Spinal Cord Independence Measure Version Research Articles

Assessment of ability realization using the 4th version of the Spinal Cord Independence Measure

Context Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities after spinal cord lesions (SCL). Objective To adapt a Spinal Cord Ability Realization Measurement Index (SCI-ARMI) formula to the new Spinal Cord Independence Measure version 4 (SCIM4). Methods Using data from 156 individuals for whom American Spinal Injury Association Motor Score (AMS) and SCIM4 scores were collected, we obtained an estimate for the highest possible SCIM4 given the patient’s AMS value, using the 95th percentile of SCIM4 values at discharge from rehabilitation (SCIM95) for patients with any given AMS at discharge. We used the statistical software environment R to implement the quantile regression method for linear and quadratic formulas. We also compared the computed model with the SCIM95 model obtained using data from the present study group, positioned in the SCIM95 formula developed for SCIM3. Results The coefficients of the computed SCIM95 formula based on SCIM4 scores were statistically non-significant, which hypothetically reflects the small sample relative to the goal of estimating SCIM4 95th percentile. Predicting the ability using SCIM4 scores positioned in the SCIM95 formula used for SCIM3, however, yielded SCIM95 values, which are very close to those of the new SCIM95 formula (Mean difference 2.16, 95% CI = 1.45, 4.90). Conclusion The SCI-ARMI formula, which is based on the SCIM95 formula developed for SCIM3, is appropriate for estimating SCI-ARMI at present, when SCIM4 scores are available. When sufficient additional data accumulates, it will be appropriate to introduce a modified SCI-ARMI formula.

Revisiting functioning recovery in persons with spinal cord injury undergoing first rehabilitation: Trajectory and network analysis of a Swiss cohort study.

Information about an individual's functioning and its longitudinal development is key to informing clinical rehabilitation. However, the description and understanding of the detailed longitudinal course of functioning, i.e., functioning trajectories, is rare in the current SCI literature. The aim of this study was to re-estimate previously identified functioning trajectories of individuals with spinal cord injury (SCI) undergoing initial rehabilitation in Switzerland using trajectory analysis, and to identify highly influential functioning domains that could become trajectory-specific targets for clinical interventions using network analysis. The study was based on data from the Swiss SCI Cohort Study and included individuals with SCI (N = 1099) who completed their rehabilitation in one of four collaborating centers between May 2013 and March 2022. For the trajectory analysis, functioning was operationalized using the total sum score of the Spinal Cord Independence Measure version III (SICM III), which was assessed at up to four time points (T1-T4) during rehabilitation. For the network analysis, individual SCIM III items were used to operationalize relevant functioning problems at T1 (admission) and T4 (discharge). The re-estimation of trajectory analysis confirmed the previously identified mean functioning trajectory classes of stable high functioning (N = 239; 21.75%), early (N = 33; 3.00%), moderate (N = 753; 68.52%), and slow (N = 74; 6.73%) functioning improvement. The network analysis revealed highly connected functioning problems at T1 for the moderate functioning improvement class, including "Feeding", "Dressing upper body", and "Dressing lower body", "Mobility in bed", and "Use of toilet". These functioning domains might indicate potential trajectory-specific targets for clinical interventions. This study has increased our knowledge about functioning trajectories of individuals with SCI undergoing initial rehabilitation in Switzerland and its findings may inform discussions about the application and use of functioning trajectories in clinical practice. Due to the exploratory nature of this study, further research is needed to confirm the findings presented.

Factors Influencing Social and Community Participation of People with Spinal Cord Injury in Karnataka, India.

Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R2 = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R2 = 0.327) were determinants of CHART mobility. Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program.

Minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR).

Retrospective cohort study. To find minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR) in Thai participants with spinal cord injury (SCI). Rehabilitation ward at Maharaj Nakorn Chiang Mai Hospital. Data of individuals with SCI who were not diagnosed with central cord syndrome and were admitted for the first time for rehabilitation were analyzed. Upper extremities motor score, self-care and mobility items of Spinal Cord Independence Measure version III were collected and used to calculate SCAR difference between data on date of admission and discharge. MCID and MDC were calculated by distribution-based method and categorized for each subgroup according to SCI characteristics. From data of 311 individuals, MCID of SCAR is approximately 4 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level, and 2 for individual with paraplegia AIS A, B, C. MDC of SCAR should be 1 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level and 0.5 for individual with paraplegia AIS A, B, C. This study provides MCID and MDC of SCAR in each subgroup. These values could be used as a benchmark for clinicians and researchers to determine whether participant has significant improvement or not after receiving an intervention.

Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care

Context/Objective Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources. Design An observational prospective cohort study. Setting A single Level-1 specialized trauma center. Participants 213 individuals sustaining an AIS-D tSCI. Interventions Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team. Outcome measures Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively. Results A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation. Conclusion Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.

Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III)

Qualitative studies. To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment. Research lab. Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses. Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version. This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.

Gait Training with Robotic Exoskeleton Assisted Rehabilitation System in Patients with Incomplete Traumatic and Non-Traumatic Spinal Cord Injury

This pilot study aimed to assess the safety and feasibility of robotic gait training and its' effects on gait parameters in individuals with incomplete motor spinal cord injury-SCI (AIS C and AIS D). The study was conducted in a tertiary research center with indigenously developed Robotic Exoskeleton Assisted Rehabilitation Systems (REARS). Primary outcome measures used were the ten-meter walk test (10MWT), two-minute walk test (2MWT), six-minute walk test (6MWT), the timed up and go test (TUG), the walking index for spinal cord injury II (WISCI II), and the spinal cord independence measure version III (SCIM III) at baseline, 12 sessions, and after 24 sessions (endpoint) of training. At baseline, individuals who could not perform 10MWT, TUG, and 6MWT were grouped in G1 for analysis. Participants in G2 were able to perform all the tests at baseline. The median (interquartile range [IQR]) age and duration of illness was 41 (24) years and 167 (147) days, respectively. Five out of seven participants had non-traumatic etiology and five were males. After completing training, participants in G1 were able to complete the 10MWT, 6MWT, and TUG, and the mean (SD) scores were 0.2 m/s (0.2), 66.3 m (61.2) and 113.3 s (117.4), respectively. Participants in G2 could perform the TUG test 13.5 s faster at the end of the study (11.9 s vs 25.4 s). The minimum clinically important difference (MCID) for TUG was 10.8 s. In G2, the pre-post training change in mean score of 10MWT and 6MWT was 0.11 m/s and 42 m, respectively; these values approached the MCID for these measures. None of the participants had any injury during training. Robotic gait training with REARS is safe and feasible. Such training may lead to an improvement in balance and walking capacity.

Using a 3D-Printed Hand Orthosis to Improve Three-Jaw Chuck Hand Function in Individuals With Cervical Spinal Cord Injury: A Feasibility Study.

Individuals with cervical spinal cord injury (C-SCI) often use a tenodesis grip to compensate for their hand function deficits. Although clinical evidence confirms that assistive devices can help achieve hand function improvements, the currently available devices have some limitations in terms of their price and accessibility and the difference in the user's muscle strength. Therefore, in this study, we developed a 3D-printed wrist-driven orthosis to improve the gripping effect and tested the feasibility of this device by assessing its functional outcomes. A total of eight participants with hand function impairment due to a C-SCI were enrolled, and a wrist-driven orthosis with a triple four-bar linkage was designed. The hand function of the participants was assessed before and after they wore the orthosis, and the outcomes were assessed using a pinch force test, a dexterity test (Box and block test, BBT), and a Spinal Cord Independence Measure Version III questionnaire. In the results, before the participants wore the device, the pinch force was 0.26 lb. However, after they wore the device, it increased by 1.45 lb. The hand dexterity also increased by 37%. After 2 weeks, the pinch force increased by 1.6 lb and the hand dexterity increased by 78%. However, no significant difference was observed in the self-care ability. The results showed that this 3D-printed device with a triple four-bar linkage for individual with C-SCI improved pinch strength and hand dexterity in these patients, but did not improve their self-care ability. It may help patient in the early stages of C-SCI to learn and use the tenodesis grip easily. However, the usability of the device in daily life needs further research.

Safety and Potential Efficacy of Selective Dorsal Rhizotomy in Adults with Spinal Cord Injury-Induced Spasticity: An Open-Label, Non-Randomized, Single-Arm Trial

Despite the abundant literature on the use of selective dorsal rhizotomy (SDR) in spastic cerebral palsy, no investigation has evaluated its use in adult patients with chronic spinal cord injury (SCI)-induced spasticity. The present investigation aimed to evaluate the safety and potential efficacy of SDR in chronic SCI-induced spasticity for the first time. In this open-label, single-arm, non-randomized clinical trial, all patients were assigned to the single study intervention arm and underwent SDR. The primary outcome measure was the safety profile of SDR. Secondary outcome measures were Modified Ashworth Scale, Penn Spasm Frequency Scale, visual analog scale for spasticity, Spinal Cord Injury Spasticity Tool, Spinal Cord Independence measure version III, and Short Form 36 Health Survey Questionnaire. Six patients with cervical SCI and 4 with thoracic SCI were allocated to the single study intervention arm. No adverse event attributable to the SDR was found. Moreover, all secondary outcome measures of the study improved significantly over the study period (P < 0.001). Multiple regression analysis also found a significant association between level of injury and changes in average Modified Ashworth Scale scores (P= 0.041), Spinal Cord Injury Spasticity Tool score (P= 0.013), and Spinal Cord Independence measure version III total (P= 0.002) and mobility domain scores (P= 0.004) at 12-month postoperatively. This clinical trial indicated that SDR is a safe and potentially effective procedure in patients with severe and intractable SCI-induced spasticity. However, future clinical trials with larger sample sizes and adequate power are required to validate our findings regarding efficacy.

Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury

ObjectiveTo establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). DesignA cross-sectional study. SettingTertiary rehabilitation center and communities. ParticipantsA total of 309 (168 WU and 141 AM) participants with SCI. InterventionsNot applicable. Main Outcome Measure(s)SCIM III scores. ResultsParticipants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99). ConclusionsThe present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients’ ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.

Quantitative Functional Recovery Assessment of Spinal Cord Injury by using “Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI)”: An Observational Study

Background: Spinal cord injury (SCI) refers to a physical injury to the spinal cord that distorts normal spinal cord function. The sudden occurrence of SCI leading to paralysis of the muscles below the level of injury leads to major functional limitations. Thus, the Spinal Cord Injury- Ability Realization Measurement Index (SCI-ARMI) tool was developed that evaluates functional recovery quantitatively. Purpose: To assess changes in quantitative functional recovery before and after rehabilitation of spinal cord injury by using Quadric Formula of SCI-ARMI. Methodology: SCI-ARMI was used as an outcome measure. Participants followed a routine conventional approach. They were assessed before starting inpatient rehabilitation and after 4 weeks of inpatient rehabilitation by taking Spinal Cord Independence Measure version III (SCIM-III) and AIS motor score (AMS) along with age and gender as a factor for calculation of SCI-ARMI. Results: A highly significant difference was found with a p-value of &lt;0.001. That is suggestive of significant changes in SCI-ARMI scores before and after conventional rehabilitation. Change in this score and improvement in functional performance was influenced by the conventional approach of inpatient rehabilitation. Conclusion: The present study concludes that SCI ARMI is useful and effective tool that monitors achievement of rehabilitation potential and helps to observe changes in quantitative functional recovery in individuals with SCI. Clinical Implication: SCI-ARMI is valid and reliable tool and also takes less time for calculation that can be incorporated into routine clinical assessment for the evaluation of functional performance and rehabilitation potential in SCI population. Keywords: SCI-ARMI, Quantitative Functional Recovery, Spinal Cord Injury.

Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: A simultaneous evaluation of prognostic factors

Objective This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient’s outcomes were also studied. Settings Rofeideh Rehabilitation Hospital. Outcome Measures Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM). Method In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis. Results The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient’s outcomes. Furthermore, there was a significant difference between different levels of injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05). Conclusion Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.

Clinical Utility of Diffusion Tensor Imaging as a Biomarker to Identify Microstructural Changes in Pediatric Spinal Cord Injury.

Lack of clarity about the neurological consequence of spinal cord injury (SCI) in children causes speculation about diagnoses, recovery potential, and treatment effectiveness. Diffusion tensor imaging (DTI) has shown promising results as a biomarker to evaluate spinal cord integrity at a microstructural level. To look at the difference between pediatric participants with and without SCI to determine which DTI metrics best categorize spinal cord tissue damage and to correlate DTI metrics with two clinical measures: Capabilities of the Upper Extremity Test (CUE-T) and Spinal Cord Independence Measure version III (SCIM-III). This single-site, prospective study included pediatric participants with SCI (n = 26) and typically developed (TD) control subjects (n = 36). All participants underwent two magnetic resonance imaging (MRI) scans on a 3T MR scanner. Participants with SCI also completed the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), CUE-T, and SCIM-III outcomes measures. This study found significant strength of association between fractional anisotropy (FA) and upper extremity muscle strength (UEMS) in participants with SCI. Most DTI parameters showed a significant difference between participants with SCI and TD participants and a moderate correlation with the CUE-T total score. Regional effects on group differences were found to be significant. This study demonstrates the strength of association between DTI parameters and clinical measures in the pedantic SCI population. It illustrates DTI as a potential biomarker of SCI location and severity in the pediatric SCI population.

Using the interviewer-administered version of Work Rehabilitation Questionnaire (WORQ) in Russia: cross-cultural adaptation and psychometric properties in traumatic spinal cord injury

Purpose (1) To perform a cross-cultural adaptation of Work Rehabilitation Questionnaire to Russian (WORQ-R); (2) to report the psychometric properties of WORQ-R in patients with traumatic spinal cord injury (TSCI). Materials and methods WORQ is designed to evaluate the work functioning of individuals who are engaged in vocational rehabilitation. We performed a formal cross-cultural adaptation of WORQ from English to Russian utilizing a standardized 3-step approach. We examined the psychometric properties of WORQ-R in terms of its reliability and construct validity through the use of classical and modern test theory in the TSCI population. Results The adaptation process achieved equivalence between Russian and English versions of WORQ. WORQ-R proved to cover major issues concerning functioning in vocational rehabilitation and was simple to understand. The internal consistency of WORQ-R was good (Cronbach’s Alpha = 0.83). Rasch analysis confirmed the unidimensionality of the WORQ-scale and high reliability (PSI = 0.97) based on a testlet solution. WORQ-R score showed a strong negative correlation with the Functional Independence Measure, moderate negative correlation with the Spinal Cord Independence Measure Version III and the SF-36, moderate positive correlation with the Spinal Cord Injury Secondary Conditions Scale. Conclusions WORQ-R showed good validity and reliability in persons with TSCI allowing vocational professionals to have comprehensive information on vocational functioning. IMPLICATIONS FOR REHABILITATION SCI is a disabling condition that causes impairments in body structure and function leading to activity limitations and participation restrictions. WORQ is a generic tool that allows for an assessment of work-related aspects of functioning in different populations of persons with disabilities. This study demonstrates the psychometric properties of the Russian version of WORQ in the SCI population. WORQ-R is recommended as a tool to describe the biopsychosocial and related vocational background to gain a better understanding of needs among SCI persons in terms of vocational rehabilitation.

Identification of Classes of Functioning Trajectories and Their Predictors in Individuals With Spinal Cord Injury Attending Initial Rehabilitation in Switzerland

ObjectivesTo identify classes of functioning trajectories in individuals with spinal cord injury (SCI) undergoing initial rehabilitation after injury and to examine potential predictors of class membership to inform clinical planning of the rehabilitation process. DesignLongitudinal analysis of the individual's rehabilitation stay using data from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). SettingInitial rehabilitation in specialized centers in Switzerland. ParticipantsIndividuals with newly acquired SCI (N=748; mean age, 54.66±18.38y) who completed initial rehabilitation between May 2013 and September 2019. The cohort was primarily composed of men (67.51%), persons with paraplegia (56.15%), incomplete injuries (67.51%), and traumatic etiologies (55.48%). InterventionsNot applicable. Main Outcome MeasuresFunctioning was operationalized with the interval-based sum score of the Spinal Cord Independence Measure version III (SCIM III). For each individual, the SCIM III sum score was assessed at up to 4 time points during rehabilitation stay. The corresponding time of assessment was recorded by the difference in days between the SCIM III assessment and admission to the rehabilitation program. ResultsLatent process mixed model analysis revealed 4 classes of functioning trajectories within the present sample. Class-specific predicted mean functioning trajectories describe stable high functioning (n=307; 41.04%), early functioning improvement (n=39; 5.21%), moderate functioning improvement (n=287; 38.37%), and slow functioning improvement (n=115; 15.37%), respectively. Out of 12 tested factors, multinomial logistic regression showed that age, injury level, injury severity, and ventilator assistance were robust predictors that could distinguish between identified classes of functioning trajectories in the present sample. ConclusionsThe current study establishes a foundation for future research on the course of functioning of individuals with SCI in initial rehabilitation by identifying classes of functioning trajectories. This supports the development of specifically tailored rehabilitation programs and prediction models, which can be integrated into clinical rehabilitation planning.

Cross-cultural adaptation and psychometric testing of the Thai version of the Spinal Cord Independence Measure III-Self Report.

Cross-sectional reliability and validation study. To translate and assess the psychometric properties of the Thai version of the Spinal Cord Independence Measure III-Self Report (TH-SCIM-SR) in Thai spinal cord injury (SCI) patients. Faculty of Medicine Siriraj Hospital, Mahidol University. A cross-cultural forward and backward translation of the original Spinal Cord Independence Measure III-Self Report (SCIM-SR) was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, to create the TH-SCIM-SR. The inclusion criteria were Thai patients with SCI duration of ≥3 months. Patients were evaluated by a team of healthcare professionals using the Thai version of the Spinal Cord Independence Measure Version III (TH-SCIM III). Study patients subsequently completed the TH-SCIM-SR two times with a 3-day interval between evaluations. Cronbach's Alpha, Pearson's correlation coefficient, and intraclass correlation coefficient (ICC) were used to examine internal consistency, concurrent validity, and reliability, respectively. Bland-Altman plot was used to compare scoring results between the TH-SCIM III and the TH-SCIM-SR. Thirty-two patients were included. Cronbach's alpha of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.91, 0.94, 0.75, and 0.90, respectively. The reliability analysis showed good reliability. The test-retest ICC of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.95, 0.95, 0.78, and 0.96, respectively. Regarding construct validity, the subscales of TH-SCIM-SR demonstrated a strong correlation with those of the TH-SCIM III (0.85-0.96). TH-SCIM-SR showed good reliability and validity for assessing functional independence in Thai patients with SCI.

A prediction model of functional outcome at 6 months using clinical findings of a person with traumatic spinal cord injury at 1 month after injury.

Retrospective statistical analysis of database. Prediction of the Spinal Cord Independence Measure version III Total Score (SCIM-TS) at 6 months after injury based on physical findings at 1 month after injury is an important index for rehabilitation approach in the recovery phase. Spinal Injuries Center, Fukuoka, Japan. The study participants were selected from patients with traumatic spinal cord injuries who were registered in the Japan Single Center Study for Spinal Cord Injury Data Base (JSSCI-DB) of the Japan Spinal Injuries Center specializing in spine and spinal cord injuries. Of the 534 participants registered with the JSSCI-DB between January 2012 and October 2018, we retrospectively extracted 137 participants for 6 months after injury, and these participants were included in this study. According to multiple regression analysis, SCIM-TS at 6 months after injury could be predicted based on only six variables, i.e., age at injury, three key muscles (C6 wrist extensors, C8 finger flexors, and L3 knee extensors), and two mobility assessments (WISCI and SCIM-item13) (Adjusted R-Squared: 0.83). These six independent variables were significant factors reflecting SCIM-TS at 6 months. In rehabilitation after traumatic spinal cord injuries, a simple and reliable prognostic model can help accurately predict the achievable activity of daily living competency to set a goal. In addition, if the procedure is simple, evaluation can be completed in a short period of time, and the physical burden on both treating staff and patients can be reduced.

Muscle Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury

ObjectiveDetermine trunk and shoulder muscle strength cutoff points for functional independence and wheelchair skills, and verify the predictive capacity of relative and absolute peak torque in men with spinal cord injury (SCI). DesignCross-sectional study. SettingRehabilitation hospital setting. ParticipantsMen (N=54) with SCI were recruited and stratified into high and low paraplegia groups. InterventionsAll participants performed maximum strength tests for shoulder abduction or adduction (isokinetic) and trunk flexion or extension (isometric) to determine relative and absolute peak torque cutoff points for the Spinal Cord Independence Measure version III (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). Main outcome measuresThe primary outcome measures were SCIM-III, AMWC-Brazil test, and strength variables (peak torques). Demographic characteristics obtained from participants’ electronic medical records were the secondary outcomes used as predictor variables of functional independence. ResultsThe best predictive model for SCIM-III (R=0.78, P≤.05) used the sum of trunk flexion and extension relative peak torque values to determine the cutoff points (1.42 N·m/kg for a score of 70). Relative shoulder abduction peak torque was used in the predictive models for AMWC outcomes: performance score (R=0.77, P≤.05, cutoff points of 0.97 N·m/kg for 300.0m) and 3-minute overground wheeling (R=0.72, P≤.05, cutoff points of 0.96 N·m/kg for 18.5s). ConclusionsRelative peak torque showed better predictive capacity compared to absolute peak torque. Cutoff points were established for relative muscle strength and could help health professionals set appropriate goals for individuals with SCI to achieve high functional independence and wheelchair ability.

Translation and Cross-Cultural Adaptation of Spinal Cord Independence Measure version III in Hindi Language.

Background:The Spinal Cord Independence Measure (SCIM III) specifically assesses individuals with spinal cord injuries.Objectives:The objective of this study was to translate the SCIM-III into Hindi language to make it available for use in large Indian Hindi speaking population in their native language.Methods:The SCIM III was translated into the Hindi version with a forward–backward translation and made ready for application by a translation committee. The tool was then reviewed by a review committee to check the translation. Then, pilot testing was done, where patients’ responses and comments were noted. A sample of 10 patients was recruited for the pilot testing.Results:The scale was translated into Hindi by the liberal and literal methods. Translation and replacement of the words was done in discussion with professional translator in Hindi language and expert committee. After forward–backward translation and clinical review submitting the final version and then pilot study was done on 10 patients (7 males and 3 females) of spinal cord injury. The mean age is 27.1 years and mother tongue of all the patients was Hindi (100%).Conclusion:The Hindi version of the SCIM III is easy and understandable to the large Hindi speaking Indian population.

Gait Training Using a Wearable Robotic Device for Non-Traumatic Spinal Cord Injury: A Case Report

Introduction:We aimed to report the clinical evaluation results of gait training with the Honda Walking Assist Device® (HWAT) in a patient with spinal cord injury (SCI).Patients and Methods:A 63-year-old male with SCI (grade D on the American Spinal Injury Association Impairment Scale) underwent 20 HWAT sessions over 4 weeks. The self-selected walking speed (SWS), mean step length, cadence, 6-minute walking test (6MWT), Walking Index for SCI score, SCI Functional Ambulation Inventory gait score, American Spinal Injury Association Impairment Scale grade, neurological level, upper and lower extremity motor scores, modified Ashworth Scale, Penn Spasm Frequency Scale, and Spinal Cord Independence Measure version III were measured on admission, at the start of HWAT, at 2 and 4 weeks post-HWAT, and at discharge. Three-dimensional kinematic gait analysis and electromyographic assessments were performed before and after HWAT.Results:The patient safely completed 20 HWAT sessions. We found improvements above the clinically meaningful difference in SWS and 6MWT as well as increased hip extension, ankle plantar- and dorsi-flexion range of motion and increased hip extensor, abductor, adductor, and ankle plantar flexor muscle activity.Discussion:The SWS improved more markedly during the HWAT intervention, exceeding the minimal clinically important difference (0.10 to 0.15 m/s) in walking speed for people with SCI until discharge. Moreover, the 6MWT results at 2 weeks after the start of HWAT exceeded the cutoff value (472.5 m) for community ambulation and remained at a similar value at discharge.Conclusion:The walking distance (6MWT) and the walking speed (SWS) both demonstrated clinically important improvements following 20 treatment sessions which included HWAT.