Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury

Study Design: Prospective, longitudinal cohort study. Objectives: To quantify the effect of formal training in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) on the classification accuracy and to identify the most difficult ISNCSCI rules. Settings: European Multicenter Study on Human Spinal Cord Injury (EMSCI). Methods: EMSCI participants rated five challenging cases of full sensory, motor and anorectal examinations before (pre-test) and after (post-test) an ISNCSCI instructional course. Classification variables included sensory and motor levels (ML), completeness, ASIA Impairment Scale (AIS) and the zones of partial preservation. Results: 106 attendees were trained in 10 ISNCSCI workshops since 2006. The number of correct classifications increased significantly ( P