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Spinal Cord Injury: Progress, Promise, and Priorities
TABLE 6-5 ISRT’s Set of Standard Tests to Assess Patient Outcomes
Conventional clinical and neurological assessments
Dynamometry for appropriate muscles
Tests for motor-evoked potential responses to transcranial magnetic stimulation
Tests for reflexes in paraspinal muscles
Quantitative sensory testing, including electrical sensory perceptual threshold
Tests for sympathetic skin response
The heterogeneity of spinal cord injuries not only provides a reason for developing this scale but also presents challenges. These challenges can be addressed, however, by looking at similar rating scales that have been developed for other neurological disorders that have variable severities, including the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and the Unified Parkinson’s Disease Rating Scale (UPDRS). ALSFRS is used to assess 10 behaviors, including swallowing, speaking, and movement, by using four to five defined functional status end points for each behavior. For example, in the handwriting evaluation, the choices are
slow or sloppy, all words are legible;
not all words are legible;
able to grip pen but unable to write; and
unable to grip pen.
UPDRS was developed in 1987 in response to the need for a rating scale that could monitor the longitudinal progression of Parkinson’s disease (Fahn et al., 1987). Like ALSFRS, this scale includes groups of questions devoted to motor function, activities of daily living, and behavior and mood. The scale is used to quantify an individual’s total disability and can be used to monitor the progression of the disease.
Currently, both the ISRT and the Christopher Reeve Paralysis Foundation are in the process of developing new assessment techniques for use in large-scale clinical trials of interventions for spinal cord injuries. Coordination and collaboration are needed to develop a standard set of assessment measures to ensure valid comparisons of data between these and other groups. This effort could benefit from a consensus conference, similar to the World Federation of Neurology Airlie House Therapeutic Trials in ALS workshop (Munsat, 1995), that could be sponsored by the New York State