Table 4.

Strength and limitations of ordinal LE outcome measures

	Targets of assessment	Strengths	Limitations
ISNCSCI	Sensory and muscle strength	◦ Gold standard assessment in SCI ◦ Minimal equipment needed ◦ Can be assessed in most patients and at all time points (independent of severity of SCI)	◦ Multidimensional ordinal scale ◦ Assessor training is mandatory ◦ No assessment of walking function ◦ Can be time consuming
LEMS	Muscle strength	◦ Can be assessed in most patients and at all time points (independent of severity of SCI) unidimensional measure	◦ Ordinal scale ◦ LEMS does not always correlate with walking quality
Berg balance score	Balance trunk control	◦ Minimal equipment needed ◦ No advanced training needed	◦ Patient can maintain balance but may not walk ◦ Ordinal score ◦ Ceiling effects
Mini-BESTest	Balance trunk control	◦ Minimal equipment needed ◦ No advanced training needed	◦ Ordinal score
SCIM III (mobility items only)	Ambulatory capacity ability to climb stairs functional mobility	◦ Moderate training required ◦ Low costs ◦ Can be assessed in interview ◦ Clinically relevant and commonly used ◦ Only scale to consider real world performance	◦ Assesses walking distance in 3 broad categories (<10 m, 10–100 m, >100 m) and dependence on any assistive device ◦ Does not assess gait ◦ Ordinal score ◦ Ceiling effects
FIM (mobility items only)	Ambulatory capacity ability to climb stairs	◦ Moderate training required ◦ Minimal equipment needed	◦ Does not assess gait ◦ Not SCI specific outcome measure ◦ Low sensitivity to subtle changes ◦ Not free available
WISCI II	Dependence/independence for walking with or without assistance	◦ Low costs ◦ Complements other functional tests in LE (e.g., 10MWT, 6mWT)	◦ Ceiling effect in majority of patients (not suitable for patients with good walking function) ◦ Ordinal scale
SCI-FAI	Gait (quality of walking) assistive devices ambulatory capacity	◦ Low costs ◦ Can be assessed in clinic and in community	◦ Ceiling effects in good walkers ◦ Multidimensional ordinal scale
SCI-FAP	Ambulatory capacity	◦ Assesses walking tasks of greater complexity (e.g., different floor surfaces) ◦ Moderate training needed	◦ Multidimensional ordinal scale ◦ Specific equipment needed ◦ Ceiling effects
Neuromuscular recovery scale	Pre injury movement pattern	◦ Can differentiate between compensation and recovery	◦ Advanced training needed ◦ Body weight support treadmill needed ◦ Yet to be established

ISNCSCI International standards for neurological classification of spinal cord injury, LEMS lower extremity motor score, WISCI II walking index for spinal cord injury, SCIM III spinal cord independence measure, SCI-FAI spinal cord injury functional ambulation inventory, SCI-FAP spinal cord injury functional ambulation profile