Study Design: Cross-sectional validation study. Objectives: To validate the Italian version of the Spinal Cord Independence Measure Self-Report (SCIM SR). Setting: Two spinal cord injury (SCI) rehabilitation facilities in Italy. Methods: The SCIM III comprises items on 19 daily tasks, grouped into three subscales: 'Self-care,' 'Respiration and sphincter management' and 'Mobility'. The total SCIM score ranges between 0 and 100. The Italian self-reported version (SCIM SR) was translated from the German tool. We studied 116 patients on their first hospitalization for rehabilitation after an SCI. At the time of discharge, patients were evaluated by the rehabilitation team using the SCIM III and self-assessed their independence with regard to activities of daily living using the SCIM SR. Pearson's correlation, Bland-Altman method, and stratified and regression analyses were used to examine the differences between evaluations. Results: On the basis of Pearson's correlation, there was good agreement between the data from the SCIM III and SCIM SR (r = 0.918 for 'Self-care,' 0.806 for 'Respiration and sphincter management,' 0.906 for 'Mobility' and 0.934 for total scores). By Bland-Altman analysis, patients rated their functioning nearly the same as professionals-the mean difference between SCIM III and SCIM SR scores was approximately 0 for all subscales and total scores. The stratified and regression analyses failed to identify any specific factor that was associated with differences between SCIM III and SCIM SR scores. INTRODUCTIONThe Spinal Cord Independence Measure version III (SCIM III) is a scale that rates the independence of patients with spinal cord injuries (SCIs) 1 with regard to performing activities of daily living. This tool was developed specifically for SCI patients and has become a widely used instrument to measure functioning in activities of daily living. The chief advantage of this instrument, which was first published in 1997, 2 is its sensitivity to changes in the performance on tasks that are relevant to patients with SCIs. The validity and reliability of the third version of the SCIM have been tested in multicenter studies, which have demonstrated it to have satisfactory psychometric properties. [3][4][5] SCIM III comprises items on 19 daily tasks that are grouped into three subscales that assess 'Self-care' (6 items, range 0-20), 'Respiration and sphincter management' (4 items, range 0-40) and 'Mobility' (9 items, range 0-40). The total SCIM III score ranges from 0 to 100, and higher scores reflect better performance or greater independence of a person. 3 Item scores are graded for increasing difficulty and weighted by clinical relevance. Each item has between 2 and 9 grades. SCIM III is ranked by a multidisciplinary team, primarily in inpatient settings; this procedure is time-consuming.
Objective Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. Methods We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10 months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. Results Thirteen PIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p = .005 and p = .008, respectively). SCIM self‐care sub‐score also statistically significant improved from 3 to 4 at 12 months (p = .016). No complication or donor morbidity occurred. Conclusions Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.
As the general population ages, the rising prevalence of vascular lesions of the spinal cord will become significant. The aim of this study was to compare the neurological and functional outcomes of patients with ischemic spinal cord injury (ISCI) and traumatic spinal cord injury (TSCI). We conducted a retrospective study in a spinal cord unit of 2 rehabilitation hospitals. We studied 168 patients with a TSCI and 72 with an ISCI. At admission and discharge, patients were evaluated by American Spinal Injury Association Impairment Scale (AIS) standards and Spinal Cord Independence Measure (SCIM). Length of stay, occurrence of complications, and discharge dispositions were also recorded. Linear and logistic regression models were used to analyze the effects of the etiology of the lesion, AIS level at admission, and level of the lesion. Patients with an ISCI were older and experienced fewer cervical lesions and fewer complete lesions than patients with TSCI. By linear and logistic regression, etiology was a predictor (together with lesion features) of functional (SCIM improvement and SCIM at discharge) outcome, with traumatic patients having better outcome than ischemic ones. Age, AIS level, and lesion level were the chief predictors of length of stay, occurrence of complications, and discharge dispositions. A diagnosis of ischemia and trauma could be a determinant of functional recovery in SCI patients.
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