While this study does not involve a particular treatment for spinal cord injury, it has important implications for evaluating children for improvement of function after treatments. To my knowledge, this is the first time that the International Standards for Classification of Spinal Cord Injury (ISCSCI) has been tested for reliability in children. They find that the motor examinations are not reliable repeatable in children under 15 years old and the senory examination is not reliable in children under 5 years old. Although the article does not say so, I think that we need a better neurological assessment system for children with spinal cord injury.

[*] Mulcahey MJ, Gaughan J, Betz RR and Johansen KJ (2006). The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths. Spinal Cord Study design:Intra-rater reliability study, cross-sectional design.Objectives:To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children.Setting:Nonprofit pediatric hospital.Methods:In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury. Coefficients >0.90=high reliability; 0.75-0.90=moderate reliability and <0.75=inadequate reliability.Results:Children <four years (N=7) were unable to participate in the exams. TM ICC, CI=0.888, 0.821-0.93 (N=73); PP ICC, CI=0.975, 0.96-0.98 (N=67) and LT ICC, CI=0.974, 0.974-0.985 (N=68). When age was considered, 4-5 year: TM ICC, CI=0.917, 0.69-0.98 (N=11), PP=0.912, 0.49-0.985 (N=7), LT=0.948, 0.63-0.993 (N=6); for 6-11 year: TM ICC, CI=0.711, 0.226-0.892 (N=18), PP=0.952, 0.867-0.983 (M=17), LT=0.952, 0.867-0.983 (N=17); for 12-15 year: TM ICC, CI=0.893, 0.723-0.959 (N=19), PP=0.982, 0.953-0.993 (N=19), LT=0.982, 0.953-0.993 (N=19); for 16-21 year: TM ICC, CI=0.912, 0.80-0.961 (N=25), PP=0.98, 0.954-0.991 (N=25), LT=0.98, 0.954-0.991 (N=25). ICC for severity and type of injury >0.90 except for TM in complete injuries (0.808).Conclusion:The ISCSCI exams may have poor utility in children under 4 years. While reliability values for the motor and sensory exams met or exceeded recommended values, wide CI suggest poor precision of the motor exam in children under 15 years of age and sensory exams in children under 5 years.Sponsorship:This study was supported by the Shriners Hospitals for Children, Philadelphia Hospital.Spinal Cord advance online publication, 3 October 2006; doi:10.1038/sj.sc.3101987. 1Rehabilitation and Clinical Research, Shriners Hospitals for Children, Philadelphia Hospital, Philadelphia, PA, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17016490