The Walking Index for Spinal Cord Injury (WISCI/WISCI II): nature, metric properties, use and misuse.

STUDY DESIGN: Literature review. OBJECTIVE: To critically review all publications/internet sites that have described/used the Walking Index for Spinal Cord Injury (WISCI II), as a measure of impairment of walking function after spinal cord injury (SCI), in order to identify its psychometric properties, clarify its nature, specify misuse and incorporate the findings in an updated guide. METHOD: A systematic literature search was done of Ovid MEDLINE, CINAHL, PsychINFO, Cochrane Central Register of Controlled Trials, Scopus and electronic sites using key words: WISCI or WISCI II, SCI, paraplegia/ tetraplegia/ quadriplegia and ambulation/gait/walking. Among 1235 citations retrieved, 154 relevant articles/sites were identified, classified and examined by the authors; recommendations were made based on findings. RESULTS AND DISCUSSION: The validity (face/concurrent/content/construct/convergent/criterion) and reliability of the WISCI II has been documented in clinical trials and clinical series, and considered adequate by systematic reviewers. In chronic SCI subjects, reliable determination of the maximum (as opposed to self-selected) WISCI II level requires more time and experience by the assessor. The correct use of WISCI II is clarified for testing acute/chronic phases of recovery after SCI, age of subjects, devices and settings. The WISCI II and walking speed measures may be performed simultaneously. CONCLUSION: The increased use of the WISCI II is attributed to its unique characteristics as a capacity measure of walking function and its strong metric properties. Appropriate use of the WISCI II was clarified and incorporated into a new guide for its use. Combining it with a walking speed measure needs further study.

Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study.

STUDY DESIGN: Cross-sectional and longitudinal direct observation of a constrained consensus-building process in nine consumer panels and three rehabilitation professional panels. OBJECTIVES: To illustrate differences among consumer and clinician preferences for the restoration of walking function based on severity of injury, time of injury and age of the individual. SETTING: Regional Spinal Cord Center in Philadelphia, USA. METHODS: Twelve panels (consumer and clinical) came to independent consensus using the features-resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) at different stages of recovery. RESULTS: Walking is given priority early in the game by eight out of nine consumer panels and by two out of three professional panels. The exception consumer panel (ISCI<50) moved walking later in the game, whereas the exception professional panel (rehRx) moved wheelchair early but walking much delayed. Bowel and Bladder was given primary importance in all panels. CONCLUSIONS: Walking is a high priority for recovery among consumers with spinal cord injury irrespective of severity of injury, time of injury and age at time of injury. Among professional staff, walking is also of high priority except in rehabilitation professionals.

Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals.

STUDY DESIGN: Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada. OBJECTIVES: To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation. SETTING: Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada. METHODS: Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery. RESULTS: Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking. CONCLUSIONS: These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.

Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study.

STUDY DESIGN: Construction of an international walking scale by a modified Delphi technique. OBJECTIVE: The purpose of the study was to develop a more precise walking scale for use in clinical trials of subjects with spinal cord injury (SCI) and to determine its validity and reliability. SETTING: Eight SCI centers in Australia, Brazil, Canada (2), Korea, Italy, the UK and the US. METHODS: Original items were constructed by experts at two SCI centers (Italy and the US) and blindly ranked in an hierarchical order (pilot data). These items were compared to the Functional Independence Measure (FIM) for concurrent validity. Subsequent independent blind rank ordering of items was completed at all eight centers (24 individuals and eight teams). Final consensus on rank ordering was reached during an international meeting (face validation). A videotape comprised of 40 clips of patients walking was forwarded to all eight centers and inter-rater reliability data collected. RESULTS: Kendall coefficient of concordance for the pilot data was significant (W=0. 843, P<0.001) indicating agreement among the experts in rank ordering of original items. FIM comparison (Spearman's rank correlation coefficient=0.765, P<0.001) showed a theoretical relationship, however a practical difference in what is measured by each scale. Kendall coefficient of concordance for the international blind hierarchical ranking showed significance (W=0.860, P<0.001) indicating agreement in rank ordering across all eight centers. Group consensus meeting resulted in a 19 item hierarchical rank ordered 'Walking Index for Spinal Cord Injury (WISCI)'. Inter-rater reliability scoring of the 40 video clips showed 100% agreement. CONCLUSIONS: This is the first time a walking scale for SCI of this complexity has been developed and judged by an international group of experts. The WISCI showed good validity and reliability, but needs to be assessed in clinical settings for responsiveness.

Right hemisphere specialization for mental rotation in normals and brain damaged subjects.

Hemisphere specialization for mental rotation was investigated utilizing Shepard's (1971) paradigm. In each of two experiments, the procedure involved presenting pairs of novel non-verbal stimuli at various angles of disparity. Subjects were instructed to construct a mental image of one stimulus, rotate this image, and judge whether or not the image was a congruent match with its mate. Both response time and accuracy were measured. In Experiment 1, the testing of right-handed normals revealed a significant left visual field advantage for accuracy (p less than .0001) and response time (p less than .05). In Experiment 2, a comparison of right parietal lesioned patients with both left parietal lesioned patients and matched normal controls likewise revealed significant right lesion effects for accuracy (p greater than .0001) and response time (p greater than .01). Right hemisphere specialization for mental rotation was documented for both normals and brain damaged subjects.

Sensation-seeking behavior and the incidence of spinal cord injury.

Professionals in the rehabilitation field differ in their conceptualization of the role of premorbid personality factors as related to risk behavior and incidence of traumatic injury. Some hold that specific premorbid personality traits can be identified for the spinal cord injured population; others argue that no one personality trait or specific combination of traits is descriptive of this heterogeneous population. This study explores the relationship between the sensation-seeking behavioral patterns and incidence of traumatic spinal cord injury (SCI). The Sensation-Seeking Scale (SSS) was administered to 56 patients with spinal cord injury (50 males and 6 females) between the ages of 16 and 50. A description of the incident causing injury was obtained for all 56 patients and subsequently rated by non-medical judges on a dimension of prudence-imprudence. No significant correlations were found between sensation-seeking scores and rated prudence of onset of injury, and sensation-seeking scores were no higher for SCI patients than for a comparable normal population. These findings indicate that spinal cord injury is not related to sensation-seeking, and, more generally, support the view that no premorbid personality trait distinguishes the SCI population from the normal.