Scoring acute spinal cord injury: a study of the utility and limitations of five different grading systems

We recorded Frankel Scale, Yale Scale, Motor Index Score, Modified Barthel Index, Functional Independence Measurement scores, and important clinical parameters simultaneously and repetitively for 35 consecutive acute spinal cord injury patients. We found that 1) these scores can be determined as long as "yes/no" communication can be obtained reliably, pharmacological paralysis is not present, and a reliable observer with a flexible schedule is available, 2) impairment based scores (FS, YS, MIS) have little tendency to change during acute care, 3) function based scales (MBI, FIM) can be distorted by acute care phenomena which limit self care, 4) impairment-based and disability-based scales do not convert reliably, 5) none of these scales correlated strongly with common milestones for mobility or nutrition and 6) a good description of a population of ASCI patients can be made by a combination of two scales, one based on impairment and the other on disability.