OBJECTIVE:To examine current practices in assessing seated trunk control (STC) after spinal cord injury (SCI), a key factor in rehabilitation outcomes and independence. Enablers and barriers to uptake of assessment tools in practice were identified using the Theoretical Domains Framework and mapped to the Capability-Opportunity-Motivation for Behavior Change model. DESIGN:Explanatory sequential mixed methods design using a survey of assessment tools used, followed by focus groups and interviews to triangulate survey responses, understand factors driving uptake, and identify ideal assessment characteristics. SETTING:Leading SCI institutions in the United States. PARTICIPANTS:US-based clinicians and clinical researchers experienced in SCI rehabilitation. (Survey: n= 67; Focus Groups and Interviews: n= 66) INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:Survey of commonly used assessment tools. RESULTS:The survey showed that 72% of 67 respondents used STC assessments, most frequently the Berg Balance Scale, whereas qualitative findings highlighted the Function in Sitting Test for SCI and observation as key assessments of STC. Analysis using the Theoretical Domains Framework and Capability-Opportunity-Motivation for Behavior Change identified barriers relating to Opportunity to use STC assessments: including limited evidence, absence of standardized guidelines, funding constraints, and insurance limitations. Capability-related facilitators to the use of assessments were practitioner knowledge and practical skills, whereas Motivation-related drivers were clinical relevance and sensitivity to change of assessments. CONCLUSIONS:In SCI rehabilitation in the US health care context, trunk control assessment is considered essential, although systemic and evidentiary challenges limit its integration. These findings underscore the need for codeveloped guidelines and further research to demonstrate the robustness of assessments in monitoring progress, fall risk, and activity independence.

Objectives:To document, through a survey, perceptions of functional electrical stimulation (FES) from people with spinal cord injury (SCI) and carers, clinicians, and researchers (CCR). Methods:Online questionnaires were completed in Australia and New Zealand from December 1, 2021 to August 31, 2022. Subgroups included people with SCI who have used FES, people with SCI who have not used FES, CCRs who have used FES, and CCRs who have not used FES. Frequencies and percentages of subgroup data were calculated for all questions. Open-ended responses were analyzed with inductive content analysis. Results:Ninety-nine responses (70 people with SCI, 29 CCR) were analyzed. Out of the 99 responses, 47 people with SCI and 27 CCRs had used or currently use FES. Muscle strength was the most frequently reported benefit by people with SCI and CCRs who use(d) FES. Lack of training was the most frequently reported barrier to FES by people with SCI (85% of question responders) and CCRs (94%) who had used FES. People with SCI (95%) who had not used FES reported access as a barrier. The leading priorities for future research include improved ease of use for people with SCI (60% people with SCI) and clinical guidelines (48% CCR). Qualitative findings supported the quantitative findings. Conclusion:This survey identified access as a barrier to FES and echoed benefits (strength) and barriers (training) reported in previous research. Ameliorating the barriers and investigating the areas of future research identified in this study will ultimately improve FES uptake in SCI rehabilitation.

OBJECTIVE:To evaluate the effect of inspiratory muscle training (IMT) on functional sitting balance (FSB) in individuals with spinal cord injury (SCI). DESIGN:Rater-masked, parallel, 2-group randomized clinical trial. SETTING:Tertiary care SCI rehabilitation hospital. PARTICIPANTS:Forty-four participants (N=44) (aged 18-60) with C4-T6 injuries (American Spinal Injury Association Impairment Scale A-C) (cervical-SCI=25, thoracic-SCI=19, American Spinal Injury Association Impairment Scale A=33, B=11, C=0) in their first SCI-specific inpatient rehabilitation were randomly assigned into experimental and control groups. INTERVENTIONS:Both groups received standard respiratory care and physiotherapy. The experimental group received additional flow-resistive IMT sessions over 6 weeks. MAIN OUTCOME MEASURES:FSB was measured using the Function in Sitting Test-SCI, and respiratory function was assessed via maximal inspiratory pressure, sustained maximal inspiratory pressure, and Fatigue Index Test score at baseline, 4 weeks and 6 weeks. Data were analyzed using repeated measures general linear model framework in IBM SPSS version 21. RESULTS:Analysis showed significant improvements in FSB for both groups (P<.001). Sustained maximal inspiratory pressure, maximal inspiratory pressure, and Fatigue Index Test scores improved only for the experimental group (P<.05). Post-hoc analyses of interaction effects showed significantly greater improvements in all variables in the experimental group. CONCLUSIONS:This study is the first to show that FSB improves more with addition of IMT to standard care in individuals with SCI.

Background:Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored. Objectives:To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI. Methods:A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships. Results:Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (SD) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (r s= .441, p = .01, and r s= .434, p = .006, respectively). A significant correlation between SMIP and A:U ratio (r s= -.330, p = .043) was observed. Conclusion:We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.

Study design/setting Secondary analysis. Objectives To compare the change in maximal inspiratory pressure (PI max ) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury. Methods Data originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PI max, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30–80% weekly PI max, twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A–C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PI max from baseline at the end of week four were analysed. Results Over 4 weeks, there was no difference in the change in PI max between groups (Absolute change in PI max (cmH 2 O): p = 0.456, Percent change in PI max relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH 2 O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PI max × number of breaths), p = 0.535). Conclusions Our findings support both methods of IMT as the change in PI max and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PI max .

ObjectiveThe aim of the study is to identify differences in demographics, severity of disease, and rates of hospital readmission among adults discharged to skilled nursing facilities and inpatient rehabilitation facilities after hospitalization for coronavirus 2019.DesignThis is a retrospective cohort study of adults hospitalized with coronavirus 2019 infection at academic medical centers participating in the Vizient Clinical Data Base between April 1, 2020, and June 30, 2021, who were discharged to skilled nursing facilities or inpatient rehabilitation facilities (N = 39,882). Data from the Clinical Data Base are used with permission of Vizient, Inc. All rights reserved.ResultsAmong adults hospitalized with coronavirus 2019 infection, those discharged to skilled nursing facilities were 1.4 times more likely to require hospital readmission than those discharged to inpatient rehabilitation facilities. They were, on average, older (73 vs. 61 yrs, P < 0.001) and had shorter hospital lengths of stay (15 vs. 26 days, P < 0.0001) than the patients discharged to inpatient rehabilitation facilities. Persons discharged to inpatient rehabilitation facilities were more likely to have received intensive care and mechanical ventilation while hospitalized (P < 0.001).ConclusionsIndividuals discharged to inpatient rehabilitation facilities after hospitalization for coronavirus 2019 differ from those discharged to skilled nursing facilities on a number of key variables, including age, hospital length of stay, having received intensive care, and odds of hospital readmission.

As part of a clinical trial to assess safety of autologous human Schwann cells in persons with chronic spinal cord injury (SCI), participants engaged in a multimodal conditioning program pre- and post- transplantation. PURPOSE: To assess the impact of this conditioning program on measures of cardiometabolic health. METHODS: Eight individuals with SCI completed the program for 12-weeks during the pre-transplant phase and 6-months post-transplant. Twice weekly, participants underwent functional electrical stimulation cycling and locomotor training (bodyweight supported or overground). Participants completed home-based aerobic and resistance circuit exercise three times per week. At baseline and 6-months post-transplant, participants performed a graded exercise test on an arm crank ergometer to assess cardiorespiratory fitness (VO2peak). Fasting blood samples were obtained to assess lipid profile and participants completed an oral glucose tolerance test. Insulin resistance was estimated by the Homeostatic Model Assessment 2 (HOMA2-IR); whole body insulin sensitivity was estimated using the Matsuda index (ISIMatsuda). Paired samples t-tests were performed to compare outcomes at baseline and 6-months. RESULTS: All participants complied with the protocol and completed on average 317 ± 63-min of training per week. Participants remained weight stable throughout the program (p = 0.62) and saw modest, but not significant, improvements in fitness (ΔVO2peak = 1.1 ml/kg/min, p = 0.26). There were no significant differences in total cholesterol (C) (p = 0.91), high-density lipoprotein-C (p = 0.92), low-density lipoprotein-C (p = 0.60), triglycerides (p = 0.12), HOMA2-IR (p = 0.53) or ISIMatsuda (p = 0.30). CONCLUSIONS: The conditioning program did not improve markers of cardiometabolic health. This may be attributed to the intensity and/or volume being insufficient to elicit changes. The volume of exercise in this program was considerably greater than the population specific exercise guidelines for improving cardiometabolic health. Given the complex barriers to exercise faced by this population, promoting a higher volume of exercise for improving health seems unrealistic. More viable solutions may be to maximise the intensity of the exercise or combine with specific nutritional guidance.

Objectives:To explore the expected variability in repeated short-term (ST) and long-term (LT) inspiratory muscle performance (IMP) in individuals with chronic spinal cord injury (SCI).Methods:Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and inspiratory duration (ID) were collected from 22 individuals with chronic SCI (C1-T9, American Spinal Injury Association Impairment Scale [AIS] A-C) over 18 months. ST data were collected four times within 2 weeks (n = 19). LT data were collected at two time points at least 7 months apart (n = 20).Results:SMIP was the most reliable IMP assessment with an intraclass correlation coefficient (ICC) of 0.959, followed by MIP (ICC 0.874) and ID (ICC 0.689). The ID was the only ST measure to have a significant difference [MIP: F(3, 54) = 2.5, p = .07; SMIP: F(3, 54) = 1.3, p = .29; ID: F(1.4, 25.6) = 4.8, p = .03]. Post hoc analysis showed the mean day 1 ST ID measure was significantly different from both days 3 and 4. The percent change of ID from day 3 to day 6 was 11.6%. No LT measures differed significantly [mean change (SD) [95% CI] for MIP: 5.2 cm H2O (18.8) [-3.6, 13.9], p = .235; SMIP: 60.9 pressure time unit (166.1) [-16.9, 138.6], p = .118; ID: 0.1 s (2.5) [-1.1, 1.3], p = .855].Conclusion:These data provide a foundation for understanding normal variance in ST and LT IMP in the SCI population. Change in MIP function outside 10% is likely a true and meaningful change and may help clinicians recognize individuals with SCI at risk for respiratory compromise. Future studies should explore changes in MIP and SMIP that are associated with meaningful functional changes.

Study design The pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4. Objective To assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI). Setting Assessments: research institution or zoom. IMT: participant’s home. Methods Participants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance. Results Data from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant’s training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly ( p < 0.05) from BL2 to F1. Conclusion Our data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety. ClinicalTrials.gov Registration number: NCT04210063.

Background:People with a spinal cord injury (SCI) have a high rate of bowel-related morbidity, even compared with people with other neurological disorders. These complications lower quality of life and place a financial burden on the health system. A noninvasive intervention that improves the bowel function of people with an SCI should reduce morbidity, improve quality of life, and lead to cost savings for health care providers.Objectives:To investigate the effectiveness of noninvasive abdominal functional electrical stimulation (FES) for improving bowel function in people with a chronic SCI.Methods:A prospective, double-blinded, 1:1 randomized, placebo-controlled intervention trial will be conducted with 80 adults with chronic SCI (>12 months since injury) above T8 single neurological level. The intervention will be a 45-minute abdominal FES (or placebo) session, 3 days per week, for 6 weeks.Main Study Parameters/Endpoints:Primary endpoint is whole gut transit time before and after 6 weeks of abdominal FES. Secondary endpoints measured before and after 6 weeks of abdominal FES are (1) colonic transit time; (2) quality of life (EQ-5D-5L); (3) participant-reported bowel function (International SCI Bowel Function Basic Data Set Questionnaire and visual analogue scale); (4) respiratory function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure); (5) bladder symptoms (Neurogenic Bladder Symptom Score); (6) daily bowel management diary; and (7) unplanned hospital visits.Conclusion:Safety data will be collected, and a cost utility analysis using quality of life scores will be performed.Trial registration:Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000386831.

Objective: To investigate the feasibility and validity of using the novel axillary:umbilical (A:U) ratio and sustained maximal inspiratory pressure (SMIP) as supplementary measures in the assessment of respiratory function in people with spinal cord injury. Design: Pilot study with a single day of data collection. All measurements were taken with participants in their personal wheelchairs to best represent normal functioning and positioning for each individual. Setting: Research institution. Participants: A convenience sample of 30 community dwelling volunteers with chronic spinal cord injury (C2-T12, American Spinal Injury Association Impairment Scale A-D) participated. Interventions: Not applicable. Main Outcome Measures: Participants underwent anthropometric measurements (trunk height, abdominal circumference, axillary circumference) and assessment of inspiratory muscle performance, incluidng maximal inspiratory pressure, SMIP, and inspiratory duration, as well as standard pulmonary function tests. Results: The A:U ratio and SMIP were recorded for all participants. The SMIP was significantly related to more respiratory performance measures than the maximal inspiratory pressure (P<. 05) and the A:U ratio was significantly related to more respiratory performance measures than any other anthropometric measure (P<. 05). Additionally, an A:U ratio cutoff point detected individuals with a peak expiratory flow >= 80% of their predicted value with a sensitivity and specificity of 85.7% and 91.3%, respectively (area under the curve: 0.92). Conclusions: It is feasible to capture the A:U Ratio and SMIP in individuals with spinal cord injury. Further, the strong significant relationships of SMIP and the A:U ratio to respiratory performance measures suggests their clinical importance in the pulmonary assessment and risk stratification of people with chronic spinal cord injury. (C) 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A phase 1 open-label, non-randomized clinical trial was conducted to determine feasibility and safety of autologous human Schwann cell (ahSC) transplantation accompanied by rehabilitation in participants with chronic spinal cord injury (SCI). Magnetic resonance imaging (MRI) was used to screen eligible participants to estimate an individualized volume of cell suspension to be implanted. The trial incorporated standardized multi-modal rehabilitation before and after cell delivery. Participants underwent sural nerve harvest, and ahSCs were isolated and propagated in culture. The dose of culture-expanded ahSCs injected into the chronic spinal cord lesion of each individual followed a cavity-filling volume approach. Primary outcome measures for safety and trend-toward efficacy were assessed. Two participants with American Spinal Injury Association Impairment Scale (AIS) A and two participants with incomplete chronic SCI (AIS B, C) were each enrolled in cervical and thoracic SCI cohorts (n = 8 total). All participants completed the study per protocol, and no serious adverse events related to sural nerve harvest or ahSC transplantation were reported. Urinary tract infections and skin abrasions were the most common adverse events reported. One participant experienced a 4-point improvement in motor function, a 6-point improvement in sensory function, and a 1-level improvement in neurological level of injury. Follow-up MRI in the cervical (6 months) and thoracic (24 months) cohorts revealed a reduction in cyst volume after transplantation with reduced effect over time. This phase 1 trial demonstrated the feasibility and safety of ahSC transplantation combined with a multi-modal rehabilitation protocol for participants with chronic SCI.

Loss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in a subject with complete cervical quadriplegia (C5 ASIA Impairment Scale A) using a portable fully implanted brain-computer interface (BCI) within the home environment. The BCI consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic (ECoG) activity. Movement-intent was used to trigger functional electrical stimulation (FES) of the dominant hand during an initial 29-week laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement intent information could be decoded consistently throughout the 29-week in-laboratory study with a mean accuracy of 89.0% (range 78-93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. After study week 23, the subject began to be able to extend his right thumb volitionally in the absence of the FES orthosis. At home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80-98.95%) and an accuracy of 88.3% (range 77.6-95.5%) during closed-loop trials. A fully implanted BCI can be safely used to reliably decode movement intent from motor cortex, allowing for accurate volitional control of hand grasp and may potentially re-engage latent neural pathways to allow targeted re-innervation of muscles below the level of injury. (Funded by the Miami Project to Cure Paralysis; ClinicalTrials.gov number, NCT02564419.)

Objective To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. Design The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. Setting Research facility. Participants Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). Intervention Not applicable. Main Outcome Measures IMP, LOI, UEMS, FIST-SCI. Results UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). Conclusions The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.

Abstract Loss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in one 21-year-old male subject with complete cervical quadriplegia (C5 American Spinal Injury Association Impairment Scale A) using a portable fully implanted brain–computer interface within the home environment. The brain–computer interface consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic activity. Movement-intent was used to trigger functional electrical stimulation of the dominant hand during an initial 29-weeks laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement-intent information could be decoded consistently throughout the 29-weeks in-laboratory study with a mean accuracy of 89.0% (range 78–93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. At-home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80–98.95%) and an accuracy of 88.3% (range 77.6–95.5%) during closed-loop trials. Importantly, the temporal stability of both the functional outcomes and decoder metrics were not explored in this study. A fully implanted brain–computer interface can be safely used to reliably decode movement-intent from motor cortex, allowing for accurate volitional control of hand grasp.

Introduction Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications ( n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. Case presentation A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). Discussion The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.

OBJECTIVES:Seated balance (SB) is substantially compromised and greatly impacts the function of individuals living with a spinal cord injury (SCI). A clinically applicable criterion standard measure for SB does not exist for this population. Initial validation and reliability analysis of the Function in Sitting Test (FIST) in SCI has been published, but the authors of this study report that modifications to the tool may be necessary. This study aimed to explore the psychometrics and clinical utility of a modified version of the FIST to better measure SCI-specific functional tasks in sitting.DESIGN:The FIST was modified (FIST-SCI) by an expert panel and used by 2 graders to evaluate the SB of individuals with chronic SCI (cSCI) on 2 separate days. The Motor Assessment Scale item 3 (MAS-SCI) was included as a comparison measure.SETTING:Research facility.PARTICIPANTS:Individuals with cSCI longer than 1 year (N=38) participated in the study. Injury levels of individuals participating in this study spanned C1 to T10 (American Spinal Injury Association Impairment Scale A, 17 subjects; B, 12 subjects; and C, 9 subjects). Thirteen individuals required assistance to transfer.INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:Validity, reliability, internal consistency, sensitivity, specificity, and responsiveness.RESULTS:Validity testing found a moderate relationship between the MAS-SCI and the FIST-SCI (ρ, .522; P<.05). FIST-SCI scores distinguished individuals requiring assistance to transfer from those who were independent (t=4.51; P<.05). Inter- and intra-rater reliability were excellent (intraclass correlation coefficient (2,k)=.985 and .983, respectively) and internal consistency was excellent (α=.94). A FIST-SCI cutoff score of 45 or greater was 92% sensitive and specific in characterizing transfer ability. Standard error of the measure (1.3) and minimal detectable change (3.5) were similar to previous work.CONCLUSIONS:Initial validity of the FIST-SCI is reported, but further assessment is required. Reliability is excellent in the cSCI population. FIST-SCI scores provide clinical insight into the seated functional ability of individuals with cSCI.