Functional Tests for Persons who Self-Propel a Manual Wheelchair (4FTPSMW)

This test was developed to assist clinicians in assessing the effect of different postural supports (e.g. back support and seat cushions). The 4FTPSMW was developed by an experienced group of physiotherapists using a literature review and input from both individuals with SCI and researchers (May et al. 2003).

Number of items: 4

Procedure/Administration: The test includes 4 tasks: 1) timed forward wheeling (23m); 2) ramp ascent (forward wheeling); 3) forward vertical reach distance; and 4) one-stroke push. Five minute rest breaks were provided between tasks to limit fatigue. 

How scored: The wheeling tasks are scored in seconds and the reaching and one-stroke push tasks in centimeters.  

Interpretability: The scoring system is objective and has ratio level properties. No normative data is available.

Acceptability: Is only relevant to individual who use a manual wheelchair (i.e. not suited to individuals who use an electric wheelchair). 

Languages: N/a

Usability: The tasks were tolerated well by participants. Only the ramp ascent task was difficult for an individual with C6 SCI at 4 months post injury. 

Time to administer: It takes between 30 - 45 minutes to complete 2 trials of the 4 functional tasks including rest breaks (note: 2 trials were required for test re-test reliability rather than to eliminate the practice effect).

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: 23 m corridor, 1 m measuring stick, ramp (10.3 m and 1:13 grade), carpeted surface (1.5 cm pile), and a stop watch.

Summary:

• The 4FTPSMW is a functional test suited for the clinical setting (eg. the timed forward wheeling task is based on a distance of 23 meters (plus length of the wheelbase) - the average length of a crosswalk in a 4 lane intersection). 

 Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
TR: Green light Inter O: Green light	N/a	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• May LA, Butt C, Minor L, Kolbinson K, Tulloch K. Measurement reliability of functional tasks for person who self-propel a manual wheelchair. Arch Phys Med Rehabil 2003;84:578-83.

6-Minute Walk Test (6MWT)

• A self-paced test. It measures the distance that a patient can walk on a flat, hard surface in 6 minutes and assesses the sub-maximal level of functional capacity (American Thoracic Society 2000).
• The test in its entirety evaluates the integrated response of pulmonary, cardiovascular, and circulatory systems, in addition to level of motor control, functional neuromuscular units, and muscle (Ditunno et al. 2007).

Number of items: N/a

Procedure/Administration: The 6MWT may be performed either indoors or outdoors, along a long, flat, straight, and hard surface. The American Thoracic Society (ATS) recommends that the walking course should be 30 meters in length, marked at every 3 meters, and a turnaround point marked with a cone.

How scored: The distance (total distance walked rounding to the nearest meter) is reported. Fatigue level is also reported. Pulse oximetry (baseline heart rate and oxygen saturation) is optional.

Interpretability: For single measurements, reference equations from healthy samples using the 6MWT are not available for comparison.

Acceptability: It is suitable for patients who can walk with moderate or less assistance for 6 minutes. It is a self paced test and subjects may take stop to rest.

Languages: N/a

Usability: N/a

Time to administer: N/a

Time to score: N/a

Training required: People who administer the test should be trained using the standard protocol and then supervised for several tests before performing them alone. The test administrator should also have CPR training.

Availability: N/a

Equipment required: A countdown timer, mechanical lap counter, cones to mark the turnaround and a chair that can be easily moved along the walking course. Note: the American Thoracic Society recommends having a source of oxygen, a sphygmomanometer, a telephone and a defibrillator on hand for emergency purposes.

Summary:

• According to the American Thoracic Society, the 6MWT is easier to administer, better tolerated, and more reflective of activities of daily living than other walking tests.
• There are many sources of variability including height, age, body weight, sex, and motivation (ATS 2002).

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
Inter/Intra O: Green light	Construct: Green light	Red light	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• American Thoracic Society. ATS Statement: Guideline for the Six-Minute Walk Test. Am J Respir Crit Care Med 2002; 166: 111-117.
• Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550.
• van Hedel HJA, Wirz M, Curt A. Improving walking assessment in subjects with incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-356.

10 Meter Walking Test (10MWT)

• Assesses short duration walking speed (m/sec).  It has been used in various patient populations including stroke, Parkinson’s disease, general neurologic movement disorders and SCI (van Hedel et al. 2005; 2006).

Number of items: N/a

Procedure/Administration: The 10 MWT measures the time required to walk 10 meters. It is performed using a “flying start”: the patient walks 14 meters and the time is measured for the intermediate 10 meters. The individual walks at their preferred walking speed. Individuals can use an assistive device and must wear shoes. 

How scored: The time (seconds) is reported and can also calculate a walking speed m/sec.

Interpretability: Results of the 10 MWT have been reported in the literature for individuals with incomplete SCI.  An average time of 30 seconds has been reported. 

Acceptability: Is suitable for individuals who can, at a minimum, ambulate in household settings (i.e. > 14 m).

Languages: N/a

Usability: N/a

Time to administer: Approx 30 seconds.

Time to score: N/a

Training required: Does not require advanced training.

Availability: N/a

Equipment required: Can be administered in the clinical setting or in the community. A 14m corridor and a stopwatch are required. 

Summary:

• The 10 MWT only assesses walking ability and does not consider the amount of physical assistance required, devices or endurance. 
• The test is conducted in a controlled environment (i.e. lab or hospital setting), so results can not be directly translated to the environment (i.e. crossing a busy street).  The 10 MWT also requires an individual to ambulate a minimum of 14 m.  There have been reports in the literature that the distance is not always standardized (i.e. 10 m versus 14 m).
• It appears to be a useful measure in the SCI population for both research and clinical practice.  The scale properties (time in sec or m/sec) of the 10 MWT make it a responsive test well suited to evaluating clinical interventions.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
Inter/Intra O/TR: Green light	Construct: Green light** Concurrent: Yellow light	Green light*	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; varied (re. floor/ceiling effects; mixed results); SS= Sensitivity/Specificity; N/a= No information

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

*Responsiveness assessed using the Freidman’s test.

** For construct validity, the results with other walking tests (i.e. TUG & 6 MWT) were considered stronger evidence to support validity compared to LEMS based on ASIA.

References 

• van Hedel HJA, Dietz V, and the EM-SCI Study Group. Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 2009; 23: 117-124.
• van Hedel HJA for the EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neural Repair 2009; 23(4): 343-350.
• van Hedel HJA, Wirz M, Dietz V. Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurological Research 2008; 30: 61-73.
• van Hedel HJA, Wirz M, Curt A. Improving walking assessment in subjects with incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-356.
• van Hedel HJA  Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury:validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196.

Berg Balance Scale (BBS)

The BBS is a performance based measure of balance. Tasks are of progressing difficulty and include functional activities related to balance while reaching, bending, transferring, and standing. Originally developed for use with the elderly, the scale has been used in a variety of populations including stroke, Parkinson’s, multiple sclerosis, and recently SCI. Some researchers have used the BBS as the gold standard for balance in criterion validity studies (Liston & Brouwer, 1996; Tyson & DeSouza, 2004).

Number of items: 14

Procedure/Administration: The BBS is an observer rated measure. The rater observes the patient perform each of the tasks while ensuring the individual does not fall.

How scored: Each of the 14 tasks are rated on a 5-point scale from 0 (cannot perform) to 4 (normal performance). Total scores range from 0 (severely impaired balance) to 56 (excellent balance). Some tasks are rated according to the quality of the performance of the task, while others are evaluated by the time required to complete the task.

Interpretability: Results from studies of older adults suggest the follow cut points: 0-20 = wheelchair bound; 21-40 = walking with assistance; and 41-56 = independent. Scores below 41 are suggested to indicate increased risk of falling. Change scores >7 are said to be clinically relevant in studies of older adults. This interpretation has not been validated with SCI populations.

Acceptability: The BBS is generally well received among clinicians who specialize in the area of gait and balance training. The tool is only applicable to individuals with incomplete SCI who retain some ability to stand and walk. It has been found to be an appropriate assessment of standing balance for these individuals as shown by its strong associations with various clinical walking evaluations

Languages: English, Italian, Turkish, Brazilian-Portuguese, German, Korean, and Dutch.

Usability: The BBS is limited to those patients with SCI who have some form of standing and/or ambulatory capacity.

Time to administer: Approximately 20 minutes (in relative well functioning older adults). In general the time required is inversely related to the lower extremity ability of the individual.

Time to score: N/a

Training required: Raters are typically health professional with knowledge of balance and trained to assign ratings.

Availability: www.aahf.info/pdf/Berg_Balance_Scale.pdf.

Equipment required: 2 standard chairs (1 with arms and 1 without), a stop watch, step or stepstool, and a ruler

Summary: N/a

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
InterO: Green light	Concurrent: Green light	N/a	Red light (ceiling effect)

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada 1989; 41(6): 304-311.
• Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord advance online publication, 22 September 2009; doi: 10.1038/sc.2009.119.
• Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil 1996; 77: 425-430.
• Tyson SF, DeSouza LH. Development of the Brunel Balance assessment: a new measure of balance disability post stroke. Clin Rehabil 2004; 18: 801-810.
• Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cord injury: Validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair 2010;24: 70-77.

Clinical Outcome Variables Scale (COVS)

The COVS is a measure of mobility that has been applied to specific diagnostic groups such as stroke, traumatic brain injury, amputations, and musculoskeletal injuries (Berker et al. 2007). It has been applied in acute, inpatient/outpatient rehabilitation, and community settings. Its items include rolling, lying to sitting, sitting balance, transfers, ambulation, wheelchair mobility, and arm function (Campbell & Kendall 2003).

 

Number of Items: 13

Procedure/Administration: The COVS can be conducted via in-person interviews or over the telephone (TCOVS).

How scored: Each item is scored on a 7-point scale ranging from 1(fully dependent mobility) to 7 (normal independent mobility).

Interpretability: Scores are generally reported as a single score ranging from 13 to 91. Lower scores reflect poorer levels of mobility. In an SCI population, 2 subscales have been reported: 1) general mobility with scores ranging from 7-49; and 2) ambulation with scores ranging from 5-35.

Acceptability: N/a

Languages: English

Usability: N/a

Time to administer: Telephone interview takes 5 minutes (subjects are given the questions ahead of time). In-person assessment takes 35 minutes.

Time to score: N/a

Training required: Raters should be trained in the administration of both the COVS and TCOVS.

Availability: N/a

Equipment required: Bed sticks, bed ladders, lifting blocks, transfer boards, leg straps, exercise mat, ramp (1inch to 12inch rise), and a 6 inch platform

Summary: The tool offers a more relevant and complete profile of mobility after SCI when compared with other mobility tools.

Psychometric Summary:

COVS
Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
N/a		Discriminant: Yellow light		N/a		N/a
TCOVS
Results		Results		Results		Floor/ceiling
TR: Green light ER: Green light		N/a		N/a		N/a

Note: TR= Test re-test; IC= Internal Consistency;Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity; ER=Equivalence reliability between COVS and TCOVS.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome Variables Scale when administered via telephone to assess mobility in people with spinal cord injury. Arch Phys Med Rehabil 2007; 88: 632-7.
• Campbell J, Kendall M. Investigating the suitability of the Clinical Outcome Variables Scale (COVS) as a mobility outcome measure in spinal cord in jury rehabilitation. Physiother. Can 2003; 55: 135-144.

Capabilities of Upper Extremity Instrument (CUE)

The CUE measures functional limitation and assesses the amount of difficulty experienced in performing specific actions with one or both arms and hands in individuals with tetraplegia (Marino et al. 1998).

Number of items: 32: fifteen items inquire about unilaterally (left and right) hand and arm function and 2 items assess bilateral hand and arm use.

Procedure/Administration: Interview format. Questions focus on the individuals’ ability to reach or lift; pull and push with their arms; move and position their arm and wrist; use their hand and fingers; and press with the tip of the index finger.

How scored: Responses are given on a 7-point scale representing self-perceived difficulty in performing the action, with scores ranging from 1 (unable to perform) to 7 (can perform without difficulty).

Interpretability: Item by item results of the test are straight forward to interpret. Total scores range from 32 to 224 with higher scores reflecting better function. Left and right arm/hand function can be derived separately. A percent of normal function score is also possible using the following algorithm ((total score – 32) / 192 * 100%.

Acceptability: The method of item generation would suggest the CUE is likely to be widely accepted with therapists and individuals with an SCI.

Languages: English

Usability: N/a

Time to administer: 30 minutes.

Time to score: N/a

Training required: None.

Availability: N/a

Equipment required: None.

Summary:

• The CUE has considerable potential clinical appeal because it reflects hand and/or arm function and scores can be derived for either limb which is appealing given the number of individuals with incomplete injuries.

Psychometric Summary:

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
IC: Green light TR: Green light		Discriminant: Yellow light		Yellow light		Yellow light

Note: TR= Test re-test; IC= Internal Consistency;Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information

References:  

• Marino RJ, Shea JA, Stineman MG. The Capabilities of Upper Extremity Instrument: Reliability and Validity of a Measure of Functional Limitation in Tetraplegia. Arch Phys Med Rehabil 1998;79:1512-21.
• Mulcahey MJ, Smith BT, Betz RR. Psychometric rigor of the Grasp and REslease Test for measuring functional limitation of persons with tetraplegia: a preliminary analysis. J Spinal Cord Med 2004; 27:41-6.

Functional Standing Test (FST)

• Assesses an individual’s ability to perform one handed reaching tasks while standing (Triolo et al. 1994).
• The FST consists of 21 tasks (6 are the same as in the Jebson Test of Hand Function). 
• Tasks involve performing both gross and fine motor skills; crossing midline; and lifting and lowering light and heavy objects. Examples of tasks include: lifting light objects down from the lowest shelf; stacking checkers on the counter top at the midline; lifting heavy objects up to the top shelf.

Number of items: 21 tasks (6 of which are the same as in the Jebson Test of Hand Function

Procedure/Administration: Tasks are done as quickly as possible and the individual is allowed to use assistive devices such as knee-ankle-foot-orthoses (KAFO) or functional neuromuscular stimulation

How scored: The time in minutes/seconds to complete each of the 21 tasks is recorded.

Interpretability: N/a

Acceptability: Was originally developed using able-bodied individuals and has been modified for individuals with SCI. However, the only testing of the FST for SCI has been done in individuals with T3-6 injuries

Languages: N/a

Usability: N/a

Time to administer: The time to complete the entire test (i.e. total standing time) was 15.58 + 2.99 minutes. Time required for each task ranged from 1.86 to 13.70 seconds for individuals with SCI.

Time to score: N/a

Training required: Training is required to administer the test.

Availability: N/a

Equipment required: A standard Jebson Test board and a set of shelves mounted on a counter top 36 inches high (to simulate a kitchen cabinet). 

Summary:

• The tasks simulate skills required to work in a kitchen environment but theses skills are easily transferred to other environments (e.g. shopping). The tasks cover a broad range of difficulty.
• The specialized equipment may limit its usefulness in some clinical/research settings.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
Inter O: Red light*	SS: Red light	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

* the ICC values for the IO reliability ranged from 0.13 – 0.98. If the tasks that were identified as being unreliable in the SCI group were eliminated, then the results for reliability would be assessed as yellow.

 This test was not readily available and has not been included in this summary.

References

• Triolo RJ, Bevelheimer T, Eisenhower G, Wormser D. Inter-rater reliability of a clinical test of standing function. J Spinal Cord Med. 1994;18:14-22.

The Grasp and Release Test (GRT)

The GRT was designed to assess hand neuro-prosthesis in individuals with C5-C6 SCIs, but has also been used to assess hand function prior to and following tendon transfers in people with C6-7 level injuries (Harvey et al. 2001). The GRT assesses the ability to pick up, move, and release six objects of varying sizes, weights and textures using a palmar or lateral grasp (Stroh Wuolle et al. 1994, Harvey et al. 2001). Each object was chosen to represent one or more objects routinely manipulated for activities of daily living (ADL) that represented a range of difficulties.

Number of items: 6 tasks

Procedure/Administration: Clinician administered standardized performance test. Specific instructions are provided for establishing the start position and for recording a successful completion of the task.

How scored: Subjects are scored on their ability to successfully move each of the objects as many times as possible in 30 seconds. Each hand is tested and scored separately. A pretrial practice test for each object is permitted and practice continues until a successful completion is achieved

Interpretability: A summed score is calculated by adding the item scores. If a subject fails to move an item, they score zero for that particular item. Single items may be used.

Acceptability: N/a

Languages: N/a

Usability: Completion of the tool may vary depending on the individual’s abilities. For example, subjects with paralysis of the finger and/or thumb flexor muscles are generally unable to hold the fork or paperweight between the thumb and index finger so floor effects are possible.

Time to administer: Approximately 20 minutes, including the pretest.

Time to score: Minimal

Training required: N/a

Availability: N/a

Equipment required: The objects used in the GRT include a peg, paperweight, fork, block, can and videotape.

Summary: This is a well standardized quick test of hand function that would be appropriate for a limited sub-sample of individuals with SCI.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
TR: Green light	Criterion: Green light	Green light	Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

This test was not readily available and has not been included in this summary.

References

• Harvey LA, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1-16 years following injury. Spinal Cord 2001;39:37-43.
• Mulcahey MJ, Smith BT, Betz RR. Psychometric rigor of the Grasp and REslease Test for measuring functional limitation of persons with tetraplegia: a preliminary analysis. J Spinal Cord Med 2004; 27:41-6.
• Stroh Wuolle K, Van Doren CL, Thorpe GB, Keith MW, Peckham PH. Development of Quantitative Hand Grasp and Release Test for Patients with Tetraplegia using a Hand Neuroprosthesis. The Journal of Hand Surgery: 1994;19:209-18.
• Taylor P, Esnouf J, Hobby J. The functional impact of the Freehand System on tetraplegic hand function. Clinical results. Spinal Cord 2002;11:550-6.

Hand-Held Myometer

The Hand-Held Myometer is a portable device used as a quantitative and objective method of muscle assessment (Schwartz et al. 1992). Testing is performed using one of two techniques, 1) make or 2) break. The ‘make’ technique requires the examiner to resist a maximal voluntary contraction by the patient, thereby producing an isometric contraction. In the ‘break’ technique, the examiner applies adequate force to overcome the patient, thereby producing an eccentric contraction.

Number of items: N/a

Procedure/Administration: Clinician administered. The mean force of three administrations for each muscle group tested is preferred (Noreau et al. 1998) and some investigators suggest a practice trial (Andrews et al. 1996). A break of 5 to 10 seconds between trials is suggested. The starting position of the individual and the myometer is critical and encouragement to maximize muscle contraction is suggested (Noreau et al. 1998).

How scored: The recommended unit of measurement is Kg in order avoid interpretation issues. Measurements are generally rounded to the nearest Kg. 

Interpretability: Normative values for various adult age groups are available. A predicted muscle force can be calculated by taking into consideration the individual’s gender, weight, and age. By comparing the predicted force to the observed force, an estimate of percentage of deficit may be determined. However, no meaningful cut-points have been reported.  Computer software is available to assist with data analyses.

Acceptability: N/a

Languages: N/a

Usability: N/a

Time to administer: 30 minutes for a bilateral assessment of the upper extremities. And, multiple position changes are required to capture maximal muscle contractions

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: A myometer. Initial cost of this device may be seen as a limitation to its general use.

Summary:

• Myometer testing presents an objective, quantifiable method of measuring muscle strength. However this does not necessarily reflect function.
• It is superior to MMT for detection of mild to moderate weakness and changes in muscle strength. It also eliminates potential bias from the evaluator for various age groups and gender.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
InterO: Green light	N/a	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Andrews AW, Thomas MW, Bohannon RW. Normative Values for Isometric Muscle Force Measurements Obtained With Hand-held Dynamometers. Physical Therapy 1996; 76:248-259.
• Burns SP, Breuninger A, Kaplan C, Marin H. Hand-Held Dynamometry in Persons with Tetraplegia. Am. J. Phys. Med. Rehabil. 2005;84:22-29.
• Cohen ME, Herbison GJ, Shah A. Relationship Between Two Measure of Upper Extremity Strength: Manual Muscle Test Compared to Hand-Held Myometry. Arch Phys Med Rehabil 1992;73:1063-1068.
• Noreau L & Vachon J. Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord 1998;36:716-723.
• Schwartz S, Cohen ME, Herbison GJ, Shah A. Relationship Between Two Measure of Upper Extremity Strength: Manual Muscle Test Compared to Hand-Held Myometry. Arch Phys Med Rehabil 1992;73:1063-1068.

Jebsen Hand Function Test

The JHFT was developed to provide a standardized and objective evaluation of several major aspects of hand function using simulated activities of daily living.

Number of items: 7

Procedure/Administration: Fine motor, weighted and non-weighted hand function is assessed through writing; turning over 3 by 5 inch cards; picking up small common objects; simulated feeding; stacking checkers; picking up large objects; and picking up large heavy objects. Patients are required to perform all of the subtests with both the right and left hands, with the non-dominant hand tested first (Jebsen et al. 1969). 

How scored: The scoring method is the time necessary to complete each subtest (rounded the nearest second). The results are measured by using a stop watch.

Interpretability: Test results appear easy to interpret. Norms are available with the instruction manual. Slow times reflect a less desirable performance.

Acceptability: The JHFT represents one of the oldest standardized tests of hand function and used individuals with SCI during its initial development.

Languages: English

Usability: N/a

Time to administer: 30-45 minutes

Time to score: ~15 minutes.

Training required: Training is not required – however, given the standardized nature of the JHFT assessors should refer to the Jebsen paper for details on how to administer the test (Jebsen et al.1969).

Availability: N/a

Equipment required: N/a

Summary: The JHFT only assesses the speed and not the quality of performance

Psychometric Summary:

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
TR: Green light		N/a		N/a		N/a

Note: TR= Test re-test; IC= Internal Consistency;Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Bovend Eerdt TJH, Dawes H, Johansen-Berg H, Wade DT. Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke. Clinical Rehabilitation 2004; 18: 195-202.
• Jebsen RH, Taylor N, Trieschmann RB, Trotter MH, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil 1969;50:311-19.
• Spaulding SJ, McPherson HH, Strachota E, Kuphal M, Ramponi M. Jebsen Hand Function Test: Performance of the Uninvolved Hand in Hemiplegia and of Right-handed, Right and Left Hemiplegic Persons. Arch Phys Rehabil 1988;69:419-22.
• Stern EB. Stability of the Jebsen-Taylor Hand Function Test Across Three Test Sessions. The American Journal of Occupational Therapy 1992;46:647-49.

Modified Functional Reach Test (mFRT)

The FRT was originally designed as a simple reach test designed to assess standing balance. It was then modified by Lynch et al. (1998) to assess sitting balance in individuals with SCI (i.e. modified FRT). Balance is defined as the ability to maintain control over upright posture during forward reach without stabilization.

Number of items: N/a

Procedure/Administration: The individual is seated on a bench and the maximum distance forward they could reach is measured with the upper extremity flexed to 90 degrees. The anatomical landmark is the ulnar styloid process. No weight bearing is allowed through the non reaching arm. The individual is allowed two practice trials and then the following three trials are recorded. 

How scored: The average of the three trials is reported in either cm or inches. 

Interpretability: No normative data exists for the mFRT for any health care condition at this time. 

Acceptability: The mFRT has been developed specifically for individuals with SCI. As long as an individual has 90 degrees of shoulder flexion, he/she can complete the test.

Languages: N/a

Usability: The mFRT requires an individual to have 90 degrees of shoulder flexion and it is therefore not suitable for individuals with limited range of motion or musculoskeletal deformity. 

Time to administer: N/a

Time to score: N/a

Training required: A meter stick/yardstick (attached horizontally to the wall); seat (mat or bench approximately 61 cm in width); and a backboard (at an angle of 80 degrees).

Summary:

• The mFRT mimics a very functional activity that is required in daily living. It can distinguish between individuals who have abdominal and back extensors (i.e. high tetraplegia/high paraplegia versus low paraplegia) but not between individuals with high lesions. 

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
TR: Green light	N/a	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther 1998;78:128-133.

Rivermead Mobility Index (RMI)

The RMI was originally developed to measure mobility for patients with acquired brain injury (Hseih et al. 2000). It evaluates patients’ bed mobility, postural transfers, and walking ability. The RMI covers a range of activities, from turning over in bed to running (Hseih et al. 2000).

Number of items: 15-item scale: 14 questions and one direct observation

Procedure/Administration: The RMI uses a combined interview and observation format.

How scored: Question 5 requires the patient to stand for 10 seconds without any aid. The other questions require the patient to respond either yes (scored 1) or no (scored 0). For question 5, if the subject can stand for 10 seconds, a response of ‘yes’ is indicated.

Interpretability: Scores for the 15 items are summed. The range of scores is between 0 (poor mobility) and 15 (good mobility). No information is available regarding norms or meaningful cut scores.

Acceptability: N/a

Languages: N/a

Usability: Several questions refer to either walking or running which may not be appropriate for all SCI patients.

Time to administer: 3-5 minutes

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary:

• The RMI is simple and quick to complete making it easy to perform in the home, institutional or office settings. There is minimal patient or clinician burden.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
N/A	Criterion: Green light*	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

* correlated with WISCI, SCIM, FIM and BI.

References

• Forlander DA, Bohannon RW. Rivermead Mobility Index: a brief review of research to date. Clinical Rehabilitation 1999; 13: 97-100.
• Hsieh CL, Hsueh IP, Mao HF. Validity and responsiveness of the Rivermead Mobility Index in stroke patients. Scand J Rehab Med 2000; 32: 140-142.
• Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005;43:27-33.

The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)

The SCI-FAI is a mobility measure focusing on gait abnormalities (Field-Fote et al. 2001). It was developed to assess ambulation in SCI patients. The gait parameters were developed by a panel of experts in SCI rehabilitation and consist of three components:

• Gait parameter (weight shift, step width, step rhythm, step height, foot contact, step length)
• Assistive devices use (degree of assistance provided by each of device - eg. cane, walker, parallel bars
• Walking mobility (walking distance, speed, and walking frequency)

Number of items: N/a

Procedure/Administration: Raters provide scores for each of the gait parameter and assistive device use components. The gait parameter component is scored out of 20, 10 points for each of the right and left sides. The assistive device component is scored out of 14 (7 points for each side), and assesses upper and lower extremities in addition to the left and right limbs. In the walking mobility component, subjects are asked about their walking frequency on a scale of 0 to 5 (0 = does not walk; 5 = regularly walks in community). The distance walked in two minutes is also measured.  Walking can be videotaped for later evaluation.

How scored: Scores within each component are summed. Component scores range from 0 to 20 in the gait parameter component, 0 to 14 in the assistive device component, and 0 to 5 in the walking mobility component. 

Interpretability: Higher score indicate higher levels of function. It is not meaningful to combine component scores into an overall total score.  No cut scores or norms are given.

Acceptability: The SCI-FAI can only be used among SCI patients who can ambulate independently, with or without the use of assistive devices.  

Languages: N/a

Usability: The SCI-FAI can be completed during regular check ups or during home visits. Patients are to walk for a maximum of 2 minutes and can use what ever walking devices they require. The SCI-FAI is short in duration and scoring is straight forward for all items on the scale.

Time to administer: 2 minutes

Time to score: N/a

Training required: Training is required for proper recognition of separate criterion; though the test can be scored reliably from video recording, which allows the rater to rewind, pause and slow down the tape.

Availability: N/a

Equipment required: N/a

Psychometric Summary:

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
Inter O: Yellow light Intra O: Green light		Convergent: Green light		Red light		N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Field- Fote E, Fluet G, Schafer S, Scheider E, Smith R, Downey P, Huhl C. The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). J Rehabil Med. 2001;33:177-181

Sollerman Hand Function Test

 This test was developed to provide an overall measure of hand and grip function when engaging in ADLs (Sollermen & Ejeskar 1985).  It was designed to measure grips that are needed for certain ADLs such as eating, driving, personal hygiene, and writing. The test includes subtests that represent common handgrips (volar, transverse volar, spherical volar and pinch positions - pulp, lateral, tripod, and the five finger) and activities (using a key; picking up coins from a flat surface; writing with a pen; using a phone; and pouring water from a jug).

Number of items: 20

Procedure/Administration: Clinician administered standardized performance test.  A test box is placed in front of the patients who are required to start each subtask in a seated position but they may stand to complete a task if necessary. Three subtasks are completed using the hands bilaterally while the rest are completed with each hand separately. The subtests are timed and the performance is observed.

How scored: Scoring takes into account the time taken, level of difficulty displayed, and the quality of performance using the correct pinch or grip position. Patients are then scored on a 5-point scale from 0 (task cannot be performed at all) to 4 (task is completed without any difficulty within the time frame (20 seconds) and with the prescribed hand-grip of normal quality). Scoring the test can be challenging as the assessor must be aware of multiple factors occurring simultaneously (passage of time, difficulty, correct positioning and quality of performance). Definitions for interpreting the scoring scheme are not inherently obvious.

Interpretability: A total sum score is created by adding up the scores from the different subtests.  Scores range from 0 to 80 with higher scores reflecting a better performance. Subjects with no hand function impairment typically score 80 with the dominant hand and 77-79 for the non-dominant hand.

Acceptability: The test was designed with tetraplegic patients in mind and therefore reflects the needs of this group.

Languages: English

Usability: N/a

Time to administer: 20-25 minutes (one minute for each subsection plus introduction of the test)

Time to score: N/a

Training required: It can be used by clinicians who have little experience - though knowledge of hand function is an asset when scoring.

Availability: N/a

Equipment required: Special equipment is required.

Summary: N/a

Clinical Summary:

• The Sollerman (unlike the Jebsen Hand Function Test) considers the quality and level of difficulty with the performance which are important components with respect to hand function.

Psychometric Summary :

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
Inter O: Green light	Criterion: Green light	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Dellhag B & Burckhardt CS. Predictors of Hand Function in Patients with Rheumatoid Arthritis. Arthritis Care and Research 1995;8:16-20.
• Sollerman C & Ejeskär A. Sollerman Hand Function Test. A Standardised Method and its Use in Tetraplegic Patients. Scand J Plast Reconstr Hand Surg 1995;29:167-176.

Tool for assessing mobility in wheelchair-dependent paraplegics

The tool is used to quantify the mobility of individuals with SCI who use a wheelchair through the assessment of motor tasks such as moving from lying to sitting; completing a horizontal transfer; completing a vertical transfer; pushing a wheelchair on flat ground; pushing a wheelchair up/down ramps; and negotiating curbs in a wheelchair (Harvey et al. 1998).

Number of items: 6

Procedure/Administration: This is a performance based assessment. For each task, subjects are scored on a six-point scale with 6 representing complete independence, and 1 representing total assistance.  Patients must perform the tasks in the following order: Task 1) supine to long sitting; Task 2) horizontal transfer; Task 3) vertical transfer; Task 4) push on flat; Task 5) push on ramp; Task 6) negotiate curbs. For tasks 2 through 6, the patients are allowed three attempts with the best score recorded.  If a task is not attempted, ‘not applicable’ is recorded.

How scored: N/a

Interpretability: Higher scores indicate greater independence. The scores for each task are not meant to be added together to give an overall score. Rather, each task is given a score and interpretation is in relation to that specific task. No norms or cut scores are available at this time.

Acceptability: The tool was designed specifically for individuals with paraplegia who use a manual wheelchair.

Languages: N/a

Usability: N/a

Time to administer: Less than 15 minutes

Time to score: N/a

Training required: Trained physiotherapist

Availability: N/a

Equipment required: A 25 meter hallway, cones, a 15 meter ramp, and curbs 2.5 cm and 15 cm high are required for the test.

Summary:

• The results of the assessment tool summarize the basic level of wheelchair mobility of patients in a manner that is readily understood by other professionals

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IO: Green light	N/a	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Harvey LA, Batty J, Fahey A. Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics. Spinal Cord 1998;36:427-431.

Tetraplegia Hand Activity Questionnaire (THAQ)

The THAQ is a measure of arm and hand function in individuals with tetraplegia (Land et al. 2004). It consists of 9 subclasses: self-care, dressing, continence, mobility, eating and drinking, work/admin/telecom, leisure, household, and miscellaneous.

Number of items: 153

Procedure/Administration: Information is collected using an interview format.

How scored: Items are scored based on 3 dimensions: 1) Performance or Doing (0= without difficulty to 3=help from others); 2) Use of an aid (0=never and 3=always); 3) Importance of performing activity independently (0=not important to 2 very important).

Interpretability: There is no information regarding interpretability of the scores (e.g. norms).

Acceptability: It is specific to the tetraplegic population. The items were identified by client population.

Languages: N/a

Usability: The test may not be useful when the individual is an in-patient as exposure to out of facility activities (i.e. community living, work, leisure) is required.

Time to administer: 30-45 minutes

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary: The THAQ is a SCI specific questionnaire used to assess performance, use of an aid and importance in completing actual activities. It has relevant application for individuals with tetraplegia who have completed in-patient rehabilitation. The test may not be useful when the individual is an in-patient as exposure to out of facility activities related to community living, work, leisure, which are not typically addressed in early phases of in patient rehabilitation.The THAQ could potentially be used as a method of goal identification for intervention and/or as a test to measure change after intervention. However, while the THAQ is promising considerable additional development and psychometric assessment is required before recommendations can be made to use the scale clinically.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
N/a	N/a	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Land NE, Odding E, Duivenvoorden HJ, Bergen MP, Stam HJ. Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury. Spinal Cord 2004;42:294-301.

Timed Motor Test (TMT)

• Assesses the capacity to perform ADL in children with SCI (who use a manual wheelchair).
• Tasks include: donning a shirt; donning sweat pants; performance of even transfers; performance of uneven transfers (4 inch height difference); wheelchair propulsion on even surfaces; and wheelchair performance up a ramp (Chafetz et al. 2004).

Number of items: 6

Procedure/Administration: The individual completes each task 5 times, except for wheelchair skills which is only done 3 times. They are instructed to complete the task quickly but safely. If they are unsuccessful in completing the task, they can re-try it and if they are not able to complete all 5 trials then no time is reported. If the individual requires more than 20 seconds to complete the task then it is considered “incomplete”. 

How scored: A clinician records the time (seconds) to complete each task. Based on the results of the reliability data it was decided to use the fastest 3 trials for scoring each task.

Interpretability: No norms are available and the results for the 3 fastest trials for each task were not reported.

Acceptability: N/a

Languages: N/a

Usability: N/a

Time to administer: The scale takes between 60–90 minutes to complete.

Time to score: N/a

Training required: No special training is required.

Availability: N/a

Equipment required: Anadjustable mat; an 80 foot (24.3 m) corridor; and a 45 foot (13.72 m) ramp with an 8 degree angle.  

Summary:

• The TMT includes common ADL tasks for children with SCI.
• The objective scale such as time (seconds) is useful to detect change.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
TR: Yellow light* Inter/Intra O: Green light	Construct: Yellow light**	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

* TR values for each of the 6 tasks were >0.75 for 4 tasks, 0.67 for one task and 0.30 for one task. An overall value of adequate (++) was selected to best represent the range of values.
** There is support for construct validity by using the data comparing known groups (TLSO versus no brace). F values were reported and 5 out of 6 tasks demonstrated that the TLSO times were significantly (p<0.05) compared to no brace.

 A copy of this tool could not be found.

References

• Chafetz R, McDonald C, Mulcahey MJ, Betz R, Anderson C, Vogel L, Gaughan JP, Martin S, O'Dell MA, Flanagan A. Timed motor test for wheelchair users: initial development and application in children with spinal cord injury. J SCI Med 2004;27:S38-43.

Timed Up and Go Test (TUG)

• A test of basic functional mobility for frail elderly persons (Mathias et al. 1986).
• Is a timed walking test designed to measure gait performance and balance.  

Number of items: N/a

Procedure/Administration: The individual is instructed to stand up from an arm chair, walk 3 meters, return to the chair and sit down at their preferred walking speed.

How scored:

Time for ‘Up and Go’ test:  _________sec.

Unstable on turning?  Y/N

Walking aid used?  Y/N  Type of aid: ______________

Interpretability: N/a

Acceptability: The test is not suitable for many individuals with SCI.

Languages: N/a

Usability: N/a

Time to administer: N/a

Time to score: N/a

Training required: Does not require any special training.

Availability: N/a

Equipment required: Chair with armrests.

Summary:

• Discriminates balance and ambulatory function between patients and evaluate change over time in a single patient.
• The TUG is a quick and easy test to administer and can be done in any setting (i.e. clinical setting or community). The task is very functional and incorporates mobility, balance and lower extremity leg strength. 
• TUG appears to be a very useful measure for individuals with incomplete SCI who have lower extremity function and provides some information on a basic mobility task.  

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
TR< 40 sec & Inter O< 40 sec: Green light   TR>40 sec & Inter O>40 sec : Green light	Construct: Green light	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67:387-389.
• van Hedel HJA Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196.

The Van Lieshout Test Short Version (VLT-SV)

This test was originally developed to assess basic functional modalities of the arm and hand in individuals cervical SCIs. It assesses positioning and stabilization of the arms, opening and closing of the functional hand, grasping and releasing of the hands, and manipulation of the thumbs and fingers (Post et al. 2006). The VLT-SV assesses forward reaching, arm extension against gravity, thumb closure, finger strength, pen grip, lighting a match and opening a bottle (Spooren et al. 2006).

Number of items: 10

Procedure/Administration: Clinician administered standardized performance test. All tasks are performed while the patient is seated in their wheelchair for the “best hand” only.  The VLT-SV is scored on a 6-point scale, where 0 = task was not possible, and 5 = highest level of accomplishment. Individual item scores take into acount the 1) ability to complete the task; 2) behavioural quality of performance (e.g./accuracy of task completion); and 3) independence in performing the task without using external support (e.g./assistance of the contra-lateral arm).

How scored: A total score may be calculated by summing the scores of all 10 items.

Interpretability: Scores range from 0 to 50 with higher scores indicating greater functional ability.

Acceptability: It was developed with the cervical SCI population in mind, implying appropriate item selection / challenge. During administration of the test, the patient and clinician together identify for the best way to complete the task.

Languages: The test’s measurement properties have only been assessed for the Dutch version. English and German versions are available but the measurement properties have yet to be tested.

Usability: N/a

Time to administer: 25 – 35 minutes

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: Current published literature does not provide details about standardization of the test (e.g./ table heights, distance of reaching tasks, etc.)

Summary:The VLT-SV presents as a promising new measure that should be able to capture evidence of change in hand function.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC: Green light InterO: Green light	Construct: Green light	Green light	Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Post MWM, van Lieshout F, Seelen HAM, Snoek GJ, IJzerman MJ, Pons C. Measurement properties of the short version of the Van Lieshout test for arm/hand function of persons with tetraplegia after spinal cord injury. Spinal Cord 2006; 44: 763-771
• Spooren AI, Janssen-Potten YJ, Post MW, Kerckhofs E, Nene A, Seelen HA. Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test. Spinal Cord 2006; 44: 772-779.

Walking Index for Spinal Cord Injury (WISCI) and WISCI II

The WISCI is a measure of ambulation designed specifically for SCI clinical trials (Ditunno et al. 2000). The WISCI evaluates the amount of physical assistance, braces or devices required to walk 10 metres. 

Number of items: N/a

Procedure/Administration: The client walks 10 meters – this distance represents household ambulation.

How scored: The clinician observes walking and rates the level which the person is considered safe. A score from 0 to 20 is assigned. Level 0: “patient is unable to stand and/or participate in walking” to level 20: “ambulates with no devices, with brace and no assistance”.

Interpretability: No normative data or cut scores are available but the WISCI is gaining popularity and comparisons can be made with existing studies. Scores are self evident.

Acceptability: The WISCI is an SCI specific test. It covers the entire range of walking ability.

Languages: English

Usability: A score is possible even if the individual cannot walk 10m. However, because the furthest walk distance is 10m, it would not be suitable for individuals with minor impairments

Time to administer: Varies between subjects.

Time to score: Minimal.

Training required: Training beyond knowledge of ambulation is not required. Scoring definitions provided are clear.

Availability: N/a

Equipment required: Equipment is typically available in the clinical setting: 5 meter parallel bars and walking devices (e.g. braces, cane, walker).

Summary:

• The WISCI levels are relevant to individuals with SCI. There is no additional burden is as the test falls into typical clinical practice parameters.  Administration time is.
• It would be a useful to incorporate the WISCI into clinical practice and to evaluate new SCI therapies.  Additional tests may be necessary to assess endurance (e.g. 6MWT) and/or walking speed (eg.10MWT), especially for individuals with greater walking capacity.

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
Inter O: Green light		Construct: Green light		Yellow light		Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Ditunno JF, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V, Marchetti M, Barbeau H Frankel HL D'Andrea Greve JM, Ko HY, Marshall R, Nance P. Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study. Spinal Cord 2000;38:234-243.
• Dittuno PL Dittuno JF. Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 2001;39:654-656.
• Ditunno JF, Burns AS, Marino RJ. 2005. Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. J Rehab Res Dev 2005;42(Suppl 1): 35-41.
• Ditunno JF, Scivoletto G, Patrick M, Biering-Sorensen F, Abel R, Marino R. Validation of the walking index for spinal cord injury in a US and European clinical population. Spinal Cord 2008; 46: 181-188.
• Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005;43:27-33.
• van Hedel HJA Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196.

Wheelchair Circuit (WC)

The WC assesses manual wheelchair mobility (i.e. skill and performance). Tasks cover 3 aspects of mobility: 1) tempo (tasks = figure-of-8 shape and sprint); 2) technical skill (tasks = crossing a doorstep, mounting a platform, and transferring); and 3) physical capacity (tasks = wheelchair propulsion and ascending slopes).

Number of items: N/a

Procedure/Administration:

How scored: No normative data is available, but results can be compared to published data. Separate scores for ability (ordinal scale); performance time (seconds); and physical strain (formula using HR data) are calculated.

Interpretability: N/a

Acceptability: The WC includes functional tasks developed specifically for the SCI population. However, the tasks are only relevant to manual wheelchair users. Some tasks may be too difficult / not suitable if individuals have medical complications or are older.

Languages: N/a

Usability: N/a

Time to administer: N/a

Time to score: N/a

Training required: Clinicians require specialized training to perform exercise testing and a practice test is recommended.   

Availability: N/a

Equipment required:  An adjustable mat; treadmill (with 3% and 6% grade); HR monitor; stop watch; 0.10 m platform on floor; wood doorstep height 0.4 m; open space; and 15 m corridor. are required for the WC. 

Summary:

• The performance time and physical strain are useful to monitor progress once the individual achieves a maximal score on the ability score or if they have not demonstrated any change over repeated administrations.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
Inter O/Intra O: Green light	Construct: Yellow light	Green light	Yellow light**

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

** Varied (re: floor/ceiling effects; mixed results)

References

• Dallmeijer AJ, van der Woude LH, Hollander AP, van As HH. Physical performance during rehabilitation in persons with spinal cord injuries. Med Sci Sports Exerc 1999;31:1330-1335.
• Harvey LA, Batty J, Fahey A. Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics. Spinal Cord 1998;36:427-431.
• Janssen TW, van Oers CA, van der Woude LH, Hollander AP. Reliability of heart rate response to non-steady-state activities of daily living in men with spinal cord injuries. Scand J Rehabil Med 1994;26:71-78.
• Kilkens OJ, Dallmeijer AJ, De Witte LP, Van Der Woude LH, Post MW. The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil 2004;85:424-431.
• Kilkens OJ, Post MW, van der Woude LH, Dallmeijer AJ, van den Heuvel WJ. The Wheelchair Circuit: reliability of a test to assess mobility in persons with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1783-1788.

Wheelchair Skills Test

The WST is a comprehensive measure used to objectively evaluate manual wheelchair skills (Kirby et al. 2002). Existing wheelchair tests (Harvey et al. 1998) do not include the level of wheelchair skills required for daily functioning.

Number of items: 50

Procedure/Administration: The revised WST 2.4 includes 50 skills in 10 areas (brakes, armrests, footrests, rolling, turning, reaching, transfers, fold/open, obstacles, and wheelie). The individual is required to use a manual wheelchair and two attempts, with a rest, are permitted to complete the task.

How scored: Scoring is on a pass-fail basis (pass=1, fail=0, N/A=not applicable) with an additional goal attainment score (GAS), for which the clinician indicates whether or not the skill is a reasonable goal for the individual case (N/G=not a goal). The total WST score for individuals with SCI was 68.4+15.1%, indicating that these individuals were able to complete approximately 70% of the tasks deemed suitable.

Interpretability: N/a

Acceptability: N/a

Languages: N/a

Usability: N/a

Time to administer: On average, it takes 27.0+9.3mins (range 12–70mins) to complete

Time to score: N/a

Training required: The clinician requires test familiarization and a spotter is mandatory.

Availability: N/a

Equipment required: A specialized wheelchair circuit or access to a variety of environmental obstacles.

Summary:

• The tasks cover a wide range of difficulty while remaining functional. It is a generic tool that can be used for several populations (e.g. SCI, amputees, stroke, musculoskeletal disorders, able-bodied) and it was developed using both inpatient and community dwelling samples.

. Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
WST 2.4: TR: Green light Inter O/ Intra O: Green light	WST 2.4: Construct: Green light Criterion: Yellow light	N/a	WST2.4 Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; varied (re. floor/ceiling effects; mixed results).

SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References:

• Kirby RL, Swuste J, Dupuis DJ, MacLeod DA, Monroe R. The Wheelchair Skills Test: a pilot study of a new outcome measure. Arch Phys Med Rehabil 2002;83:10-18. 
• Harvey LA, Batty J, Fahey A. Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics. Spinal Cord 1998;36:427-431.

The Barthel Index

The Barthel Index is one of the oldest developed measures of ADLs. It was originally developed to assess the severity of disability in personal care and mobility in stroke patients (Mahoney & Barthel 1965).

Item	Scoring
Bathing Grooming Feeding	0=dependent; 5=independent
Dressing Toilet use Ascend/descend stairs	0=dependent; 5=needs help; 10=independent
Bowel management Bladder management	0=dependent; 5=occasional accident; 10=independent
Bed/wheelchair transfer	0=unable, 5=major help needed; 10= minor help; 15=independent
Mobility (level surface)	0=unable; 5=wheelchair >50yards; 10=walks >50 yards; 15=independent

 

Number of items: 10

Procedure/Administration: Scores are obtained using direct observation, self-report, or responses from family/friends. Scores based on the past 48 hours are preferred.

How scored: Total scores are calculated by summing the individual item scores. Scores are weighted and range from 0 (dependence) to 100 (independence).

Interpretability: Scores reflect the nursing burden and social acceptability of the activity. Cut scores have been established on the stroke population and are not necessarily representative for the SCI population. Scores of 0-20 indicate total dependence; 21-60: severe dependence; 61-90: moderate dependence and 91-99: slight dependence. 

Acceptability: Though the test items are deemed important to society, they may not reflect activities that are of importance to individuals with SCI.

Languages: The 10 item English version has been assessed for the SCI population.

Usability: There is minimum patient burden unless the entire test is scored by observation. Only the modified BI has published properties for the SCI population. Floor and ceiling effects makes the scale less useful for the SCI population.

Time to administer: 2-10 minutes to complete (more if assessed by observation).

Time to score: N/a

Training required: No training is required though clinical experience/practice is beneficial.

Availability: N/a

Equipment required: None

Summary:

• The BI is one of the best researched ADL tools and has been used with a number of patient populations. Use of adaptive aids is permitted with a score of ‘independent’.
• The BI covers very basic functional abilities and while a score of 100 suggests independence, assistance may still be required with other higher order tasks such as cooking/cleaning and therefore other measures are needed to assess these areas.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC/TR: Green light Inter O: Yellow light	Criterion: Green light Construct: Yellow light	Green light	Floor/Ceiling: Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil 1979;60:145-154.
• Kucukdeveci AA, Yavuzer G, Tennant A, Suldur N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med 2000;32:87-92.
• Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J 1965;14:61-65.

Frenchay Activities Index (FAI)

The FAI assesses frequency of doing Instrumental Activities of Daily Living (IADL); the index includes items which reflect the patient’s behavior in the areas of domestic chores, leisure/work, and outdoor activities (Holbrook & Skilbeck 1983). A revised 13-item FAI* has recently been assessed among SCI patients. The following summary therefore focuses on the revised FAI.

Number of items: 13

Procedure/Administration: Self administered or interview format. Items include washing up; preparing main meals; washing clothes; driving car/bus travel; light housework; heavy housework; local shopping; social occasions; actively pursuing hobby; gainful work; travel outings/car rides; gardening; and household/car maintenance. 

How scored: Responses measure the frequency of engaging in an activity on a 2 and 3 point ordinal scale. Four items (washing up, washing clothes, driving a car/bus travel, and gainful work) are scored on a 2-point scale. The 9 other items are scored on a 3-point scale. Total score are derived by summing the score from each item and range from 0 (no activity) to 22 (most frequently doing the activities).

Interpretability: Higher scores indicate greater frequency of doing IADL. The raw scores of the 13-item FAI can be transformed to interval scores thereby enabling clinicians and researchers to quantify and monitor IADL function in SCI patients (Hsieh et al. 2007).

Acceptability: The 13 item revised FAI was developed specifically for use with SCI patients.

Languages: English

Usability: The revised 13-item scale is brief, quick to complete, and reflects the everyday activities of normal living

Time to administer: Between 5 and 15 minutes

Time to score: N/a

Training required: Minimal

Availability: N/a

Equipment required: N/a

Summary: The FAI does not assess whether patients can perform IADL.

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
Reliability Coefficient: Yellow light		Construct*: Yellow light		N/a		Floor : Yellow light

TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

* Based on Rasch analysis and the authors’ findings that the results assess a single, unidimensional IADL for SCI patients living in the community.

References

• Holbrook M, Skilbeck CE. An Activities Index for use with stroke patients. Age and Ageing 1983; 12: 166-170.
• Hsieh CL, Jang Y, Yu TY, Wang WC, Sheu CF, Wang YH. A Rasch analysis of the Frenchay Activities Index in patients with spinal cord injury. Spine 2007; 32: 437-442.

Functional Independence Measure (FIM)

The FIM assesses physical and cognitive disability. It consists of two subscales, motor and socio-cognitive.

Number of items: 18

Procedure/Administration: The tool is completed by observation of performance.  The motor subscale includes 13 items: eating, grooming bathing, dressing upper extremity, dressing lower extremity, bowel management, bladder management, transfers to bed, chair or wheelchair, transfer to tub, toilet and shower, walking or wheelchair propulsion and stair climbing. The socio-cognitive subscale includes 5 items: comprehension, expression, social interaction, problem solving and memory.

How scored: Each item is scored on a 7 point ordinal scale ranging from 1 (total dependence) to a score of 7 (total independence). The scoring considers the use of adaptive equipment and/or the extent of personal assistance or supervision required to complete the task.  FIM motor, cognitive and/or total scores can be derived by summing items.

Interpretability: Total FIM scores range from 18 (totally dependent) to 126 (totally independent); motor scores range from 13 (total dependence) to 91 (total independence); and cognitive scores range from 5 (total dependence) to 35 (total independence).  Higher scores reflect fewer care hours required upon discharge (Heinemann et al. 1997; Hamilton et al. 1999).

Acceptability: The FIM is not SCI specific. It has limitations in sensitivity to component abilities within tasks for people with SCI. There is a ceiling effect with the socio-cognitive subscale for individuals with and it does not measure the social, psychological, or vocational impact of disability experienced by those living with SCI.

Languages: The FIM has been translated into 10 languages.

Usability: The FIM is used widely for research, clinical and administrative purposes. 

Time to administer: 45 minutes.

Time to score: N/a

Training required: Certification for FIM administration is required

Availability: Information on training can be obtained from http://www.udsmr.org/. See McDowell & Newell (1996) for a copy of the FIM.

Equipment required: None

Summary:

• The FIM is often considered the gold standard for assessing ADLs.
• Though it is the best researched measure of function, it may not be sensitive to the subtle important changes in function for SCI individuals.
• As a result of the limitations of the FIM for use with individuals with SCI, the SCIM was developed and may perhaps be a better tool to use with SCI patients.

Psychometric Summary:

FIM
Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
IC: Yellow light TR/Inter O: Green light		Construct/Criterion: Green light		Red light		Floor/Ceiling: Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Davidoff GN, Roth EJ, Haughton JS, Ardner MS. Cognitive dysfunction in spinal cord injury patients: sensitivity of the Functional Independence Measure subscales vs. neuropsychologic assessment. Arch Phys Med Rehabil 1990;71:326-329.
• Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients Arch Phys Med Rehabil, 1993; 74: 531-536.
• Granger CV, Hamilton BB, Keith RA et al. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil 1986;1:59-74.
• Graves D. The construct validity and explanatory power of the AISA Motor Score and the FIM: implications for theoretical models of spinal cord injury Top Spinal Cord Inj Rehabil 2005;10:65-74.
• Hall KM, Cohen ME, Wright J, Call M, Werner P. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil 1999;80:1471-1476.
• Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehab Med 1994;26:115-119.
• Hamilton BB, Deutsch A, Russell C, Fiedler RC, Granger CV. Relation of disability costs to function: spinal cord injury. Arch Phys Med Rehabil 1999;80:385-391.
• Heinemann AW, Kirk P, Hastie BA Semik,P, Hamilton BB, Linacre JM, Wright BD, Granger C. Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury. Arch Phys Med Rehabil 1997;78:143-149.
• McCabe MA, Granger CV. Content validity of a pediatric Functional Independence Measure. Appl Nurs Res 1990;3:120-122.
• McDowell I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires. Oxford University Press, New York NY, 1996.
• Middleton JW, Harvey LA, Batty J, Cameron I, Quirk R, Winstanley J. Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury. Spinal Cord 2006; 44: 495-504.
• Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996;77:1226-1232.

Functional Independence Measure Self-Report (FIM-SR)

This FIM-SR, similar to the FIM, assesses burden of care and functional impairment. The original FIM is completed by trained clinicians whereas the FIM-SR is completed by the patient. The FIM-SR, contains 6 scales: self-care, sphincter control, mobility, locomotion, communication, and social cognition (Masedo et al. 2005).

Number of items: N/a

Procedure/Administration: The FIM Self Report was developed for administration by telephone interview. The scores can be reported as FIM Motor scores, FIM Cognitive scores or FIM Total summed scores.

How scored: The 18 items are rated on a 1 – 7 scale where 1 = total assistance is needed and 7 = complete independence.

Interpretability: Total FIM-SR scores range from 18 (total dependence) to 126 (total independence). The higher the FIM score, the fewer care hours required upon discharge (Hamilton et al. 1999; Heinemann et al. 1997).

Acceptability: Most items on the FIM-SR generalize to all populations, however modified versions of the FIM exist to accommodate the needs of individuals with SCI. The motor scale adequately discriminated subjects with different injury levels

Languages: N/a

Usability: N/a

Time to administer: Requires minimal time to complete (is very short).

Time to score: N/a

Training required: Health care professionals scoring the FIM–SR are required to complete training and testing protocol.

Availability: N/a

Equipment required: N/a

Summary:

• The instrument reports the patient perspective on their level of independence and in general, is well known as the internationally accepted, global tool to measure functional independence.  
• The FIM-SR has less clinician and client burden than the original FIM which requires observation of tasks.

Psychometric Summary

 

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC/TR: Green light	Convergent: Red light	Red light	Ceiling (Cognitive scale)

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Graves D. The construct validity and explanatory power of the AISA Motor Score and the FIM: implications for theoretical models of spinal cord injury Top Spinal Cord Inj Rehabil 2005;10:65-74.
• Hall KM, Cohen ME, Wright J, Call M, Werner P. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil 1999;80:1471-1476.
• Hamilton BB, Deutsch A, Russell C, Fiedler RC, Granger CV. Relation of disability costs to function: spinal cord injury. Arch Phys Med Rehabil 1999;80:385-391.
• Heinemann AW, Kirk P, Hastie BA Semik,P, Hamilton BB, Linacre JM, Wright BD, Granger C. Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury. Arch Phys Med Rehabil 1997;78:143-149.
• Masedo AI, Hanley M, Jensen MP, Ehde D, Cardenas DD. Reliability and validity of a self-report FIM (FIM-SR) in persons with amputation or spinal cord injury and chronic pain. Am J Phys Med Rehabil 2005;84:167-176.

Klein-Bell Activities of Daily Living Scale (K-B Scale)

The K-B Scale is a generic instrument that can be used with persons with or without disability. It was developed to measure ADL independence in both adults and children.  Items are divided into six sub-dimensions: Mobility, Emergency Communication, Dressing, Elimination, Bathing/Hygiene, and Eating. The majority of items measure ADLs and others measure body function (bladder/bowel emptying and incontinence, chewing/swallowing food and liquids, verbalizing telephone messages).

Number of items: 170

Procedure/Administration: Each subtask on this performance oriented measure is scored as able to perform (score = 1), unable to perform (score = 0), or not applicable (score = 1).

How scored: Subtask weights of 1, 2, or 3 are assigned to each subtask. In developing the weights, four factors were considered, including: importance to health, difficulty for non-disabled persons, time required to perform the task, and the burden of care-giving. Overall independence scores range from 0 to 313 (0%-100%).

Interpretability: Higher scores indicate greater independence.

Acceptability: The scale was not designed specifically for SCI subjects; therefore, items included in the scale may not be important for SCI populations.

Languages: N/a

Usability: N/a

Time to administer: 1-3 hours

Time to score: 15 minutes

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary:

• The K-B Scale divides each activity into its essential components to get a measure of basic ADL. This is advantageous over other known ADL scales as it makes it possible to detect problematic items within activities and thus helps to better identify rehabilitation treatment.
• The authors suggest using the scale as a method to generate discussion about goals they wish to achieve.

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
IO: Green light		Construct: Green light		Red light		Ceiling: Red light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Dahlgren A, Karlsson A-K, Lundgren Nilsson Ã…, Fridén J, Claesson L. Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale. Spinal Cord 2007; 45: 475-484.
• Lynch KB, Bridle MJ. Validity of the Jebsen-Taylor Hand Function Test in Predicting Activities of Daily Living. The Occupational Therapy Journal of Research 1989; Volume 9, Number 5: 316-18.

Lawton Instrumental Activities of Daily Living scale (IADL)

This IADL scale was developed to assess the complex ADLs for older adults living in the community (Lawton & Brody 1969). It assesses a person’s ability to perform tasks such as using a telephone, doing laundry, and handling finances. Each item relies on either cognitive or physical function, though all require some degree of both.

Number of items: 8

Procedure/Administration: The scale can be administered with a written questionnaire or by interview. The patient or a family member or caregiver may provide answers. Responses to each of the eight items in the scale will vary ranging from independence in performing the activity to not performing the activity at all.

How scored: Responses range from 0 (unable or partially able) to 1 (able).  Alternatively, the level of independence can be reflected using a three point scale; 0=unable, 1=needs assistance or 2=independent.

Interpretability: Item responses are summed to derive a scale score with higher scores indicating great independence. 

Acceptability:  Only one study, with findings of weak construct validity has been performed to test the IADL psychometric properties among an SCI population

Languages: English

Usability: It is easy to administer and provides various response options for each item, thereby, enabling flexibility when scoring.

Time to administer: 1 minute

Time to score: N/a

Training required: N/a

Availability: www.abramsoncenter.org/pri/documents/iadl.pdf

Equipment required: N/a

Summary:

• The IADL measures more complex (instrumental) levels of functioning than other ADL instruments. The IADL scale is therefore likely to be more sensitive in detecting earlier, less severe dysfunction.
• The content of IADL measures often reflects specific cultural concerns. For example, British measures frequently include the ability to make a cup of tea. There is also potential for gender bias as the scale may overemphasize tasks customarily performed by women and thus overestimate dependency in men.

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
N/a		Construct: Red light		N/a		Green light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Lawton G, Lundgren-Nilsson A, Biering-Sorensen F, Tesio L, Slade A, Penta M, Grimby G, Ring H, Tennant A. Cross-cultural validity of FIM in spinal cord injury. Spinal Cord 2006; 44: 746-752.

Physical Activity Scale for Individuals with Physical Disabilities (PASIPD)

The PASIPD is a modified version of the 10 item Physical Activity Scale for the Elderly (PASE) (Washburn et al. 1993). It captures information about leisure, household, and work related physical activity over the preceding 7 days (Washburn et al. 2002). The PASIPD was developed targeting individuals with visual/auditory and locomotor/SCI disabilities. It solicits information about the frequency (number of days a week) and duration (daily hours) of current participation. The specific activity performed in each of these areas is also captured. The PASIPD assesses 5 distinct dimensions of physical activity: home repair, lawn and garden work, housework, vigorous sport and recreation, moderate sport and recreation, and occupation and transportation.

Number of items: 13

Procedure/Administration: Survey administered by mail, telephone, or in person. Individuals respond to 2 ordinally ranked responses. Frequency responses range from 1 (never) to 4 (often) while duration responses range from 1 (less than 1) hour to 4 (greater than 4 hours). 

How scored: The average hours per day for each item is multiplied by a MET value associated with the intensity of the activity and summing over items 2 through 13. Scores range from 0 (no activity) to >100 METS hr/day (very high).

Interpretability: N/a

Acceptability: Items were developed with disabled population in mind.

Languages: N/a

Usability: N/a

Time to administer: Approximately 15 minutes.

Time to score: Not mentioned, but can be complicated.

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary:

• The PASIPD has the potential to provide in-depth information about the degree of activity in the form of Metabolic Equivalents (METS hr/day) and or descriptive information about various activities individuals are performing as well as the frequency and duration of this activity.

Psychometric Summary

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC: Red light	Construct: Yellow light	N/a	Red light (Floor) Green light (Ceiling)

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol.1993 Feb;46:153-62.
• Washburn RA, Zhu W, McAuley E, Frogley M, Figoni SF. The Physical Activity Scale for Individuals With Physical Disabilities: Development and Evaluation. Arch Phys Med Rehabil 2002; 83: 193-200.

Quadriplegia Index of Function (QIF)

The QIF was developed in 1980 to provide a functional assessment that would be useful in documenting the small but clinically significant gains made by quadriplegics throughout in-patient rehabilitation (Gresham et al. 1986). This index assesses transfers, grooming, bathing, feeding, dressing, wheelchair mobility, bed activities, bowel program, bladder program and understanding of personal care. The first 9 areas represent functional performance activities and the final area is a questionnaire - designed to assess the client’s understanding of skin care, nutrition, equipment medications and infections.

Number of items: 37

Procedure/Administration: Information is collected in an interview format. Scores are provided to give credit for being able to complete a portion of the task rather than the entire task.

How scored: Each category of functional performance is calculated according to weighted scores - Functional performance categories:  /180; Understanding of personal care: /20; Total:  200 /2 =  /100.  The functional performance categories are scored on a 5 point scale from 0 (dependent) to 4 (independent).

Interpretability: No information regarding interpretability of the scores (e.g.: norms or cut points) is provided.

Acceptability: The QIF was designed for the SCI population and specifically for individuals with tetraplegia. It has been tested on a total of 59 SCI subjects in two separate studies.

Languages: N/a

Usability: N/a

Time to administer:  Less than 30 minutes when the assessor is familiar with the measure.

Time to score: N/a

Training required: None

Availability: N/a

Equipment required: None

Summary: N/a

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
Inter O: Yellow light		Construct: Green light		Red light		N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Gresham GE, Labi ML, Dittmar SS, Hicks JT, Joyce SZ, Stehlik MA. The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients. Paraplegia 1986;24:38-44
• Yavuz N, Tezyurek M, Akyuz M. A comparison of two functional tests in quadriplegia: the quadriplegia index of function and the functional independence measure. Spinal Cord 1998;36:832-837.

Quadriplegia Index of Function (QIF) – Short Form

The QIF – SF was developed to provide a sensitive global functional scale for measuring gains in individuals with tetraplegia during rehabilitation. Items include: wash/dry hair, turn supine to side in bed, lower extremity dressing, open carton/jar, transfer from bed to wheelchair and lock wheelchair. These items were selected from five of the functional performance categories of self-care and mobility on the QIF in order to reduce item redundancies of the original 37-item version. 

Number of items: 6

Procedure/Administration: Information is collected in interview format. It is scored on a 5 point scale from 0 (dependent) to 4 (independent). 

How scored: Scores from the 6 items are summed and scores range from 0 to 24.

Interpretability: Higher scores indicate greater independence in key ADLs. Ceiling effects may be plausible for individuals with lower level injuries.

Acceptability: The QIF – Short Form is designed specifically for SCI population.

Languages: N/a

Usability: N/a

Time to administer: 4-6 minutes

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary:

• The QIF – Short Form is more practical to use than the original QIF as the number of items have been reduced.

Psychometric Summary

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
IC: Green light		Criterion: Green light		N/a		N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Marino RJ, Goin JE. Development of a short-form Quadriplegia Index of Function scale. Spinal Cord 1999;37:289-296.

Self Care Assessment Tool (SCAT)

The SCAT was developed by experienced clinicians to assess cognitive and functional skills required by individuals with an SCI below C7 to perform self-care (McFarland et al. 1992). Cognitive and functional skills are measured in eight self-care areas: bathing/grooming; nutritional management; medications; mobility/transfers/safety; skin management; bladder management; and bowel management.  For each area the clinician assesses the cognitive and functional skills. The items in the SCAT consider the use of physical assistance as well as assistive devices. The scale for each item is yes/no/not applicable.

Number of items: 81 (41 cognitive and 40 functional)

Procedure/Administration: The SCAT is an interviewer administered test. A cognitive and a functional subscale score can be calculated as well as an overall score, although no details are provided on how to calculate the scores. 

How scored: N/a

Interpretability: No standardized norms are available and no results were reported so it is difficult to make any comparisons. 

Acceptability: The SCAT was developed specifically for the SCI patient population whereas many other self-care measures have been developed for a broad range of health conditions. However, the SCAT does not appear to be widely used in either the clinical setting or in research.

Languages: N/a

Usability: The tool has been used in both the rehabilitation and community setting.

Time to administer: No information available.

Time to score: No information available.

Training required: None

Availability: For a copy, contact the authors of the original article (McFarland et al; 1992).

Equipment required: N/a

Summary: N/a

Psychometric Summary:      

Reliability		Validity		Responsiveness
Results		Results		Results		Floor/ceiling
TR: Yellow light Inter O: Green light		Predictive: Green light		N/a		N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

* TR was assessed using Pearson correlation coefficients
** Validity was predictive validity (construct as no gold standard exists) and it was assessed by comparing pre-discharge score with 6 months post discharge score.

References

• McFarland SM, Sasser L, Boss BJ, Dickerson JL, Stelling JD. Self-care assessment tool for spinal cord injured persons. SCI Nursing 1992;9:111-116.

Self Reported Functional Measure (SRFM)

The 13 item Self Reported Functional Measure (SRFM) was developed to provide clinically useful information pertinent to the different levels of the disablement process.  It is suitable for people with SCI and was designed to correspond closely in wording, format, and scoring to the Functional Independence Measure (FIM). While the FIM provides seven levels of measurement of 13 motor functions (basic activities of daily living (ADL)) and measurements of cognitive and communication functions, the SRFM has four-level response categories to 13 items of basic ADL and 5 items of instrumental ADL.  (The cognitive and communications domains were excluded to difficulties with accurate self-report of these items.) 

Number of Items: 18

Procedure/Administration: The SRFM is a self report tool that may be administered either in person or by mail.

How Scored: The 4-point scale is as follows: 4 = no extra time or help, 3 = extra time or special tool, 2 = some help, and 1 = total help or never do. Total scores are derived by summing the scores from each question. 

Interpretability: Scores range from 13 to 52, with lower scores indicating greater need for assistance. No cut scores or normative values are available for this tool.

Acceptability:  The SRFM is comprehensible to persons with a fourth grade reading level. The SRFM has high test-retest reliability and excellent internal consistency. The SRFM total score was significantly correlated to the hours of daily assistance the responder required.  This scale has been adapted specifically for the SCI population from the FIM.

Languages: N/a

Usability: The SRFM is a self-report tool that can be mailed to respondents.

Time to Administer: The SRFM can be completed in less than10 minutes.

Time to Score: N/a

Training Required: No specialized administration learning is required.

Availability: A complete copy of the scale can be obtained in the paper by Hoenig et al. 1998.

Equipment Required: None

Clinical Summary: The SRFM covers personal functioning such as moving around indoors and personal hygiene. The scores of the SRFM can indicate the amount of assistance (burden of care) an individual requires. This may be useful when monitoring treatment efficacy after rehabilitation or when the individual has returned to the community. With the development of the Spinal Cord Independence Measures, the use of the SRFM among SCI populations may be limited, however, there is no evidence to suggest the SRFM performs less adequately.

Psychometric Summary:

Reliability		Validity		Responsiveness
Rigor	Results	Rigor	Results	Rigor	Results	Floor/ceiling
++	IC +++ TR +++	++	Convergent ++ Construct ++

Note: +++ = Excellent; ++ = Adequate; + = Poor; IC=internal consistency; TR=test-retest

Skin Management Needs Assessment Checklist (SMNAC)

The SMNA (Berry et al. 2004), extracted from the Needs Assessment Checklist (Kenny & Hamilton 1999), was developed as a post discharge measure to assess client knowledge and ability to perform skin checks, pressure relief and prevention of skin breakdown.  It is based on the individual’s perception of his/her ability to independently perform skin management activities.

Number of items: 14 indicators.

Procedure/Administration: The self-report measure requires individuals to demonstrate or, for an individual with a high lesion, instruct their personal care attendant to perform the activities. Each item on the SMNAC receives a score ranging from 0-3 (0-complete dependence; 1-mostly dependent; 2-moderately dependent; 3-complete independence) or N/A (not applicable, representing no rehabilitation need or goal to be identified).

How scored: The items are summed to generate a total score out of 36. The value reported is a proportion (client score/36).

Interpretability: Higher scores reflect greater independence. No risk specific scores or normative data is available at this time.

Acceptability: N/a

Languages: N/a

Usability: There is minimal patient burden; however, some embarrassment may be evident.

Time to administer: 20 minutes to administer and score

Time to score: None

Training required: None, however, experience with wound care may enhance tool use

Availability:  A copy can be obtained from the author.

Equipment required: None

Summary: The SMNAC provides SCI specific information related to skin management needs. Its score may be used to identify the problems for individuals living in the community to establish priorities and goal setting or to inform community health care professionals about a clients’ ability to manage skin management activities.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC: Green light	SS: Red light	Red light	N/A

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Berry C, Kennedy P, Hindson L. Internal consistency and responsiveness of the skin management needs assessment checklist post spinal cord injury. J Spinal Cord Med 2004;27:63-71.
• Keith RA, Lipsey MW. The role of theory in rehabilitation assessment, treatment and outcomes. In: Glueckauf RL, Sechrest LB, Bond GR, McDonel EC. (ed). Improving Assessment in Rehabilitation and Health. Sage Publications, Newbury Park, CA, 1993, p 33-60.
• Kennedy P, Hamilton LR. The needs assessment checklist: a clinical approach to measuring outcome.  Spinal Cord 1999;37:136-139.

Spinal Cord Injury Lifestyle Scale (SCILS)

The SCILS is a self-report measure of the frequency of health-related behaviour performance in individuals with SCI. The tool was designed to enable examination of the effectiveness of clinical and educational efforts for health maintenance and prevention of secondary impairments (Pruitt et al. 1998). The items were developed from a review of the literature on secondary impairments related to SCI.  In addition, expert clinicians (physician assistants, nurses and physiotherapists) generated items describing health related behaviours. Each item describes different health behaviours. The 5 subscales include: cardiovascular, genitourinary, neuromuscular, skin, and psychosocial.  Its purpose is to evaluate the effectiveness of clinical and educational efforts for health maintenance and the prevention of secondary impairments following SCI.

Number of items: 25

Procedure/Administration:  Data can be collected by pen and paper or through interview if the individual is unable to write. The frequency with which each behaviour has been performed over the past 3 months is rated using an ordinal scale where 4-‘almost always’, 3-‘frequently’, 2-‘sometimes’, 1-‘rarely’ and 0-‘never’. One item (genitourinary) is reverse scored.

How scored: A score is generated for each scale by totaling scores of each item using a 0-4 point scale. A total score is calculated by summing the 5 scale scores. Sub-scale scores may be used to identify/address specific areas of concern.

Interpretability: Higher total scores are intended to indicate better performance of behaviours which in turn promote health in individuals with SCI. The scores could be used for each sub-scale or as a tool for general overall health. There are no norms or reported cut scores.

Acceptability: Individuals with SCI participated in item elimination during tool development therefore the included items should resonate with the population.

Languages: English

Usability: N/a

Time to administer: 10-15 minutes

Time to score: 10-15 minutes

Training required: N/a

Availability: A copy is available from the authors.

Equipment required: N/a

Summary:

• Although the authors identified a comprehensive list of secondary impairments, only some of these impairments have been included in the tool. For example, some of the missed items include autonomic dysreflexia, deep vein thrombosis, pressure relief in bed, and adjustment to disability.

Psychometric Summary:

Reliability	Validity	Responsiveness
Results	Results	Results	Floor/ceiling
IC: Yellow light	Construct/Concurrent: Red light	N/a	N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Pruitt SD, Wahlgren DR, Epping-Jordan JE, Rossi AL. Health behavior in persons with spinal cord injury: development and initial validation of an outcome measure. Spinal Cord 1998;36:724-731

The Spinal Cord Independence Measure (SCIM)

The SCIM, now in its third iteration, is a new disability scale developed to specifically address the ability of SCI patients to accomplish ADLs (Catz et al. 1997). The SCIM assesses three areas:1) self-care (feeding, grooming, bathing, and dressing); 2) respiration and sphincter management and 3) mobility (bed and transfers and indoor/outdoor).

Number of items: 19

Procedure/Administration: Clinical staff scores the items based on the activities the patient is performing during the regular daily activities or as the patient reports in an interview.

How scored: Item scores are weighted related to the assumed clinical relevance. Scores are derived by adding up the items producing a total score (0 to 100) and/or subscale scores (self care: 0-20; respiration and sphincter management: 0-40; mobility 0-40).

Interpretability: Higher scores reflect higher levels of independence.

Acceptability: This is an SCI specific measure of basic functional independence.

Languages: English

Usability: Minimal staff/patient burden is required as the variables collected are important to patient care and reflect basic areas of patient concern.

Time to administer: 30-45 minutes to conduct and score.

Time to score: 30-45 minutes to conduct and score.

Training required: N/a

Availability: A copy of the SCIM III can be obtained from the article by Catz et al. (2007).

Equipment required: None

Summary:

• The SCIM is quickly becoming one of the best research tools within the SCI population and has high clinical relevance for the rehabilitation for individuals with either traumatic/non-traumatic and complete/incomplete SCI.
• Ceiling and floor effects (especially floor) may be an issue for individuals at either who have very high or low level lesions. 

Psychometric Summary:

SCIM
Results		Results		Results		Floor/ceiling
IC/Inter O: Green light		Construct: Yellow light Criterion: Green light		Red light		N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997;35:850-856.
• Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord 2001a;39:97-100.
• Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A. The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure. Disabil Rehabil 2001b;23:263-268.
• Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A. Disability assessment by a single rater or a team: a comparative study with the Catz-Itzkovich spinal cord independence measure. J Rehabil Med 2002;34:226-230.
• Catz A, Goldin D, Fishel B, Ronen J, Bluvshtein V, Gelernter I. Recovery of neurologic function following nontraumatic spinal cord lesions in Israel. Spine 2004;29:2278-2282.
• Catz A, Greenberg E, Itzkovich M, Bluvshtein V, Ronen J, Gelernter I. A new instrument for outcome assessment in rehabilitation medicine: Spinal cord injury ability realization measurement index. Arch Phys Med Rehabil 2004;85:399-404.
• Catz A, Itzkovich M, Tesio L, Biering-Sørensen F, Weeks C, Laramee M, Craven BC, Tonack M, Hitzig SL, Glazer E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergstrom EM, Bluvshtein V, Ronen J. A multi-center International Study on the Spinal Cord Independence Measure, Version III: Rasch psychometric validation. Spinal Cord Resubmission requested 2006.
• Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergstrom EM, Bluvshtein V, Ronen J. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2007; 45: 275-291.
• Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, Chadwick R, et al. Spinal Cord Independence Measure, Version III: Applicability to the UK spinal cord injured population. J Rehabil Med 2009; 41: 723-728.
• Grijalva I, Guizar-Sahagun G, Castaneda-Hernandez G, Mino D, Maldonado-Julian H, Vidal-Cantu G, Ibarra A, Serra O, Salgado-Ceballos H, Arenas-Hernandez R. Efficacy and safety of 4-aminopyridine in patients with long-term spinal cord injury: a randomized, double-blind, placebo-controlled trial. Pharmacotherapy 2003;23:823-834.
• Itzkovich M, Tripolski M, Zeilig G, Ring H, Rosentul N, Ronen J, Spasser R, Gepstein R, Catz A. Rasch analysis of the Catz-Itzkovich spinal cord independence measure. Spinal Cord 2002;40:396-407.
• Itzkovich M, Tamir A, Philo O, Steinberg F, Ronen J, Spasser R, Gepstein R, Ring H, Catz A. Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation. Am J Phys Med Rehabil 2003;82:267-272.
• Itzkovich M, Catz A, Biering-Sørensen F. SCIM III Reliability And Validity: A Multi-Center International Study. ISCoS Meeting Oct 2005 Munich, Germany Abs 34/8 http://www.iscos.org.uk/index.html Accessed May 2, 2006
• Jackson AB, Dijkers M, DeVivo MJ, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil 2004;85:1740-1748.
• McKinley WO, Seel RT, Gadi RK, Tewksbury MA. Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison. Am J Phys Med Rehabil 2001;80:693-699.
• Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005;43:27-33.
• Popovic MR, Thrasher TA, Adams ME, Takes V, Zivanovic V, Tonack MI. Functional electrical therapy: retraining grasping in spinal cord injury. Spinal Cord 2006;44:143-151.
• Ronen J, Itzkovich M, Bluvshtein V, Thaleisnik M, Goldin D, Gelernter I, David R, Gepstein R, Catz A. Length of stay in hospital following spinal cord lesions in Israel. Spinal Cord 2004;42:353-358.
• Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M. Effects on age on spinal cord lesion patients' rehabilitation. Spinal Cord 2003;41:457-464.
• van Hedel HJA, Dietz V, and the EM-SCI Study Group. Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 2009; 23: 117-124.
• van Hedel HJA for the EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neural Repair 2009; 23(4): 343-350.