Each classification variable such as levels or AIS, which is affected by the “*”-tagged scores, should also be designated with an “*”.

While “*”-tagged scores above the sensory/motor level will in most cases be handled as normal during classification, “*”-tagged scores at or below the motor/sensory level indicating a non-SCI-related impairment superimposed to the deficit caused by the SCI will typically be handled as not normal.

If an examiner tags a score with the “*”, details on the reason for this and how this “*”-tagged score should be handled during the classification process need to be specified in the Comments box. To address this issue, a general “*” concept applicable to the motor as well as the sensory exam independent from the level of occurrence (above, at, or below the sensory/motor level) is introduced in this edition: In those cases with non-SCI-related impairments, abnormal sensory and/or motor scores should be scored as examined and tagged with an “‘*” to indicate that a non-SCI condition is impacting the examination results. Additionally, guidelines on how to indicate the presence of “5*”s in classification variables such as levels or the AIS are missing. However, no such concept exists for documentation of non-SCI-related sensory deficits function. In the 7th edition of ISNCSCI, the only method for documentation of non-SCI-related impairments is the use of the “5*” grade in the motor exam. In particular, age-related impairments represent a growing problem due to the increasing age of acutely injured persons seen in industrial countries. Such problems include among others chronic peripheral nerve injuries, acute or chronic pain, or age-related muscle weakness. Documentation of non-SCI-related impairments: Most of the questions received by the International Standards Committee over the last few years were related to the correct documentation of non-SCI-related, pre-existing musculoskeletal or neurological problems.

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