title: Functional motor preservation below the level of injury in subjects with American Spinal Injury Association Impairment Scale grade A spinal cord injuries.
abstract: OBJECTIVE
  To assess how frequently subjects with spinal cord injuries (SCIs) classified as American Spinal Injury Association Impairment Scale (AIS) grade A have substantial preserved motor function below the neurologic level of injury, despite having no preserved sensory or motor function at the S4-5 spinal cord segment.
  
  
  METHODS
  Analysis of the European Multicenter Study about Spinal Cord Injury database to determine how frequently subjects assessed as AIS A would have been AIS D based on motor scores alone (ie, had scores of ≥3 in at least half of the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] key muscles below the neurologic level of injury, despite having no sacral sparing).
  
  
  METHODS
  Eighteen European centers.
  
  
  METHODS
  Individuals with traumatic SCI at any level (total of 2557 assessments).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  ISNCSCI assessments.
  
  
  RESULTS
  Over the first year after SCI (with assessments at approximately 1, 4, 12, 24, and 48wk) and for all rostrocaudal levels of injury, only 3.2% of AIS A assessments were found to meet the AIS D motor score criteria. The percentage was highest for lumbar (16.3%) and lower thoracic (4.4%) SCI. No trends were observed across time points.
  
  
  CONCLUSIONS
  These results suggest that the low frequency of individuals with an AIS A classification and high levels of motor function are not a significant concern in subject recruitment for clinical trials, unless the level of SCI is within the lumbar cord.
authors.affiliation: International Collaboration On Repair Discoveries, University of British Columbia, and Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Zariffa
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.forename: John D
authors.initials: JD
authors.lastname: Steeves
mesh_terms: D000344:Afferent Pathways / Q000503:physiopathology; D002574:Cervical Vertebrae; D004525:Efferent Pathways / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae; D009068:Movement; D016032:Randomized Controlled Trials as Topic; D013119:Spinal Cord Injuries / Q000145:classification* / Q000503:physiopathology*; D013904:Thoracic Vertebrae; D015599:Trauma Severity Indices