Three neurophysiological measures are registered: MEP (motor evoked potentials), SSEP (somatosensory evoked potentials) and NCV (nerve conduction velocity).


From: Washington University Neuroscience


MEPs and SSEPs of the tibials and ulnaris nerves quantify the status of the efferent and afferent pathways in the spinal cord. In comparison to the ISNCSCI protocol measures the evoked potentials are independent of the cooperation and consciousness of the patient. The NCV are used for diagnosis of peripherical nerve lessions.


Physiological SSEP of the tibialis nerve


The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment protocol consists of two sensory examinations, a motor examination and a classification framework (the impairment scale) to quantify the severity of the spinal cord injury.

Online form for calculation of the ISNCSCI:

Form in EMSCI-database (offline):



The following definitions are used in grading the degree of impairment:




Complete. No sensory or motor function is preserved in the sacral segments S4-S5.


Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.


Incomplete. Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3 (Grades 0-2).


Incomplete. Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade greater than or equal to 3.


Normal. Sensory and motor functions are normal.


SCIM - Spinal Cord Independence Measure

The Spinal Cord Independence Measure (SCIM) is a disability scale developed specifically for patients with spinal cord lesions. The SCIM was developed by Catz and Itzkovich in 1997 [1] and was further developed and adapted since then [2-6]. The SCIM focuses on the amount of used personal assistance and/or the use of technical aids regarding the scoring of a subjects' independence.

In the EMSCI project the actual version SCIM 3 is used [3]. The SCIM includes the following areas of function:

  • self-care (subscore (0-20))
  • respiration and sphincter management (0-40)
  • mobility (0-40)

Each area is scored according to its proportional weight in these patients' general activity. The final score ranges from 0 to 100.





images/stories/1. Catz, A., et al., SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord, 1997. 35(12): p. 850-6.
images/stories/. Bluvshtein, V., et al., SCIM III is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord. 49(2): p. 292-6.
images/stories/. Itzkovich, M., et al., The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil, 2007. 29(24): p. 1926-33.
images/stories/. Catz, A., et al., [SCIM--spinal cord independence measure (version II): sensitivity to functional changes]. Harefuah, 2002. 141(12): p. 1025-31, 1091.
images/stories/. Catz, A., et al., The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord, 2001. 39(2): p. 97-100.
images/stories/. Catz, A., et al., The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure. Disabil Rehabil, 2001. 23(6): p. 263-8.

altAssessment of the walking ability of patients with movement disorders is an important outcome measure in rehabilitation. Valid and reliable walking tests that quantify gait performance allow therapists to evaluate the development of the patient's walking ability throughout his/her rehabilitation. "Valid" refers to the ability of an instrument in assessing what it is intended to measure; "reliable" refers to the reproducibility of measurements that is, to what extent replicated measurements agree. Several timed walking tests have been developed for this purpose. The validity and reliability of these tests have been investigated in several populations, varying from healty elderly people to patients with stroke, Parkinson's disease or lower-limb ampution.

In patients with a spinal cord injury (SCI), 2 walking tests have been validated: the Spinal Cord Injury-Functional Ambulation Inventory and the Walking Index for Spinal Cord Injury (WISCI), which was revised later in the WISCI II.

The WISCI II has an original scale that quantifies a patient's walking ability; a score of 0 indicates that a patient cannot stand and walk and the highest score of 20 is assigned if a patient can walk more than 10m without walking aids of assistance. We introduced this test, together with 3 timed walking tests, in our SCI center. The timed walking test are Timed Up & Go (TUG) test, 10-meter walking test (10MWT), and the 6-minute walk test (6MWT). The TUG measures the time (in seconds) it takes a patient to stand up from an armchair, walk 3m, return to the chair, and sit down.

This test was originally developed as a clinical measure of balance in elderly people. The 10MWT measures the time (in seconds) that it takes a patient to walk 10m; it assesses the short duration walking speed. This test has been used in gait studies of patients with neurologic movement disorders in general, as well as of patients with stroke and Parkinson's disease. The 6MWT measures the distance (in meters) walked within 6 minutes. This test is useful in assessing cardiovascular exercise capacity in elderly patients with congestive heart failure of chronic lung disease and walking ability in patients with acquired brain injury. The validity and reproducibility of these timed tests, however, have not been assessed in patients with SCI.

Our purpose in this study was to investigate the concurrent validity and reliability of these 3 timed walking tests. Because walking ability varies considerably among patients with SCI, we also investigated the validity of these tests in subgroups of patients with good and poor walking function.

(From: van Hedel HJ, 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 Feb;86(2):190-6.)



  • Rossier P, Wade DT. Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil. 2001 Jan;82(1):9-13. (Link)
  • Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991 Feb;39(2):142-8. (Link)
  • Ditunno Jr JF, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V, Marchetti M, Barbeau H, Frankel HL, D'Andrea Greve JM, Ko H-Y, Marshall R, Nance P. Walking index for spinal cord injury (WISCI): an international multicenter validity and reliability study. Spinal Cord. 2000 38, 234-243. (Link)

There is no part of urology that has made so much progress in the last 25 years as neuro-urology. Seminal developments have been made in the selective effectiveness of drugs influencing neurogenic lower urinary tract dysfunction but having limited side effects. Additional advances are also likely to be made in the methods of neuromodulation and tissue engineering. Neuro-Urology is predominantly influenced by our dynamic-functional understanding and the functionally oriented planning and implementation of treatment. The initial treatment options in many areas of neuro-urology are conservative, but, when possible, not irreversible. If these are ineffective or lead to late complications (e.g. by congenital paraplegia), there are a series of organ sparing or organ manipulating operations which can restore organ function. These make it possible to save renal function from continuing damage, and, in many cases, to restore urinary continence. The permanent indwelling catheter should remain excluded from the treatment of neurogenic lower urinary tract dysfunction. With adequate treatment, patients with neurogenic lower urinary tract dysfunction can be protected from severe complications and reintegrated into their normal social environment. After the acute phase of rehabilitation, urology is the most commonly required specialist area for paraplegic patients. In the past, urological problems have contributed most to the short lifespan of patients with an accident related spinal cord injury. Using modern neuro-urological treatment strategies, not only is lifespan increased but the quality of life of the patient is permanently improved.


Nowadays, due to modern neuro-urological management, the typical neurogenic bladder with diverticula, pseudodiverticula, trabecula, and bilateral vesico-uretero-renal reflux damaging the upper urinary tract is rarely seen.