy introduced with the 2019 ISNCSCI revision:
Rupp R, Schuld C, Biering-Sørensen F, et al. A taxonomy for consistent handling of conditions not related to the spinal cord injury (SCI) in the International Standards for Neurological Classification of SCI (ISNCSCI). Spinal Cord. 2022;60(1):18-29.

Rationale and examples for the 2019 definition of the Zone of Partial Preservation:
Schuld C, EMSCI Study Group, Kirshblum S, et al. The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries. Spinal Cord. 2024;62:79-87.

Example cases focusing on the correct application of the non-SCI taxonomy and the 2019 ZPP definition:
Snider B, Kirshblum S, Rupp R, et al. International Standards for Neurological Classification of Spinal Cord Injury: Case Examples Reinforcing Concepts From the 2019 Revision. Top Spinal Cord Inj Rehabil. 2025;31(3):1-14.

ISNCSCI Training Resources

>>>>International Standards Training E-Learning Program (InSTeP)

ISNCSCI Motor Exam Guide
ISNCSCI Key Sensory Points Guide
ISNCSCI Workbook Practice – Cases
ISNCSCI Workbook – Practice Cases & Answers
ASIA Clinical (Trials) ISNCSCI Training Program

Expedited-ISNCSCI (E-ISNCSCI) Examination

Instructions of the E-ISNCSCI Version 2

References

Burns SP et al. Development and Validation of an Algorithm for Item Reduction of the International Standards for Neurological Classification of Spinal Cord Injury Examination to Determine Level and Severity of SCI. Top Spinal Cord Inj Rehabil. 2025;31(3):61-67.

Resources for People with Lived Experience

What is the ISNCSCI Exam? Adult Brochure
What is the ISNCSCI Exam? Pediatric Brochure

ISNCSCI Calculators

Two online ISNCSCI calculators have been developed with significant contributions from current members of the International Standards Committee.

EMSCI ISNCSCI Calculator
Praxis ISNCSCI Algorithm

ISNCSCI Webinars and Podcasts

TSCIR Webinars
The Good and Bad of an Abbreviated ISNCSCI Exam

ASIA Webinars
Cases of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) with Classification Challenges (January 15, 2021)
Available in the eLearning center – http://asia.learnshare.com/

International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Ask the Experts! (June 25, 2021)
Available in the eLearning center – http://asia.learnshare.com/

SCI Science Perspectives Podcasts
Community EP051 – Continuing to Shorten the ISNCSCI (or “ASIA”) Exam with Dr. Stephen Burns
Scholarly EP050 – Version 2 of the “Expedited” ISNCSCI (E-ISNCSCI) with Dr. Stephen Burns

Community EP036 – Staying Up to Date on the Neurological Exam with Dr. Rüdiger Rupp
Scholarly EP035 – Staying Up to Date on the ISNCSCI with Dr. Rüdiger Rupp

References to Support Evidence-Based Knowledge About ISNCSCI

ISNCSCI Examination Reliability and Validity

Heutehaus L, Schuld C, Solinas D, et al. Revisiting the Examination of Sharp/Dull Discrimination as Clinical Measure of Spinothalamic Tract Integrity. Front Neurol. 2021;12:677888.

Hales M, Biros E, Reznik JE. Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review. Top Spinal Cord Inj Rehabil. 2015;21(3):241-249.

Mulcahey MJ, Gaughan JP, Chafetz RS, Vogel LC, Samdani AF, Betz RR. Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury. Arch Phys Med Rehabil. 2011 Aug;92(8):1264-9.

Marino RJ, Jones L, Kirshblum S, et al. 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;32(2):166-170.

Savic G, Bergstrom EMK, Frankel HL, et al. Inter-rater Reliability of Motor and Sensory Examinations Performed According to American Spinal Injury Association Standards. Spinal Cord. 2007;45:444-451.

Jonsson M, Tollback A, Gonzales H, et al. Inter-rater reliability of the 1992 International Standards for Neurological and Functional Classification of Incomplete Spinal Cord Injury. Spinal Cord. 2000;38(11):675-679.

Cohen ME, Bartko J. Reliability of ISCSCI-92 for neurological classification of spinal cord injury. In: Ditunno JF, Donovan WH, Maynard FM, eds. Reference Manual for the International Standards for Neurological and Functional Classification of Spinal Cord Injury. Chicago, IL: American Spinal Injury Association; 1994:59–65.

ISNCSCI Classification Challenges

Kirshblum S, Schmidt Read M, Rupp R. Classification Challenges of the 2019 Revised International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord. 2022;60(1):11-17.

Snider B, Eren F, Reeves R, et al. International Standards for Neurological Classification of Spinal Cord Injury: Classification Accuracy and Challenges. Top Spinal Cord Inj Rehabil. 2023;29(1):1-15.

Snider B, Kirshblum S, Rupp R, et al. International Standards for Neurological Classification of Spinal Cord Injury: Classification Questions and Cases. Top Spinal Cord Inj Rehabil. 2025;31(3):77-88.

Importance of ISNCSCI Training

Franz S, Heutehaus L, Weinand S, et al. Theoretical and Practical Training Improves Knowledge of the Examination Guidelines of the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2022;60(1):1-10.

Armstrong AJ, Clark JM, Ho DT, et al. Achieving Assessor Accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2017;29(8):1639-1648.

Letter to the editor to the publication of Amstrong et al., Spinal Cord 29(8), 2017 from the International Standards Committee: ASIA International Standards Committee, ASIA Education Committee, Rupp R. Assessor accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—recommendations for reporting items. Spinal Cord. 2018;56, 819–820.

Schuld C, Wiese J, Franz S, et al. 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):282-288.

Liu N, Zhou MW, Krassioukov AV, Biering-Sørensen F. Training effectiveness when teaching the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to medical students. Spinal Cord. 2013 Oct;51(10):768-71.

Chafetz RS, Vogel LC, Betz RR, et al. International Standards for Neurological Classification of Spinal Cord Injury: Training Effect on Accurate Classification. J Spinal Cord Med. 2008;31(5):538-542.

Evidence for ISNCSCI Changes and Clarifications