The Assessment of Walking Capacity Using the Walking Index for Spinal Cord Injury: Self-Selected Versus Maximal Levels
Abstract
Kim MO, Burns AS, Ditunno JF Jr, Marino RJ. The assessment of walking capacity using the Walking Index for Spinal Cord Injury: self-selected versus maximal levels.
Objectives
To assess (1) the frequency and magnitude of differences between self-selected and maximal walking capacity following spinal cord injury (SCI) by using the Walking Index for Spinal Cord Injury (WISCI) and (2) how these levels differ in efficiency and velocity.
Design
Prospective cohort.
Setting
Academic medical center.
Participants
Fifty people with chronic incomplete SCI.
Interventions
Not applicable.
Main Outcome Measures
Subjects ambulated at the level used in the community (self-selected WISCI) and the highest level possible (maximal WISCI). Velocity (in m/s), Physiological Cost Index (PCI), and Total Heart Beat Index (THBI) were calculated. Differences were compared using the paired t test (parametric) or Wilcoxon signed-rank test (nonparametric).
Results
For 36 subjects, maximal WISCI was higher than self-selected WISCI; 21 subjects showed an increase of 3 levels or more. Ambulatory velocity was higher for self-selected WISCI compared with maximal WISCI (.68m/s vs .56m/s, P<.001). PCI and THBI at self-selected WISCI were lower than at maximal WISCI (PCI, 0.99 beats/m vs 1.48 beats/m, P<.001; THBI, 3.39 beats/m vs 4.75 beats/m, P<.001).
Conclusions
Many people with chronic SCI are capable of ambulating at multiple levels. For these people, ambulation at self-selected WISCI was more efficient as evidenced by greater velocity and decreased PCI and THBI. The findings have implications for assessing walking capacity within the context of clinical trials.
aDepartment of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
bDepartment of Rehabilitation Medicine, the Regional SCI Center of the Delaware Valley, Thomas Jefferson University, Philadelphia, PA.
Correspondence to Anthony S. Burns, MD, Thomas Jefferson University, 132 S 10th St, Ste 375, Main Bldg, Philadelphia, PA 19107
Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant no. H133N000023).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT