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Appendix A: Definitions of ASIA, GCS and GOS scales

1. ASIA (American Spinal Injury Association): Standard neurological classification of spinal cord injury

The full scoring system and chart are available at the following web site:

www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf

Final grading of impairment is summarised as:

A = Complete:

No motor or sensory function is preserved in the sacral segments S4-S5.

B = Incomplete:

Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.

C = Incomplete:

Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.

D = Incomplete:

Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more.

E = Normal:

Motor and sensory function are normal.

2. GCS (Glasgow Coma Scale): Assessment of coma and impaired consciousness

A description of the GCS is available in Teasdale G and Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4.

The GCS is composed of 3 sub-scales, each scored from 1 (worst) to 5 (best):

  1. Best eye response
  2. Best verbal response
  3. Best motor response

Each aspect of performance should be considered and reported but the sum of the scores provides an overview of the brain injury:

Severe:

GCS ≤ 8

Moderate:

GCS 9 to 12

Minor:

GCS ≥ 13.

3. GOS (Glasgow Outcome Scale): Assessment of coma and impaired consciousness

A description of the GOS is available in Jennett B and Bond M. Assessment of outcome after severe brain damage. Lancet 1975 Mar 1;1(7905):480-4.

Dead

Vegetative state:

Unable to interact with environment; unresponsive

Severe disability:

Able to follow commands/ unable to live independently

Moderate disability:

Able to live independently; unable to return to work or school

Good recovery:

Able to return to work or school

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