Spinal Cord Function Score of Botsford and Esses

Botsford and Esses developed a functional score for patients with spinal cord injury. The authors are from the University of Toronto.

Parameters:

(1) motor subscore

(2) sensation subscore

(3) rectal subscore

(4) bladder subscore

Muscle testing using the MRC scale (15 per side):

(1) ankle dorsiflexion

(2) ankle plantar flexion

(3) knee flexion

(4) knee extension

(5) hip flexion

(6) hip extension

(7) hip abduction

(8) hip adduction

(9) shoulder flexion

(10) shoulder extension

(11) elbow flexion

(12) elbow extension

(13) wrist flexion

(14) wrist extension

(15) hand grip

Muscle Strength	Medical Research Council (MRC)
no contraction	0
flicker or trace of contraction	1
active movement with gravity eliminated	2
active movement against gravity	3
active movement against gravity and resistance	4
normal power	5

from Brooke

motor subscore for left side =

= SUM(points for all 15 muscles on the left side)

motor subscore for right side =

= SUM(points for all 15 muscles on the right side)

motor subscore =

= ((motor subscore for left side) + (motor subscore for right side)) / 2

Parameter	Finding	Points
sensation	normal	10
	incomplete loss, patchy	7
	incomplete loss, below level of lesion	5
	complete loss, patchy (dermatomal)	5
	complete loss, below level of lesion	0
rectal	normal voluntary anal contractions	10
	decreased voluntary anal contractions	5
	unable to generate voluntary anal contractions	0
bladder function	normal	5
	not normal	0

total score =

= (points for motor function) + (points for sensation) + (points for rectal function) + (points for bladder function)

Interpretation:

• minimum subscore: 0

• maximum muscle subscore for either side: 75

• minimum total score: 0

• maximum total score: 100

• The higher the total score the more normal the motor and sensory function.

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