Original Article
Spinal Cord (2007) 45, 452–459; doi:10.1038/sj.sc.3101987; published online 3 October 2006
The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths
M J Mulcahey1, J Gaughan2, R R Betz3 and K J Johansen4
- 1Rehabilitation and Clinical Research, Shriners Hospitals for Children, Philadelphia Hospital, Philadelphia, PA, USA
- 2Department of Biostatistics, Temple University School of Medicine, Temple University, Philadelphia, PA, USA
- 3Department of Orthopaedics, Shriners Hospitals for Children, Philadelphia Hospital, Philadelphia, PA, USA
- 4Faculty Development/Colloquia Lead School of Education, Capella University, Minneapolis, MN, USA
Correspondence: MJ Mulcahey, Rehabilitation and Clinical Research, Shriners Hospitals for Children, Philadelphia Hospital, 3551 North Broad Street, Philadelphia, PA 19140, USA
Abstract
Study design:
Intra-rater reliability study, cross-sectional design.
Objectives:
To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children.
Setting:
Nonprofit pediatric hospital.
Methods:
In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury. Coefficients >0.90=high reliability; 0.75–0.90=moderate reliability and <0.75=inadequate reliability.
Results:
Children <four years (N=7) were unable to participate in the exams. TM ICC, CI=0.888, 0.821–0.93 (N=73); PP ICC, CI=0.975, 0.96–0.98 (N=67) and LT ICC, CI=0.974, 0.974–0.985 (N=68). When age was considered, 4–5 year: TM ICC, CI=0.917, 0.69–0.98 (N=11), PP=0.912, 0.49–0.985 (N=7), LT=0.948, 0.63–0.993 (N=6); for 6–11 year: TM ICC, CI=0.711, 0.226–0.892 (N=18), PP=0.952, 0.867–0.983 (M=17), LT=0.952, 0.867–0.983 (N=17); for 12–15 year: TM ICC, CI=0.893, 0.723–0.959 (N=19), PP=0.982, 0.953–0.993 (N=19), LT=0.982, 0.953–0.993 (N=19); for 16–21 year: TM ICC, CI=0.912, 0.80–0.961 (N=25), PP=0.98, 0.954–0.991 (N=25), LT=0.98, 0.954–0.991 (N=25). ICC for severity and type of injury >0.90 except for TM in complete injuries (0.808).
Conclusion:
The ISCSCI exams may have poor utility in children under 4 years. While reliability values for the motor and sensory exams met or exceeded recommended values, wide CI suggest poor precision of the motor exam in children under 15 years of age and sensory exams in children under 5 years.
Sponsorship:
This study was supported by the Shriners Hospitals for Children, Philadelphia Hospital.
Keywords:
tetraplegia, paraplegia, rehabilitation
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