Comparison of functional and medical assessment in the classification of persons with spinal cord injury

Abstract

For many reasons, persons with spinal cord injury (SCI) are classified according to a set of guidelines in which the term classification refers to a numeric value based on some selection of motor, sensory, and/or functional tests. The resulting classification is used as a means of quantifying the extent of neurological injury. Scales that focus on neurological injury (in the acute phase) differ from those that focus on functional ability (in the chronic phase). The relationship among these scales in grouping persons with SCI has not been ascertained. The purpose of the present study was to compare several classification systems within the same group of spinal cord injured subjects. Thirty subjects with traumatic SCI were classified by the same examiner and grouped according to three classification systems: 1) the American Spinal Injury Association (ASIA) Scale; 2) the Bracken Scale; and, 3) the wheelchair basketball (BB) Sports Test. Calculation of Spearman's Rho correlation coefficients showed positive associations between the ASIA Scale and BB Sports Test (0.81). The Bracken Scale showed a negative correlation with the ASIA system (-0.66) and the BB Sports Test (-0.48). Of the three classification systems, the ASIA Scale showed the greatest discrimination in grouping subjects with SCI in both mixed (complete and incomplete), as well as incomplete injuries. It was clear that these three systems could result in different patterns of subject grouping and thus might affect the outcome of the clinical research studies.