Spinal cord injury care system: fifteen-year experience at the Rehabilitation Institute of Chicago

Yarkony, Gary M.; Roth, Elliot J.; Meyer, Paul R.; Lovell, Linda; Heinemann, Allen W.; Betts, Henry B.

doi:10.1038/sc.1990.42

Cited by 15 publications

(9 citation statements)

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“…The FIM scale 24 (which does not integrate use of devices or braces) was originally developed as a measurement tool assessing burden of care for all types of disability. The locomotion item describes walking and wheelchair locomotion along seven levels of function from total assistance to independence with emphasis on amount of physical assistance needed (for further in-depth discussion see Ditunno et al 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Neurological recovery was defined on the basis of improvement of motor scores (total and LEMS) and AIS. The global FIM 24 is an 18-item scale with seven possible functional levels. Only the locomotor (walking/wheelchair) item, which is scored from 1 to 7, was assigned.…”

Section: Methodsmentioning

confidence: 99%

“…The Modified Barthel Index (MBI) for SCI has been reported by Yarkony et al 24 in a large group of subjects from one center, but the MBI has not been utilized in multicenter studies. The Spinal Cord Independent Measure (SCIM) initially reported in 1997 25 is currently being studied in international studies and is a global scale, with better precision than the FIM and a more detailed description of walking than the RMI, BI and FIM.…”

Section: Introductionmentioning

confidence: 99%

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Walking index for spinal cord injury (WISCI): criterion validation

et al. 2004

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Study design: Retrospective examination. Objectives: To compare the Walking Index for Spinal Cord Injury (WISCI) and current scales for their sensitivity to walking changes in subjects with a spinal cord lesion (SCL) and further validate the WISCI for use in clinical trails. Setting: A large rehabilitation hospital in the center of Italy. Patients and methods: Retrospective review was performed on 284 patient records with an SCL. Measurements included neurological evaluation with Lower Extremity Motor Scores (LEMS) according to the American Spinal Injury Association (ASIA) and walking status assessed by Barthel Index (BI (0-15)), Rivermead Mobility Index (RMI (three levels)), Functional Independence Measure (FIM (1-7)), Spinal Cord Independence Measure (SCIM (0-8)), and WISCI (0-20). The WISCI is a 21-level hierarchical scale which incorporates gradations of physical assistance and devices required for walking. Improvement in walking is based on the change of scores from admission to discharge. Statistical analysis included Spearman rank correlation and w 2 test; Po0.05. Results: There was a significant positive correlation between WISCI and other scales (WISCI and BI r ¼ 0.67, Po0.001; WISCI and RMI r ¼ 0.67, Po0.001; WISCI and SCIM r ¼ 0.97, Po0.001; WISCI and FIM r ¼ 0.7, Po0.001). The initial ASIA grade was predictive of mobility outcome on the WISCI: of the 78 ASIA A patients, only five achieved independent walking versus 4/17 ASIA B (P ¼ 0.02), 56/109 ASIA C (Po0.001) and 39/44 ASIA D (Po0.001). The correlation of LEMS to the WISCI was 0.58 (Po0.001). At discharge, patients were distributed into 12 WISCI levels versus four FIM, three BI, two RMI and five SCIM levels. The most frequent WISCI levels at discharge were 13 (walker, no braces or assistance), 16 (two crutches, no braces or assistance) and 20 (no devices or assistance). Conclusions: Similar correlation between the WISCI and the other scales indicates that all these measures address the same concept, mobility, which is a measure of concurrent validity. The correlation is not 100% because of conceptual differences (the WISCI incorporates gradations of physical assistance and devices required for walking while most of the other scales focus on burden of care or mobility in the environment). The WISCI is more detailed and appears more sensitive to walking recovery than the other scales, as demonstrated by our patients' score distribution at discharge. Within each of the most frequent WISCI levels (13,16,20) LEMS and other walking features varied; therefore the scale would benefit from further refinement based on speed, distance and energy cost.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Walking index for spinal cord injury (WISCI): criterion validation

et al. 2004

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“…A yearly follow up after discharge is very important concerning the reduction of complications. 5 Team work is important in order to obtain optimal results, and every member of the team is important; but the most important team member is the spinal cord injured patient himself. It is essential that he real izes that he is responsible for his own treatment and for the prevention of compli cations.…”

Section: Discussionmentioning

confidence: 99%

“…2 Falls as a cause of spinal cord injury are relatively more common in Iceland than in other countries. [3][4][5][6] …”

Section: Introductionmentioning

confidence: 99%

Spinal cord injuries in Iceland 1973-1989. A follow up study

Knútsdóttir¹

1993

Spinal Cord

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All traumatic SCI patients in Iceland come to the Neurosurgical Department of Borgarspitalinn, the City Hospital in Reykjavik for their initial treatment. From 1973From -1989 were rehabilitated at BorgarspHalinn.The purpose of this study was to look at the most common complications and the social functions of SCI patients after discharge from the Rehabilitation Department.A questionnaire was sent to 59 of the 79 patients. They represent almost the whole population of the spinal cord injured population in Iceland. Forty-five patients (76.3%) answered the questionnaire, 69% male, 31% female. Sixty seven percent were under the age of 30 years at the time of injury. Twenty-nine percent had a complete spinal cord injury; 53.3% were wheelchairbound (Frankel grade A, B, C); 55.6% were quadriplegic, and 44.4% paraplegic.The commonest complications were pain (64.4%), urinary tract infections (62.2%) and spasticity (60%); and 58% of the wheelchairbound patients had had pressure sores. Fifty-five point five percent were married; 71 % had an active sexual life after the injury; 54% of the wheelchairbound patients were not quite independent and required some assistance with activities of daily living (ADL) tasks; and 29% were not working or studying compared to 11%, who were, before the injury. No significant changes were seen in social function after the injury.The results show that more emphasis must be placed on the prevention of complications such as urinary tract infections and pressure sores and on the treatment of chronic pain and spasticity.

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