Walking Index for Spinal Cord Injury II

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Objective[edit | edit source]

The Walking Index for Spinal Cord Injury (WISCI) is a scale that measures the type and amount of assistance (in terms of requirements of assistive devices, or human helpers) required by a person with spinal cord injury (SCI) for walking.[1] It is an ordinal scale which rates people with SCI from being unable to walk to independent walking and designed to indicate the grades of impairment occurring after SCI and their relationship to the function of walking.[2] A year following the release of the 19 level WISCI, it was modified to WISCI II with the inclusion of two levels,[3]

Intended Population[edit | edit source]

The WISCI/WISCI II was designed as a tool to measure improvement in walking ability specifically for spinal cord injury.[1] It is precisely useful for the following categories of patients:

  1. Individuals with SCI that are able to stand and walk with parallel bars are suitable for assessment with the WISCI. Only patients with reciprocal gait should be considered when scoring the WISCI II.[2]
  2. A number of individuals with ASIA Impairment Scale grade A below T10 and AIS B, C, D qualify for assessment with the WISCI II.[4]
  3. Individuals with tetraplegic presentation require motor strength in their triceps upto a grade of 3 or more to be able to sufficiently support their body weight. [5][6]
  4. Individuals presenting with tetrapelgia and arm strength in triceps that is less than grade 3 would not be easily classified by the WISCI.[7]

Method of Use/Scoring[edit | edit source]

The WISCI assessment is carried out by physical therapist. To score the WISCI/WISCI II the descriptors that relate to the present walking performance of an individual with SCI is observed. Then, appropriate level of highest walking performance is assigned to the patient. The physical therapist selects the level at which the patient is safest as observed, with patient's comfort level described in addition to this. In case other devices apart from those that have been stated in the standard definitions are used during the assessment, they should be documented as descriptors. Also, if there is a discrepancy between two observers, the record with the higher level should be selected. The patient should be observed with the WISCI level documented on using the scale rated from 0 to 20 at baseline (called the Baseline WISCI), the subject is then observed again at the defined interval (called the interval WISCI). The gains in walking can be obtained by simply subtracting the baseline WISCI from the interval WISCI, which is known as the "changed WISCI".[2]

Equipment Needed[edit | edit source]

The following equipment may be required/recorded during assessment[3]:

  1. Walkers (conventional, if rolling walkers are used, they must be identified in the descriptors). A platform walker is considered equivalent to a walker.
  2. The use of advanced reciprocating gait orthosis (ARGO) should be excluded.
  3. Axillary or Lofstrand (Canadian) crutches may be used.
  4. Braces which could mean one or two braces should be identified in the descriptors. For other braces such as ace wraps or splint should be described under "other".
  5. Long leg braces, whether they are locked or unlocked at the ankle must be indicated in the descriptors.
  6. Braces must not be covered by clothes to ensure that physical therapist and other professional staff make visual determination that patient has a brace.

Completion Time[edit | edit source]

The WISCI II may take about 5 to 15 minutes to complete. Especially, during the acute phase, the time required could be longer and shorter during follow-up assessments. [2]

Evidence[edit | edit source]

Validity[edit | edit source]

WISCI II has been highly reported to have a high validity in multiple dimensions, which has resulted in it broad acceptance.[2] 24 experts agreed on a hierarchical ranking in SCI walking function in terms of content and face validity for the WISCI.[1][3] A prospective study consisting of 170 subjects in four different countries found that progression through the levels of the scale followed a monotonic pattern, which was observed in over 80% of the subjects.[8] In the study, a 0.91 (p < 0.001) correlation between walking capacity from WISCI and impairment (LEMS) was found at the final assessment, which supported construct and content validity. Other studies have also demonstrated the criterion-related, predictive and concurrent validity, and also the convergent and divergent construct validity.[9][8][10][11][12]

Reliability[edit | edit source]

Marino et al.[13], reported an inter and intra-rater relability of 1.00 for self-selected WISCI II levels. The inter-rater reliability for maximal level WISCI II was 0.98 and the intra-rater reliability was 1.00.

Reproducibility[edit | edit source]

In a study[9] carried out on 76 subjects who have chronic SCI, WISCI II demonstrated excellent reproducibility, having an intra-class correlation coefficient of 0.99 for self-selected and maximum WISCI II level. It produced smallest real differences of 0.79 for self-selected level and 0.60 for maximum level which connotes that differences in a WISCI II level can be interpreted as being real in a patient with chronic SCI.

Conclusion[edit | edit source]

The WISCI has been widely accepted for the assessment of walking function in patients with SCI due to its excellent psychometric properties as well as recommendations by different authorities, It is essential that users carry out the assessment according to the instruction in the testing guide for accurate results.

Resources[edit | edit source]

[14]

References[edit | edit source]

  1. 1.0 1.1 1.2 Ditunno JF Jr, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano Vet al. Walking Index for Spinal Cord Injury (WISCI): an international multicenter validity and reliability study. Spinal Cord2000;38,234–243.
  2. 2.0 2.1 2.2 2.3 2.4 Ditunno JF, Ditunno PL, Scivoletto G, Patrick M, Dijkers M, Barbeau H, Burns AS, Marino RJ, Schmidt-Read M. The Walking Index for Spinal Cord Injury (WISCI/WISCI II): nature, metric properties, use and misuse. Spinal Cord. 2013 May;51(5):346-55.
  3. 3.0 3.1 3.2 Ditunno PL, Ditunno JF Jr. Walking Index for Spinal Cord Injury (WISCIII): scale revision. Spinal Cord2001;39,654–656.
  4. Ditunno JF. Validation and refinement of the Walking Index for Spinal Cord Injury (WISCI) in a clinical setting. J Spinal Cord Med. 2004;27(2):160.
  5. Dobkin BH, Apple D, Barbeau H, Basso M, Behrman A, Deforge D, Ditunno J, Dudley G, Elashoff R, Fugate L, Harkema S. Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury. Neurorehabilitation and Neural Repair. 2003 Sep;17(3):153-67.
  6. Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M.  Walking index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005; 43(1): 27‐33.
  7. Ditunno JF, Burns AS, Marino RJ. Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. Journal of rehabilitation research and development. 2005 May 1;42(3):35.
  8. 8.0 8.1 Ditunno JF, Scivoletto G, Patrick M, Biering-Sorensen F, Abel R, Marino R. Validation of the walking index for spinal cord injury in a US and European clinical population. Spinal Cord 2007; 45, 275–291
  9. 9.0 9.1 Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF. The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair 2011; 25, 149–157
  10. Curt A, van Hedel HJ, Klaus D, Dietz V. Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma 2008; 25, 677–685
  11. Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for Spinal Cord Injury (WISCI): criterion validation. Spinal Cord 2005; 43, 27–33.
  12. van Hedel HJ, Dietz V, Curt A. Assessment of walking speed and distance in subjects with an incomplete spinal cord injury. Neurorehabil Neural Repair 2007; 21, 295–301
  13. Marino RJ, Scivoletto G, Patrick M, Tamburella F, Read MS, Burns AS et al. Walking index for spinal cord injury version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilities. Am J Phys Med Rehabil 2010; 89, 7–15
  14. Walking Index for SCI II. Emma Marino. Available at https://www.youtube.com/watch?v=Fkm6WolhDLw