Validity and reliability of a locomotor stage-based functional rating scale in spinal cord injury

Abstract

Study design: This is a prospective observational cohort study. Objectives: The objectives of this study were to apply and adapt a rating scale based on locomotor stages (LSs) derived from cerebral palsy (CP) to spinal cord injury (SCI) and to quantify its inter-rater reliability and construct validity. Methods: The inter-rater reliability of LSs originally developed for children with CP was tested in a chronic SCI cohort. On the basis of the distribution of the LSs for CP, Locomotor Stages in Spinal Cord Injury (LOSSCI) were defined. Their validity was then tested with the Spinal Cord Independence Measure (SCIM) in another acute SCI cohort. Results: The 10-point LSs for CP were assessed by two raters in 65 chronic patients. Weighted Cohen's kappa (WCk) was 0.985 (Po0.0001). Only four mismatches were found, resulting in an accuracy of 93.4%. On the basis of the distribution of the LSs for CP in SCI, the five-point LOSSCI grading scale was developed. WCk of LOSSCI was 0.976 (Po0.0001). Only three mismatches between raters were found, resulting in an overall accuracy of 95.1%. The validity data sets consisted of 448 SCIM records from 161 patients obtained within the first year after injury. Spearman's correlation coefficients were the highest between LOSSCI and SCIM indoor mobility (room and toilet; R = 0.82) and the lowest between LOSSCI and SCIM respiration and sphincter management (R = 0.68). Conclusion: LOSSCI provides a reliable and valid clinical tool to assess locomotor function in SCI. LOSSCI not only reflects bipedal walking but also covers a wide range of key motor skills.

Walking Ability Outcome Measures in Individuals with Spinal Cord Injury: A Systematic Review

“…Twenty-one articles were excluded ( Figure 1 ) because of the following reasons: (i) not directly related to walking ability but to general motor activity or disability; (ii) psychometric properties were not analyzed; (iii) discriminative selection of walking ability outcome measures according to the type of ambulatory assistive devices (AADs). Finally, 17 articles were included in this review [ 4 , 10 , 11 , 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…The LOSSCI is a five-stage scale result of applying and adapting to SCI [ 28 ] the original Vojta’s 10 specific locomotor stages for children with cerebral palsy [ 46 ]. Each LOSSCI stage should be evaluated in ascending order and the grading is determined by the highest stage the person can accomplish: (i) orienting to and touching or grasping an object in supine position, (ii) trunk uprighting in prone position, (iii) creeping, (iv) crawling or walking with AAD, (v) independent bipedal locomotion.…”

“…The person’s highest stage is reached when at least one item in a stage is achieved. The LOSSCI is based on the idea that the progress of people with SCI during rehabilitation is to some extent comparable to the typical development of ontogenic locomotion in children [ 28 ].…”

“…As alternative tool to all the walking ability outcome measures above mentioned, the LOSSCI allows to assess the locomotor progress of a person with SCI from an ontogenic point of view, and it has shown to be a valid and reliable outcome measure [ 28 ]. Concerning bipedal stance, LOSSCI conceives the use of AADs and includes items of independent locomotion such as walking on flat surfaces and stopping on command, walking up an incline, and one-legged standing.…”

Can Clinical Assessment of Postural Control Explain Locomotive Body Function, Mobility, Self-Care and Participation in Children with Cerebral Palsy?

“…LS quantifies human ontogenetic postural development by describing increasing levels of postural control from the kinematics of different locomotor capacities, from birth to independent walking. This includes grasping and other upper limb capacities (like weight bearing on the elbow or hand) in a linear way (instead of in parallel, like in Manual Ability Classification System), which arise along with more mature levels of postural control [ 8 , 34 ] ( Supplementary Table S1 ).…”