NEUROLOGICAL ISSUES

The case histories of two patients who had had a spinal cord injury (S CI) were selected by the senior author and sent to four experts in the held of SCI. Based on the 1992 American Spinal Injury Association (AS IA) and International Medical Society of Paraplegia (IMSOP) standards, the four participants plus the senior author recorded the motor and s ensory scores, the ASIA impairment scale (AIS), the neurological level (NL) and the zone of partial preservation (ZPP). Several minor scorin g errors occurred among the participants, especially with motor scores when key muscles could not be tested due to pain, or external immobil ization devices. Difficulties with interpretation occurred with the mo tor levels and the ZPP for the patient with a complete injury. This ex ercise points to the need for all examiners of SCI patients to thoroug hly familiarize themselves with the standards and to use the motor and sensory scores to arrive at a NL and ZPP. They also indicate a need t o revise the standards to clarify the determination of sensory levels and how to score muscles whose strength is inhibited by pain.