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RehabMeasures Instrument

Spinal Cord Injury Functional Ambulation Inventory

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Purpose

The SCI-FAI assesses functional walking ability in ambulatory individuals with SCI (Field-Fote et al., 2001).

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Instrument Details

Acronym SCI-FAI

Area of Assessment

Coordination
Functional Mobility
Gait
Range of Motion

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • An observational gait assessment that includes 3 key domains of walking function.
  • Higher scores denote higher levels of function in each subscale.
  • Not considered meaningful to combined subscales into an overall composite score due to each domain measuring different types of function.
  • The SCI-FAI is composed of three subscales, these include:
  • Subscale 1) Gait Parameters: max score = 20 pts (each limb scored individually and assessed by evaluating the following):
    A) Weight shift
    B) Step width
    C) Step rhythm
    D) Step height
    E) Foot contact
    F) Step length
  • Subscale 2) Assistive Device: max score = 14 pts (each limb scored individually)
    A) Ranks assistive devices by the degree of assistance they provide; includes use of UE weight bearing devices and LE orthotics
  • Subscale 3) Temporal Distance max score = 5 pts
    A) Assesses walking mobility described as the capability and frequency a patient walks during a normal day
    B) Includes a 2-minute walk test

Number of Items

32

Equipment Required

  • Video Camera optional (improved reliability)

Time to Administer

15-30 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2011; Updated by Jennifer H. Kahn, PT, DPT, NCS and the SCI EDGE task force of the Neurology Section of the APTA in 2012.

Body Part

Lower Extremity

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

R

R

R

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

R

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

Inter-rater reliability is adequate when using live scoring whereas inter-rater reliability is excellent when using video-taped scoring. Thus, use of video-taped scoring might yield more reliable scoring.

Spinal Injuries

back to Populations

Standard Error of Measurement (SEM)

Ambulation Measures Review: (Lam et al, 2008; complied from data in Field-Fote et al, 2001)

  • SEM = 0.7 points (out of a maximum possible score of 20 for gait score)

Minimal Detectable Change (MDC)

Ambulation Measures Review: (Lam et al, 2008, compiled from data in Field-Fote et al, 2001) 

  • Smallest Real Difference (SRD) = 1.9 points, for gait score 
  • Smallest Real Difference (SRD) % = 13% 

*The SRD represents the smallest real clinical change beyond 0.

Normative Data

Acute SCI AIS-D Patients: (Lemay and Nadeau, 2010; = 32, 15 paraplegia, 17 tetraplegia; mean age = 47.9 (12.8) years; time post lesion 77.2 (44.3) days; Limited sample size, so use with caution)

 

SCI-FAI Norms

 

 

Scale

Mean (SD)

Range

SCI-FAI parameter (/20)

18.5 (3.3)

7–20

Paraplegia

17.8 (4.5)

7–20

Tetraplegia

19.0 (1.8)

14–20

SCI-FAI assistive devices (/14)

11.4 (2.7)

7–14

Paraplegia

11.1 (2.4)

7–14

Tetraplegia

11.8 (3.0)

7–14

SCI-FAI mobility (/5)

3.7 (1.2)

2–5

Paraplegia

3.4 (1.2)

2–5

Tetraplegia

4 (1.1)

2–5

2MWT (m)

109.3 (48.6)

11-214

Paraplegia

101.3 (50)

11-212

Tetraplegia

115.9 (48)

43-214

Interrater/Intrarater Reliability

Incomplete SCI : (Field-Fote et al, 2001; n = 22; mean age = 32; 4 raters scored each participant 3 times) 

100% agreement among raters for the objective sections of the inventory (assistive device use and temporal distance measures). 

Inter-rater reliability of the gait score, tested by comparing scores of the four raters obtained during a rating session; 

  • Adequate to Excellent Inter-rater reliability (ICC's ranged from 0.703 to 0.840) 
  • Adequate Live Scoring (LS) ICC = 0.703 
  • Excellent Video Tape 1 (VS1) ICC = 0.800 
  • Excellent Video Tape 2 (VS2) ICC = 0.840 
  • Excellent Intra-rater reliability (ICC's ranged from 0.850 to 0.960; comparing rater’s score of the Live Score to the same rater’s Video Tape 1 scores) 
    • Rater 1: ICC = 0.903 
    • Rater 2: ICC = 0.956 
    • Rater 3: ICC = 0.942 
    • Rater 4: ICC = 0.850

Criterion Validity (Predictive/Concurrent)

Incomplete SCI: (Field-Fote et al, 2001)

  • Gait scores and walking speed 
    • Excellent: Video Tape 1 and walking speed (r = -0.742)
    • Excellent: Video Tape 2 and walking speed (r = -0.700)
  • Self-report of walking mobility
    • Excellent: Video Tape 1 and participant self-report of walking mobility (r = 0.697)

Construct Validity

Acute SCI AIS-D Patients : (Lemay and Nadeau, 2010) 

Excellent Convergent validity with other measures of ability (see below)

 

SCI-FAI Correlations with Clinical Assessments:

 

 

 

 

 

 

 

 

SCI-FAI gait parameter

SCI-FAI assistive devices

SCI-FAI mobility

2MWT

WISCI II

10MWT

TUG

BBS

0.747**

0.714**

0.740**

0.781**

0.816**

0.792**

-0.815**

SCI-FAI gait parameter

 

0.609**

0.716**

0.805**

0.761**

0.777**

-0.761**

SCI-FAI assistive devices

 

 

0.690**

0.740**

0.980**

0.788**

-0.802**

SCI-FAI mobility

 

 

 

0.688**

0.630**

0.756**

-0.724**

2MWT

 

 

 

 

0.749**

0.932^**

-0.623^**

WISCI II

 

 

 

 

 

0.795**

-0.799**

10MWT

 

 

 

 

 

 

-0.646^**

BBS = Berg Balance Scale ?2MWT = 2-min walk test ?10MWT = 10-m walk test ?SCI-FAI = Spinal Cord Injury Functional Ambulation Inventory ?TUG = Timed Up and Go ?WISCI II = Walking Index for Spinal Cord Injury

 

 

 

 

 

 

 

 

Incomplete SCI: (Field-Fote et al, 2001) 

  • Excellent for gait score and LEMS prior to training (r=0.74) and following training (r=0.64)

Incomplete SCI : (Field-Fote et al, 2001) 

  • Gait scores and walking speed 
    • Excellent : Video Tape 1 and walking speed (r = -0.742) 
    • Excellent: Video Tape 2 and walking speed (r = -0.700) 
  • Self-report of walking mobility 
    • Excellent: Video Tape 1 and participant self-report of walking mobility (r = 0.697)

Content Validity

Incomplete SCI: (Field-Fote et al, 2001) 

Ten physical therapists with at least 5 years of experience identified and ranked 6 parameters considered essential to walking performance for the gait score portion of the test. Item rankings were refined based on viewing of video taped walking sessions.

Floor/Ceiling Effects

Acute SCI AIS-D Patients: (Lemay and Nadeau, 2010; n=32) 

Ceiling effects were present on each section of the SCI-FAI (see table below). Percentage of patients tested who reach maximal scores: 

  • Gait Parameter = 68.8% 
  • Assistive devices = 34.4% 
  • Walking mobility = 34.4%

 

Patients reaching maximal scores on clinical assessments:

 

 

Scale

Score

%

SCI-FAI (gait parameter)

20/20

68.8

SCI-FAI (assistive devices)

14/14

34.4

SCI-FAI (walking mobility)

5/5

34.4

BBS

56/56

37.5

WISCI-II

20/20

44.8

SCI-FAI = Spinal Cord Injury Functional Ambulation Inventory ?BBS = Berg Balance Scale ?WISCI-II = Walking Index for Spinal Cord Injury

 

 

Responsiveness

Incomplete SCI : (Field-Fote et al, 2001; n = 22; mean age = 32; 4 raters scored each participant 3 times) 

Some evidence suggesting sensitivity: The change in the gait parameter scores following a walking focused rehabilitation program was 44.7%. Changes in gait speed and LEMS were correlated with the change in the gait parameter score. 

  • Moderate correlation between % change in gait score and change in LEMS (r=0.58)

Bibliography

Dawson, J., Shamley, D., et al. (2008). "A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury." Spinal Cord 46(12): 768-780. 

Field-Fote, E. C., Fluet, G. G., et al. (2001). "The spinal cord injury functional ambulation inventory (SCI-FAI)." Journal of Rehabilitation Medicine 33(4): 177-181. 

Lam, T., Noonan, V., et al. (2007). "A systematic review of functional ambulation outcome measures in spinal cord injury." Spinal Cord 46(4): 246-254. 

Lemay, J. and Nadeau, S. (2009). "Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale." Spinal Cord 48(3): 245-250.