Spinal Cord Injury Assessment Guiding Principles: Difference between revisions

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== Introduction ==
== Introduction ==
Physiotherapy assessment of spinal cord injury is "the vision of the possibilities patient could attain in the perfect situation, and adapt it to the specific person's world".<ref name=":1">Harding M. Spinal Cord Injury Physiotherapy Assessment, Prognosis, and Goal Setting Course. Physioplus 2022.</ref>  
Physiotherapy assessment of spinal cord injury (SCI) is "the vision of the possibilities patient could attain in the perfect situation, and adapt it to the specific person's world".<ref name=":1">Harding M. Spinal Cord Injury Physiotherapy Assessment, Prognosis, and Goal Setting Course. Physioplus 2022.</ref>  


The description of health can be found in the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability and Health]] (ICF). It offers a standard language to be used among health providers to describe healths-related state.<ref name=":0">Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE. [https://www.nature.com/articles/s41393-018-0097-8 Lower extremity outcome measures: considerations for clinical trials in spinal cord injury.] Spinal cord. 2018 Jul;56(7):628-42.</ref> The use of ICF in the spinal cord injury assessment facilitates communication and understanding of team roles within a spinal cord injury multidisciplinary team. It  challenges clinicians to think holistically. <ref>Sykes C. Health Classifications 1 - An Introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006.</ref><ref>Rauch A, Cieza A, Stucki G. How to Apply the International Classification of Functioning, Disability and Health (ICF) for Rehabilitation Management in Clinical Practice. Eur J Phys Rehabil. 2008;44(3):329-42.</ref>The following components of health condition are included in the ICF: body functions and structures, activities, participation, environmental factors, personal factors. The goal of the assessment is to collect information about disordered movement patterns, underlying impairments, activity restrictions, and societal participation and to identify the structural or functional mechanisms influencing the improvement for the purpose of intervention planning. <ref>Ryerson S. Neurological Assessment: The Basis of Clinical Decision Making. In: Lennon S, Stokes M, editors. Pocketbook of Neurological Physiotherapy. Elsevier Health Sciences; 2008 Oct 10.</ref><ref>Bernhardt J, Hill K. We Only Treat What It Occurs to us to Assess: The Importance of Knowledge-based Assessment. Science-based Rehabilitation: Theories into Practice. 2005:15-48.</ref><ref name=":0" />The assessment should be ongoing to tailor-make treatment plan based on observed changes in patient's function and behaviour.
The description of health can be found in the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability and Health]] (ICF). It offers a standard language to be used among health providers to describe healths-related state.<ref name=":0">Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE. [https://www.nature.com/articles/s41393-018-0097-8 Lower extremity outcome measures: considerations for clinical trials in spinal cord injury.] Spinal cord. 2018 Jul;56(7):628-42.</ref> The use of ICF in the spinal cord injury assessment facilitates communication and understanding of team roles within a spinal cord injury multidisciplinary team. It  challenges clinicians to think holistically. <ref>Sykes C. Health Classifications 1 - An Introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006.</ref><ref>Rauch A, Cieza A, Stucki G. How to Apply the International Classification of Functioning, Disability and Health (ICF) for Rehabilitation Management in Clinical Practice. Eur J Phys Rehabil. 2008;44(3):329-42.</ref>The following components of health condition are included in the ICF: body functions and structures, activities, participation, environmental factors, personal factors. The goal of the assessment is to collect information about disordered movement patterns, underlying impairments, activity restrictions, and societal participation and to identify the structural or functional mechanisms influencing the improvement for the purpose of intervention planning. <ref>Ryerson S. Neurological Assessment: The Basis of Clinical Decision Making. In: Lennon S, Stokes M, editors. Pocketbook of Neurological Physiotherapy. Elsevier Health Sciences; 2008 Oct 10.</ref><ref>Bernhardt J, Hill K. We Only Treat What It Occurs to us to Assess: The Importance of Knowledge-based Assessment. Science-based Rehabilitation: Theories into Practice. 2005:15-48.</ref><ref name=":0" />The assessment should be ongoing to tailor-make treatment plan based on observed changes in patient's function and behaviour.
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== Objective Assessment ==
== Objective Assessment ==
=== Body functions and structures ===
You can read more about spinal cord injury objective assessment [[Assessment of Spinal Cord Injury#Objective Assessment|here]]


== Outcome Measures ==
== Outcome Measures ==
The physiotherapist has access to a significant number of accurate and sensitive outcome measures in a spinal cord injury assessment.<ref name=":0" /> No single outcome measure exists that monitor changes and is applicable for the assessment of all individuals with spianl cord injury. It is important to choose the most appropriate ones which corresponds with the stage, level of the patient and the patient's goals. When assessing the patient at different stages of rehabilitation, the physiotherapist may need to use alternative outcome measures. <ref name=":1" />
The physiotherapist has access to a number of accurate and sensitive outcome measures in a spinal cord injury assessment.<ref name=":0" /> No single outcome measure exists that monitor changes and is applicable for the assessment of all individuals with spinal cord injury. It is important to choose the most appropriate ones which corresponds with the stage, level of the patient and the patient's goals. When assessing the patient at different stages of rehabilitation, the physiotherapist may need to use alternative outcome measures. <ref name=":1" />
 
When using outcome measures, the physiotherapist must remember that "outcome measurement tools do not take into account how a functional improvement was achieved ".<ref name=":0" /> This statement gives an important message about the compensatory mechanism that can develop over the course of the rehabilitation which can alter the true effect of a therapeutic intervention.
 
=== Upper Extremity Outcome Measures ===


When using outcome measures, the physiotherapist must remember that "outcome measurement tools do not take into account how a functional improvement was achieved ".<ref name=":0" /> This statement give an important message about the compensatory mechanism developed over the course of the rehabilitation which can alter the true effect of a therapeutic intervention.  
* [[Nine-Hole Peg Test|9 hole Peg test]] is used to measure finger dexterity in patients with various neurological diagnoses
* Dynamometer
* [[Modified Ashworth Scale|Modified Ashworth scale]] helps to determine lower-extremity spasticity in patients with SCI<ref>Harb A, Kishner S. [https://www.ncbi.nlm.nih.gov/books/NBK554572/ Modified Ashworth Scale.] 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. </ref><ref>Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sarı A, Durmus B. [https://www.nature.com/articles/sc201748 Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries]. Spinal Cord. 2017 Oct;55(10):944-949.</ref>
* [[Action Research Arm Test (ARAT)|The Action Research Arm Test (ARAT)]] or the modified Action Research Arm Test (mARAT) assess upper limb function based on the ability to complete functional tasks.<ref>Wilson N, Howel D, Bosomworth H, Shaw L, Rodgers H. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104013/ Analysing the Action Research Arm Test (ARAT): a cautionary tale from the RATULS trial]. Int J Rehabil Res. 2021 Jun 1;44(2):166-169.</ref>


=== Lower Extremity Outcome Measures ===
=== Lower Extremity Outcome Measures ===
When the focus is on locomotion the following lower extremity outcome measures may be appropriate:
When the focus is on locomotion the following lower extremity outcome measures may be appropriate:


Non-ambulatory measures
''Non-ambulatory measures''
 
* [[International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)|International Standards for Neurological Classification of Spinal Cord Injury]] includes a motor (manual test of arm and leg key muscles) and a sensory (light touch, sharp) evaluation
* Lower extremity motor score (LEMS) is a voluntary muscle strength of 10 key leg muscles, 5 on the left and 5 on the right side, and each muscle is assessed on the scale from 0 to 5, where 5 is normal. Patient can receive a maximum combined score of 50 points (5 x 10 muscles)
* [[Berg Balance Scale]] (BBS) is a balance measure validated for people with SCI<ref>Lemay JF, Nadeau S. [https://www.nature.com/articles/sc2009119 Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale]. Spinal Cord. 2010 Mar;48(3):245-50.</ref>
* [[Balance Evaluation Systems Test (BESTest)|Mini-BESTest]] is used for balance assessment  in higher-functioning patients with SCI<ref>Jørgensen V, Opheim A, Halvarsson A, Franzén E, Roaldsen KS. [https://academic.oup.com/ptj/article/97/6/677/3089732?login=false Comparison of the berg balance scale and the mini-BESTest for assessing balance in ambulatory people with spinal cord injury: Validation study.] Phys Ther. 2017;97:677–87.</ref>
* [[Community Balance and Mobility Scale]] assesses balance in higher-functioning patients with SCI<ref>Chan K, Guy K, Shah G, Golla J, Flett HM, Williams J, et al. [https://www.nature.com/articles/sc2016140 Retrospective assessment of the validity and use of the community balance and mobility scale among individuals with subacute spinal cord injury.] Spinal Cord. 2017;55:294–9.</ref>
* [[Modified Ashworth Scale|Modified Ashworth scale]]
* Penn Spasm Frequency Scale (PSFS)  is a self-assessment tool for muscle spasm frequency and severity applied in  the SCI population<ref>Mills PB, Vakil AP, Phillips C, Kei L, Kwon BK. [https://www.nature.com/articles/s41393-018-0063-5 Intra-rater and inter-rater reliability of the Penn Spasm Frequency Scale in People with chronic traumatic spinal cord injury]. Spinal Cord. 2018 Jun;56(6):569-574.</ref>
* Wheelchair Propulsion Test (WPT) assesses the ability to propel a wheelchair over 10 m at a comfortable speed. <ref>Andrews AW, Vallabhajosula S, Ramsey C, Smith M, Lane MH. Reliability and normative values of the Wheelchair Propulsion Test: A preliminary investigation. NeuroRehabilitation. 2019;45(2):229-237.</ref>
''Ambulatory measures''


* [[International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)|International Standards for Neurological Classification of Spinal Cord Injury]] consists of a motor (manual test of arm and leg key muscles) and a segmental sensory (light touch, pinprick) evaluation.
Ambulatory outcome measures are available when gait speed, endurance, turns and the position changes from sitting/standing to walking needs to be quantified. Other variables can be assessed during the performance of these tests, but it depends on its complexity. <ref>van Hedel HJA, EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair. 2009;23:343–50.</ref> For example safety with street crossing at the crosswalks can be evaluated, as it is defined by the walking speed of 0.6 m/s, however the evaluator must consider region where the task will be performed (rural vs city), as the demand for the speed may vary. Another example is a walking speed. Walking above 1.0 m/s for elderly people correlates with independent living. <ref>Zörner B, Blanckenhorn WU, Dietz V, Curt A. Clinical algorithm for improved prediction of ambulation and patient stratification after incomplete spinal cord injury. J Neurotrauma. 2010;27:241–52.</ref>
* lower extremity motor score, LEMS Voluntary muscle force of 10 key leg muscles (5 on each side) are scored on a 6 point ordinal scale from 0 (none) to 5 (normal) with a maximum combined score of 50 points.
* Berg Balance Scale“ (BBS) is an established measure for people with SCI<ref>Lemay JF, Nadeau S. [https://www.nature.com/articles/sc2009119 Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale]. Spinal Cord. 2010 Mar;48(3):245-50.</ref>
* Mini-BESTest  outcome measures that assess balance in higher-functioning patients with SCI and show no ceiling effect in these individuals
* Community Balance and Mobility Scale  outcome measures that assess balance in higher-functioning patients with SCI and show no ceiling effect in these individuals
Ambulatory measures


assess important features of gait, including speed, endurance, turns and the adjustment from sitting/standing to walking. They only directly measure speed, but this is affected by the other variables to a greater or lesser extent depending on the duration and complexity of the test:<ref>van Hedel HJA, EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair. 2009;23:343–50.</ref>he speed needed to safely cross a street at many crosswalks was defined as 0.6 m/s, but crosswalk timers vary by region and sometimes require a faster walking velocity. Independent living has been correlated with a walking speed above 1.0 m/s for elderly people<ref>Zörner B, Blanckenhorn WU, Dietz V, Curt A. Clinical algorithm for improved prediction of ambulation and patient stratification after incomplete spinal cord injury. J Neurotrauma. 2010;27:241–52.</ref>
The following are examples of the ambulatory outcome measures:  


* 10 meter walk test (10MWT)assess gait speed
* [[10 Metre Walk Test|10 metre walk test]] (10MWT) for a gait speed assessment.
* six-minute walk test (6mWT) assess endurance, fatigability and cardiovascular fitness<ref>Barbeau H, Elashoff R, Deforge D, Ditunno J, Saulino M, Dobkin BH. Comparison of speeds used for the 15.2-meter and 6-minute walks over the year after an incomplete spinal cord injury: The SCILT Trial. Neurorehabil Neural Repair. 2007;21:302–6.</ref><ref>Dobkin BH. Short-distance walking speed and timed walking distance: Redundant measures for clinical trials? Neurology. 2006;66:584–6.</ref>
* [[Six Minute Walk Test / 6 Minute Walk Test|Six-minute walk test]] (6mWT) is used for endurance, fatigability and cardiovascular fitness assessment.<ref>Barbeau H, Elashoff R, Deforge D, Ditunno J, Saulino M, Dobkin BH. Comparison of speeds used for the 15.2-meter and 6-minute walks over the year after an incomplete spinal cord injury: The SCILT Trial. Neurorehabil Neural Repair. 2007;21:302–6.</ref><ref>Dobkin BH. Short-distance walking speed and timed walking distance: Redundant measures for clinical trials? Neurology. 2006;66:584–6.</ref>
* timed up and go test (TUG)assesses the time needed to stand up from a chair, walk 3 m, turn around, walk back to the chair and sit down.
* [[Timed Up and Go Test (TUG)|Timed up and go test]] (TUG) is looking at the time required for the patient to stand up from a chair, walk 3 m, turn around, walk back to the chair and sit down.
* “two minute walk test” (2mWT) is derived from the 6mWT and assesses performance by measuring the distance a person can walk within a less demanding period of 2 min. It is not yet a well-established assessment in SCI.
* [[2 Minute Walk Test|Two minute walk test]] (2mWT) is a variation of the 6mWT and assesses the distance during 2 min walk. This assessment IS NOT well-established in SCI.
* 3D gait analysis” is considered the gold standard for the assessment of gait  
* 3D gait analysis is the gold standard for the assessment of gait.
* Instrumented walkways“ offer a good alternative to the costly 3D gait analysis systems. They are portable, affordable, require no advanced training to use and provide valid and reliable spatio-temporal parameters of gait (e.g., speed, step length, stance time, swing time, single support time and base of support) <ref>Nair PM, Hornby TG, Behrman AL. Minimal detectable change for spatial and temporal measurements of gait after incomplete spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18:273–81.</ref>
* Instrumented walkways are portable devices that offer gait analysis, including speed, step length, stance time, swing time, single support time and base of support. <ref>Nair PM, Hornby TG, Behrman AL. Minimal detectable change for spatial and temporal measurements of gait after incomplete spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18:273–81.</ref>
* [[Walking Index for Spinal Cord Injury II|Walking Index for Spinal Cord Injury]] (WISCI) is used to measure impairment in ambulation after spinal cord injury (SCI)<ref>Ditunno JF Jr, Ditunno PL, Scivoletto G, Patrick M, Dijkers M, Barbeau H, Burns AS, Marino RJ, Schmidt-Read M. [https://www.nature.com/articles/sc20139 The Walking Index for Spinal Cord Injury (WISCI/WISCI II): nature, metric properties, use and misuse]. Spinal Cord. 2013 May;51(5):346-55</ref>


=== Functional Performance Outcome Measures ===
=== Functional Performance Outcome Measures ===


* Spinal Cord Independence Measure III” (SCIM III) is a SCI-specific disability assessment that describes the ability of a person with SCI to perform various activities of daily living (ADLs)  
* [[Spinal Cord Independence Measure (SCIM)|Spinal Cord Independence Measure III]] (SCIM III) assesses the ability of a person with SCI to perform activities of daily living.
* [[Functional Independence Measure (FIM)|Functional Independence Measure]] (FIM) helps to determine a person's functional capacity and independence<ref>Lawton G, Lundgren-Nilsson A, Biering-Sørensen F, Tesio L, Slade A, Penta M, Grimby G, Ring H, Tennant A. [https://www.nature.com/articles/3101895 Cross-cultural validity of FIM in spinal cord injury]. Spinal Cord. 2006 Dec;44(12):746-52.</ref>
* Canadian Occupational Performance Measure (COPM) is used to assess person's perceived performance of daily activities and his or her satisfaction with the performance.<ref>Berardi A, Galeoto G, Guarino D, Marquez MA, De Santis R, Valente D, Caporale G, Tofani M. [https://www.nature.com/articles/s41394-019-0196-6 Construct validity, test-retest reliability, and the ability to detect change of the Canadian Occupational Performance Measure in a spinal cord injury population.] Spinal Cord Ser Cases. 2019 May 29;5:52.</ref>
 
=== Additional Outcome Measures ===
 
* [[Montreal Cognitive Assessment (MoCA)|Montreal Cognitive Assessment]] (MoCA)is a screening tool for cognitive impairment<ref>Pellichero A, Best K, Leblond J, Coignard P, Sorita É, Routhier F. [https://medicaljournalssweden.se/jrm/article/view/166/533#toc Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study]. J Rehabil Med. 2021 Sep 9;53(9):jrm00226</ref>
* [[Visual Analogue Scale]] (VAS) for pain assessment
 
*


*  
*  

Revision as of 22:56, 20 May 2022

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Introduction[edit | edit source]

Physiotherapy assessment of spinal cord injury (SCI) is "the vision of the possibilities patient could attain in the perfect situation, and adapt it to the specific person's world".[1]

The description of health can be found in the International Classification of Functioning, Disability and Health (ICF). It offers a standard language to be used among health providers to describe healths-related state.[2] The use of ICF in the spinal cord injury assessment facilitates communication and understanding of team roles within a spinal cord injury multidisciplinary team. It challenges clinicians to think holistically. [3][4]The following components of health condition are included in the ICF: body functions and structures, activities, participation, environmental factors, personal factors. The goal of the assessment is to collect information about disordered movement patterns, underlying impairments, activity restrictions, and societal participation and to identify the structural or functional mechanisms influencing the improvement for the purpose of intervention planning. [5][6][2]The assessment should be ongoing to tailor-make treatment plan based on observed changes in patient's function and behaviour.

Subjective Assessment[edit | edit source]

Body functions and structures[edit | edit source]

In this section physiotherapist asks questions and review medical record seeking information on current and past medical history, including:

  • mechanism of injury: traumatic vs. non-traumatic
  • presence or history of other injuries related to the primary reason for assessment
  • medical management and current precautions
  • progression of the condition
  • pre-morbid medical history
  • presence of complications related to the spinal cord injury, including myocitis ossificans, syringomyelia, spasticity, pressure sores, autonomic dysreflexia, infections, postural hypotension

Activity[edit | edit source]

Activity is defined as difficulty in performing physical action or tasks. In this section, physiotherapist ask about and observe patient's current and past abilities to perform activities of daily living with or without assistance of special equipment. Current equipment that patient uses may facilitate or restrict mobility. It includes:

  • nasal gastric tube
  • suctioning machine
  • ventilator.

Physiotherapist must notice technology that patient uses: assistive device, standard or special wheelchair, etc.

Participation[edit | edit source]

The ICF defines participation as a "limitation in performing socially defined life task and roles".[7]It includes socialising (interpersonal interaction and relationship), traveling, working, taking care of own health, taking care of the members of the family, taking care of own finances, play and leisure. [8]The limitations can be due to functional impairment related to a spinal cord injury and/or its secondary complications. Physiotherapist must acknowledge the presence of the multidisciplinary team members who are involved in managing these limitations: speech language pathologist, nutritionist, dietician, wound care nurse, or a psychologist. For this domain patient is asked about previous therapy, patient's goals and envisaged outcome.

Environmental factors[edit | edit source]

When discussing environmental factors, physiotherapist must include assessment of the barriers and resources in the community.[1] The following examples represent environmental factors:

  • accessibility of the patient's residence: mountainous, rural or urban area, sandy
  • weather conditions: hot, dry, snowy, windy
  • distance from healthcare
  • access to specialised service or technology

Personal factors[edit | edit source]

Understanding patient's personal factors allows the physiotherapist to determine the individual's level of function and to design patient-specific interventions. [9]The examples of personal factors include:

  • degree of functioning
  • disability socio-economic status
  • mental well-being including forgetfulness, beliefs, attitude [9]
  • lack of knowledge about health care and prevention [9]
  • lifestyle choices and practising prevention care [9]
  • self-awareness, stress management, help-seeking behaviour[9]
  • household: amenities, access, support structures[1]
You can read more about spinal cord injury subjective assessment here.

Objective Assessment[edit | edit source]

Body functions and structures[edit | edit source]

You can read more about spinal cord injury objective assessment here

Outcome Measures[edit | edit source]

The physiotherapist has access to a number of accurate and sensitive outcome measures in a spinal cord injury assessment.[2] No single outcome measure exists that monitor changes and is applicable for the assessment of all individuals with spinal cord injury. It is important to choose the most appropriate ones which corresponds with the stage, level of the patient and the patient's goals. When assessing the patient at different stages of rehabilitation, the physiotherapist may need to use alternative outcome measures. [1]

When using outcome measures, the physiotherapist must remember that "outcome measurement tools do not take into account how a functional improvement was achieved ".[2] This statement gives an important message about the compensatory mechanism that can develop over the course of the rehabilitation which can alter the true effect of a therapeutic intervention.

Upper Extremity Outcome Measures[edit | edit source]

Lower Extremity Outcome Measures[edit | edit source]

When the focus is on locomotion the following lower extremity outcome measures may be appropriate:

Non-ambulatory measures

  • International Standards for Neurological Classification of Spinal Cord Injury includes a motor (manual test of arm and leg key muscles) and a sensory (light touch, sharp) evaluation
  • Lower extremity motor score (LEMS) is a voluntary muscle strength of 10 key leg muscles, 5 on the left and 5 on the right side, and each muscle is assessed on the scale from 0 to 5, where 5 is normal. Patient can receive a maximum combined score of 50 points (5 x 10 muscles)
  • Berg Balance Scale (BBS) is a balance measure validated for people with SCI[13]
  • Mini-BESTest is used for balance assessment in higher-functioning patients with SCI[14]
  • Community Balance and Mobility Scale assesses balance in higher-functioning patients with SCI[15]
  • Modified Ashworth scale
  • Penn Spasm Frequency Scale (PSFS) is a self-assessment tool for muscle spasm frequency and severity applied in the SCI population[16]
  • Wheelchair Propulsion Test (WPT) assesses the ability to propel a wheelchair over 10 m at a comfortable speed. [17]

Ambulatory measures

Ambulatory outcome measures are available when gait speed, endurance, turns and the position changes from sitting/standing to walking needs to be quantified. Other variables can be assessed during the performance of these tests, but it depends on its complexity. [18] For example safety with street crossing at the crosswalks can be evaluated, as it is defined by the walking speed of 0.6 m/s, however the evaluator must consider region where the task will be performed (rural vs city), as the demand for the speed may vary. Another example is a walking speed. Walking above 1.0 m/s for elderly people correlates with independent living. [19]

The following are examples of the ambulatory outcome measures:

  • 10 metre walk test (10MWT) for a gait speed assessment.
  • Six-minute walk test (6mWT) is used for endurance, fatigability and cardiovascular fitness assessment.[20][21]
  • Timed up and go test (TUG) is looking at the time required for the patient to stand up from a chair, walk 3 m, turn around, walk back to the chair and sit down.
  • Two minute walk test (2mWT) is a variation of the 6mWT and assesses the distance during 2 min walk. This assessment IS NOT well-established in SCI.
  • 3D gait analysis is the gold standard for the assessment of gait.
  • Instrumented walkways are portable devices that offer gait analysis, including speed, step length, stance time, swing time, single support time and base of support. [22]
  • Walking Index for Spinal Cord Injury (WISCI) is used to measure impairment in ambulation after spinal cord injury (SCI)[23]

Functional Performance Outcome Measures[edit | edit source]

  • Spinal Cord Independence Measure III (SCIM III) assesses the ability of a person with SCI to perform activities of daily living.
  • Functional Independence Measure (FIM) helps to determine a person's functional capacity and independence[24]
  • Canadian Occupational Performance Measure (COPM) is used to assess person's perceived performance of daily activities and his or her satisfaction with the performance.[25]

Additional Outcome Measures[edit | edit source]

Team Communication/Team Roles[edit | edit source]

Goal Setting[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Harding M. Spinal Cord Injury Physiotherapy Assessment, Prognosis, and Goal Setting Course. Physioplus 2022.
  2. 2.0 2.1 2.2 2.3 Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE. Lower extremity outcome measures: considerations for clinical trials in spinal cord injury. Spinal cord. 2018 Jul;56(7):628-42.
  3. Sykes C. Health Classifications 1 - An Introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006.
  4. Rauch A, Cieza A, Stucki G. How to Apply the International Classification of Functioning, Disability and Health (ICF) for Rehabilitation Management in Clinical Practice. Eur J Phys Rehabil. 2008;44(3):329-42.
  5. Ryerson S. Neurological Assessment: The Basis of Clinical Decision Making. In: Lennon S, Stokes M, editors. Pocketbook of Neurological Physiotherapy. Elsevier Health Sciences; 2008 Oct 10.
  6. Bernhardt J, Hill K. We Only Treat What It Occurs to us to Assess: The Importance of Knowledge-based Assessment. Science-based Rehabilitation: Theories into Practice. 2005:15-48.
  7. Jette AM, Haley SM, Kooyoomjian JT. Are the ICF Activity and Participation dimensions distinct? J Rehabil Med. 2003 May;35(3):145-9.
  8. Alve YA, Bontje P. Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review. Top Spinal Cord Inj Rehabil. 2019 Winter;25(1):41-61.
  9. 9.0 9.1 9.2 9.3 9.4 Pilusa S, Myezwa H, Potterton J. 'I forget to do pressure relief': Personal factors influencing the prevention of secondary health conditions in people with spinal cord injury, South Africa. S Afr J Physiother. 2021 Mar 15;77(1):1493.
  10. Harb A, Kishner S. Modified Ashworth Scale. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
  11. Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sarı A, Durmus B. Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord. 2017 Oct;55(10):944-949.
  12. Wilson N, Howel D, Bosomworth H, Shaw L, Rodgers H. Analysing the Action Research Arm Test (ARAT): a cautionary tale from the RATULS trial. Int J Rehabil Res. 2021 Jun 1;44(2):166-169.
  13. Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord. 2010 Mar;48(3):245-50.
  14. Jørgensen V, Opheim A, Halvarsson A, Franzén E, Roaldsen KS. Comparison of the berg balance scale and the mini-BESTest for assessing balance in ambulatory people with spinal cord injury: Validation study. Phys Ther. 2017;97:677–87.
  15. Chan K, Guy K, Shah G, Golla J, Flett HM, Williams J, et al. Retrospective assessment of the validity and use of the community balance and mobility scale among individuals with subacute spinal cord injury. Spinal Cord. 2017;55:294–9.
  16. Mills PB, Vakil AP, Phillips C, Kei L, Kwon BK. Intra-rater and inter-rater reliability of the Penn Spasm Frequency Scale in People with chronic traumatic spinal cord injury. Spinal Cord. 2018 Jun;56(6):569-574.
  17. Andrews AW, Vallabhajosula S, Ramsey C, Smith M, Lane MH. Reliability and normative values of the Wheelchair Propulsion Test: A preliminary investigation. NeuroRehabilitation. 2019;45(2):229-237.
  18. van Hedel HJA, EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair. 2009;23:343–50.
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