Instead of the 5 motor levels from the fifth cervical to the first thoracic, these surgeons have developed a 10-level scale called the International Classification for Surgery of the Hand in Tetraplegia (ICSHT).
Abbreviations: ASIA = American Spinal Injury Association; FIM = Functional Independence Measure; ICF = International Classification of Functioning, Disability, and Health; ICIDH = International Classification of Impairments, Disabilities, and Handicaps; ICSHT = International Classification for Surgery of the Hand in Tetraplegia; IOM = Institute of Medicine; ISCoS = International Spinal Cord Society; MRI = magnetic resonance imaging; QIF = Quadriplegia Index of Function; SCI = spinal cord injury; SCIM = Spinal Cord Independence Measure; WHO = World Health Organization; WISCI = Walking Index for Spinal Cord Injury.
While the ISCSCI remains the most commonly used motor and sensory assessment in tetraplegia, the International Classification for Surgery of the Hand in Tetraplegia (ICSHT), an alternative classification scheme, has been introduced specifically for surgical planning in the UL in tetraplegia [2,7].
While the ICSHT was designed to aid planning of surgical reconstruction, it may be more sensitive than the ISCSCI, at least for assessment of strength, since it evaluates more key UL muscles.
Despite the strengths and international use of the ISCSCI and the ICSHT, both evaluation and classification schemes depend upon manual strength testing, which is an inadequate measure in isolation of other strength measures because of variability in scaling (ordinal scales 0-5 vs ordinal scales 0-5 that include "+"), grading of strength, and limb position during testing.
Strength-testing all UL muscles and classifying the UL according to both the ISCSCI and ICSHT are recommended.
Acute trials should incorporate the ICSHT motor and sensory exam and classification system in addition to the ISCSCI and should consider the role of electrodiagnostics.