TABLE 6-4 Tools to Assess Spinal Cord Injury in Humans

Functional recovery

 

American Spinal Injury Association (ASIA) International Standards for Neurological Classification

 

Analyzes the effect that the injury has on both motor and sensory systems

 

Is based on the extent of injury and muscle strength

 

Uses an alphabetical score from A (the most severe) to E (the least severe)

 

Insensitive to small but significant changes in motor and sensory functions

 

May not be sensitive enough to detect even several spinal levels of regeneration in thoracic injuries

 

Does not specifically address functions that affect a patient’s quality of life

 

Does not assess pain, bowel, bladder, or sexual function

 

Functional Independence Measure (FIM)

 

Is an 18-item, seven-level ordinal scale

 

Is designed to assess areas of dysfunction in activities that commonly occur

 

The scale has few cognitive, behavioral, and communication-related functional items

 

Is not specific for spinal cord injuries but is designed to assess neurological, musculoskeletal, and other disorders

 

Functional Assessment Measure (FAM)

 

Was developed to augment the FIM

 

Specifically addresses functional areas that are relatively less emphasized in FIM, including cognitive, behavioral, communication, and community functioning measures

 

The scale has few cognitive, behavioral, and communication-related functional items

 

Is not specific for spinal cord injuries but is designed to assess neurological, musculoskeletal, and other disorders

 

Spinal Cord Independence Measure (SCIM)

 

Is specifically designed to assess spinal cord injuries and to be sensitive to changes

 

Analyzes self-care, respiration, and sphincter management and mobility

 

Is more sensitive than FIM for spinal cord injuries

 

Electrophysiology

 

Assesses MEPs or SSEP

 

Stimulates corresponding cortical areas of the brain and records the response in target nerves to see if connections are still functional

 

Is correlated to impairment of locomotor activity

 

Is noninvasive

 

Electrical activity may not coordinate with function

 

Hard to assess subtle but critical improvements to circuitry

 

Does not assess pain, bowel, bladder, or sexual function



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