脊髓独立性评定及其第3版介绍

功能能力评定是脊髓损伤患者功能结局评定的主要项目之一。目前常用评定脊髓损伤患者功能能力的量表有Bar-thel指数、修订Barthel指数、功能独立性评定、脊髓独立性评定、脊髓损伤步行指数等。其中,脊髓独立性评定是为评价脊髓损伤患者的功能能力而专门设计的量表,已经过两次修订和国际多中心试验验证,具有良好的信度、效度和灵敏性,可适用于不同文化背景下的脊髓损伤患者的功能能力评定。但该评定方法也存在一定的局限性,需要进一步完善。     

Locomotor training within an inpatient rehabilitation program after pediatric incomplete spinal cord injury

BACKGROUND AND PURPOSE: The outcomes of intense locomotor training after incomplete spinal cord injury (SCI) have been described in adults with acute and chronic injuries and with various levels of ambulatory function. This case report describes a comprehensive inpatient rehabilitation program with a locomotor training component in a child with a severe incomplete SCI. CASE DESCRIPTION: A 5-year-old girl injured at C4 participated in locomotor training for 5 months during inpatient rehabilitation. OUTCOMES: The patient's Functional Independence Measure for Children II (WeeFIM II) mobility score increased from 5/35 to 21/35. Her Walking Index for Spinal Cord Injury II (WISCI II) score improved from 0 to 12. The patient returned to walking in the community with assistive devices. DISCUSSION: It is feasible to include an intense locomotor training program in the clinical rehabilitation setting for a child with a severe SCI, and the outcomes were consistent with results in adults. Further investigation with experimental designs and more participants will determine the extent to which this intervention benefits the pediatric population with SCI.     

四肢瘫患者的功能评定

对四肢瘫患者进行全面、精确的功能评定有利于发现患者的功能障碍点,以便进行有针对性的康复训练,提高康复治疗效果。Barthel指数、功能独立性测定、四肢瘫功能指数、简易四肢瘫功能指数量表及脊髓独立性测量等量表均曾用于评价四肢瘫患者,笔者对上述量表在评价四肢瘫患者功能方面的各自特点及相互比较进行综述。     

The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels

OBJECTIVES: To assess (1) the frequency and magnitude of differences between self-selected and maximal walking capacity following spinal cord injury (SCI) by using the Walking Index for Spinal Cord Injury (WISCI) and (2) how these levels differ in efficiency and velocity. DESIGN: Prospective cohort. SETTING: Academic medical center. PARTICIPANTS: Fifty people with chronic incomplete SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects ambulated at the level used in the community (self-selected WISCI) and the highest level possible (maximal WISCI). Velocity (in m/s), Physiological Cost Index (PCI), and Total Heart Beat Index (THBI) were calculated. Differences were compared using the paired t test (parametric) or Wilcoxon signed-rank test (nonparametric). RESULTS: For 36 subjects, maximal WISCI was higher than self-selected WISCI; 21 subjects showed an increase of 3 levels or more. Ambulatory velocity was higher for self-selected WISCI compared with maximal WISCI (.68 m/s vs .56 m/s, P<.001). PCI and THBI at self-selected WISCI were lower than at maximal WISCI (PCI, 0.99 beats/m vs 1.48 beats/m, P<.001; THBI, 3.39 beats/m vs 4.75 beats/m, P<.001). CONCLUSIONS: Many people with chronic SCI are capable of ambulating at multiple levels. For these people, ambulation at self-selected WISCI was more efficient as evidenced by greater velocity and decreased PCI and THBI. The findings have implications for assessing walking capacity within the context of clinical trials.     

Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests

OBJECTIVE: To assess the validity and reliability of 3 timed walking tests (Timed Up & Go [TUG], 10-meter walk test [10MWT], 6-minute walk test) in subjects with spinal cord injury (SCI). DESIGN: Cross-sectional study and repeated assessments. SETTING: The SCI center of a university hospital in Switzerland. PARTICIPANTS: Validity was assessed by using the data of 75 patients with SCI, and reliability was determined with 22 patients with SCI. INTERVENTION: Patients performed the timed tests and the Walking Index for Spinal Cord Injury II (WISCI II) on the same day. Three measurements within 7 days were taken to assess reliability. MAIN OUTCOME MEASURES: The measures were scatterplots, correlation coefficients ( r ), and the Bland-Altman plot. Validity was determined in patients with different walking abilities. RESULTS: Overall, correlation of the 3 timed walking tests was excellent with each other (| r |>.88) and moderate with the WISCI II (| r |>.60). The correlation between the timed tests for patients with poor walking ability remained high (| r |>.70) but decreased in WISCI II (| r |<.35). High correlation coefficients ( r >.97) were found for intra- and interrater reliability. However, TUG and 10MWT reliability were negatively influenced by a poor walking function. CONCLUSIONS: The 3 timed tests are valid and reliable measures for assessing walking function in patients with SCI.     

Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient

The Spinal Cord Independence Measure (SCIM) is, at present, the only comprehensive rating scale that measures the ability of patients with spinal cord lesions (SCL) to perform everyday tasks according to their value for the patient. This article describes the scale and its scoring techniques, presents the purposes for which SCIM is used, and details its advantages for patients with SCL. Findings of an international multicenter study supported the validity and reliability of its third version, despite intercultural differences, and demonstrated its superior sensitivity to changes in function compared with the Functional Independence Measure. SCIM can be used in patients with SCL for ability assessment, as a compact guide for determining certain treatment goals, and for outcome assessment following interventions designed to promote recovery.     

A new instrument for outcome assessment in rehabilitation medicine: Spinal cord injury ability realization measurement index

OBJECTIVES: To introduce a new measure of disability weighted for the neurologic deficit in patients with spinal cord lesions and to examine the effect on the instrument of being in rehabilitation. DESIGN: Development of instrument and preliminary comparative before-after study. SETTING: Spinal department in a rehabilitation hospital in Israel. PARTICIPANTS: Seventy-nine patients with spinal cord lesions. INTERVENTIONS: Patients were repeatedly assessed during rehabilitation with the American Spinal Injury Association Impairment Scale (AIS) to measure neurologic motor impairment and with the Spinal Cord Independence Measure (SCIM-II) to measure disability. Scores of the 2 assessments were combined to create the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI). MAIN OUTCOME MEASURES: A preliminary formula for the calculation of SCI-ARMI using the individual patients' SCIM-II and AIS motor scores and changes in SCI-ARMI values through rehabilitation. RESULTS: The highest observed SCIM-II scores at patients' AIS level correlated highly with the AIS motor scores (r=.96, P<.01). A regression performed for this linear relationship resulted in a preliminary SCI-ARMI formula. The calculated SCI-ARMI values improved during rehabilitation irrespective of patient age, gender, lesion level, or lesion severity (P<.001). CONCLUSIONS: The preliminary version of the SCI-ARMI can be used to assess quantitatively changes in functional ability, isolating them from the effect of neurologic changes.     

Use of electrical stimulation and exercise to increase muscle strength in a patient after surgery for cervical spondylotic myelopathy

ABSTRACT

Current literature offers little research on the restoration of function in patients following anterior decompression surgery for cervical spondylotic myelopathy. This case report describes the functional outcomes for a physical therapy program using a protocol of alternate day electrical stimulation to hip and knee extensor muscles along with exercise. The protocol, designed to increase lower extremity strength necessary for ambulation in a patient who was status post anterior cervical decompression and fusion surgery, consisted of treatment sessions five times per week for 6 weeks and included electrical stimulation [medium frequency alternating current (MFAC)] in conjunction with active range of motion exercises, followed by functional mobility training and gait training. Outcome measures included Manual Muscle testing, the Functional Independence Measure (FIM), and the Walking Index for Spinal Cord Injuries (WISCI). Improvement was demonstrated in all three measures following the use of the treatment regimen, suggesting there may be a benefit to the use of electrical stimulation and exercise to increase lower extremity strength and improve gait outcomes in this population. Definitive conclusions regarding the correlation between this treatment protocol and the outcomes achieved are limited by the case report design. Carefully designed research studies are needed to demonstrate the effectiveness of the protocol.     

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.Key words: Locomotor training, Spinal cord injury, Paraplegia     

Activity-Based Therapy for Recovery of Walking in Individuals With Chronic Spinal Cord Injury: Results From a Randomized Clinical Trial

ObjectiveTo examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation.DesignRandomized controlled trial with delayed treatment design.SettingOutpatient program in a private, nonprofit rehabilitation hospital.ParticipantsVolunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI).InterventionsA total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.Main Outcome MeasuresNeurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check).ResultsSignificant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs −0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002).ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.     

Reliability Validity and Responsiveness of the Spinal Cord Independence Measure 4th Version in a Multicultural Setup

ObjectiveTo examine the fourth version of the Spinal Cord Independence Measure for reliability and validity.DesignPartly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations.SettingA multicultural cohort from 19 spinal cord injury units in 11 countries.ParticipantsA total of 648 patients with spinal cord injury.InterventionAssessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge.Main outcome measuresSCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness.ResultsTotal agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons.ConclusionsThe validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.     

Muscle force and gait performance: relationships after spinal cord injury

OBJECTIVES: To relate locomotor function improvement, within the first 6 months after spinal cord injury (SCI), to an increase in Lower Extremity Motor Score (LEMS) and to assess the extent to which the level of lesion influenced the outcome of ambulatory capacity. DESIGN: Longitudinal and cross-sectional analyses. SETTING: Seven SCI rehabilitation centers. PARTICIPANTS: Patients (N=178) were analyzed longitudinally (group A, motor complete; group B, motor incomplete; nonwalking or group C, motor incomplete and able to stand). The cross-sectional analysis included 86 patients (paraplegic, n=46; tetraplegic, n=40; group 1 with limited and group 2 with unrestricted walking function 6 mo after SCI). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Walking Index for Spinal Cord Injury (WISCI), gait speed, and LEMS. RESULTS: For group A, 24.8% of the patients improved in LEMS (median range, 0-10) and 7.7% in walking function (WISCI median range, 0-8; mean gait speed range, 0 to .14+/-.10 m/s). For group B, LEMS improved in 93.5% of the patients (median range, 14-28) and walking function in 84.8% of the patients (WISCI median range, 0-10; mean gait speed range, 0 to .41+/-.45 m/s) (P<.001). For group C, LEMS and walking function improved in 100% of the patients (LEMS median range, 29-41; WISCI median range, 8-16; mean gait speed range, .36+/-.29 m/s to .88+/-.44 m/s) (P=.001). In groups B and C, the improvement of walking function was greater than in LEMS. The cross-sectional analysis showed that group 1 patients with tetraplegia had more muscle strength (median LEMS, 31.5), and equal walking function (WISCI, 8; walking speed, 0.4+/-0.3 m/s) compared with patients with paraplegia (LEMS, 23; P<.01; WISCI, 12; P=0.6; speed, 0.4+/-0.3 m/s; P=.68). In group 2, patients with tetraplegia had slightly more strength (LEMS, 48) and equal walking function (WISCI, 20; walking speed, 1.4+/-0.3 m/s) compared with patients with paraplegia (LEMS, 45; P<.05; WISCI, 20; P=1.0; speed, 1.4+/-0.3 m/s; P=.89). CONCLUSIONS: An improvement in locomotor function does not always reflect an increase in LEMS, and LEMS improvement is not necessarily associated with improved locomotor function. LEMS and ambulatory capacity are differently associated in patients with tetra- and paraplegia. Functional tests seem to complement clinical assessment.     

Turkish adaptation of Spinal Cord Independence Measure--version III

Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the Turkish adaptation of the SCIM III (T-SCIM III). The SCIM III was translated into Turkish. Reliability, (internal consistency, interrater reliability, and test-retest reliability), validity (with Functional Independence Measurement), and sensitivity (changes in 8-week exercise program) were studied. Internal consistency for total score was sufficient (Cronbach α=0.79). The interrater reliability was moderate to high (Cohen κ between 0.72 and 1). Convergent validity was high (r=0.89, P<0.01). The T-SCIM III was found to be more sensitive than the Functional Independence Measurement to changes in function. Hence, we recommend the use of T-SCIM III in clinical practice as a reliable, valid, and easy-to-use tool.     

踝足矫形器对下腰段脊髓损伤患者日常生活活动及步行能力的影响

目的观察踝足矫形器(AFO)对下腰段脊髓损伤患者日常生活活动能力(ADL)及步行能力的影响。方法29例L3节段以下(含L3)脊髓损伤患者,经系统康复训练后,再根据患者功能情况分别装配静态或动态AFO,训练前后用改良Barthel指数(MBI)和功能独立性评测(FIM)对患者进行评定,并测定行走距离。结果配戴矫形器后,患者的ADL明显提高,尤其是行走能力,较配戴前提高(P<0.05);29例患者有26例可达社区功能性步行,3例达家庭功能性步行。结论根据功能情况选用不同的AFO,可帮助下腰段脊髓损伤患者重建步行功能,提高生活自理能力。     

下肢矫形器对脊髓损伤患者ADL和行走能力的影响分析

目的观察装配下肢矫形器对脊髓损伤患者的日常生活活动能力(ADL)及行走能力的影响程度。方法19例脊髓损伤后截瘫患者,应用下肢矫形器进行站立和行走训练,训练前后用改良Barthel指数MBI和功能独立性评测FIM评分,并测定行走距离,再进行比较分析。结果装配矫形器后ADL能力明显提高,尤其是移动和行走能力,装配前后比较有显著差异(P<0.01,P<0.05);19例患者中8例达到社区功能性步行,6例达到家庭功能性步行,5例达到治疗性步行。结论在脊髓损伤患者的康复治疗中,装配下肢矫形器可以提高其生活自理能力和行走能力。     

Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study

Abstract

Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Independence Measure (SCIM) version III for Spain and to validate the Spanish version of the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, back-translation and assessment of cultural equivalence procedures. eSCIM version III, was administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal consistency (Cronbach’s α), (3) validation and confirmation of the correlation between eSCIM III and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The reliability of eSCIM III showed an intra-class coefficient value >0.97 in the different subscales assessed. Internal consistency of eSCIM III was shown by a Cronbach’s α value of 0.93. The validity of eSCIM III was confirmed by the close correlation with FIM (r?=?0.94, p?<?0.0001). The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be culturally equivalent to the original version, as reliability and validity of this tool were demonstrated. It can be used in Spain for functional assessment of patients with spinal cord injury.

• Implications for Rehabilitation

• Development of the Spanish version of the Spinal Cord Independence Measure version III.

• The importance of the adaptation of Spinal Cord Independence Measure (SCIM) is that it guarantees the possibility of measuring the same concept in different cultures and countries.

• The eSCIM III is the first, specific assessment tool in patients with spinal cord injury adapted for its use in Spain.

• The eSCIM III is a tool conceptually equivalent to the original version. It has the reliability and validity of SCIM III in order to be used by clinicians.

     

下肢步行机器人对脊髓损伤后日常生活能力及步行能力的影响

目的:探讨下肢步行机器人对脊髓损伤后日常生活能力及步行能力的影响。方法:颈胸段脊髓损伤患者40例随机分为2组各20例。对照组进行常规的运动治疗,内容包括肌力训练、牵伸训练、平衡训练、转移、站立训练、步行及步态训练等;观察组增加步行机器人训练。于治疗前和治疗6周、12周后,采用6min步行距离、改良Barthel指数(MBI)和功能独立性评测(FIM)对患者进行评定,并重点关注其中的步行项及上下楼梯项。结果:治疗6及12周后,2组患者MBI、FIM总分及2个量表中的步行项、上下楼梯项分值,6min步行距离测试分值均较治疗前呈逐渐提高(均P0.05),且观察组优于对照组(均P0.05)。结论:常规运动治疗结合步行机器人训练可明显改善C-D级脊髓损伤患者步行能力及ADL分值。     

Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling

ObjectiveThe objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI).DesignSurvey, cross-sectional study, and model testing using structural equation modeling.SettingTwo inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel.ParticipantsConvenience sample of 156 individuals with SCI (N=156).InterventionsNot applicable.Main Outcome MeasuresQoL assessed by the World Health Organization Quality of Life Assessment-BREF.Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury.The Spinal Cord Independence Measure to assess SCI-related task performance.ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model.ResultsLevel of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL.ConclusionsIn order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients.     

The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure

Purpose : To examine the suitability of the revised Spinal Cord Independence Measure, the Catz-Itzkovich SCIM, for evaluation of patients with spinal cord lesions, as compared to the original SCIM and to the Functional Independence Measure (FIM). Method : The revised SCIM was applied by paired independent teams of occupational therapists, physiotherapists and nurses and the FIM by a single nurse. The examiners assigned scores to the functional capabilities of 28 patients with spinal cord lesions. The scores by the revised SCIM were analysed for reproducibility as between the two teams of examiners (interrater reliability) and for their correlation with the FIM scores. Results : The frequency of identical scoring by two independent examiners (total agreement) was 80% or higher for 13/18 individual functions listed in the revised SCIM. In the self-care category it was 80-99%, as compared to 75-87% before revision. In neither bowel management nor bed mobility was there an increase over the original SCIM in the frequency of identical scores, despite rephrasing and restructuring of the scoring criteria. A high correlation was noted between the paired scores for all functions listed as well as for those comprising each of the four functional categories ( r = 0.90-0.96, p < 0.001). The total revised-SCIM scores were significantly correlated with those derived by the FIM ( r = 0.835, p < 0.001). Conclusions : The findings indicate that the newly revised SCIM (Catz-Itzkovich) is a valid and highly reproducible measure of daily function in patients with spinal cord lesions, and is superior to the original SCIM. We recommend that it supersede the original SCIM.     

The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure

PURPOSE: To examine the suitability of the revised Spinal Cord Independence Measure, the Catz-ltzkovich SCIM, for evaluation of patients with spinal cord lesions, as compared to the original SCIM and to the Functional Independence Measure (FIM). METHOD: The revised SCIM was applied by paired independent teams of occupational therapists, physiotherapists and nurses and the FIM by a single nurse. The examiners assigned scores to the functional capabilities of 28 patients with spinal cord lesions. The scores by the revised SCIM were analysed for reproducibility as between the two teams of examiners (interrater reliability) and for their correlation with the FIM scores. RESULTS: The frequency of identical scoring by two independent examiners (total agreement) was 80% or higher for 13/18 individual functions listed in the revised SCIM. In the self-care category it was 80-99%, as compared to 75-87% before revision. In neither bowel management nor bed mobility was there an increase over the original SCIM in the frequency of identical scores, despite rephrasing and restructuring of the scoring criteria. A high correlation was noted between the paired scores for all functions listed as well as for those comprising each of the four functional categories (r = 0.90-0.96, p <0.001). The total revised-SCIM scores were significantly correlated with those derived by the FIM (r = 0.835, p < 0.001). CONCLUSIONS: The findings indicate that the newly revised SCIM (Catz-Itzkovich) is a valid and highly reproducible measure of daily function in patients with spinal cord lesions, and is superior to the original SCIM. We recommend that it supersede the original SCIM.