Patient preferences for order of the sensory portion of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination

Abstract

Objective: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) includes testing light touch (LT) and sharp/dull discrimination, also known as pinprick (PP) testing. The order these tests are performed varies by clinician and no true standard exists. The objective of this study was to determine patients’ perceptions of discomfort from each modality and their preferences for the order of the sensory exam.

Design: A questionnaire was administered following the exam regarding the degree of pain/discomfort experienced from each modality and patients’ preferences for testing order.

Participants: 91 adults with traumatic SCI, 55% with neurologically complete injuries and 34% first-time examinees/those who did not recall a previous sensory examination.

Main Outcome Measures: Level of pain/discomfort from both sensory modalities and preference on order of sensory testing.

Results: All subjects reported that LT was not painful. 57% reported the PP testing as not painful, 24% as moderately painful, and 18.7% as very painful. The majority (66%) reported no preference for testing order, however, first-time examinees and those who did not recall previous sensory testing, were more likely to describe PP testing as “very painful” and report more “very painful” experiences when PP testing was completed first.

Conclusions: First-time examinees including those who did not recall previous sensory testing, may experience more pain/discomfort from PP testing especially when PP is tested first. Therefore, testing LT first, especially for the first-time examinee and those who do not recall a previous exam, may allow for a more comfortable experience.

Keywords:

• Spinal cord injuries
• Patient preference
• Neurologic examination