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Spinal Cord Ability Ruler
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For more information about the instrument Spinal Cord Ability Ruler
Classification
Exploratory: Spinal Cord Injury (SCI)
Short Description of Instrument
The Spinal Cord Ability Ruler (SCAR) was developed using items from the upper limb motor assessments of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM) to create an interval scale to measure volitional performance after SCI (Catz, Itzkovich et al. 2007, Fromovich-Amit, Biering-SØrensen et al. 2009, Kirshblum, Waring et al. 2011, Bluvshtein, Front et al. 2012, Reed, Mehra et al. 2017, Harvey 2018). A Rasch analysis was used to develop a new scoring system. The SCAR was developed and tested using the European Multicenter Study about Spinal Cord Injury (EMSCI) database and included individuals with tetraplegia and paraplegia (Reed, Mehra et al. 2017).
Scoring
The SCAR contains the right and left C5-C8 strength scores; 16 items from the Spinal Cord Independence Measure (SCIM). An overall score of 0-100 points is derived using a formula that transforms the logit score of the existing 6-point manual muscle test used in the International Standards for Neurological Classification of SCI Worksheet (ISNCSCI) and each of the included SCIM items are coded with a score transformation (Reed, Mehra et al. 2017).
Rationale/Justification
The SCAR was developed and tested using the European Multicenter Study about Spinal Cord Injury (EMSCI) database (Reed, Mehra et al. 2017). It is a novel application of combining scores from the ISNCSCI and the SCIM to create a new scoring system to measure volitional performance and does not involve new items of measurement.
 
Strengths/Weaknesses: The SCAR can be used retrospectively on data that have already been collected because the revised scores can be derived from the original scores (Harvey 2018). The SCAR should be used "cautiously in clinical trials involving people with suspected central cord syndromes." (Harvey 2018)
References
Key reference:
Reed R, Mehra M, Kirshblum S, Maier D, Lammertse D, Blight A, et al. Spinal cord ability ruler: an interval scale to measure volitional performance after spinal cord injury. Spinal Cord. 2017;55:730-738.
 
Additional references:
Bluvshtein V, Front L, Itzkovich M, Benjamini Y, Galili T, Gelernter I, Aidinoff E, Hart J, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven C, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, BergstrÖm EM, Catz A. A new grading for easy and concise description of functional status after spinal cord lesions. Spinal Cord. 2012 Jan;50(1):42-50.
 
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35:850-856.
 
Catz A, Itzkovich M, Tesio L, Biering-SØrensen F, Weeks C, Laramee MT, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45:275-291.
 
Fromovich-Amit Y, Biering-SØrensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, Hart J, Baskov A, Dreval O, Terese P, Catz A. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord. 2009 Aug;47(8):597-603.
 
Harvey LA. The Spinal Cord Ability Ruler (SCAR): combining aspects of two widely-used outcome measures into one. Spinal Cord. 2018;56:413.
 
Kirshblum SC, Waring W, Biering-Sorensen F, Burns SP, Johansen M, Schmidt-Read M, Donovan W, Graves D, Jha A, Jones L, Mulcahey MJ, Krassioukov A. Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med. 2011;34(6):547-554.
 
Steeves J, Curt A, Mehra M, Rupp R, Blight A, Maier D, Jones L, Lammertse D, Abel R, Kirshblum S, Weidner N. The Spinal Cord Ability Ruler (SCAR) complements the Spinal Cord Independence Measure (SCIM). Spinal Cord. 2018;56(5):525-526.