Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)

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Tool Description

  • SCI-specific ambulation measure focusing on gait abnormalities.
  • The gait parameters were developed by a panel of experts in SCI rehabilitation and consist of three components:

1. Gait parameter (weight shift, step width, step rhythm, step height, foot contact, step length)

2. Assistive devices use (degree of assistance provided by each of device - eg. cane, walker, parallel bars

3. Walking mobility (walking distance, speed, and walking frequency)

ICF Domain:

Activity – subcategory: Mobility.

Number of Items:

10

Brief Instructions for Administration & Scoring

Administration:

  • Clinician-administered; self-report and performance based measure.
  • Clinicians provide scores for each of the gait parameter and assistive device use components.
  • In the walking mobility component, subjects are asked about their walking frequency on a scale of 0 to 5 (0 = does not walk; 5 = regularly walks in community). The distance walked in two minutes is also measured.  Walking can be videotaped for later evaluation.
  • Administration time is very quick (approximately 5 minutes).

Equipment: None.

Scoring:

  • The gait parameter component is scored out of 20, 10 points for each of the right and left sides.
  • The assistive device component is scored out of 14 (7 points for each side), and assesses upper and lower extremities in addition to the left and right limbs.
  • Scores within each component are summed. Component scores range from 0 to 20 in the gait parameter component, 0 to 14 in the assistive device component, and 0 to 5 in the walking mobility component.
  • It is not meaningful to combine component scores into an overall total score.

Interpretability

MCID: not established in SCI
SEM: 0.7 points (gait parameter subscale, Lam et al. 2008)
MDC: Smallest Real Difference (SRD) = 1.9 points (13%) (gait parameter subscale, Lam et al. 2008)

  • Higher score indicate better levels of function.
  • No cut scores or norms have been established for the SCI population.
  • Published data for the SCI population are available for comparison (see Interpretability section of the Study Details sheet).

Languages:

English.

Training Required:

None.

Availability:

See the ‘How-to use’ page of this tool.

Clinical Considerations

  • The SCI-FAI can only be used among SCI patients who can ambulate independently, with or without the use of assistive devices.
  • The SCI-FAI can be completed during regular check ups or during home visits. Individuals walk for a maximum of 2 minutes and can use whatever walking devices they require. The SCI-FAI is short in duration and scoring is straightforward for all items on the scale.

Measurement Property Summary

# of studies reporting psychometric properties: 3

Reliability:

  • Inter-rater reliability of the SCI-FAI is high for video-taped testings (ICC=0.800-0.840) and moderate for live testing (ICC=0.703).
  • Intra-rater reliability across the 4 raters was high (ICC=0.850-0.956).

[Field-Fote et al. 2001]

Validity:

  • There is an moderate correlation (r=0.58) between % change in gait score and change in Lower Extremity Motor Scores (LEMS).
  • Correlation of SCI-FAI subscales (parameter, assistive devices and mobility) is high with the:
    • Berg Balance Scale (Spearman’s r=0.714-0.747)
    • 2 Minute Walk Test (Spearman’s r=0.688-0.805)
    • Walking Index of Spinal Cord Injury II (Spearman’s r=0.630-0.980)
    • 10 Meter Walk Test (Spearman’s r=0.756-0.788)
    • Timed Up and Go test (Spearman’s r=-0.724- -0.802).

[Field-Fote et al. 2001, Datta et al. 2009, Lemay & Nadeau 2010]

Responsiveness:

  • Subjects who participated in experimental walking rehabilitation intervention, showed a statistically significant increase (44.7%) in mean gait score following training.

[Field-Fote et al. 2001]

Floor/ceiling effect:

  • Ceiling effect was present on 3 subscales (parameter, assistive devices and walking mobility) of the SCI-FAI; % of subjects reaching maximal score on the scale for each is as follows:
    • Parameter – 68.8%
    • Assistive Devices – 34.4%
    • Walking Mobility – 34.4%.

[Lemay & Nadeau 2010]

Reviewer

Dr. Janice Eng, Marzena Zhou

Date Last Updated:

Mar 2, 2017

Download the measure

Download Worksheet:

Worksheet Document

Video

n/a

Scoring

The gait parameter component is scored out of 20, 10 points for each of the right and left sides. The assistive device component is scored out of 14 (7 points for each side), and assesses upper and lower extremities in addition to the left and right limbs. In the walking mobility component, subjects are asked about their walking frequency on a scale of 0 to 5 (0 = does not walk; 5 = regularly walks in community). The distance walked in two minutes is also measured.  Walking can be videotaped for later evaluation.

Equipment Needed

SCI-FAI:

Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries. Arch Phys Med Rehabil 2009;90:1208-17.
http://www.ncbi.nlm.nih.gov/pubmed/19577035

Field- Fote E, Fluet G, Schafer S, Scheider E, Smith R, Downey P, Huhl C. The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). J Rehabil Med. 2001;33:177-181
http://www.ncbi.nlm.nih.gov/pubmed/11506216

Lam T, Noonan VK, Eng JJ. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord. 2008;46(4):246-54.
http://www.ncbi.nlm.nih.gov/pubmed/17923844

Lemay JF and Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord (2010) 48, 245–250; doi:10.1038/sc.2009.119
http://www.ncbi.nlm.nih.gov/pubmed/19773797