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Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop. Method: Evaluation of currently available SCI functional outcome measures by a multinational work group. Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM is the only functional recovery outcome measure designed specifically for SCI. Conclusions: The multinational work group recommends that the latest version of the SCIM (SCIM III) continue to be refined and validated and subsequently implemented worldwide as the primary functional recovery outcome measure for SCI. The QIF may continue to be developed and validated for use as a supplemental tool for the nonambulatory tetraplegic population.

Study design: Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broadbased international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. Objectives: Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies. Methods: a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. Results: Imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain and psychosocial tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. Conclusion: Significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial.

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Study design: Intra-rater reliability study, cross-sectional design. Objectives: To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children. Setting: Nonprofit pediatric hospital. Methods: In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury.

Objective: To evaluate the accuracy and agreement of International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) classification and to determine the effectiveness of formal training for pediatric clinicians. Study Population: Participants (N ¼ 28) in a formal 90-minute classification training session. Outcome Measure: Pre/post-training examination of 10 case examples of a variety of neurological classifications. Results: Regardless of years of experience with the ISCSCI, a statistically significant improvement (P , 0.05) in classification was achieved after formal training. Before training, 27% (539 of 1,960) of the questions were answered incorrectly. After training, the percentage of incorrect classifications decreased to 11% (198 of 1,960) incorrect (P , 0.05). After training, the percentage of incorrect motor level classifications decreased by 23% (42% to 19% incorrect; P , 0.05). Post-training improvements were also demonstrated (P , 0.05) in classifying sensory levels (9% to 3% incorrect), neurological levels (31% to 6% incorrect), and severity of injury (9% to 0% incorrect). After training, reductions in classification errors (P , 0.05) were demonstrated in American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (from 20% to 7%), B (50% to 11%), C (71% to 46%), and D (63% to 16%). Conclusions: This study demonstrated the benefits of formal, standardized training for accurate classification of the ISCSCI. Effective training programs must emphasize the guidelines and decision algorithms used to determine motor level and ASIA AIS designations because these remained problematic after training and are often a concern of patients/parents and are primary endpoints in clinical trials for neurological recovery.