The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.

Background: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. Objective: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. Design: Multicenter cohort study. Setting: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. Subjects: 425 patients with spinal cord lesions (SCL). Interventions: SCIM III assessments by professional staff members. Rasch analysis of admission scores. Main outcome measures: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. Results: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. Conclusions: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.Spinal Cord (2007) 45, 275-291.

The findings provide some clarification on factors associated with the occurrence of SHCs after SCI and are useful for informing health-promotion planners, clinicians, and stakeholders regarding the odds of SHCs with aging or among specific impairment groups.

Objective: To determine the clinical efficacy of functional electrical therapy in the rehabilitation of grasping function for quadriplegics. Study design: Randomized intervention-versus-control trial. Setting: Rehabilitation hospital for spinal cord injury in Toronto, Canada. Methods: A total of 21 people with new spinal cord injuries ranging from C3 to C7 were randomly assigned to two groups: Control (N ¼ 9) and Intervention (N ¼ 12). The intervention was functional electrical therapy, which consisted of repetitive grasping exercises using a neuroprosthesis that applied surface electrical stimulation to the arm to generate and/or assist grasping movements. It was applied by registered Occupational Therapists in a clinical setting. Main outcome measures were: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), and the Rehabilitation Engineering Laboratory Hand Function Test. Consumer perceptions of functional electrical therapy were assessed via qualitative interviews. Results: Differences between the Control and Intervention groups could be observed although they are not significant due to an insufficient number of participants. Consumer perceptions were positive, including improved Activities of Daily Living and self-satisfaction. Conclusion: Functional electrical therapy has the potential to be an effective treatment modality to restore grasping function in quadriplegia. It can be implemented by occupational therapists in a clinical setting. Further research is required to establish suitable indications for participant selection. In addition, a larger number of participants is needed to demonstrate statistical significance of the Functional Electrical Therapy.

The majority of participants considered home mechanical ventilation to be a positive benefit for independent living, enhancing their overall health. They were clear as to the issues of importance to them, and formulated recommendations for health care providers and policy makers that could improve the quality of their daily lives. Many of the issues identified in the present report are faced by the growing community of ventilator users.

This paper presents the results of a 2-year mixed methodology (quantitative and qualitative) study examining the reintegration and quality of life of community-residing adults with spinal cord injury (SCI). A convenience sample of 100 individuals with SCI completed three questionnaires for the quantitative study phase. A self-selected subsample of 34 of the participants then attended qualitative focus groups to further explore adjustment to living in the community after SCI. The results revealed that locus of control is crucial to subjective quality of life, productivity status, satisfaction with performance of daily activities and satisfaction with community integration. Respondents confirmed that substantial adjustments are required after SCI, and that these can be aided through education, involvement in productive activity and participation in social and leisure activities. A dominant finding was that social support and peer mentoring were invaluable. Stable health and appropriate pain management were crucial to subjective satisfaction with community integration, yet for many of the respondents these were elusive. Although the participants valued the rehabilitation process, they felt that "the system" was not client-centred and that the timing of services and information was not always relevant to individual needs. The clinical and practical implications of these results are discussed.

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