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Construct Overview of Spinal Cord Injury

Please note that this section is an archive and is no longer being updated.

Background

Spinal Cord Injury (SCI) occurs when there is damage to the spinal cord, which often results in major or permanent life changes. This damage may cause the loss of mobile functioning or paralysis. More than one half of all SCIs occur in the 16- to 30-year-old age group and 82% of the cases have been men.¹ Currently in the United States, there are between 183,000 and 230,000 individuals living with SCI.² Many times following SCI, individuals may go through a period of physical and psychological adjustment. SCI could change one's life by affecting their physical functioning, independence, and sexual, social and vocational roles.³

Interventions with SCI include those that focus on adjustment following the injury itself. Factors such as independent functionality and quality of life are focused on with individuals with SCI.

VA Relevance

Research suggests that many veterans struggle with adjusting to SCI.⁴ During this period of change individuals may experience feelings of depression.⁴ Impaired psychological functioning and high levels of stress may be more prevalent in persons with disabilities than in the general population.^4,5 There is not a higher prevalence of SCI in the veteran population as compared to the general population. However, there have been several studies that have focused on the veteran population in investing different factors related to SCI, such as Posttraumatic Stress Disorder (PTSD). Research has found that SCI veterans with paraplegia had more severe current PTSD symptoms as compared to SCI veterans with quadriplegia.¹⁰ The same study concluded that SCI does not significantly increase PTSD prevalence in the veteran population, and perhaps the reason that quadriplegic veterans do not experience the symptoms related to PTSD is because they have high levels of damage to the spinal cord that could impact the nerve fibers that are responsible for the sympathetic arousal relate to PTSD.¹⁰ An individual's risks for PTSD and overall ability to function after SCI is of great importance to clinicians in order to develop programs to best meet their needs.

Measurement

There are a few instruments that have been used to assess different factors in individuals with SCI. These factors include physical impairment, functional ability, psychological functioning, and quality of life. The instruments used to assess factors in SCI individuals include structured interviews, self-report questionnaires, as well as direct observation.

Structured interviews enable an individual to answer questions in a consistent and standardized manner. Instruments requiring self-reports and direct observation can be more subjective and require more evidence for reliability. Some reports have indicated that there are reliable and valid measures of SCI.⁸ Instruments used with SCI individuals have been widely used with stroke patients and other injuries that have caused disabilities. The instruments are most often used to monitor change when individuals are in rehabilitation programs. The goal for the instruments is to measure the functional and psychological outcome of individuals who may have experienced a SCI or another injury that affects their functional and psychological ability. Although some instruments used with SCI individuals have been found to be reliable, many of the instruments used with SCI individuals to assess quality of life have been found to have low psychometric standards.⁹ Thus, further studies are needed to evaluate the psychometric properties of instruments measuring different factors in individuals with SCI.

Through literature review, METRIC identified three commonly used interviewer-administered, self-report, and direct observation instruments used with SCI individuals and ranked them according to number of citations, as determined by the ISI Web of Knowledge.¹¹ What follows is a brief summary of each instrument and three applicable references.

Most Frequently Cited Instruments

1. Functional Independence Measure (FIM)
   [105 Citations]
2. Barthel Index
   [26 Citations]
3. Quality of Life Index (QOLI)
   [12 Citations]

1. Go BK, DeViro MJ, Richards JS. The epidemiology of spinal cord injury. In Spinal Cord Injury: Clinical Outcomes from the Model Systems. SL Stover, J.A. DeLisa, & G.G. Whiteneck (Eds). 1995; 21-55. Gaithersburg, MD: Aspen.
2. Ditre JW, Radnitz CL. Pre-and postinjury substance misuse among veterans with spinal cord injury. Rehabilitation Psychology. 2005; 50(2): 142-148.
3. Middleton JW, Tate RL, Geraghty TJ. Self-efficacy and spinal cord injury: psychometric properties of a new scale. Rehabilitation Psychology. 2003; Nov: 48(4): 281-288.
4. Radnitz CL, Broderick CP, Perez-Strumolo L, Tirch DD, Festa J, Schlein IS, Walczak S, Willard J, Lillian LB, Binks M. The prevalence of psychiatric disorders in veterans with spinal cord injury: A controlled comparison. J Nerv Ment Dis. 1996; July 184(7): 431-433. [Abstract]
5. Rintala DH, Robinson-Whelen S, Matamoros, R. Subjective stress in male veterans with spinal cord injury. Journal of Rehabilitation Research & Development. 2005; May/June: 42(3): 291-304. [Abstract]
6. May LA, Warren, S. Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord. 2002; 40: 341-350. [Abstract]
7. Timbeck RJ, Spaulding SJ. Ability of the functionality independence measure to predict rehabilitation outcomes after stroke: a review of the literature. Physical & Occupational Therapy in Geriatrics. 2003; 22(1): 63-76.
8. Roth E, Davidoff G, Haughton J, Ardner M. Functional assessment in spinal cord injury: a comparison of the modified Barthel Index and the 'adapted' functional independence measure. Clinical Rehabilitation. 1990; 4: 277-285.
9. May LA, Warren S. Measuring quality of life of persons with spinal cord injury: external and structural validity. Spinal Cord. 2002; 40: 341-350.
10. Radnitz CL, Hsu L, Tirch DD, Willard J, Lillian LB, Walczak S, Festa J, Perez-Strumolo L, Broderick CP, Binks M, Schlein I, Bockian N. A comparison of Posttraumatic Stress Disorder in Veterans With and Without Spinal Cord Injury. Journal of Abnormal Psychology. 1998; November 107(4): 676-680. [Abstract]
11. ISI Web of Knowledge, Accessed October 2005. Available: http://isi01.isiknowledge.com/portal.cgi/wos/.