International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012

Currently, the ISNCSCI2 are used to document impairments of only motor and sensory function after SCI. These standards are now in the seventh edition. However, SCI, especially cervical lesion levels, may be life threatening because of the imbalance in the autonomic nervous system (ANS) function. Furthermore, this imbalance might be a risk factor for progressive deterioration of neurological function following SCI. Despite success with the ISNCSCI, assessment of remaining autonomic function after SCI is lacking. The joint Autonomic Standards Committee of ASIA and ISCoS supported a working group to develop a framework for the assessment and documentation of specific autonomic function in individuals following SCI. In 2009, this group published the first version of the international standards to assess remaining autonomic function.3 It was recommended that this assessment should be part of the clinical evaluation of individuals with SCI. Since the original publication of the ISAFSCI, practical clinical experience in using the tool has been gained prompting modifications of the standards. In this booklet we omitted the urodynamic component of the ISAFSCI. Although extremely valuable, the methodology and interpretation of urodynamics is too complex to include in these standards. This group strongly recommends that patients have urodynamic studies as a part of their SCI autonomic assessment and endorses the use of the International Spinal Cord Injury Urodynamic Basic Data Set (see Appendix II).4 It is anticipated that ISAFSCI and this booklet will be revised in the future. Any comments or recommendations regarding revisions are greatly appreciated and should be forwarded to ASIA_Office@shepherd.org.