• The Trunk Control Test for individuals with SCI (TCT-SCI) is a 13-item trunk function scale for individuals with SCIs.
  • It evaluates a person’s balance during the execution of 13 different motor tasks, starting from an unsupported seated position, then attempting motor tasks that are either static or dynamic in equilibrium.
  • Recently, cutoff scores on the TCT have been established that predict whether someone can perform ADLs independently (as measured by the SCIM-III – see Typical Values cell below).

Clinical Considerations

The TCT-SCI will help to identify the level of trunk control people have, and which activities of daily living (ADLs, e.g., toileting, dressing, feeding) that people may be able to perform independently – with or without upper limb support.

ICF Domain

Activity ▶ Mobility

Administration

Clinician-administered.

Length

Approximately 10 minutes.

Number of Items

13 items, three domains.

Initial Position – Seated with feet on a supporting surface, knees flexed at 90 degrees, without trunk support, hands resting on thighs.

  • Static equilibrium:
    • 1: Maintaining the initial sitting position
    • 2 & 3: Maintaining the sitting position with each leg crossed over the other in turn
  • Dynamic equilibrium:
    • 4: Touching the feet.
    • 5: Lying down in the supine position (i.e., on the back) and then returning to the initial position.
    • 6 & 7: Rolling onto the right and left sides.
  • Dynamic equilibrium for carrying out activities with the upper limbs.
    • Items 8-12: Reaching tasks performed from the initial position with the unilateral upper limb in 90° shoulder flexion, elbow in full extension, forearm in pronation, hand joint in neutral plantar dorsiflexion, and fingers in extension (3 directions on each side).

Equipment

  • Flat seat.
  • A piece of cardboard in the form of a circle 10 cm in diameter is utilized as a dartboard.

Scoring

Most items on the test are scored from 0 to 2.

  • 0 = Falls/not done
  • 1 = Needs support of arms
  • 2 = Maintains position for 10 seconds

*Items 6 & 7 – Rolling onto the left/right side are scored 0 if the person can not complete and 1 if they can (supported or not).

The maximum score is 24 points, with higher scores indicating better trunk function.

Person may test 3 times, and the best result is their score.

Languages

N/A

Training Required

None.

Availability

The Trunk Control Test for Individuals with SCI (TCT-SCI) worksheet can be found in the appendix of the following article: https://pubmed.ncbi.nlm.nih.gov/24710149/

Measurement Property Summary

# of studies reporting psychometric properties: 4

Interpretability

  • MCID: not established in SCI
  • SEM: not established in SCI
  • MDC: not established in SCI

Typical Values

SCIM III Item: TCT Cutoff score for performing task independently:

  • Feeding: 2
  • Bathing:
    • Upper body: 5
    • Lower body: 14
  • Dressing:
    • Upper body: 6
    • Lower body: 15
  • Grooming: 4
  • Respiration: 1
  • Use of toilet: 18
  • Mobility in bed: 10
  • Transfers: bed-wheelchair: 17
  • Transfers: Wheelchair-toilet/tub: 18
  • Mobility indoors wheelchair users: 9
  • Mobility for moderate distances – Wheelchair users: 11
  • Mobility outdoors – Wheelchair users: 13
  • Transfers: wheelchair-car: 20
  • Transfers: ground-wheelchair: 19

(Quinzaños-Fresnedo et al. 2024; N=604 participants with SCI; 70.6% males, 29.4% females; mean(SD) age: 34.5 (14.17) years AIS A (47.1%), AIS B (9.4%), AIS C (23.2%), AIS D (20.2%); Injury level: High tetraplegia (C4 and above) (31.4%), low tetraplegia (below C4) (16.1%), high paraplegia (T6 and above) (14.9%), and low paraplegia (below T6) (37.6%); mean (SD) time since injury was 134 ± 360 days)

Reliability – High

  • Inter-rater reliability is High for the TCT-SCI (ICC = 1.00; KW = 0.987)

(Sato et al. 2022; n=9; 8 males, 1 female; mean age 64.0 years; ASIA A-D; mean (SD) time since injury: 3515.9 (5984.2) days)
(Quinzaños et al. 2014; n=177; 72.9% males, 27.1% females; mean age 38.1 years; ASIA A-D; injury level: 39.5% cervical, 54.2% thoracic, 6.2% lumbar; mean (SD) time since injury: 6.65 (8.38) months)

  • Test-retest reliability is High for the TCT-SCI (KW = 0.99)

(Quinzaños et al. 2014; n=177; 72.9% males, 27.1% females; mean age 38.1 years; ASIA A-D; injury level: 39.5% cervical, 54.2% thoracic, 6.2% lumbar; mean (SD) time since injury: 6.65 (8.38) months)

  • Internal consistency is High for the TCT-SCI (Cronbach’s alpha = 0.98)

(Quinzaños et al. 2014; n=177; 72.9% males, 27.1% females; mean age 38.1 years; ASIA A-D; injury level: 39.5% cervical, 54.2% thoracic, 6.2% lumbar; mean (SD) time since injury: 6.65 (8.38) months)

Validity – High

  • High correlation with the TASS: rs = 0.68
  • High correlation with the UEMS: rs = 0.82
  • High correlation with the mFIM: rs = 0.72

(Sato et al. 2023; n=30; 5 males, 25 females; mean age 63.8 years; ASIA A-D; tetraplegia and paraplegia; mean (SD) time since injury: 1142.0 (1720.7) days)

  • High correlation with the SCIM: rs = 0.873

(Quinzaños et al. 2014; n=177; 72.9% males, 27.1% females; mean age 38.1 years; ASIA A-D; injury level: 39.5% cervical, 54.2% thoracic, 6.2% lumbar; mean (SD) time since injury: 6.65 (8.38) months)

Responsiveness

No values were reported for the responsiveness of the TCT-SCI for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the TCT-SCI for the SCI population.

Reviewers

Dr. Janice Eng, Dr. Carlos L. Cano-Herrera, Matthew Querée

Date Last Updated

31 December 2024

Quinzaños J, Villa AR, Flores AA, Pérez R. Proposal and validation of a clinical trunk control test in individuals with spinal cord injury. Spinal Cord. 2014; 52: 449-54. doi: 10.1038/sc.2014.34.
https://pubmed.ncbi.nlm.nih.gov/24710149/

Quinzaños-Fresnedo J, Contreras-Juvenal R, Quezada-López DC, Rodríguez-Barragán MA, Barrera-Ortiz A, Aguirre-Güemez AV. Determination of cut-off points in the Trunk control test for spinal cord injury to assess the ability to perform different activities of daily living. Spinal Cord. 2024; 62: 12-16. doi: 10.1038/s41393-023-00940-z.
https://pubmed.ncbi.nlm.nih.gov/37974004/

Sato H, Miyata K, Yoshikawa K, Chiba S, Ishimoto R, Mizukami M. Validity of the trunk assessment scale for spinal cord injury (TASS) and the trunk control test in individuals with spinal cord injury. J Spinal Cord Med. 2024; 47: 944-951. doi: 10.1080/10790268.2023.2228583.
https://pubmed.ncbi.nlm.nih.gov/37534928/

Sato H, Miyata K, Yoshikawa K, Kusano S, Mizukami M. Reliability and minimal detectable change of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and the trunk control test for individuals with spinal cord injury. Spinal Cord Ser Cases. 2022; 8: 30. doi: 10.1038/s41394-022-00502-0.
https://pubmed.ncbi.nlm.nih.gov/35279669/

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