S. Aito - Academia.edu (original) (raw)
Papers by S. Aito
The Neuroradiology Journal, 2003
The Neuroradiology Journal, 2009
Spinal Cord, 2003
Objectives: To assess the incidence of complications during the acute stage of spinal cord lesion... more Objectives: To assess the incidence of complications during the acute stage of spinal cord lesions and the possible correlations between them and the type of care and rehabilitation provided. Setting: Spinal cord injured patients consecutively admitted to 37 Italian Rehabilitation Centres (RCs). Methods: The study population was drawn from the GISEM (Italian Group for the Epidemiological Study of Spinal Cord Injuries) study (1997-1999), which involved the participation of 37 RCs and Spinal Units (SUs), situated all over Italy, mainly in the northern and central part of the country. Only patients admitted within 60 days from the traumatic injury were considered. This yielded a population of 588 patients (18% females and 82% males). Six of the most common complications were considered: trophic skin changes, heterotopic ossifications, urinary complications, respiratory complications, deep-vein thrombosis and pulmonary embolism. Results: Results revealed a high incidence of trophic skin changes (23.3%), while over half of the patients presented at least one of the complications under examination. Trophic skin changes occurred exclusively among the patients whose admission to the SUs had been delayed or who had received initial treatment in nonspecialised Centres. Conclusions: Optimal rehabilitation care, with regard to the prevention of complications during the acute phase, entails early admission to a specialised multidisciplinary facility, namely an SU.
Spinal Cord, 2014
Study design: Retrospective data analysis. Objectives: Traumatic spinal cord injury (TSCI) is a d... more Study design: Retrospective data analysis. Objectives: Traumatic spinal cord injury (TSCI) is a devastating injury that causes a lifelong disability, involving mostly young men. The aim of the study was to analyse some clinical and epidemiological features of TSCI patients admitted to the Spinal Unit of
Spinal Cord, 2005
Introduction: Diving accidents mostly occur in a young and healthy population and most of the pat... more Introduction: Diving accidents mostly occur in a young and healthy population and most of the patients develop tetraplegia with a severe lifelong disability. From 1978 to 2002, 65 patients with spinal injuries due to diving accidents were admitted to the Regional Spinal Unit of Florence. Material and methods: A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. Results: In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. Conclusions and discussion: Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8 h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.
Spinal Cord, 2014
Dear Spinal Cord reader, ISCoS has officially been recognised as an NGO by the World Health Organ... more Dear Spinal Cord reader, ISCoS has officially been recognised as an NGO by the World Health Organisation. Our Society, then, besides improving the knowledge of the pathologies derived by spinal cord impairments and promoting research and continuous cultural interchange among clinicians and researchers, will be more and more directed towards the implementation of new prevention strategies and the establishment of new specialised centres. In order to reach such goals, that represent an essential part of our mission, it is mandatory to sensibilize and involve the civil society. ISCOS shall advise, encourage, guide and support the efforts of those responsible for the care of people with spinal cord lesions and when requested, coordinate these activities throughout the world. It should then advertise its issues towards the political world, the public administrators, the productive society, health and charity organizations, NGOs and other stakeholders. Our collaboration with the World Health Organization (WHO) is an essential part of this issue. We have worked along with WHO officers and with them we have published IPSCI (International Perspectives on Spinal Cord Injury), that summarizes the best available evidence and suggests measures for improving the survival, health and participation of people with spinal cord injury. ISCoS and WHO will continue to join forces in areas where they can make the greatest difference, especially in prevention and educational issues worldwide. Such collaboration has finally resulted in the official acknowledgment of ISCOS by WHO, as one of the most significant organization in the field of Spinal Cord Injuries. In order to attend this role, ISCOS mission includes the better understanding of the phenomenon of Spinal Cord Injuries (SCI) worldwide by the epidemiological point of view, with the aim of proposing the most appropriate prevention strategies to the public administrators and governments, given that causes of Spinal Cord Injuries are very different from one area of the globe to another. ISCOS is then more and more becoming an Organisation whose role is also represented by the capacity of influencing the health political strategies both in the fields of prevention and treatment. In our role of NGO and representatives of the civil society, we are invited by WHO to participate to the regional meetings as well as to the plenary global meetings. In Turkey, last September 2013, the European regional meeting was held. In that occasion we stressed the importance of enhancing the prevention strategies of major traumas and Spinal Cord Lesions and the necessity to cover all European areas with specialised centres, in order to give all the European citizens the same chances of surviving and having an acceptable quality of life with the right social integration (http://www.youtube.com/watch?v ¼ drWM0ZqGELI). ISCOS is now supporting the establishment of a Spinal Unit in Albania, where, at the moment, the needed specialised assistance in absent. It has designated one of its members as Ambassador to Albania and, together with the local Authorities, is driving such project, also by providing the needed education to the involved health professionals. With the same aim ISCOS has previously created an Internet based learning platform, able to give both the basic and advanced knowledge to all those interested in such issue. Recognising the need to disseminate information about comprehensive management of Spinal Cord Injury (SCI), ISCoS took the initiative to develop elearnSCI.org, a web-based teaching and educational resource. The content has been developed by 332 leading SCI professionals and educationists from around the world and reflects realities in both high and low resource settings. It will be of relevance to students, those new to the field of SCI and to SCI practitioners everywhere. This program is totally free and may be used by doctors of different disciplines, nurses, physiotherapists, occupational therapists, psychologists, social workers and peer consultants. We are sure that our collaboration with WHO will contribute to enhance the efforts towards the goals of ISCoS and finally to serve the persons with SCI. It will represent another very important challenge that we are proud to deal with.
Spinal Cord, 2008
Background: To assess over the past year the sexuality of male patients with spinal-cord injury (... more Background: To assess over the past year the sexuality of male patients with spinal-cord injury (SCI) over 50 years of age with spinal lesions of at least 20 years. Methods: Subjects were stratified in two groups: 44 individuals under 60 years and 55 individuals over 60 years. A detailed sexual anamnesis was taken for all, and the SF-36 Health Survey questionnaire was completed, with questions 13 and 14 concerning overall sexual life answered through the International Index of Erectile Function. Results: The younger group reached a median score of þ 50 for each domain of the SF-36; however, the differences between the two groups are not statistically relevant. The physical domain of the SF-36 showed a median score of 43.2 for the younger versus 41.1 for the older, whereas the mental domain showed 44.8 and 43.1, respectively. In the first group, 29/44 (65.9) individuals claimed erectile dysfunction versus 43/55 (78.1%) in the second, whereas 34/44 (77.2%) of the first group reported having sexual intercourse versus 13/55 (23.6%) with Po0.01 (w 2 test). In the 2nd, 29/55 (52.7%) individuals reported physical intimacy without sexual intercourse. For each group, the overall sexual satisfaction is statistically correlated to the duration of the relationship (linear progression test Po0.05). Conclusions: Median quality of life was high. Sexual intercourse is fundamental only for males of the first group. Most aging couples presented a different way of thinking about sex without the need for intercourse. Physicians should acquire knowledge about sexuality and aging in SCI patients. Sponsorship: This study was not sponsored.
Spinal Cord, 2013
To develop a web-based educational resource for health professionals responsible for the manageme... more To develop a web-based educational resource for health professionals responsible for the management of spinal cord injury (SCI). The resource: www.elearnSCI.org is comprised of seven learning modules, each subdivided into various submodules. Six of the seven modules address the educational needs of all disciplines involved in comprehensive SCI management. The seventh module addresses prevention of SCI. Each submodule includes an overview, activities, self-assessment questions and references. Development of the resource: Three hundred and thirty-two experts from The International Spinal Cord Society (ISCoS) and various affiliated societies from 36 countries were involved in developing the resource through 28 subcommittees. The content of each submodule was reviewed and approved by the Education and Scientific Committees of ISCoS and finally by an Editorial Committee of 23 experts. Key features: The content of the learning modules is relevant to students and to new as well as experienced SCI healthcare professionals. The content is applicable globally, has received consumer input and is available at no cost. The material is presented on a website underpinned by a sophisticated content-management system, which allows easy maintenance and ready update of all the content. The resource conforms to key principles of e-learning, including appropriateness of curriculum, engagement of learners, innovative approaches, effective learning, ease of use, inclusion, assessment, coherence, consistency, transparency, cost effectiveness and feedback. Conclusion: www.elearnSCI.org provides a cost effective way of training healthcare professionals that goes beyond the textbook and traditional face-to-face teaching.
Neurorehabilitation and Neural Repair, 2014
Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (... more Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) has previously been published. This formula was based on a model of Spinal Cord Independence Measure (SCIM95), the 95th percentile of the SCIM III values, which correspond with the American Spinal Injury Association Motor Scores (AMS) of SCI patients. Objective. To further develop the original formula. Setting. Spinal cord injury centers from 6 countries and the Statistical Laboratory, Tel-Aviv University, Israel. Methods. SCIM95 of 661 SCI patients was modeled, using a quantile regression with or without adjustment for age and gender, to calculate SCI-ARMI values. SCI-ARMI gain during rehabilitation and its correlations were examined. Results. A new quadratic SCIM95 model was created. This resembled the previously published model, which yielded similar SCIM95 values in all the countries, after adjustment for age and gender. Without this adjustment, however, only 86% of the non-Israeli SCIM III observations were lower than those SCIM95 values (P < .0001). Adding the variables age and gender to the new model affected the SCIM95 value significantly (P < .04). Adding country information did not add a significant effect (P…
Spinal Cord, 1999
A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dis... more A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose Methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight Heparin and gastroprotected medication. Complete transection of the spinal cord and
Disability and Rehabilitation, 2007
To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability a... more To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
Spinal Cord, 2006
Background: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three ... more Background: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. Objective: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. Design: Multicenter cohort study. Setting: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. Subjects: 425 patients with spinal cord lesions (SCL). Interventions: SCIM III assessments by professional staff members. Rasch analysis of admission scores. Main outcome measures: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. Results: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. Conclusions: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.
Spinal Cord, 2002
Study design: Prospective clinical trial.Objectives: To evaluate the efficacy of a specific proto... more Study design: Prospective clinical trial.Objectives: To evaluate the efficacy of a specific protocol for prevention of thrombo-embolic disease occurring during the acute stage of spinal cord lesions, based on the simultaneous use of pharmacological plus mechanical procedures.Setting: Regional Spinal Unit of Florence, Italy.Introduction: Deep venous thrombosis (DVT) is a dangerous pathology whose first clinical sign can be represented by unexpected pulmonary embolism (PE). Its incidence in acute spinal cord injured (SCI) patients is reported to range between 9% and 90%. Its prevention represents one of the major challenges for the clinicians involved in the care of such patients.Method: Two hundred and seventy-five SCI patients consecutively admitted to our Centre were investigated by colour doppler ultrasonography of lower limbs and pelvis on admission, after 30–45 days and whenever clinically requested. Subcutaneous Nadroparine, a low molecular weight heparin (LMWH), plus early mob...
The journal of spinal …, 2008
Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel In... more Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF ...
The Neuroradiology Journal, 2003
The Neuroradiology Journal, 2009
Spinal Cord, 2003
Objectives: To assess the incidence of complications during the acute stage of spinal cord lesion... more Objectives: To assess the incidence of complications during the acute stage of spinal cord lesions and the possible correlations between them and the type of care and rehabilitation provided. Setting: Spinal cord injured patients consecutively admitted to 37 Italian Rehabilitation Centres (RCs). Methods: The study population was drawn from the GISEM (Italian Group for the Epidemiological Study of Spinal Cord Injuries) study (1997-1999), which involved the participation of 37 RCs and Spinal Units (SUs), situated all over Italy, mainly in the northern and central part of the country. Only patients admitted within 60 days from the traumatic injury were considered. This yielded a population of 588 patients (18% females and 82% males). Six of the most common complications were considered: trophic skin changes, heterotopic ossifications, urinary complications, respiratory complications, deep-vein thrombosis and pulmonary embolism. Results: Results revealed a high incidence of trophic skin changes (23.3%), while over half of the patients presented at least one of the complications under examination. Trophic skin changes occurred exclusively among the patients whose admission to the SUs had been delayed or who had received initial treatment in nonspecialised Centres. Conclusions: Optimal rehabilitation care, with regard to the prevention of complications during the acute phase, entails early admission to a specialised multidisciplinary facility, namely an SU.
Spinal Cord, 2014
Study design: Retrospective data analysis. Objectives: Traumatic spinal cord injury (TSCI) is a d... more Study design: Retrospective data analysis. Objectives: Traumatic spinal cord injury (TSCI) is a devastating injury that causes a lifelong disability, involving mostly young men. The aim of the study was to analyse some clinical and epidemiological features of TSCI patients admitted to the Spinal Unit of
Spinal Cord, 2005
Introduction: Diving accidents mostly occur in a young and healthy population and most of the pat... more Introduction: Diving accidents mostly occur in a young and healthy population and most of the patients develop tetraplegia with a severe lifelong disability. From 1978 to 2002, 65 patients with spinal injuries due to diving accidents were admitted to the Regional Spinal Unit of Florence. Material and methods: A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. Results: In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. Conclusions and discussion: Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8 h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.
Spinal Cord, 2014
Dear Spinal Cord reader, ISCoS has officially been recognised as an NGO by the World Health Organ... more Dear Spinal Cord reader, ISCoS has officially been recognised as an NGO by the World Health Organisation. Our Society, then, besides improving the knowledge of the pathologies derived by spinal cord impairments and promoting research and continuous cultural interchange among clinicians and researchers, will be more and more directed towards the implementation of new prevention strategies and the establishment of new specialised centres. In order to reach such goals, that represent an essential part of our mission, it is mandatory to sensibilize and involve the civil society. ISCOS shall advise, encourage, guide and support the efforts of those responsible for the care of people with spinal cord lesions and when requested, coordinate these activities throughout the world. It should then advertise its issues towards the political world, the public administrators, the productive society, health and charity organizations, NGOs and other stakeholders. Our collaboration with the World Health Organization (WHO) is an essential part of this issue. We have worked along with WHO officers and with them we have published IPSCI (International Perspectives on Spinal Cord Injury), that summarizes the best available evidence and suggests measures for improving the survival, health and participation of people with spinal cord injury. ISCoS and WHO will continue to join forces in areas where they can make the greatest difference, especially in prevention and educational issues worldwide. Such collaboration has finally resulted in the official acknowledgment of ISCOS by WHO, as one of the most significant organization in the field of Spinal Cord Injuries. In order to attend this role, ISCOS mission includes the better understanding of the phenomenon of Spinal Cord Injuries (SCI) worldwide by the epidemiological point of view, with the aim of proposing the most appropriate prevention strategies to the public administrators and governments, given that causes of Spinal Cord Injuries are very different from one area of the globe to another. ISCOS is then more and more becoming an Organisation whose role is also represented by the capacity of influencing the health political strategies both in the fields of prevention and treatment. In our role of NGO and representatives of the civil society, we are invited by WHO to participate to the regional meetings as well as to the plenary global meetings. In Turkey, last September 2013, the European regional meeting was held. In that occasion we stressed the importance of enhancing the prevention strategies of major traumas and Spinal Cord Lesions and the necessity to cover all European areas with specialised centres, in order to give all the European citizens the same chances of surviving and having an acceptable quality of life with the right social integration (http://www.youtube.com/watch?v ¼ drWM0ZqGELI). ISCOS is now supporting the establishment of a Spinal Unit in Albania, where, at the moment, the needed specialised assistance in absent. It has designated one of its members as Ambassador to Albania and, together with the local Authorities, is driving such project, also by providing the needed education to the involved health professionals. With the same aim ISCOS has previously created an Internet based learning platform, able to give both the basic and advanced knowledge to all those interested in such issue. Recognising the need to disseminate information about comprehensive management of Spinal Cord Injury (SCI), ISCoS took the initiative to develop elearnSCI.org, a web-based teaching and educational resource. The content has been developed by 332 leading SCI professionals and educationists from around the world and reflects realities in both high and low resource settings. It will be of relevance to students, those new to the field of SCI and to SCI practitioners everywhere. This program is totally free and may be used by doctors of different disciplines, nurses, physiotherapists, occupational therapists, psychologists, social workers and peer consultants. We are sure that our collaboration with WHO will contribute to enhance the efforts towards the goals of ISCoS and finally to serve the persons with SCI. It will represent another very important challenge that we are proud to deal with.
Spinal Cord, 2008
Background: To assess over the past year the sexuality of male patients with spinal-cord injury (... more Background: To assess over the past year the sexuality of male patients with spinal-cord injury (SCI) over 50 years of age with spinal lesions of at least 20 years. Methods: Subjects were stratified in two groups: 44 individuals under 60 years and 55 individuals over 60 years. A detailed sexual anamnesis was taken for all, and the SF-36 Health Survey questionnaire was completed, with questions 13 and 14 concerning overall sexual life answered through the International Index of Erectile Function. Results: The younger group reached a median score of þ 50 for each domain of the SF-36; however, the differences between the two groups are not statistically relevant. The physical domain of the SF-36 showed a median score of 43.2 for the younger versus 41.1 for the older, whereas the mental domain showed 44.8 and 43.1, respectively. In the first group, 29/44 (65.9) individuals claimed erectile dysfunction versus 43/55 (78.1%) in the second, whereas 34/44 (77.2%) of the first group reported having sexual intercourse versus 13/55 (23.6%) with Po0.01 (w 2 test). In the 2nd, 29/55 (52.7%) individuals reported physical intimacy without sexual intercourse. For each group, the overall sexual satisfaction is statistically correlated to the duration of the relationship (linear progression test Po0.05). Conclusions: Median quality of life was high. Sexual intercourse is fundamental only for males of the first group. Most aging couples presented a different way of thinking about sex without the need for intercourse. Physicians should acquire knowledge about sexuality and aging in SCI patients. Sponsorship: This study was not sponsored.
Spinal Cord, 2013
To develop a web-based educational resource for health professionals responsible for the manageme... more To develop a web-based educational resource for health professionals responsible for the management of spinal cord injury (SCI). The resource: www.elearnSCI.org is comprised of seven learning modules, each subdivided into various submodules. Six of the seven modules address the educational needs of all disciplines involved in comprehensive SCI management. The seventh module addresses prevention of SCI. Each submodule includes an overview, activities, self-assessment questions and references. Development of the resource: Three hundred and thirty-two experts from The International Spinal Cord Society (ISCoS) and various affiliated societies from 36 countries were involved in developing the resource through 28 subcommittees. The content of each submodule was reviewed and approved by the Education and Scientific Committees of ISCoS and finally by an Editorial Committee of 23 experts. Key features: The content of the learning modules is relevant to students and to new as well as experienced SCI healthcare professionals. The content is applicable globally, has received consumer input and is available at no cost. The material is presented on a website underpinned by a sophisticated content-management system, which allows easy maintenance and ready update of all the content. The resource conforms to key principles of e-learning, including appropriateness of curriculum, engagement of learners, innovative approaches, effective learning, ease of use, inclusion, assessment, coherence, consistency, transparency, cost effectiveness and feedback. Conclusion: www.elearnSCI.org provides a cost effective way of training healthcare professionals that goes beyond the textbook and traditional face-to-face teaching.
Neurorehabilitation and Neural Repair, 2014
Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (... more Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) has previously been published. This formula was based on a model of Spinal Cord Independence Measure (SCIM95), the 95th percentile of the SCIM III values, which correspond with the American Spinal Injury Association Motor Scores (AMS) of SCI patients. Objective. To further develop the original formula. Setting. Spinal cord injury centers from 6 countries and the Statistical Laboratory, Tel-Aviv University, Israel. Methods. SCIM95 of 661 SCI patients was modeled, using a quantile regression with or without adjustment for age and gender, to calculate SCI-ARMI values. SCI-ARMI gain during rehabilitation and its correlations were examined. Results. A new quadratic SCIM95 model was created. This resembled the previously published model, which yielded similar SCIM95 values in all the countries, after adjustment for age and gender. Without this adjustment, however, only 86% of the non-Israeli SCIM III observations were lower than those SCIM95 values (P < .0001). Adding the variables age and gender to the new model affected the SCIM95 value significantly (P < .04). Adding country information did not add a significant effect (P…
Spinal Cord, 1999
A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dis... more A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose Methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight Heparin and gastroprotected medication. Complete transection of the spinal cord and
Disability and Rehabilitation, 2007
To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability a... more To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
Spinal Cord, 2006
Background: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three ... more Background: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. Objective: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. Design: Multicenter cohort study. Setting: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. Subjects: 425 patients with spinal cord lesions (SCL). Interventions: SCIM III assessments by professional staff members. Rasch analysis of admission scores. Main outcome measures: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. Results: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. Conclusions: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.
Spinal Cord, 2002
Study design: Prospective clinical trial.Objectives: To evaluate the efficacy of a specific proto... more Study design: Prospective clinical trial.Objectives: To evaluate the efficacy of a specific protocol for prevention of thrombo-embolic disease occurring during the acute stage of spinal cord lesions, based on the simultaneous use of pharmacological plus mechanical procedures.Setting: Regional Spinal Unit of Florence, Italy.Introduction: Deep venous thrombosis (DVT) is a dangerous pathology whose first clinical sign can be represented by unexpected pulmonary embolism (PE). Its incidence in acute spinal cord injured (SCI) patients is reported to range between 9% and 90%. Its prevention represents one of the major challenges for the clinicians involved in the care of such patients.Method: Two hundred and seventy-five SCI patients consecutively admitted to our Centre were investigated by colour doppler ultrasonography of lower limbs and pelvis on admission, after 30–45 days and whenever clinically requested. Subcutaneous Nadroparine, a low molecular weight heparin (LMWH), plus early mob...
The journal of spinal …, 2008
Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel In... more Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF ...