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Walking Index for Spinal Cord Injury (WISCI) and WISCI II

Previously Mr. MR enjoyed exercising 4 days per week at the rehabilitation hospital central gym, accessing the community with public transportation bus service, and visiting with friends and family. At 6 months post injury, Mr. Rajah has been making good progress. He is living independently, and is looking forward to returning to driving. The clinical team discusses the merits of the Walking Index for Spinal Cord Injury (WISCI) and WISCI II for patient assessment.
What does the WISCI I and II test?
1. The WISCI a measure of ambulation was developed for specifically for SCI clinical trials using a modified Delphi technique. The WISCI II is a SCI specific measure developed to assess functional walking capacity, including the amount of physical assistance and/or braces required. It would be a useful to incorporate the WISCI II in clinical practice and to evaluate new SCI therapies. Additional tests may be necessary to assess endurance (e.g. 6MWT) and/or walking speed (eg.10MWT), especially for individuals with greater walking capacity.
Describe the WISCI I and II.
1. Existing measures of function (e.g. FIM, Barthel Index, Rivermead Mobility Index) do not adequately measure walking ability due to the limited scale responses (i.e. not sufficient incremental differences between levels). The WISCI evaluates the amount of physical assistance, braces or devices required to walk at 10 m.
2. The original WISCI incorporated 20 levels, including increasing levels of physical assistance and devices (arm devices for using parallel bars, walkers, crutches and canes as well as leg braces) required for walking. Level 0 was “patient is unable to stand and/or participate in walking” to level 19 “ambulates with no devices, no braces and physical assistance, 10m”.
3. The WISCI II contains an additional item “ambulates with no devices, with brace and no assistance”.
4. Ten meter distance selected as it represents household ambulation and it represents the international metric.
Describe WISCI I and II numerical rating system.
1. The clinician observes and rates the level which the person is considered safe. For the WISCI II, a score from 0 to 20 is assigned. It is not clear if practice tests are allowed.
What are the advantages of the WISCI I and II ?
1. The WISCI II is an SCI specific test. It covers the entire range of walking ability.
2. Unlike other tests such as the Timed Up and Go, the WISCI II scoring includes the type of assistance or device required.
3. A score is possible even if the individual cannot walk 10 m.
4. The hierarchical ranking of the WISCI II scale has been validated by demonstration of monotonic progression of walking capacity.
What are the disadvantages of the WISCI I and II?
1. The WISCI II does not consider walking speed or energy consumption required for walking or an indication of endurance since the distance covered is only 10m.
2. Because the furthest walk distance is 10m, it would not be suitable for individuals with minor impairments. In one study, 17% (42/249) of individuals had a score of 20 (i.e. ceiling effect).
3. Comparisons with timed tests (e.g. 6 Minute Walk Test, 10 Meter Walk Test) indicated that the WISCI II is not as responsive.
4. Walking speed data would improve responsiveness and decrease the ceiling effect.
Summary – WISCI I and II

Interpretability – No normative data or cut scores are available but the WISCI II is gaining popularity and comparisons can be made with existing studies. Scores are self-evident.

Acceptability – The WISCI levels are relevant to individuals with SCI. There is no additional burden is as the test falls into typical clinical practice parameters.

Feasibility – Equipment required is typically available in the clinical setting and includes: 5 meter parallel bars and walking devices (e.g. braces, cane, walker). Administration time is client dependent. Special training beyond knowledge of ambulation is not required. Scoring definitions provided are clear. Information regarding specific instructions (e.g. practice attempts) is lacking.