The Walking Index for Spinal Cord Injury (WISCI) is a functional capacity scale designed to measure improvements in ambulation in persons with spinal cord injury, by evaluating the amount of physical assistance, braces or devices required to walk 10 meters. The WISCI II is currently the most recent version.
Participants are progressed systematically through a validated sequence of capacity levels, incorporating devices and personal assistance, to their maximum walking capacity.
The WISCI II ranks levels according to the severity of underlying impairment rather than the need for physical assistance, walking aids or braces, etc.
There is minimal additional burden for clinicians to administer the WISCI as the test falls into typical clinical practice parameters.
A score is possible even if the individual cannot walk 10 m. However, because the furthest walk distance is 10m, it may not be suitable for individuals with minor impairments.
It would be a useful to incorporate the WISCI II into 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.
5-meter parallel bars and mobility aids (e.g. braces, cane, walker – typically available in a clinical setting).
The clinician observes walking and rates the level which the person is considered safe.
For WISCI I, a score from 1 to 19 is assigned. Level 1: “patient ambulates in parallel bars, with braces and physical assistance of two persons, less than 10 meters” to level 19: “patient ambulates with no devices, no braces and no physical assistance, 10 meters”.
For WISCI II, a score from 0 to 20 is assigned. Level 0: “patient is unable to stand and/or participate in walking” to level 20: “ambulates with no devices, with brace and no assistance”.
No formal training required. However, knowledge of ambulation is beneficial.
WISCI I can be found here.
WISCI II can be found here.
MCID: not established SEM & MDC: SEM, SRD values from Burns et al. 2011, MDC calculated from data in Burns et al. 2011
For self-selected WISCI II level: SEM=0.283, SRD=0.785, MDC= 0.784
For self-selected WISCI II speed: SEM=0.091, SRD=0.254 m/s, MDC = 0.252
For max WISCI II level: SEM=0.215, SRD=0.597, 0.596
For max WISCI II speed: SEM=0.059, SRD=0.163 m/s, MDC=0.164
No normative data or cut scores are available for the SCI population but the WISCI II is gaining in popularity and comparisons can be made with existing studies.
Published data for the SCI population is available for comparison (see Interpretability section of the Study Details sheet).
# of studies reporting psychometric properties: 1
(N=1) (Ditunno et al. 2000)
Inter-rater reliability was tested by agreement between raters; 100% agreement was achieved across all 24 individual international participants and all eight teams.
(N=1) (Ditunno et al. 2000)
Correlation of the WISCI I is High with the Functional Independence Measure (Spearman’s r=0.765).
No values were reported for the responsiveness of the WISCI I at this time.
No values were reported for the presence of floor/ceiling effects in the WISCI for the SCI population.
# of studies reporting psychometric properties: 10
Test-retest reliability is High for self-selected (SS) WISCI II level (ICC=0.994) and walking speed (ICC=0.930), and maximum WISCI II level (ICC=0.995) and walking speed (ICC=0.971).
Inter-rater reliability is High for SS WISCI II (ICC=1.00) and max WISCI II (ICC=0.98).
(Morganti et al. 2005, Burns et al. 2011, Marino et al. 2010)
Validity: Low to High
Correlations for the WISCI II are:
High with the Berg Balance Scale (Spearman’s r=0.82-0.92)
High with the Functional Independence Measure (Spearman’s r=0.70-0.77)
High with the Timed Up and Go (Spearman’s r=-0.799)
High with the Spinal Cord Independence Measure- Mobility subscale (Spearman’s r=0.81)
High with the Rivermead Mobility Index (Spearman’s r=0.67)
High with the Barthel Index (Spearman’s r=0.67)
Low to High with the 6-Minute Walk Test (Spearman’s r=0.28-0.76)
Low to Highwith the 10 Meter Walk Test (Spearman’s r=-0.21 – -0.79)
Low to Moderate with the Lower Extremity Motor Score (Spearman’s r=0.32-0.50)
(Ditunno & Ditunno 2001, Morganti et al. 2005, Van Hedel, Wirz & Curt 2005, van Hedel et al. 2006, Ditunno et al. 2007, Ditunno et al. 2008, Burns et al. 2011, Wirz et al. 2010, Lemay & Nadeau 2010)
WISCI II differed between interval 1 and 2 (p=0.005), but not between 2 and 3 (p=0.18) or 3 and 4 (p=0.31) – (4 time intervals: 1) within first month; 2) after 3 months; 3) after 6 months; 4) after 12 months).
(Van Hedel, Wirz & Curt 2005, van Hedel et al. 2006)
Ceiling effect detected in WISCI II; 44.8% of subjects reached maximal score.
(van Hedel et al. 2006, Ditunno et al. 2007, Lemay & Nadeau 2010)
Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF. The reproducibility and convergent validity of the Walking Index for Spinal Cord Injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair, 2011; 25:149-157. http://www.ncbi.nlm.nih.gov/pubmed/21239706
Ditunno JF, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V, Marchetti M, Barbeau H Frankel HL D’Andrea Greve JM, Ko HY, Marshall R, Nance P. Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study. Spinal Cord 2000;38:234-243. http://www.ncbi.nlm.nih.gov/pubmed/10822394
Ditunno JF, Burns AS, Marino RJ. 2005. Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials. J Rehab Res Dev 2005;42(Suppl 1): 35-41. http://www.ncbi.nlm.nih.gov/pubmed/16195961
Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550. http://www.ncbi.nlm.nih.gov/pubmed/17507642
Ditunno JF, Scivoletto G, Patrick M, Biering-Sorensen F, Abel R, Marino R. Validation of the walking index for spinal cord injury in a US and European clinical population. Spinal Cord 2008; 46: 181-188. http://www.ncbi.nlm.nih.gov/pubmed/17502878
Hasegawa T, Uchiyama Y, Uemura K, Harada Y, Sugiyama M, Tanaka H. Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury. Spinal Cord. 2014;52(5):396-9. http://www.ncbi.nlm.nih.gov/pubmed/24614853
Kim MO, Burns AS, Ditunno JF, Marino RJ. The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels. Arch Phys Med Rehabil. 2007;88(6):762-7. http://www.ncbi.nlm.nih.gov/pubmed/17532899
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
Marino RJ, Scivoletto G, Patrick M, Tamburella F, Read MS, Burns AS, Hauck W, Ditunno Jr. J. Walking Index for Spinal Cord Injury Version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilities. Am J Phys Med Rehabil, 2010; 89:7-15. http://www.ncbi.nlm.nih.gov/pubmed/20026943
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
Scivoletto G, Tamburella F, Laurenza L, Torre M, Molinari M, Ditunno JF. Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility. Spinal Cord. 2014;52(1):65-9. http://www.ncbi.nlm.nih.gov/pubmed/24145685
Tamburella F, Scivoletto G, Iosa M, Molinari M. Reliability, validity, and effectiveness of center of pressure parameters in assessing stabilometric platform in subjects with incomplete spinal cord injury: a serial cross-sectional study. J Neuroeng Rehabil. 2014;11:86. http://www.ncbi.nlm.nih.gov/pubmed/24886312
van Hedel HJA Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196. http://www.ncbi.nlm.nih.gov/pubmed/15706542
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