Purpose. To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. Method. 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. Results. 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 α 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. Conclusions. 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.

The recovery of walking function is considered of extreme relevance both by patients and physicians. Consequently, in the recent years, recovery of locomotion become a major objective of new pharmacological and rehabilitative interventions. In the last decade, several pharmacological treatment and rehabilitative approaches have been initiated to enhance locomotion capacity of SCI patients. Basic science advances in regeneration of the central nervous system hold promise of further neurological and functional recovery to be studied in clinical trials. Therefore, a precise knowledge of the natural course of walking recovery after SCI and of the factors affecting the prognosis for recovery has become mandatory. In the present work we reviewed the prognostic factors for walking recovery, with particular attention paid to the clinical ones (neurological examination at admission, age, aetiology gender). The prognostic value of some instrumental examinations has also been reviewed.Based on these factors we suggest that a reliable prognosis for walking recovery is possible. Instrumental examinations, in particular evoked potentials could be useful to improve the prognosis.

Recent progress with spinal cord injured (SCI) patients indicates that with training they can recover some locomotor ability. Here we addressed the question of whether locomotor responses developed with training depend on re‐activation of the normal motor patterns or whether they depend on learning new motor patterns. To this end we recorded detailed kinematic and EMG data in SCI patients trained to step on a treadmill with body‐weight support (BWST), and in healthy subjects. We found that all patients could be trained to step with BWST in the laboratory conditions, but they used new coordinative strategies. Patients with more severe lesions used their arms and body to assist the leg movements via the biomechanical coupling of limb and body segments. In all patients, the phase‐relationship of the angular motion of the different lower limb segments was very different from the control, as was the pattern of activity of most recorded muscles. Surprisingly, however, the new motor strategies were quite effective in generating foot motion that closely matched the normal in the laboratory conditions. With training, foot motion recovered the shape, the step‐by‐step reproducibility, and the two‐thirds power relationship between curvature and velocity that characterize normal gait. We mapped the recorded patterns of muscle activity onto the approximate rostrocaudal location of motor neuron pools in the human spinal cord. The reconstructed spatiotemporal maps of motor neuron activity in SCI patients were quite different from those of healthy subjects. At the end of training, the locomotor network reorganized at both supralesional and sublesional levels, from the cervical to the sacral cord segments. We conclude that locomotor responses in SCI patients may not be subserved by changes localized to limited regions of the spinal cord, but may depend on a plastic redistribution of activity across most of the rostrocaudal extent of the spinal cord. Distributed plasticity underlies recovery of foot kinematics by generating new patterns of muscle activity that are motor equivalents of the normal ones.

What are the building blocks with which the human spinal cord constructs the motor patterns of locomotion? In principle, they could correspond to each individual activity pattern in dozens of different muscles. Alternatively, there could exist a small set of constituent temporal components that are common to all activation patterns and reflect global kinematic goals. To address this issue, we studied patients with spinal injury trained to step on a treadmill with body weight support. Patients learned to produce foot kinematics similar to that of healthy subjects but with activity patterns of individual muscles generally different from the control group. Hidden in the muscle patterns, we found a basic set of five temporal components, whose flexible combination accounted for the wide range of muscle patterns recorded in both controls and patients. Furthermore, two of the components were systematically related to foot kinematics across different stepping speeds and loading conditions. We suggest that the components are related to control signals output by spinal pattern generators, normally under the influence of descending and afferent inputs.