[ Toolkit For ]

Spinal Cord Independence

Measure III (SCIM III)

A clinical guideline for performing the SCIM III

February 2016 | Version 6.0

TOOLKIT FOR SCIM III

This toolkit is supported by the Rick Hansen Institute and Acknowledgements

was created by the following collaborators: Occupational Therapists from L' Institut de
Kristen Walden, BScPT réadaptation Gingras-Lindsay-de-Montréal
National Clinical Liaison Antoinette De Iure
Rick Hansen Institute Chantal Legault
Tova Plashkes, MScPT Diane Marin
National Clinical Liaison Laura Luticone
Rick Hansen Institute
Marie Riley-Nobert
Shannon Sproule, BScPT Marie-Ève Lamarche
National Clinical Liaison
Rick Hansen Institute Nancy Dubé

Cynthia Morin, MClSc(OT)

National Clinical Liaison Physical Therapists from G.F. Strong
Rick Hansen Institute Rehabilitation Centre
Amrit Dahliwal
Gillian Coates
Jean Cremin
Naomi Franks

Finally, we would like to thank Dr. Amiram Catz, MD,

Clinical Associate Professor, Tel Aviv University, Israel
for his suggestions.
For questions or comments on this toolkit, please
contact [email protected].
 BACKGROUND
01 About RHSCIR
The RICK HANSEN SPINAL CORD INJURY REGISTRY (RHSCIR) is a pan-Canadian prospective
observational registry located at 31 major Canadian acute care and rehabilitation facilities.
Across Canada, RHSCIR is collecting comprehensive SCI data for the purpose of improving
SCI care and clinical outcomes. Using standardized research protocols and data collection
forms, RHSCIR tracks the experiences and outcomes of people with traumatic SCI during
their journey from injury, through acute care and rehabilitation to community reintegration.
Details about participants' spinal cord injuries including extent of injury and level of
paralysis, recovery, and success of various treatments are among the data recorded.

The data collected in RHSCIR contains powerful information that will help track the
effectiveness of specific treatments, practices or programs for improving functional
outcomes and quality of life after SCI. RHSCIR promotes, encourages and supports the
pursuit of excellence in all areas of SCI health care management.

To learn more about RHSCIR, please visit www.rickhanseninstitute.org.

BACKGROUND

RHSCIR facilities are located in 15 cities across Canada.

Version 6.0 February 2016 | 5

 02 WHY IS THIS INFORMATION
IMPORTANT?
The Spinal Cord Independence Measure (SCIM), now in its third iteration, is a disability scale
developed specifically for the SCI population to assess various activities of daily living (ADLs)
(1). It is has become one of most frequently used research tools for assessing response to
treatments in individuals with SCI. Many other outcome measures are not specific or sensitive
enough to detect important functional changes in individuals with SCI over time (2).

Benefits to Clinicians and Patients

Collection and reporting of this data can benefit clinicians and patients by:

Monitoring the patient’s functional progress.

Directing and prioritizing therapeutic interventions.

Setting realistic and timely goals with the patient.

Assisting with identifying the patient's equipment and care needs in preparation for discharge.
WHY IS THIS INFORMATION IMPORTANT?

Assisting with focussing patient education.

A SCI specific validated outcome measure for evaluating clinical interventions and changes
in the patient’s function.

Benefits to the Program

Collection and reporting of this data can benefit your program by:

Determining required equipment and supplies to optimize clinical practice and safety (e.g.
walking aids, transfer aids, body weight support treadmills, orthoses, etc.).

Assisting with continuity of care between health care providers by providing a common
language to talk about function.

Offering facilities comparators to national data.

Reporting metrics to facility administrators which may assist with determining staffing
allocation and budget priorities.

6 | Toolkit for SCIM III

 Benefits to Research
Collection and reporting of this data can benefit your research by:

Collection of this data can assist with providing a larger pool of data from the SCI population
across Canada which will allow for more accurate and meaningful interpretation and analysis.

Assisting with assessment and evaluation of the effectiveness of treatment approaches.

What Happens Once I Collect the Data?

Providing invaluable data to RHSCIR: Once you perform the assessment and document the data
on the clinical form, your facility’s Rick Hansen Spinal Cord Injury Registry (RHSCIR) coordinator
will collect this information and input the data into the registry database along with additional
relevant clinical information. The national RHSCIR team has developed a number of practices
to ensure patient confidentiality is maintained and strict privacy policies and procedures are
adhered to.

Providing a baseline for management of SCI across Canada: The de-identified data from your
site will be aggregated and reported back to your facility on a bi-annual basis and will provide
information on your hospital's patients enrolled in RHSCIR.

To access your facility's data reports, visit Supporting Clinical Initiatives in SCI (SCI2) website at
http://sci2.rickhanseninstitute.org. Your facility's RHSCIR coordinator, or designated representative,
will provide you the login information that is required to access your facility's data reports at your

WHY IS THIS INFORMATION IMPORTANT?

request.

You can also access the SCI2 site by visiting www.rickhanseninstitute.org.

Version 6.0 February 2016 | 7

 03 RESOURCE REQUIREMENTS

Performing the SCIM requires minimal staff burden or changes in clinical practice as the
variables that are evaluated are important to patient care, and reflect basic areas of patient
assessment that are typically routinely collected as a component of clinical practice (3).

To complete the assessment and collection of data as outlined in

this toolkit, the following resources are required:

Time
The estimated time required to perform SCIM III is approximately 30-45 minutes:
however often the SCIM can be completed as part of initial and discharge assessments
that may already be practiced by your facility.
There is also a self-report version of the SCIM (SCIM-SR), which is completed by patient
interview. The SCIM-SR is estimated to take less time to complete than the clinician
administered SCIM III (4).
The assessment should be performed within 72 hours of admission and repeated within
72 hours of discharge.

Equipment
None
RESOURCE REQUIREMENTS

8 | Toolkit for SCIM III

 04 FORMS

Clinical Assessment Forms

Once the SCIM III or the SCIM-SR has been done at admission to rehab, it is only required to be
repeated at discharge. Of course, some therapists and patients may find it useful to repeat it more
frequently to assess or demonstrate progress. An example of the Clinical Assessment Form for the
SCIM III is on the following pages of this Toolkit. Electronic versions of the form can be viewed and
downloaded from the SCI2 website (http://sci2.rickhanseninstitute.org).

Also available on the SCI2 website is the Self-Report version of the SCIM (SCIM-SR). The SCIM-SR
has been validated and correlates well with the clinician collected version (Pearson’s r for total score
= 0.87). Therefore, the scores from both versions can be compared to each other (4).

This form meets the minimum requirements for data collection; please add any additional facility
specific information to the form. If you would like assistance with incorporating your facility
information on the form, please contact us at [email protected].

FORMS

Version 6.0 February 2016 | 9

 SCIM – Spinal Cord Independence Measure

(Version III, 2002-2011)

ADDRESSOGRAPH

Traumatic ⃝ NTSCI ⃝ Level/AIS (if known)

__________
Paraplegia ⃝ Tetraplegia ⃝ Complete ⃝ Incomplete ⃝
SCI
Assessment Date:
Admission (A) __________________ Re-Assessment (RA) __________________ Discharge (DC) __________________

Self Care
Item Score
A RA DC
1. Feeding (cutting, opening containers, pouring, bringing food to mouth, holding cup with fluid)
0. Needs parenteral, gastrostomy or fully assisted oral feeding
1. Needs partial assistance for eating and/or drinking, or for wearing adaptive devices
2. Eats independently; needs adaptive devices or assistance only for cutting food and/or pouring and/or opening containers
3. Eats and drinks independently; does not require assistance or adaptive devices
2. Bathing (soaping, washing, drying body and head, manipulating water tap)
A. Upper body
0. Requires total assistance
1. Requires partial assistance
2. Washes independently with adaptive devices or in a specific setting (e.g., bars, chair)
3. Washes independently; does not require adaptive devices or specific setting (not customary for healthy people) (adss)
B. Lower Body
0. Requires total assistance
1. Requires partial assistance
2. Washes independently with adaptive devices or in a specific setting (adss)
3. Washes independently; does not require adaptive devices (adss) or specific setting
3. Dressing (clothes, shoes, permanent orthoses; dressing, wearing, undressing)
A. Upper body
0. Requires total assistance
1. Requires partial assistance with clothes without buttons, zippers or laces (cwobzl)
2. Independent with cwobzl; requires adaptive devices and/or specific settings (adss)
3. Independent with cwobzl; does not require adss; needs assistance or adss only for bzl.
4. Dresses (any clothes) independently; does not require adaptive devices or specific setting
B. Lower Body
0. Requires total assistance
1. Requires partial assistance with clothes without buttons, zippers or laces (cwobzl)
2. Independent with (cwobzl); requires adaptive devices and/or specific settings (adss)
3. Independent with (cwobzl) without adss; needs assistance or adss only for bzl.
4. Dresses (any clothes) independently; does not require adaptive devices or specific setting
4. Grooming (washing hands and face, brushing teeth, combing hair, shaving, applying makeup)
0. Requires total assistance
1. Requires partial assistance
2. Grooms independently with adaptive devices
3. Grooms independently without adaptive devices

Self Care Subtotal (0-20)

FORMS

10 | Toolkit for SCIM III

 SCIM – Spinal Cord Independence Measure
(Version III, 2002-2011)

Respiration and Sphincter Management

Item Score
A RA DC
5. Respiration
0. Requires tracheal tube (TT) and permanent or intermittent assisted ventilation (IAV)
2. Breathes independently with TT; requires oxygen, much assistance in coughing or TT management
4. Breathes independently with TT; requires little assistance in coughing or TT management
6. Breathes independently without TT; requires oxygen, much assistance in coughing, a mask (e.g., peep) or IAV (bipap)
8. Breathes independently without TT; requires little assistance or stimulation for coughing
10. Breathes independently without assistance or device

6. Sphincter Management - Bladder

0. Indwelling catheter
3. Residual urine volume (RUV) > 100cc; no regular catheterization or assisted intermittent catheterization
6. RUV < 100cc or intermittent self-catheterization; needs assistance for applying drainage instrument
9. Intermittent self-catheterization; uses external drainage instrument; does not need assistance for applying
11. Intermittent self-catheterization; continent between catheterizations; does not use external drainage instrument
13. RUV <100cc; needs only external urine drainage; no assistance is required for drainage
15. RUV <100cc; continent; does not use external drainage instrument

7. Sphincter Management - Bowel

0. Irregular timing or very low frequency (less than once in 3 days) of bowel movements
5. Regular timing, but requires assistance (e.g., for applying suppository); rare accidents (less than twice a month)
8. Regular bowel movements, without assistance; rare accidents (less than twice a month)
10. Regular bowel movements, without assistance; no accidents

8. Use of Toilet (perineal hygiene, adjustment of clothes before/after, use of napkins or diapers)
0. Requires total assistance
1. Requires partial assistance; does not clean self
2. Requires partial assistance; cleans self independently
4. Uses toilet independently in all tasks but needs adaptive devices or special setting (e.g., bars)
5. Uses toilet independently; does not require adaptive devices or special setting

Respiration and Sphincter Management Subtotal (0-40)

Mobility (room and toilet)

Item Score
A RA DC
9. Mobility in Bed and Action to Prevent Pressure Sores
0. Needs assistance in all activities: turning upper body in bed, turning lower body in bed, sitting up in bed, doing push-ups in wheelchair,
with or without adaptive devices, but not with electric aids
2. Performs one of the activities without assistance
4. Performs two or three of the activities without assistance
6. Performs all the bed mobility and pressure release activities independently

10. Transfers: bed-wheelchair (locking wheelchair, lifting footrests, removing and adjusting arm rests, transferring, lifting feet)
0. Requires total assistance
1. Needs partial assistance and/or supervision, and/or adaptive devices (e.g., sliding board)
2. Independent (or does not require wheelchair)

11. Transfers: wheelchair-toilet-tub (if uses toilet wheelchair: transfers to and from; if uses regular wheelchair: locking wheelchair, lifting
footrests, removing and adjusting armrests, transferring, lifting feet)
0. Requires total assistance
1. Needs partial assistance and/or supervision, and/or adaptive devices (e.g., grab-bars)
2. Independent (or does not require wheelchair)
FORMS

Version 6.0 February 2016 | 11

 SCIM – Spinal Cord Independence Measure
(Version III, 2002-2011)

Mobility (indoors and outdoors, on even surface)

Item Score
A RA DC
12. Mobility Indoors
0. Requires total assistance
1. Needs electric wheelchair or partial assistance to operate manual wheelchair
2. Moves independently in manual wheelchair
3. Requires supervision while walking (with or without devices)
4. Walks with a walking frame or crutches (swing)
5. Walks with crutches or two canes (reciprocal walking)
6. Walks with one cane
7. Needs leg orthosis only
8. Walks without walking aids

13. Mobility for Moderate Distances (10-100 meters)

0. Requires total assistance
1. Needs electric wheelchair or partial assistance to operate manual wheelchair
2. Moves independently in manual wheelchair
3. Requires supervision while walking (with or without devices)
4. Walks with a walking frame or crutches (swing)
5. Walks with crutches or two canes (reciprocal walking)
6. Walks with one cane
7. Needs leg orthosis only
8. Walks without walking aids

14. Mobility Outdoors (more than 100 meters)

0. Requires total assistance
1. Needs electric wheelchair or partial assistance to operate manual wheelchair
2. Moves independently in manual wheelchair
3. Requires supervision while walking (with or without devices)
4. Walks with a walking frame or crutches (swing)
5. Walks with crutches or two canes (reciprocal waking)
6. Walks with one cane
7. Needs leg orthosis only
8. Walks without walking aids

15. Stair Management

0. Unable to ascend or descend stairs
1. Ascends and descends at least 3 steps with support or supervision of another person
2. Ascends and descends at least 3 steps with support of handrail and/or crutch or cane
3. Ascends and descends at least 3 steps without any support or supervision

16. Transfers: wheelchair-car (approaching car, locking wheelchair, removing arm and footrests, transferring to and from car, bringing
wheelchair into and out of car)
0. Requires total assistance
1. Needs partial assistance and/or supervision and/or adaptive devices
2. Transfers independent; does not require adaptive devices (or does not require wheelchair)

17. Transfers: ground-wheelchair

0. Requires assistance
1. Transfers independent with or without adaptive devices (or does not require wheelchair)

Mobility Subtotal (0-40)

TOTAL SCIM SCORE (0-100) Admission: ________ Re-Assessment: ________ Discharge: ________

Clinician Signature: ______________________________________________ Date: ________________________

FORMS

12 | Toolkit for SCIM III

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

This section asks about functioning in activities of daily living. For each item, please check the box next to
the statement that best reflects your current situation. Please read the text carefully and only check one
box in each section.
1. Eating and drinking
0. I need artificial feeding or a stomach tube
0. I need total assistance with eating/drinking
1. I need partial assistance with eating/drinking or for putting on/taking off adaptive
devices
2. I eat/drink independently, but I need adaptive devices or assistance for cutting food,
pouring drinks or opening containers
3. I eat/drink independently without assistance or adaptive devices

2. (a) Washing your upper body and head

Washing your upper body and head includes soaping and drying, and using a
water tap.
0. I need total assistance
1. I need partial assistance
2. I am independent but need adaptive devices or specific equipment (e.g., bars, chair)
3. I am independent and do not need adaptive devices or specific equipment

(b) Washing your lower body

Washing your lower body includes soaping and drying, and using a water tap.
0. I need total assistance
1. I need partial assistance
2. I am independent but need adaptive devices or specific equipment (e.g., bars, chair)
3. I am independent and do not need adaptive devices or specific equipment

3. (a) Dressing your upper body

Dressing the upper body includes putting on and taking off clothes like t-shirts,
blouses, shirts, bras, shawls, or orthoses (e.g., arm splint, neck brace, corset)
Easy-to-dress clothes are those without buttons, zippers, or laces.
Difficult-to-dress clothes are those with buttons, zippers, or laces.
0. I need total assistance
1. I need partial assistance, even with easy-to-dress clothes
2. I do not need assistance with easy-to-dress clothes, but I need adaptive devices or
specific equipment
3. I am independent with easy-to-dress clothes and only need assistance or adaptive
devices or a specific setting with difficult-to-dress clothes
4. I am completely independent

Version: 17Dec2014
FORMS

Version 6.0 February 2016 | 13

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

(b) Dressing your lower body

Dressing the lower body includes putting on and taking off clothes like shorts,
trousers, shoes, socks, belts, or orthoses (e.g., leg splint)
Easy-to-dress clothes are those without buttons, zippers, or laces.
Difficult-to-dress clothes are those with buttons, zippers, or laces.
0. I need total assistance
1. I need partial assistance, even with easy-to-dress clothes
2. I do not need assistance with easy-to-dress clothes, but I need adaptive devices or
specific equipment
3. I am independent with easy-to-dress clothes and only need assistance or adaptive
devices or a specific setting with difficult-to-dress clothes
4. I am completely independent

4. Grooming
Please think about activities such as washing hands and face, brushing teeth,
combing hair, shaving, or applying makeup
0. I need total assistance
1. I need partial assistance
2. I am independent with adaptive devices
3. I am independent without adaptive devices

5. Breathing
Please check only one box, depending on whether or not you need a
respiratory (tracheal) tube.

I need a respiratory (tracheal) tube…

0. as well as permanent or from time to time assisted ventilation
2. as well as extra oxygen and a lot of assistance in coughing or respiratory tube
management
4. as well as little assistance in coughing or respiratory tube management

I do not need a respiratory (tracheal) tube…

6. but I need extra oxygen or a lot of assistance in coughing or a mask (e.g., positive
end-expiratory pressure (PEEP)) or assisted ventilation from time to time (e.g.,
bilevel positive airway pressure (BIPAP))
8. and only little assistance or stimulation for coughing
10. and can breathe and cough independently without any assistance or adaptive device

Version: 17Dec2014
FORMS

14 | Toolkit for SCIM III

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

6. Bladder management
Please think about the way you empty your bladder. [Scoring of item 6: see
appendix A]

(a) Use of an indwelling catheter

0. Yes → Please go to question 7a
1. No → Please also answer questions 6b and 6c
(b) Intermittent catheterization
0. I need total assistance
1. I do it myself with assistance (self-catheterization)
2. I do it myself without assistance (self-catheterization)
3. I do not use it

(c) Use of external drainage instruments (e.g., condom catheter, diapers, sanitary
napkins)
0. I need total assistance for using them
1. I need partial assistance for using them
2. I use them without assistance
3. I am continent with urine and do not use external drainage instruments

7. Bowel management [scoring of item 7: see appendix B]

(a) Do you need assistance with bowel management (e.g., for applying
suppositories)?
0. Yes
1. No

(b) My bowel movements are…

0. irregular or seldom (less than once in 3 days)
1. regular (at least once every 3 days)

(c) Faecal incontinence (‘accidents’) happens…

0. twice a month or more
1. once a month
2. not at all

Version: 17Dec2014
FORMS

Version 6.0 February 2016 | 15

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

8. Using the toilet

Please think about the use of the toilet, cleaning your genital area and hands,
putting on and taking off clothes, and the use of sanitary napkins or diapers.
0. I need total assistance
1. I need partial assistance and cannot clean myself
2. I need partial assistance but can clean myself
4. I do not need assistance but I need adaptive devices (e.g., bars) or a special setting
(e.g., wheelchair accessible toilet)
5. I do not need any assistance, adaptive devices or a special setting

9. How many of the following four activities can you perform without assistance or
electrical aids
- turning your upper body in bed
- turning your lower body in bed
- sitting up in a bed
- doing push-ups in wheelchair (with or without adaptive devices)
0. none, I need assistance in all these activities
2. one
4. two or three
6. all of them

10. Transfers from the bed to the wheelchair

0. I need total assistance
1. I need partial assistance, supervision or adaptive devices (e.g., sliding board)
2. I do not need any assistance or adaptive devices
2. I do not use a wheelchair

11. Transfers from the wheelchair to the toilet/tub

Transferring also includes transfers from the wheelchair or bed to a toilet
wheelchair
0. I need total assistance
1. I need partial assistance, supervision or adaptive devices (e.g., grab-bars)
2. I do not need any assistance or adaptive devices
2. I do not use a wheelchair

Version: 17Dec2014
FORMS

16 | Toolkit for SCIM III

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

12. Moving around indoors

Please check only one box, depending on whether or not you usually use a
wheelchair or walk to move around indoors.

I use a wheelchair. To move around, I…

0. need total assistance
1. need an electric wheelchair or partial assistance to operate a manual wheelchair
2. am independent in a manual wheelchair

I walk indoors and I…

3. need supervision while walking (with or without walking aids)
4. walk with a walking frame or crutches, swinging forward with both feet at a time
5. walk with crutches or two canes, setting one foot before the other
6. walk with one cane
7. walk with a leg orthosis(es) only (e.g., leg splint)
8. walk without walking aids

13. Moving around moderate distances (10 to 100 metres)

Please check only one box, depending on whether or not you usually use a
wheelchair or walk to move around moderate distances (10 to 100 meters).

I use a wheelchair. To move around, I…

0. need total assistance
1. need an electric wheelchair or partial assistance to operate a manual wheelchair
2. am independent in a manual wheelchair

I walk moderate distances and I…

3. need supervision while walking (with or without walking aids)
4. walk with a walking frame or crutches, swinging forward with both feet at a time
5. walk with crutches or two canes, setting one foot before the other
6. walk with one cane
7. walk with a leg orthosis(es) only (e.g., leg splint)
8. walk without walking aids

Version: 17Dec2014
FORMS

Version 6.0 February 2016 | 17

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

14. Moving around outdoors for more than 100 metres

Please check only one box, depending on whether or not you usually use a
wheelchair or walk to move around outdoors for more than 100 metres.

I use a wheelchair. To move around, I…

0. need total assistance
1. need an electric wheelchair or partial assistance to operate a manual wheelchair
2. am independent in a manual wheelchair

I walk more than 100 metres and I…

3. need supervision while walking (with or without walking aids)
4. walk with a walking frame or crutches, swinging forward with both feet at a time
5. walk with crutches or two canes, setting one foot before the other
6. walk with one cane
7. walk with a leg orthosis(es) only (e.g., leg splint)
8. walk without walking aids

15. Going up and down stairs

Please check only one box, depending on whether or not you are able to go up
and down stairs.

0. I am unable to go up and down stairs

I can go up and down at least 3 steps…

1. but only with assistance or supervision
2. but only with devices (e.g., handrail, crutch or cane)
3. without any assistance, supervision or devices

16. Transfers from the wheelchair into the car

Transfers also include putting the wheelchair into and taking it out of the car.
0. I need total assistance
1. I need partial assistance, supervision or adaptive devices
2. I do not need any assistance or adaptive devices
2. I do not use a wheelchair

Version: 17Dec2014
FORMS

18 | Toolkit for SCIM III

 FACILITY NAME

SCIM – Spinal Cord

Independence Measure ADDRESSOGRAPH
(Version III, Self-report 2013)

17. Transfers from the floor to the wheelchair

0. I need assistance
1. I do not need any assistance
1. I do not use a wheelchair
SCORING (for clinician to complete)
Please use the following tables for items 6 and 7.
Item 6 Item 7
SCIM-SR Item Score in SCIM-SR Item Score in
6A 6B 6C SCIM-SR 7A 7B 7C SCIM-SR
Not Not Not Not
0 relevant relevant 0 relevant 0 relevant 0
if 6A=0 if 6A=0 if 7B=0 if 7B=0
1 0 0 6 0 1 1 5
1 0 1 6 0 1 2 5
1 0 2 6 1 1 1 8
1 0 3 6 1 1 2 10
1 1 0 6 0 1 0 5
1 1 1 6 1 1 0 5
1 1 2 6
1 1 3 6
1 2 0 6
1 2 1 6
1 2 2 9
1 2 3 11
1 3 0 6
1 3 1 6
1 3 2 13
1 3 3 15

Self-care subscale, Items 1-4 (0-20)

Respiration and sphincter management subscale, Items 5-8 (0-40)
Mobility subscale, Items 9-17 (0-40)

TOTAL SCIM SCORE (0-100)

/ / Enter as much of the date as is

Date SCIM Completed: known. If no details available,
YYYY MM DD check Unknown.

 Unknown

Clinician Name/Signature: ______________________________________________

Version: 17Dec2014
FORMS

Version 6.0 February 2016 | 19

 05 INSTRUCTIONS

The SCIM III is very user friendly. The authors of the SCIM intended administration and scoring of
the assessment to be self-explanatory and therefore, they didn’t include an instructional manual
for the assessment. Although no instruction manual is available from the authors of the SCIM,
some guidelines and “tips” were developed by the clinical team at RHI to improve scoring clar-
ity and inter-rater reliability with clinicians using the measure. These guidelines were developed
with consultation and feedback from clinicians and researchers who work with patients with SCI.

Guidelines for Administering and Scoring the SCIM III

There are a total of 19 items on the SCIM III, which are divided into 3 subscales (self-care, respi-
ration and sphincter management, and mobility). A total score out of 100 is achieved, with the
subscales weighted as follows: self-care: scored 0-20; respiration and sphincter management:
scored 0-40; and mobility: scored 0-40 (5).
Scores are higher in patients that require less assistance or fewer aids to complete basic activi-
ties of daily living and life support activities.
The SCIM III ideally is administered by clinical observation, however chart abstraction or clinical
consultation can also be used to score the items when necessary (6). More than one clinical
team member can contribute to the scoring as necessary (3).

Each of the 19 items should be assessed within a 72-hour period. All questions should be
answered. 'Not tested' (NT) is not an option in any of the 19 questions.
Record the score that best describes the patient’s level of function at the time of assessment,
as the score should reflect how the patient typically performs the task. For example, if the
patient’s function is affected on short-term basis due to an acute illness (i.e. influenza) when
performing the assessment, then scoring would reflect the patient’s function when he/she is
healthy. However, the intent of the SCIM is to assess and show change in function; therefore
if the patient’s function is compromised by health issues that have longer healing times (such
as a fracture or a wound), then the patient is scored on how he/she performs at the time of
the assessment.
TIPS FOR THE EXAM

If significant differences in function occur throughout the day the task should be scored
according to the patient’s baseline function.
'Assistance' refers to physical assistance, (including assistance with set-up); and 'adapted
aids' refers to any equipment the patient requires to complete the task.

20 | Toolkit for SCIM III

 Self-Care
Q1. Feeding: The patient’s level of independence with this task should be assessed at the location
where they most typically eat and drink.The patient’s ability to get to an eating location through
wheeling or walking is not considered when scoring this task. The patient is scored on their
ability to eat and drink, and if adaptive aids or assistance is required. If the patient is indepen-
dent with eating and drinking, but requires assistance with set-up, then they would achieve
a score of 2. Assistance throughout the day to ensure adequate fluid intake, should also be
considered. A camelback or customized cup would be considered an adapted aid.
Q2. Bathing (upper and lower body): This is an assessment of a patient’s ability to perform bathing
tasks including soaping, washing, drying the body and head and manipulating the water tap and
shower handle. Shower, tub or commode transfers are not considered when scoring this task.
The patient's function in their present home or institutional setting should be assessed, and
not in novel settings (such as when travelling). Stand-by assistance or supervision for safety
reasons such as checking water temperature, should be considered partial assistance.
Q3. Dressing (upper and lower body): This is an assessment of the patient’s ability to don clothing.
Their ability to transfer to a location to dress or obtain clothing from drawers or closets is not
considered when scoring this task. The patient needs to be able to do all three of the difficult-
to-dress tasks of buttons, zippers and laces (bzl) without assistance or aids to be scored as
independent. If the patient can dress without any assistance or aids, but they choose to have
assistance with this task, they would be scored according to how they function in their present
daily routine, which would be partial or full assistance. If the patient has never tried to do the
bzl’s since their injury, they should be scored based on what they say their level of function
would be for these activities. Examples of adaptive aids or specific equipment can be splints,
adapted clothing, assistive devices (such as button hooks, reachers, dressing sticks, zipper
pulls), overhead loops, bed railings, a wheelchair or an electric bed (if they position the wheel-
chair or bed in a specific position to enable them to dress).
Q4. Grooming: The patient should be evaluated on their ability to complete their typical daily groom-
ing routine. Assessment of this task includes all activities pertaining to grooming, and manag-
ing objects such as toothbrushes, combs/hairbrushes, razors and make-up brushes. Wheeling
or walking to the location of the activities is not considered when scoring this task.

Respiration and Sphincter Management

Q5. Respiration: Assistance with coughing refers to assistance with secretion clearance and can
include positioning, suctioning and physical assistance with coughing. Frequency and time
should be considered when scoring this question. If the patient requires frequent sessions for TIPS FOR THE EXAM
long periods of time for assisted coughs/secretion removal, then that would be considered 'a lot
of assistance'. If someone requires assistance occasionally for short periods of time, then that
would be considered 'a little assistance'.
Q6. Sphincter Management-Bladder: This question refers to how the patient manages their blad-
der. Transfers and positioning for bladder management is not considered when scoring this
task. Residual volume is the amount of urine that remains in the bladder after voiding. Residual
volumes can be abstracted from the patient's chart if measurement was not completed by the
assessing clinician. An external drainage instrument is any equipment that is external to the

Version 6.0 February 2016 | 21

 body and is used to collect urine. This would include condom catheters, pads and adult dia-
pers/briefs. Further explanation of the scoring options is as follows:
0. Indwelling catheter as the patient’s primary method of managing their bladder.
3. This answer refers to patients who do not have an indwelling catheter and residual vol-
umes are high or unknown. This can include patients who manually stimulate their bladder
to urinate (for example, pressing on their lower abdomen to urinate), perform infrequent
intermittent catheterizations, require assistance with intermittent catheterizations that are
performed infrequently, or use an external drainage instrument AND have high or unknown
residual volumes.
6. This answer refers to patients who have low residual volumes, perform regular intermit-
tent catherizations throughout the day with assistance; OR use an external drainage instru-
ment, have low residual volumes AND require assistance with applying the drainage device.
9. The patient has low residual volumes, performs intermittent catheterizations AND uses an
external drainage instrument. The patient is independent with doing intermittent catheter-
izations and applying an external drainage device.
11. The patient is independent with performing regular intermittent catheterizations and
does not require an external drainage instrument.
13. The patient has low residual volumes, uses an external drainage instrument and is inde-
pendent with applying the instrument.
15. The patient is continent with low residual volumes, and does not require an external
drainage instrument.
Q7. Sphincter Management – bowel: This question is about bowel emptying once the patient is
in position to perform their bowel routine. The ability to transfer, perform peri-care or manage
clothing is not considered when scoring this task. The patient would be scored '0' if they have
infrequent bowel routines (less than once every three days), irregular timing of bowel move-
ments or if they have more than 2 bowel accidents per month.
Q8. Use of Toilet: This question evaluates the patient's ability to clean themselves after toileting
(either bowel or bladder), manage clothes and/or apply pads or diapers. This would include
participants who manage their bladder from their wheelchair (such as catheterizing into a toilet
bowl from a wheelchair). If the patient does their bowel routine in bed or on a commode with
assistance and wears a drainage device for their bladder, then they would be scored at a '0' or
'1', depending on the level of assistance they require. If the patient performs their bowel routine
in bed, but are independent with this task, then they would score ‘4’ as they require a special
setting.
TIPS FOR THE EXAM

22 | Toolkit for SCIM III

 Mobility (room and toilet)
Q9. Mobility in Bed and Action to Prevent Pressure Sores: 'Without assistance' means the pa-
tient can change their position in bed and perform weight shifts without physical assistance or
the aid of an electric bed or an electric wheelchair. They can use bedrails, the side of a wheel-
chair, an overhead loop or a strap to move in bed. Doing a push up in wheelchair refers to doing
a seat lift or a lateral lean. The patient needs to be able to lift their buttocks completely off of
the cushion in their wheelchair, or completely unweight their right and left buttocks to score '6'.
A patient can use their arms and/or legs as well as adaptive devices like a table or armrests to
perform the seat lift.
Q10. Transfers: Bed to wheelchair: This question assesses the patient's ability to transfer between
a bed and a wheelchair, which includes positioning of the wheelchair and manipulating any
accessories (such as wheelchair brakes, armrests, caster locks). Scoring should also consider
the patient's ability to position their legs and any adaptive aids such as a transfer board. If the
patient uses a mechanical lift and are independent with parts or all of the transfer they would
be scored a '1' (partial assist).
Q11. Transfers: Wheelchair-Toilet-Tub: This refers to the patient's ability to transfer to either a
toilet, commode or shower surface (such as the bottom of a bathtub, shower bench, shower
chair or bath board). It is assessing the patient's ability to transfer to surfaces they typically use
for toileting or showering. If the patient uses a different surface for toileting and showering the
lower score should be chosen if the transfers have different scores.
Q12 to 14: Mobility: Questions 12, 13 and 14 involve walking a variety of distances in both indoor
and outdoor environments. The patient can use braces in all of the scoring options except the
last one (‘8‘: walk without aids’). The patient should be scored on the walking aid they use
rather than their gait pattern (ie: if they step reciprocally but use a walker they would be scored
a 4 not a 5). If the patient walks and uses a wheelchair scoring should reflect what the patient
does typically and is safe for the patient at the time of the evaluation for the particular distance.
A manual wheelchair with power assist wheels should be considered a power wheelchair. On
Item 13 and 14, if the patient requires assistance with maneuvering on some terrains (such as
grass or inclines) in a manual wheelchair, then they would score ‘1.’
Q15. Stair Management: Scoring should reflect the patient's ability to manage stairs. If the patient
is learning to climb stairs in therapy but manages stairs differently in other settings, then they
would be scored on their ability to manage stairs outside of therapy. A patient who ascends
and descends stairs on their buttocks should be scored ‘0’ as this item assesses the patient’s
ability to manage stairs using their legs.
Q16. Transfers: Wheelchair-Car: This question refers to the patient's ability to transfer in and out TIPS FOR THE EXAM
of a car. The patient's ability to manage their equipment once they have transferred into a car
should be considered. If the patient is unable to transfer into a vehicle seat, they would be
scored as ‘0’ (requires total assistance). If the patient requires an adaptation to a vehicle to
perform a vehicle transfer or requires assistance when transferring, then they would achieve a
score of ‘1.’
Q17. Transfers: Ground-Wheelchair: If the patient does not use a wheelchair, but requires assis-
tance to transfer from floor level, they would be scored '0'.

Version 6.0 February 2016 | 23

 06 REFERENCES & ADDITIONAL
RESOURCES
References
1. Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack
M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS,
Osman A, Glass C a, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V,
Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: reliability and
validity in a multi-center international study. Disabil Rehabil. 2007 Dec 30;29(24):1926–33.

2. Anderson K, Aito S, Atkins M, Otr L, Biering-sørensen F, Charlifue S, Curt A, Ditunno J, Glass

C, Marino R, Marshall R, Mulcahey MJ, Post M, Savic G. Functional Recovery Measures for
Spinal Cord Injury : An Evidence-Based Review for Clinical Practice and Research. J Spinal
Cord Med. 2007;31(2):133–44.

3. Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A, St

REFERENCES & ADDITIONAL RESOURCES

A, Box PO. Disability Assessment by a Single Rater or a Team: A Comparative Study with the
Catz-Itzkovich Spinal Cord Independence Measure. J Rehabil Med. 2002;35(4):226–30.

4. Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Lüthi H, Post MWM, von Elm
E, Wyss A, Brinkhof MWG. Development and validation of a self-report version of the Spinal
Cord Independence Measure (SCIM III). Spinal Cord. 2013 Jan;51(1):40–7.

5. Miller W, Chan C. Spinal Cord Independence Measure (SCIM) [Internet]. SCIRE. 2013 [cited
2014 Jul 24]. Available from: www.scireproject.com/outcome-measures-new/spinal-cord-
independence-measure-scim.

6. Catz A, Itzkovich M. Spinal Cord Independence Measure: Comprehensive ability rating scale
for the spinal cord lesion patient. J Rehabil Res Dev. 2007;44(1):65–8.

Additional Resources
Spinal Cord Independence Measure (SCIM) [Internet]. Physiopedia. [cited 24 July 2014].
Available from: www.physio-pedia.com/Spinal_Cord_Independence_Measure_(SCIM).

Questions or comments regarding this guideline?

Email [email protected].

24 | Toolkit for SCIM III

 07 ADDITIONAL RELEVANT
RHSCIR DATA COLLECTED
The SCIM Self-Report is collected in the RHSCIR Community Follow-up Questionnaire at one, two
and five years post-injury, as well as every five years after that.

REFERENCES & ADDITIONAL RESOURCES

Version 6.0 February 2016 | 25

Rick Hansen Institute
Blusson Spinal Cord Centre
6400 - 818 West 10th Avenue
Vancouver, BC V5Z 1M9 CANADA
Tel: 604.827.2421
Web: www.rickhanseninstitute.org
Email: [email protected]

/RickHansenInstitute @rhinstitute

28 | Toolkit for SCIM III