SCIM – spinal cord independence measure: a new disability scale for patients with spinal cord lesions

Abstract

The Spinal Cord Independence Measure (SCIM) is a new disability scale developed speci®cally for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore 0 ± 20), respiration and sphincter management (0 ± 40) and mobility (0 ± 40). Each area is scored according to its proportional weight in these patients' general activity. The ®nal score ranges from 0 to 100. This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure (FIM). Thirty patients were included. Scores were recorded one week after admission and thereafter every month during hospitalization. Each area of function was assessed by a pair of sta members from the relevant discipline. The comparison of scores between each pair of raters revealed a remarkable consistency (r=0.91 ± 0.99; P50.0001; slope&1; constant&0). The total SCIM score (mean=51, SD=21) was lower than the total FIM score (mean=87, SD=23) owing to the di erence in scale range structure and the relatively high cognitive scores of our patients; however, a relationship was noted between the scores of both scales (r=0.85, P50.01). The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients: the SCIM detected all the functional changes detected by the FIM total scoring, but the FIM missed 26% of the changes detected by the SCIM total scoring. The mean di erence between consecutive scores was higher for the SCIM (P50.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.

Functional electrical stimulation for grasping and walking: indications and limitations

“…The extent to which these patients can use their hands represents a measure of their independence, which is commonly assessed by scores in ADL, such as the Functional Independence Measurements (FIM) and Spinal Cord Independence Measure (SCIM). 36 These measures are also used to determine the extent of support and assistance the patient would need during the day, and in how far the accommodation and employment environment have to be adapted to ®t the patient's needs.…”

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein–Bell ADL Scale

“…The K-B Scale measures basic ADL divided into essential components (items) of an activity. This is an advantage over other known ADL scales 19,39,40 as it makes it possible to detect problematic items within dimensions and thus makes it a better tool for target interventions in ADL in patients with cervical SCI regardless of functional level.…”

“…56 Earlier studies have shown that diagnosis-specific scales such as the Spinal Cord Independence Measure (SCIM) 40 and the QIF 19 are more sensitive to small changes in a patient's ability to perform ADL and therefore better reflect rehabilitation outcome in cervical SCI patients than FIMt. 39 However, SCIM and QIF have items that lack requirements to assess important components of an activity.…”

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

“…Thus the shortform QIF score correlated with the Upper Extremity Motor Score (r40.8); 32 the SCIM with the FIM (r40.8), 33,54 the WISCI (r ¼ 0.97) 38 and with the NAC (r ¼ 0.47-0.85). 40 Considerable evidence of convergent validity was presented for the WISCI: with the FIM (rX0.7), 36,38 the LEMS(r ¼ 0.47-0.91), 58 the Berg Balance Scale, 57 the BI and Rivermead mobility index (both r ¼ 0.67), 38 and the SCIM (r ¼ 0.97).…”

“…The SIP68 has also been evaluated with SCI patients in two studies with relatively large sample sizes. 45,46 Instruments that were designed specifically to assess the function or mobility of SCI patients are: the Quadriplegia Index of Function (QIF) 31,30 and Short-form QIF; 32 the Spinal Cord Independence Measure (SCIM) 33 and Catz-Itzkovich revised SCIM; 35 the Walking Index for Spinal cord injury (WISCI); 36 the Needs Assessment Checklist (NAC), 40 and the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). 43 Item generation.…”