ISNCSCI Algorithm

This algorithm is designed to produce a spinal cord injury classification consistent with the International Standards for Neurological Classification of Spinal Cord Injury developed and maintained by the American Spinal Injury Association (ASIA).

Import library
- Using on a browser (unpkg)
- Using in JavaScript projects
Usage
Interfaces
- Values
Demo

Import library

Using on a browser (unpkg)

<!-- using IIFE -->
<!-- defines ISNCSCI on window object -->
<script src="https://unpkg.com/isncsci/iife/ISNCSCI.min.js"></script>

<!-- using ES module -->
<script type="module">
  // using default import
  import ISNCSCI from "https://unpkg.com/isncsci/esm/ISNCSCI.min.js"
  // using named import
  import { ISNCSCI } from "https://unpkg.com/isncsci/esm/ISNCSCI.min.js"
</script>

Using in JavaScript projects

Install library using NPM

npm i isncsci

Then import the library in your project

Named import

// Recommended with typescript
import { ISNCSCI, Exam } from 'isncsci';

Default import

import ISNCSCI from 'isncsci';

CommonJS

const { ISNCSCI } = require("isncsci");
// or
const ISNCSCI = require("isncsci").ISNCSCI;

Usage

To get a classification and the totals, you just need pass an exam as a parameter while using the ISNCSCI constructor. Interface for exam parameter can be found below.

Below is an example in TypeScript:

// create exam
let exam: Exam = {
  deepAnalPressure: "Yes",
  voluntaryAnalContraction: "Yes",
  right: {
    lowestNonKeyMuscleWithMotorFunction: "C8",
    motor: {
      C5: "5",
      /* ... */
      S1: "2*",
    },
    lightTouch: {
      C2: "2",
      /* ... */
      S4_5: "1*",
    },
    pinPrick: {
      C2: "1**",
      /* ... */
      S4_5: "0",
    }
  },
  left: {
    motor: { /* ... */ },
    lightTouch: { /* ... */ },
    pinPrick: { /* ... */ },
  },
}

// get result
let result = new ISNCSCI(exam);

// output classification result
console.log(result.classification);

// output totals result
console.log(result.totals);

Interfaces

Following shows the interfaces associated to Exam used for ISNCSCI constructor.

interface Exam {
  right: ExamSide;
  left: ExamSide;
  voluntaryAnalContraction: BinaryObservation;
  deepAnalPressure: BinaryObservation;
}

interface ExamSide {
  motor: Motor;
  lightTouch: Sensory;
  pinPrick: Sensory;
  lowestNonKeyMuscleWithMotorFunction?: MotorLevel;
}

interface Motor {
  C5: MotorMuscleValue;
  C6: MotorMuscleValue;
  C7: MotorMuscleValue;
  C8: MotorMuscleValue;
  T1: MotorMuscleValue;
  L2: MotorMuscleValue;
  L3: MotorMuscleValue;
  L4: MotorMuscleValue;
  L5: MotorMuscleValue;
  S1: MotorMuscleValue;
}

interface Sensory {
  C2: SensoryPointValue;
  C3: SensoryPointValue;
  C4: SensoryPointValue;
  C5: SensoryPointValue;
  C6: SensoryPointValue;
  C7: SensoryPointValue;
  C8: SensoryPointValue;
  T1: SensoryPointValue;
  T2: SensoryPointValue;
  T3: SensoryPointValue;
  T4: SensoryPointValue;
  T5: SensoryPointValue;
  T6: SensoryPointValue;
  T7: SensoryPointValue;
  T8: SensoryPointValue;
  T9: SensoryPointValue;
  T10: SensoryPointValue;
  T11: SensoryPointValue;
  T12: SensoryPointValue;
  L1: SensoryPointValue;
  L2: SensoryPointValue;
  L3: SensoryPointValue;
  L4: SensoryPointValue;
  L5: SensoryPointValue;
  S1: SensoryPointValue;
  S2: SensoryPointValue;
  S3: SensoryPointValue;
  S4_5: SensoryPointValue;
}

Values

Here lists the valid values for interfaces above.

Tagged values represents impairment due to non-SCI injury. Single star (*) represents consider not normal for classification. Double star (**) represents consider normal for classification.

type BinaryObservation = 'Yes' | 'No' | 'NT';

type MotorLevel =
  'C5' | 'C6' | 'C7' | 'C8' | 'T1' |
  'L2' | 'L3' | 'L4' | 'L5' | 'S1';

type MotorMuscleValue =
  '0' | '1' | '2' | '3' | '4' | '5' |
  '0*' | '1*' | '2*' | '3*' | '4*' |
  '0**' | '1**' | '2**' | '3**' | '4**' |
  'NT' | 'NT*' | 'NT**';

type SensoryPointValue =
  '0' | '1' | '2' |
  '0*' | '1*' |
  '0**' | '1**' |
  'NT' | 'NT*' | 'NT**';

Classification values

The classification elements can have the following values shown below.

Neurological levels and the neurological level of injury is a comma separated list of levels, e.g. C5, C6, C7, C8, T1 or C5, C6, C7, C8, T1, L2, L3, L4, L5, S1. The range can include levels from C1 to S3 or INT when normal values extend all the way to S4-5. All the values in the range could also be suffixed with * if a value flagged with a * was involved in the calculation. For example, if whe have only normal values for right pin prick and right light touch but one of the values has been flagged with **, Right sensory would be INT*. This applies to the following elements:

classification.neurologicalLevel.sensoryRight
classification.neurologicalLevel.sensoryLeft
classification.neurologicalLevel.motorRight
classification.neurologicalLevel.motorLeft
classification.neurologicalLevelOfInjury

Injury complete is a comma separated list that includes any of the following values: C, I.

ASIA Impairment Scale is a single comma separated list that includes any of the following values: A, B, C, D, E. All the values in the range could also be suffixed with * if a value flagged with a * was involved in the calculation. For example, if a form had only normal values and Yes for VAC and DAP, but one of the values has been flagged with **, the AIS would be E*.

Zone of Partial Preservations is a comma separated list of levels, e.g. C5, C6, C7, C8, T1 or C5, C6, C7, C8, T1, L2, L3, L4, L5, S1. Just as the neurological levels, the range can include levels from C1 to S3 or INT when normal values extend all the way to S4-5. It can also include NA if there is sensation at S4-5 or either VAC or DAP are set to Yes. All the values in the range could also be suffixed with * if a value flagged with a * was involved in the calculation. This applies to the following elements:

classification.zoneOfPartialPreservations.sensoryRight
classification.zoneOfPartialPreservations.sensoryLeft
classification.zoneOfPartialPreservations.motorRight
classification.zoneOfPartialPreservations.motorLeft

Totals values

The totals are calculated by adding the values of the motor and sensory (light touch and pin prick) columns, therefore they can be a number from 0 to 112. They, however, can receive a value of ND if there is an NT value in their column, ans NT has no numeric value to be added. This affects:

Total	Possible values
`result.totals.left.upperExtremity`	0-25, `ND`
`result.totals.left.lowerExtremity`	0-25, `ND`
`result.totals.left.lightTouch`	0-56, `ND`
`result.totals.left.pinPrick`	0-56, `ND`
`result.totals.left.motor`	0-50, `ND`
`result.totals.right.upperExtremity`	0-25, `ND`
`result.totals.right.lowerExtremity`	0-25, `ND`
`result.totals.right.lightTouch`	0-56, `ND`
`result.totals.right.pinPrick`	0-56, `ND`
`result.totals.right.motor`	0-50, `ND`
`result.totals.upperExtremity`	0-50, `ND`
`result.totals.lowerExtremity`	0-50, `ND`
`result.totals.lightTouch`	0-112, `ND`
`result.totals.pinPrick`	0-112, `ND`

Demo

Demo files that can be used as examples are found in the demo folder.

You run *.spec.* tests using npx jest demo command. You can view the test for *.html file by opening it on any modern browser that supports ES modules.

demo/cjs.spec.js: demo using CommonJS syntax
demo/esm.spec.ts: demo using ES module and TypeScript syntax
demo/iife-and-esm.html: demo using ES module and IIFE on the browser

praxis-isncsci / algorithm