Spinal Cord Independence Measure (SCIM)

Scale developed to measure the functional abilities of people with SCI and their level of independence when performing basic activities of daily living.
Four versions of the SCIM (I-IV) have been consecutively developed though data is most extensive (and clinicians generally recommend) SCIM-III.
Three areas are assessed:
1. Self-care (feeding, grooming, bathing, and dressing).
2. Respiration and sphincter management.
3. Mobility (bed and transfers and indoor/outdoor).

Clinical Considerations

Note: When assessing function in people with SCI, the Spinal Cord Independence Measure (SCIM) is usually preferred to the FIM because of the more appropriate mobility ratings and questions (e.g., ‘stairs’ item in Locomotion scale; people with SCI in wheelchairs may be fully independent but cannot provide an answer acceptable for this FIM scale).
The SCIM is one of the most frequently used assessment tools in people with SCI and has high clinical relevance in rehabilitation for people with either traumatic/non-traumatic and complete/incomplete SCI.
Minimal staff/patient burden is required as the variables collected are important to patient care and are routinely collected as a component of standard rehabilitation practice.
The SCIM is sensitive enough to measure independence and track functional changes over time in people with SCI, making it a good tool to review progress during the rehabilitation stay and following discharge to the community.
Ceiling and floor effects (especially floor) may be an issue for people who have very high or low level lesions.

ICF Domain

Activity ▶ Self-Care

Instruction for Use and Scoring

Administration

Clinician-administered; a clinician scores the items based on the activities the patient is performing during the regular daily activities or as the patient reports in an interview.
Administration time is usually 30 minutes.

Number of Items

Equipment

None

Scoring

Scores are derived by adding up the items producing a total score (0 to 100) and/or subscale scores (self care: 0-20; respiration and sphincter management: 0-40; mobility 0-40).
Item response scales vary from item to item; ranging from 0-2 to 0-15.

Languages

English, Brazilian, Greek, Spanish, Thai, Turkish, Korean, Chinese

Training Required

None

Availability

The SCIM-III worksheet is available for free and can be found in the SCIM Toolkit here.

Statistical Properties

SCIM-III

# of studies reporting psychometric properties: 24

Interpretability

Higher scores on the SCIM reflect higher levels of independence in performing basic ADLs.

Typical Values: Median Admission/Discharge SCIM Total Scores (by Injury Level):

C1-C4: 19.0/19.0
C5: 21.5/23.5
C6: 25.5/34.5
C7-8: 39.5/50.0
T1-T6: 53.5/63.0
T7-T12: 61.0/66.0

(Ackerman et al. 2010; N=114 (92M, 22F); AIS A: 91 AIS B: 23; C1-4: 13; C5: 16; C6: 18; C7-8: 12; T1-6: 38; T7-12: 17)

Scivoletto et al. (2013) found that at least four points on the Total SCIM is needed to obtain a significant but small improvement and 10 points on the Total SCIM to obtain a significant and substantial improvement.

MCID: Total: 4.20; Self-Care: 1.15; Resp. Sphinct. Mgmt.: 1.82; Mobility Rm. & Toilet: 0.61; Mobility In/Outdoors: 1.21

SEM: Total – 2.96; Self-Care – 0.95; Respiration/Sphincter – 2.19; Mobility (Room/Toilet) – 0.57; Mobility (Indoors/Outdoors) – 0.71

MDC: Total: 8.20; Self-Care: 2.64; Resp. Sphinct. Mgmt.: 6.07; Mobility Rm. & Toilet: 1.59; Mobility In/Outdoors: 1.96

(Scivoletto et al. 2013; N=255; 199 males; traumatic or ischemic SCI, 157 paraplegia, ASIA: 97A, 40B, 52C, 66D; mean (SD) time since injury: 51.6(36.8) days)

Reliability – High

High Internal Consistency – SCIM III, α = 0.83-0.89
(Anderson et al. 2011; N=390; 294 males; 187 tetraplegia, 203 paraplegia; ASIA: 135A, 54B, 80C, 121D; inpatient, mean (SD) age at injury: 45.3(17.9)) (Itzkovich et al. 2007; N=425; 309 males, 116 females; 188 tetraplegia, 237 paraplegia; study conducted between admission and discharge of rehabilitation)
High Inter-rater Reliability: SCIM III, Pearson’s r = 0.81-0.94
(Anderson et al. 2011; N=390; 294 males; 187 tetraplegia, 203 paraplegia; ASIA: 135A, 54B, 80C, 121D; inpatient, mean (SD) age at injury: 45.3(17.9)) (Itzkovich et al. 2007; N=425; 309 males, 116 females; 188 tetraplegia, 237 paraplegia; study conducted between admission and discharge of rehabilitation)
High Intra-class coefficient: SCIM III, ICC = 0.948-0.977
(Itzkovich et al. 2007; N=425; 309 males, 116 females; 188 tetraplegia, 237 paraplegia; study conducted between admission and discharge of rehabilitation)

Validity – Moderate to High

High correlation between SCIM III and Functional Independence Measure (FIM):

r = 0.80-0.84

(Bluvshtein et al. 2011; N=261; male/female ratio = 5:2; 55% tetraplegia, 45% paraplegia; ASIA A-D; study conducted between admission and discharge of rehabilitation; Anderson et al. 2011; N=390; 294 males; 187 tetraplegia, 203 paraplegia; ASIA: 135A, 54B, 80C, 121D; inpatient, mean (SD) age at injury: 45.3(17.9))

High correlation between SCIM III and Modified Barthel Index:

r = 0.88

(Xing et al. 2021; N=102; 64M, 38F; Mean (SD) age 48.8 (15.6) years; 50 Tetraplegia, 52 paraplegia; AIS A=19, B =24, C=8, D=51; Median (IQR) time since injury 2 (1.0-6.8) months)

Moderate to High Sensitivity (correctly identifying true positives) and Specificity (correctly identifying true negatives) for 10 bilateral muscle predictors from UEMS and GRASP-MMT predicting SCIM-III:

SCIM-Self-care at 6 months: Sensitivity = 86.4% (66.7-95.3%), Specificity = 89.2% (75.3-95.7%)

SCIM-Mobility at 6 months: Sensitivity = 92% (75.0-97.8%), Specificity = 91.2% (77.0-96.7%)

(Velstra et al. 2016; N=61, 45 male; Mean age 47, SD = 19 Acute (16-40 days after injury) tetraplegia at recruitment 58/61 traumatic SCI; AIS at 1 month: A=16, B=10, C=7, D=28)

High correlation between SCIM III and SCIM III-SR:

ρ = 0.87-0.95

(Fekete et al. 2013; N=99; 26 females, 73 males; median age: 48 years; complete and incomplete injuries)

High correlation between SCIM III and SCIM IV:

r = 0.89 – 0.99

(Catz et al. 2023; N=648; 476 males, 172 females; mean (SD) age 49 (17) years; level of injury: C1-L5; ASIA A-D)

Responsiveness

The ability to identify a 1-point change (admission to discharge) within the 4 areas of SCIM-III in comparison with the total FIM score were compared using the McNemar test. SCIM-III detected more numerous changes than FIM in 3 of the 4 areas; self-care, respiration and sphincter management, and mobility indoors and outdoors, but not mobility in the room and toilet. The differences between the 2 scales’ responsiveness to changes are not statistically significant.

(Itzkovich et al. 2007; Glass et al. 2009; Bluvshtein et al. 2011; Anderson et al. 2011)

Floor/Ceiling Effect

A floor effect (>50% of participants scoring the minimum at admission) was observed in 13 of 19 skills for the C1-C4 subgroup (esp. Respiration tasks, and tasks that require upper extremity function) as well as for the C5 subgroup skills that required greater upper extremity musculature.
Floor effects are also evident for “transfer ground/wheelchair” item (62%).
Ceiling effects (≥50% of participants scoring maximum at admission) were observed in (mostly lower injury groups):
- Feeding & grooming (T1-12)
- Respiration (C5-8, T1-12)
- Bed mobility (T7-12)
(Ackerman et al. 2010; N=114; 92 males, 22 females; ASIA A-B; level of injury: cervical-thoracic; ≤ 12 months post-SCI; Glass et al. 2009; Anderson et al. 2011)

Reviewer

Dr. Ben Mortenson, Dr. Carlos Cano-Herrera, Tyra Chu

Last Updated

31 December 2024

References

SCIM

Catz A, Goldin D, Fishel B, Ronen J, Bluvshtein V, Gelernter I. Recovery of neurologic function following nontraumatic spinal cord lesions in Israel. Spine 2004;29:2278-2282.
http://www.ncbi.nlm.nih.gov/pubmed/12195063

Catz A, Greenberg E, Itzkovich M, Bluvshtein V, Ronen J, Gelernter I. A new instrument for outcome assessment in rehabilitation medicine: Spinal cord injury ability realization measurement index. Arch Phys Med Rehabil 2004;85:399-404.
http://www.ncbi.nlm.nih.gov/pubmed/15031824

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.
http://www.ncbi.nlm.nih.gov/pubmed/9429264

Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord 2001a;39:97-100.
http://www.ncbi.nlm.nih.gov/pubmed/11402366

Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A. The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure. Disabil Rehabil 2001b;23:263-268.
http://www.ncbi.nlm.nih.gov/pubmed/11336099

Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A. Disability assessment by a single rater or a team: a comparative study with the Catz-Itzkovich spinal cord independence measure. J Rehabil Med 2002;34:226-230.
http://www.ncbi.nlm.nih.gov/pubmed/12392238

Catz A, Itzkovich M, Tesio L, Biering-SÃ¸rensen F, Weeks C, Laramee M, Craven BC, Tonack M, Hitzig SL, Glazer 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, Bergstrom EM, Bluvshtein V, Ronen J. A multi-center International Study on the Spinal Cord Independence Measure, Version III: Rasch psychometric validation. Spinal Cord Resubmission requested 2006.
http://www.ncbi.nlm.nih.gov/pubmed/16909143

Glass CA, Tesio L, Itzkovich M, Soni BM, Silva P, Mecci M, Chadwick R, el Masry W, Osman A, Savic G, Gardner B, Bergström E, Catz A. Spinal Cord Independence Measure, Version III: Applicability to the UK spinal cord injured population. J Rehabil Med 2009; 41: 723-728.
http://www.ncbi.nlm.nih.gov/pubmed/19774305

Grijalva I, Guizar-Sahagun G, Castaneda-Hernandez G, Mino D, Maldonado-Julian H, Vidal-Cantu G, Ibarra A, Serra O, Salgado-Ceballos H, Arenas-Hernandez R. Efficacy and safety of 4-aminopyridine in patients with long-term spinal cord injury: a randomized, double-blind, placebo-controlled trial. Pharmacotherapy 2003;23:823-834.
http://www.ncbi.nlm.nih.gov/pubmed/12885095

Itzkovich M, Catz A, Biering-SÃ¸rensen F. SCIM III Reliability And Validity: A Multi-Center International Study. ISCoS Meeting Oct 2005 Munich, Germany Abs 34/8
http://www.iscos.org.uk/index.html

Itzkovich M, Tamir A, Philo O, Steinberg F, Ronen J, Spasser R, Gepstein R, Ring H, Catz A. Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation. Am J Phys Med Rehabil 2003;82:267-272.
http://www.ncbi.nlm.nih.gov/pubmed/12649651

Itzkovich M, Tripolski M, Zeilig G, Ring H, Rosentul N, Ronen J, Spasser R, Gepstein R, Catz A. Rasch analysis of the Catz-Itzkovich spinal cord independence measure. Spinal Cord 2002;40:396-407.
http://www.ncbi.nlm.nih.gov/pubmed/12124666

Jackson AB, Dijkers M, DeVivo MJ, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil 2004;85:1740-1748.
http://www.ncbi.nlm.nih.gov/pubmed/15520968

McKinley WO, Seel RT, Gadi RK, Tewksbury MA. Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison. Am J Phys Med Rehabil 2001;80:693-699.
http://www.ncbi.nlm.nih.gov/pubmed/11523972

Morganti B, Scivoletto G, Ditunno P, Ditunno JF, Molinari M. Walking Index for spinal cord injury (WISCI): criterion validation. Spinal Cord 2005;43:27-33.
http://www.ncbi.nlm.nih.gov/pubmed/15520841

Popovic MR, Thrasher TA, Adams ME, Takes V, Zivanovic V, Tonack MI. Functional electrical therapy: retraining grasping in spinal cord injury. Spinal Cord 2006;44:143-151.
http://www.ncbi.nlm.nih.gov/pubmed/16130018

Ronen J, Itzkovich M, Bluvshtein V, Thaleisnik M, Goldin D, Gelernter I, David R, Gepstein R, Catz A. Length of stay in hospital following spinal cord lesions in Israel. Spinal Cord 2004;42:353-358.
http://www.ncbi.nlm.nih.gov/pubmed/14968104

Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M. Effects on age on spinal cord lesion patients’ rehabilitation. Spinal Cord 2003;41:457-464.
http://www.ncbi.nlm.nih.gov/pubmed/12883544

van Hedel HJA for the EMSCI Study Group. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neural Repair 2009; 23(4): 343-350.
http://www.ncbi.nlm.nih.gov/pubmed/19036717

van Hedel HJA, Dietz V, and the EM-SCI Study Group. Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 2009; 23: 117-124.
http://www.ncbi.nlm.nih.gov/pubmed/18997156

Wirz M, Muller R, Bastiaenen C. Falls in Persons With Spinal Cord Injury: Validity and Reliability of the Berg Balance Scale. Neurorehabil Neural Repair 2010 24: 70; DOI: 10.1177/1545968309341059
http://www.ncbi.nlm.nih.gov/pubmed/19675123

SCIM II

Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. The Graded Redefined Assessment of Strength Sensibility and Prehension: Reliability and Validity. Journal of Neurotrauma, 2012; 29: 905-914.
http://www.ncbi.nlm.nih.gov/pubmed/21568688

van Hedel HJA, Dietz V, and the EM-SCI Study Group. Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 2009; 23: 117-124.
http://www.ncbi.nlm.nih.gov/pubmed/18997156

Wirth B, van Hedel HJA, Kometer B, Dietz V, Curt A. Changes in activity after a complete spinal cord injury as measured by the Spinal Cord Independence Measure II (SCIM II). Neurorehabil Neural Repair, 2008; 22:145-153.
http://www.ncbi.nlm.nih.gov/pubmed/17761810

SCIM III

Ackerman P, Morrison SA, McDowel S, Vazquez L. Using the Spinal Cord Independence Measure III to measure functional recovery in a post-acute spinal cord injury program. Spinal Cord, 2010; 48:380-387.
http://www.ncbi.nlm.nih.gov/pubmed/19884897

Aguilar-rodríguez M, Peña-pachés L, Grao-castellote C, Torralba-collados F, Hervás-marín D, Giner-pascual M. Adaptation and validation of the Spanish self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2015;53(6):451-4.
http://www.ncbi.nlm.nih.gov/pubmed/25510190

Alimohammad S, Parvaneh S, Ghahari S, Saberi H, Yekaninejad MS, Miller WC. Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury. Disabil Health J. 2016;9(2):265-71.
http://www.ncbi.nlm.nih.gov/pubmed/26586171

Almeida Cd, Coelho JN, Riberto M. Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions. Disabil Rehabil. 2016;38(22):2229-34.
http://www.ncbi.nlm.nih.gov/pubmed/26800790

Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, Fjerstad JE, Graves DE, Greenwald K, Groah SL, Harkema SJ, Horton III JA, Huang M-N, Jennings M, Kelley KS, Kessler SM, Kirshblum S, Koltenuk S, Linke M, Ljungberg I, Nagy J, Nicolini L, Roach MJ, Salles S, Scelza WM, Read MS, Reeves RK, Scott MD, Tansey KE, Theis JL, Tolfo CZ, Whitney M, Williams CD, Winter CM, Zanca JM. United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III). Spinal Cord, 2011; 49: 880-885.
http://www.ncbi.nlm.nih.gov/pubmed/21445081

Bluvshtein V, Front L, Itzokovich M, Aidinoff E, Gelernter I, Hart J, 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, Bergstrom EM, Catz A. SCIM III is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord, 2011; 49:292-296.
http://www.ncbi.nlm.nih.gov/pubmed/20820178

Bonavita J, Torre M, China S, et al. Validation of the Italian version of the Spinal Cord Independence Measure (SCIM III) Self-Report. Spinal Cord. 2016;54(7):553-60.
http://www.ncbi.nlm.nih.gov/pubmed/26481705

Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, 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, Bergstrom EM, Bluvshtein V, Ronen J. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2007; 45: 275-291.
http://www.ncbi.nlm.nih.gov/pubmed/16909143

Fekete C, Eriks-hoogland I, Baumberger M, Catz A, Itzkovich M, Lüthi H, Post MW, von Elm E, Wyss A, Brinkhof MW. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2013;51(1):40-7.
http://www.ncbi.nlm.nih.gov/pubmed/22890418

Hwang WJ, Hwang S, Chung Y. Test-retest reliability of the Quebec user evaluation of satisfaction with assistive technology 2.0-Korean version for individuals with spinal cord injury. J Phys Ther Sci. 2015;27(5):1291-3.
http://www.ncbi.nlm.nih.gov/pubmed/26157203

Invernizzi M, Carda S, Milani P, Mattana F, Fletzer D, Iolascon G, Gimigliano F, Cisari C. Development and validation of the Italian version of the Spinal Cord Independence Measure III. Disability and Rehabilitation, 2010; 32(14): 1194-1203.
http://www.ncbi.nlm.nih.gov/pubmed/20131944

Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonach M, 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, Bergstrom EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study. Disability and Rehabilitation, 2007; 29(24): 1926-1933.
http://www.ncbi.nlm.nih.gov/pubmed/17852230

Itzkovich M, Shefler H, Front L, Gur-Pollack R, Elkayam K, Bluvshtein V, Gelernter I, Catz A. SCIM III (Spinal Cord Independence Measure version III): reliability of assessment by interview and comparison with assessment by observation. Spinal Cord. 2018:56:46-51
https://pubmed.ncbi.nlm.nih.gov/28895576

Joseph C, Phillips J, Wahman K, Nilsson wikmar L. Mapping two measures to the International Classification Of Functioning, Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context. Disabil Rehabil. 2016;38(17):1730-8.
http://www.ncbi.nlm.nih.gov/pubmed/26750300

Kalsi-ryan S, Beaton D, Ahn H, et al. Responsiveness, Sensitivity, and Minimally Detectable Difference of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, Version 1.0. J Neurotrauma. 2016;33(3):307-14.
http://www.ncbi.nlm.nih.gov/pubmed/26560017

Marino RJ, Kern SB, Leiby B, Schmidt-read M, Mulcahey MJ. Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury. J Spinal Cord Med. 2015;38(4):498-504.
http://www.ncbi.nlm.nih.gov/pubmed/25297342

Michailidou C, Marston L, De souza LH. Translation into Greek and initial validity and reliability testing of a modified version of the SCIM III, in both English and Greek, for self-use. Disabil Rehabil. 2016;38(2):180-8.
http://www.ncbi.nlm.nih.gov/pubmed/25875048

Mulcahey MJ, Thielen CC, Sadowsky C, Silvestri JL, Martin R, White L, Cagney JL, Vogel LC, Schottler J, Davidson L, Parry I, Taylor HB, Higgins K, Feltz ML, Sinko R, Bultman J, Mazurkiewicz J, Gaughan J. Despite limitations in content range, the SCIM-III is reproducible and a valid indicator of physical function in youths with spinal cord injury and dysfunction. Spinal Cord. 2018; 56:332-340.
https://pubmed.ncbi.nlm.nih.gov/29269778/

Ovechkin AV, Vitaz TW, Terson de paleville DG, Mckay WB. Quality of residual neuromuscular control and functional deficits in patients with spinal cord injury. Front Neurol. 2013;4:174.
http://www.ncbi.nlm.nih.gov/pubmed/24223568

Prodinger B, Ballert CS, Brinkhof MW, Tennant A, Post MW. Metric properties of the Spinal Cord Independence Measure – Self Report in a community survey. J Rehabil Med. 2016;48(2):149-64.
http://www.ncbi.nlm.nih.gov/pubmed/26926919

Riberto M, Tavares DA, Rimoli JR, Castineira CP, Dias RV, Franzoi AC, Vall J, Lopes KA, Chueire RH, Battistella LR. Validation of the Brazilian version of the Spinal Cord Independence Measure III. Arq Neuropsiquiatr. 2014;72(6):439-44.
http://www.ncbi.nlm.nih.gov/pubmed/24964111

Rudhe C, Van hedel HJ. Upper extremity function in persons with tetraplegia: relationships between strength, capacity, and the spinal cord independence measure. Neurorehabil Neural Repair. 2009;23(5):413-21.
http://www.ncbi.nlm.nih.gov/pubmed/19261766

Saberi H, Vosoughi F, Derakhshanrad N, Yekaninejad M, Khan ZH, Kohan AH, Parvaneh S, Ghahari S, Agheli F, Vosoughi F. Development of Persian version of the Spinal Cord Independence Measure III assessed by interview: a psychometric study. Spinal Cord. 2018; 56:980-986
https://pubmed.ncbi.nlm.nih.gov/29802395/

Saffari M, Pakpour AH, Yaghobidoot M, Al zaben F, Koenige HG. Cross-cultural adaptation of the spinal cord lesion-related coping strategies questionnaire for use in Iran. Injury. 2015;46(8):1539-44.
http://www.ncbi.nlm.nih.gov/pubmed/26003680

Scivoletto G, Tamburella F, Laurenza L, Molinari M. The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects. Disabil Rehabil. 2013;35(21):1808-13.
http://www.ncbi.nlm.nih.gov/pubmed/23343359

Tramonti F, Gerini A, Stampacchia G. Individualised and health-related quality of life of persons with spinal cord injury. Spinal Cord. 2014;52(3):231-5.
http://www.ncbi.nlm.nih.gov/pubmed/24343055

Unalan H, Misirlioglu TO, Erhan B, Akyuz M, Gunduz B, Irgi E, Arslan HE, Baltacı A, Aslan S, Palamar D, Kutlu A, Majlesi J, Akarırmak U, Karamehmetoglu SS. Validity and reliability study of the Turkish version of Spinal Cord Independence Measure-III. Spinal Cord. 2015;53(6):455-60.
http://www.ncbi.nlm.nih.gov/pubmed/25665539

Velstra IM, Bolliger M, Krebs J, Rietman JS, Curt A. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury. Neurorehabil Neural Repair. 2016;30(4):295-306.
http://www.ncbi.nlm.nih.gov/pubmed/26156192

Velstra IM, Bolliger M, Tanadini LG, Baumberger M, Abel R, Rietman JS, Curt A. Prediction and stratification of upper limb function and self-care in acute cervical spinal cord injury with the graded redefined assessment of strength, sensibility, and prehension (GRASSP). Neurorehabil Neural Repair. 2014;28(7):632-42.
http://www.ncbi.nlm.nih.gov/pubmed/24566986

Velstra IM, Curt A, Frotzler A, Abel R, Kalsi-Ryan S, Rietman JS, Bolliger M. Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury: European Multicenter Responsiveness Study of the GRASSP. Neurorehabil Neural Repair. 2015;29(8):755-66.
http://www.ncbi.nlm.nih.gov/pubmed/25567122

Wannapakhe J, Saensook W, Keawjoho C, Amatachaya S. Reliability and discriminative ability of the spinal cord independence measure III (Thai version). Spinal Cord. 2016;54(3):213-20.
http://www.ncbi.nlm.nih.gov/pubmed/26169167

Zarco-periñan MJ, Barrera-chacón MJ, García-obrero I, Mendez-ferrer JB, Alarcon LE, Echevarria-ruiz de vargas C. Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study. Disabil Rehabil. 2014;36(19):1644-51.
http://www.ncbi.nlm.nih.gov/pubmed/24320025

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