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Disabil Rehabil, 2014; 36(19): 1644–1651

! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2013.864713

ASSESSMENT PROCEDURES

Development of the Spanish version of the Spinal Cord Independence

Measure version III: cross-cultural adaptation and reliability and validity
study
Maria Jose Zarco-Periñan, Marı́a J. Barrera-Chacón, Inmaculada Garcı́a-Obrero, Juan Bosco Mendez-Ferrer, Luis
Eduardo Alarcon, and Carmen Echevarria-Ruiz de Vargas
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Spinal Cord Unit, Department of Rehabilitation Medicine, Hospital Universitario Virgen del Rocı́o, Seville, Spain

Abstract Keywords
Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Reliability, Spain, Spanish version of the
Independence Measure (SCIM) version III for Spain and to validate the Spanish version of Spinal Cord Independence Measure
the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, version III, spinal cord injury, validity
back-translation and assessment of cultural equivalence procedures. eSCIM version III, was
administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of History
the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal
consistency (Cronbach’s a), (3) validation and confirmation of the correlation between eSCIM III Received 6 May 2013
For personal use only.

and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The Revised 28 October 2013
reliability of eSCIM III showed an intra-class coefficient value 40.97 in the different subscales Accepted 7 November 2013
assessed. Internal consistency of eSCIM III was shown by a Cronbach’s a value of 0.93. The Published online 9 December 2013
validity of eSCIM III was confirmed by the close correlation with FIM (r ¼ 0.94, p50.0001).
The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be
culturally equivalent to the original version, as reliability and validity of this tool were
demonstrated. It can be used in Spain for functional assessment of patients with spinal
cord injury.

ä Implications for Rehabilitation

 Development of the Spanish version of the Spinal Cord Independence Measure version III.
 The importance of the adaptation of Spinal Cord Independence Measure (SCIM) is that it
guarantees the possibility of measuring the same concept in different cultures and countries.
 The eSCIM III is the first, specific assessment tool in patients with spinal cord injury adapted
for its use in Spain.
 The eSCIM III is a tool conceptually equivalent to the original version. It has the reliability and
validity of SCIM III in order to be used by clinicians.

Introduction
Spinal cord injury represents a significant health problem due to
its clinical complexity, prolonged hospitalizations required,
clinical follow-up needed throughout life and frequency of
complications involved.
To describe the real impact derived from the spinal cord injury,
it is required not only to assess the degree of deficiency presented
by these people, but also to evaluate the level of disability
originated. The concept of functionality is not easy to quantify, a
circumstance to be resolved by the use of tools of measurement [1].
Hence, the importance of developing scales for functional
assessments.
Address for correspondence: Dr Maria Jose Zarco-Periñan, PhD, Spinal
Cord Unit, Department of Rehabilitation Medicine, Hospital Universitario
Virgen del Rocı́o, Seville, Spain. Tel: +34 617557940; +34 955012598.
E-mail: mjzarcop@ono.com
The Functional Independence Measure (FIM) was developed
and designed to assess the functional level of patients, including
those with spinal cord injury [2,3]. Since its creation, this scale
has been widely used and diffused, with multiple investigations
demonstrating its metric characteristics [3–5]. However, some
studies showed certain limitations when this tool is used in
subjects with spinal cord injury, as difficulty to the sensitivity to
change [6], and in the evaluation of the functional level of patients
with tetraplegia, which led to the development of specific
instruments [7,8].
Under these premises, the Spinal Cord Independence Measure
(SCIM), was designed specifically to quantify the functional
assessment of patients with spinal cord injury. Since its
establishment, different versions were developed, resulting each
version in a more accurate and sensitive tool compared with the
previous one. Currently, the version III is used, as reliability,
validity and sensitivity to change of this scale have been
 DOI: 10.3109/09638288.2013.864713
evidenced [9,10]. The validity of each version of the SCIM has
been determined by comparison with FIM [9,10].
SCIM covers the evaluation of specific areas of function with
great relevance in the spinal cord injury, including self-care,
respiration and sphincter management, and mobility. Each area is
scored according to its proportional weight in the patient’s global
activity.
The use of SCIM version III is currently recommended to
assess the functional recovery of patients with spinal cord injury,
both in clinical and research settings, due to the clinical viability
and the clinimetric characteristics shown by the tool [9,11].
The English version of the SCIM scale has been developed, but
the use of these scales has to be standardized for different
countries and cultures. Cross-cultural adaptation of a tool not only
requires its translation following a specific methodology, but also
evaluates its metric characteristics in the new language and
culture [12].
The purpose of this study is to provide the translation and
cultural adaptation of the SCIM III to the Spanish language for its
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 10/14/14
use in our country, Spain, and subsequently confirm the reliability
and validity of the new tool, the Spanish version of the SCIM III
(eSCIM III).
Patients and method
Study design: cross-sectional study. This study has two well-
defined parts, as explained in the following sections.
Cross-cultural adaptation: methodology
For the development of eSCIM III, we used a procedure with the
For personal use only.
following steps [12,13]:
– Translation into Spanish: Two forward translations from
English into Spanish were produced by two independent
translators. Both English–Spanish translators have wide
experience and were native Spanish speakers. Translators
followed specific instructions including: a brief description
of the scale, information relative to the measurement concept
system and characteristics of the translation, and use of
clinical and culturally equivalent sentences. Each translator
independently translated the version and then compared and
discussed the result with that of the other translator, until a
common version was reached.
– Back-translation: The Spanish version of the SCIM was
again translated into English by other two translators with
wide experience. One translator was American, and the other
one had lived in the USA. Both translators did not know that
there was an original English version. The aim was to
identify possible discrepancies in the Spanish translation.
Both translations were analyzed, and a final version was
established.
– Assessment of the cultural equivalence of the Spanish
version: A committee consisting of two translators and four
clinicians (three experts in spinal cord injury and one in the
process of instrument’s adaptation), compared the original
English version and the final Spanish version. The aim of the
committee was to evaluate the translation of the scale, verify
the cultural equivalence of the new version and approve the
definitive Spanish version.
A previously established comparison criterion was used [13]:
an item was classified as Type A if it was conceptually
equivalent, i.e. the translation maintained the semantic and
conceptual equivalence from the original English version; an
item was classified as B when the meaning was similar, but
there was some change; while the item was classified as Type C
(different), if it was of questionable translation, and did not
maintain the meaning of the original item. Items classified as B
Development of the Spanish version SCIM version III 1645
or C were discussed by the members of the committee, until a
consensus was reached.
Pilot study: The new Spanish version was assessed by two study
investigators, and used initially in five patients with spinal cord
injury. Clinicians were asked about: (1) difficulties in the use of
the new tool, (2) difficulties with any of the items.
Validation of the Spanish version of the eSCIM III: patients
and procedure
Patients
A total of 64 patients with spinal cord injury previously treated in
the Spinal Cord Injury Unit were included. Inclusion criteria
were: (1) spinal cord injury of traumatic or medical origin; (2)
spinal cord injury (ASIA impairment grade A, B, C or D); (3)
verbally given consent for inclusion in the study.
Exclusion criteria included: (1) concomitant neurological
disease which may alter the functional level previously estab-
lished by the spinal cord injury; (2) presence of cognitive deficit
or psychiatric disease, which may prevent collaboration of the
patient and influence the functional level.
Procedure
Two authors of the study performed all evaluations. In a first
phase, demographic variables were collected and, subsequently
functional assessments were performed by using eSCIM III and
the FIM. Clinicians involved in patient assessment were trained
with different scales.
(1) Assessment of the reliability of the scale: To show the
reproducibility of the tool, 35 subjects were assessed by two
independent investigators who were blinded to the results of the
other assessment performed.
Reliability was assessed in terms of: (1) assessment of
agreement between raters, (2) inter-rater reliability between the
two evaluations performed, which confirm that the results are
independent of the rater, and that correlates with the patient’s
situation.
(2) Assessment of the internal consistency: This assessment is
relevant when the tool, as in our case, has different components or
subscales. Analyses performed: (1) assessment of correlation of
items with the global score of the scale, and with the score of the
corresponding subscale (item–total score correlation); (2) internal
consistency, analyzed by Cronbach’s a, in the global SCIM III and
also in each of the subscales. This evaluation separately analyzed
scores obtained at admission and discharge.
(3) Validity analysis: Validity was analyzed by means of the
correlation between the eSCIM III and the FIM scales in 64
patients of the study.
(4) Sensitivity to change: To determine the sensitivity of the
scale to changes produced in the function of the patient, changes
during the rehabilitation period were compared. All patients were
evaluated at admission and discharge of rehabilitation.
The protocol was approved from the Ethics Committees of the
hospital. Verbal consent was obtained from the patients to be
included in the study.
Statistical analysis
(1) Reliability: K-coefficient was used for evaluation of agree-
ment between raters, and Pearson’s correlation coefficient for
correlation of scale and subscale. Intra-class correlation coeffi-
cient was used to determine variability between raters. An intra-
class coefficient 40.75 for the scale and different subscales has
been used in this study for reliability analysis [14].
(2) Internal consistency: Cronbach’s a coefficient was used as a
measure of internal consistency and a value40.70 was considered
 1646 M. J. Zarco-Periñan et al. Disabil Rehabil, 2014; 36(19): 1644–1651

adequate [14]. For homogeneity evaluation the Pearson correl-
ation coefficient between each item and the total score of the scale
or corresponding subscale was used.
(3) Validity: For correlation between FIM and eSCIM III scales,
Rho Spearman’s non-parametric correlation tests were used
(4) Sensitivity to change: Wilcoxon’s non-parametric test was
used.
The statistical program Statistical Package Social Science,
version 19 (SPSS Inc, Chicago, IL) was used for the previous
analyses.
Results
Cross-cultural adaptation
Assessment of cultural equivalence
Once the eSCIM III version was obtained, after translation and
back-translation were performed, the expert committee considered
that there were no differences in the conceptual and/or semantic
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When the neurological impairment was considered (Table 1),
28 subjects (43.8%) had a complete injury, with incomplete injury
in 36 (56.3%). Twenty-seven subjects (42.2%) had tetraplegia and
37 (48.4%) showed paraplegia. According to the ASIA impair-
ment scale, 26 subjects (40.6%) were classified as grade A, and 18
(28.1%) were grade D.
Validation of the Spanish version of the SCIM version III
Reliability analysis
All items showed a high level of agreement, with a K-value40.90,
as shown in Table 2.
Inter-rater reliability: the intra-class coefficient for the eSCIM
III was 0.97 and a value 40.90 was obtained for different
subscales of the tool at admission and discharge (Tables 3 and 4).
The Pearson correlation coefficient for all subscales and the
total score was higher than 0.90 in all cases, with values ranging
from 0.90 in the self-care subscale to 0.95 in the mobility scale
(Table 3).

equivalence in 16 items (84.21%) of a total of 19 in the scale. The

three items classified as B type were two concerning the
Homogeneity of the scale: internal consistency
management of sphincter and one of mobility. The alternative
which maintains the equivalence with the original English version Correlation of the item with the scale total score:
was accepted by consensus. With respect to the pilot study, the Correlation of each item of the eSCIM III with the total score was
clinicians did not refer any difficulty in the use of the tool. higher than 0.2 in all cases, with the exception of the respiration
item with values in the range 0.17–0.85. The higher values were
Population characteristics obtained in the mobility subscale (Table 5).
Internal consistency: Cronbach’s a coefficient for the eSCIM III
A total of 64 subjects with spinal cord injury were included in the
was 0.93, with no substantial deviation of this a coefficient when
study, and 35 of them were selected for the reliability study.
Socio-demographical characteristics of both populations are
For personal use only.

shown in Table 1. Table 2. Agreement between raters: K coefficients eSCIM III.

Out of the 64 patients, 21 (32.8%) were female and 43 (67.2%)
male (mean age: 44.79  20.50 years). Thirty-eight subjects Items K Correlations p Value
(59.4%) had traumatic spinal cord injury, mainly as a consequence Feeding 0.99 0.0001
of a traffic accident (39.4%). Twenty-six subjects (40.6%) had Bathing upper body 0.96 0.0001
spinal cord injury of medical origin, most of them of vascular Bathing lower body 0.93 0.0001
origin. Dressing upper body 0.92 0.0001
Dressing lower body 0.91 0.0001
Grooming 0.95 0.0001
Table 1. Characteristics of the samples. Respiration 1 0.0001
Bladder management 1 0.0001
Reliability Validity Bowel management 0.96 0.0001
study group study group Use of toilet 0.91 0.0001
Mobility in bed 1 0.0001
Number of SCI* patients 35 64 Transfers bed/wheelchair 0.97 0.0001
Traumatic etiology 20 (57.1%) 38 (59.4%) Transfers wheelchair/toilet/tub 0.94 0.0001
– Traffic 6 (30%) 15 (39.4%) Mobility indoors 1 0.0001
– Outrage 1 (5%) 1 (2.6%) Mobility moderate distances 0.95 0.0001
– Sports accident 4 (20%) 6 (15.8%) Mobility outdoors 1 0.0001
– Occupational accident 2 (10%) 4 (10.5%) Stair management 1 0.0001
– Precipitation 5 (25%) 10 (26.3%) Transfers wheechair/card 0.98 0.0001
– Others 2 (10%) 2 (5.2%) Transfers ground/wheelchair 0.91 0.0001
Non-traumatic etiology 15 (42.1%) 26 (40.6%)
– Vascular 7 (46.6%) 8 (30.8%) eSCIM: Spanish Spinal Cord Independence Measure.
– Infections 3 (20%) 3 (11,5%)
– Tumor etiology 2 (13.3%) 7 (26.9%)
– Spinal stenosis 3 (20%) 6 (23.1%) Table 3. Reliability: inter-observer reliability. Intra-class correlation
– Others 2 (7.7%) coefficient: admission.
Déficit Neurológico
– Complete Tetraplegia 9 (25.7%) 14 (21.9%) 1 evaluator 2 evaluator
– Incomplete Tetraplegia 8 (22.9%) 13 (20.3%) eSCIM Mean (sd) Mean (sd) ICC
– Complete Paraplegia 7 (20%) 14 (21.9%)
– Incomplete Paraplegia 11 (31.5%) 23 (35.9%) Self-care 11.08 (7.01) 10.74 (6.84) 0.97
AIS grade** Respiration/sphincter 24.77 (8.42) 24.77 (8.42) 0.99
– A 14 (41.2%) 26 (40.6%) Mobility in the room 4.9 (3.4) 5.4 (3.4) 0.97
– B 10 (29.4%) 11 (17.1%) Mobility indoors/outdoors 6.9 (5.3) 7.4 (5.4) 0.7
– C 6 (17.6%) 9 (14.06%) eSCIM total 47.77 (23.64) 46.57 (24.13) 0.97
– D 5 (14.7%) 18 (28.1%)
eSCIM: Spanish Spinal Cord Independence Measure.
*SCI: Spinal cord injury. sd: standard deviation.
**AIS: American Spinal injury Association Impairment scale. ICC: Intra-class correlation coefficient.
 DOI: 10.3109/09638288.2013.864713
scale homogeneity was intended to be improved after systematic
elimination of the items. Cronbach’s a coefficient at discharge for
the eSCIM III was 0.93.
Cronbach’s a for different subscales was higher than 0.80
(Table 5), except in the ‘‘Respiration – sphincter management’’
subscale with an a value of 0.63. In this subscale, a-value
increased when ‘‘Respiration’’ item was eliminated, and
decreased when any of the other items of the scale were
eliminated. In the mobility scale, Cronbach’s a also improved
after elimination of the ‘‘Transfer bed – chair’’ item.
Validity study
eSCIM III showed a significant correlation with FIM, as
described in Table 5. The correlation between the eSCIM III
and FIM was lower at admission in rehabilitation (r ¼ 0.87,
Table 4. Reliability: inter-observer reliability. Intraclass correlation
coefficient: discharge.
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Development of the Spanish version SCIM version III 1647
p50.0001) than at discharge (r ¼ 0.94, p50.0001). A significant
correlation (p50.0001) was also obtained between the eSCIM III
subscales and FIM (Table 6), with a higher correlation at
discharge of rehabilitation (0.85–0.91).
Sensitivity to change
eSCIM III showed sensitivity to functional changes of the patients
with spinal cord injury (p50.0001). Comparison of the differ-
ences between eSCIM III scale at admission and discharge of the
rehabilitation period, and FIM showed that values obtained were
higher for eSCIM III than for FIM (p50.0001).
Discussion
Functional assessment with specific tools is fundamental in
patients with spinal cord injury. The SCIM III scale, designed
specifically for these patients, assessed the most relevant areas,
including self-care, sphincter management and mobility [9,10].

Table 6. Validity: correlation between FIM and eSCIM III at admission

1 evaluator 2 evaluator and discharge.
eSCIM Mean (sd) Mean (sd) ICC
Self-care 13.95 (6.81) 13.59 (6.87) 0.95 Admission Rho Discharge Rho
Respiration/sphincter 28.89 (8.59) 29.07 (8.72) 0.94 eSCIM III Spearman Spearman
Mobility in the room 6.85 (3.71) 6.89 (3.75) 0.96 Self-care 0.89 (p50.0001) 0.90 (p50.0001)
Mobility indoors/outdoors 9.43 (7.63) 9.5 (7.52) 0.96 Respiration-sphincter 0.86 (p50.0001) 0.87 (p50.0001)
eSCIM total 59.07 (23.63) 58.65 (23.57) 0.96 management
Mobility in the rooms 0.87 (p50.0001) 0.90 (p50.0001)
eSCIM: Spanish Spinal Cord Independence Measure. Mobility indoors/outdoors 0.81 (p50.0001) 0.85 (p50.0001)
sd: standard deviation. eSCIM total 0.87 (p50.0001) 0.94 (p50.0001)
ICC: Intra-class correlation coefficient.
For personal use only.

Table 5. Internal consistency: Cronbach’s coefficient a and scale homogeneity.

Cronbach‘s coefficient Item-total correlation Cronbach‘s coefficient Item-total correlation

eSCIM a Admission Admission a Discharge Discharge
Self-care 0.87 0.58–0.83 0.92 0.75–0.84
a if item is deleted a if item is deleted
– Feeding 0.86 0.91
– Bathing upper body 0.83 0.9
– Bathing lower body 0.87 0.9
– Dressing upper body 0.87 0.89
– Dressing lower body 0.86 0.91
– Grooming 0.83 0.9
Respiration-sphincter management 0.63 0.07–0.75 0.79 0.6–0.78
a if item is deleted a if item is deleted
– Respiration 0.42 0.44
– Bladder management 0.9 0.81
– Bowel management 0.99 0.72
– Use of toilet 0.42 0.65
Mobility in the rooms 0.93 0.79–0.87 0.79 0.78–0.84
a if item is deleted a if item is deleted
– Mobility bed 0.93 0.91
– Transfers bed/wheelchair 0.52 0.63
– Transfer wheelchair/toilet 0.59 0.62
Mobility indoors/outdoors 0.93 0.75–0.94 0.91 0.70–0.93
a if item is deleted a if item is deleted
– Mobility indoors 0.68 0.87
– Mobility moderate distance 0.66 0.86
– Mobility outdoors 0.85 0.87
– Stair management 0.85 0.89
– Transfer wheelchair/card 0.84 0.91
– Transfer ground/wheelchair 0.92 0.92
SCIM total 0.93 0.175–0.85 0.93 0.64–0.93
a if item is deleted a if item is deleted
–Self-care 0.81 0.82
– Respiration-sphincter 0.82 0.81
– Mobility in rooms 0.8 0.8
– Mobility indoors/outdoors 0.81 0.82

eSCIM: Spanish Spinal Cord Independence Measure.

 1648 M. J. Zarco-Periñan et al.
Besides, this scale has shown greater sensitivity to change
compared to FIM, particularly in areas like sphincter management
[15]. This has led us to perform the adaptation of this tool to the
Spanish language for its use in Spain.
The use of an instrument in a different language and country
requires performing the processes of translation and cultural
adaptation, i.e. to create a tool equivalent to the original scale.
This guarantees the assessment of the same concept in different
cultures, allowing the comparison of the results [13,16,17]. The
methodology used in this study assures the quality of the process,
considering eSCIM III as a tool conceptually equivalent to the
original version [13,18]. Moreover, eSCIM III is the first, specific
assessment tool in patients with spinal cord injury adapted for its
use in Spain.
This study evaluated the clinimetric characteristics and
demonstrated that eSCIM III is a valid and reliable scale to be
used in spinal cord injury. Reliability has been shown by the high
rate of agreement among raters. Moreover, our data support the
inter-rater reliability, with values higher than those obtained in
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the original version [10], for the global scale and also for the
subscales, although similar to those obtained during the cultural
adaptation performed with this tool [19,20].
By analysis of the homogeneity of the scale, we verified that
this instrument is designed to assess the same characteristic or
functional area [10], and that elimination of the items of the scale
is not required, with the exception of the item ‘‘Respiration’’. We
confirmed that, similar to the original version, the subscale
respiration-sphincter showed the lowest correlation values.
The internal consistency of eSCIM III, as measured by
Cronbach’s a coefficient, was shown to be higher than the
For personal use only.
usually accepted limit of 0.7 for the global eSCIM III (0.93 in our
study) and also for the subscales, and is in agreement with values
reported in previous studies [21]. However, the subscale
‘‘Respiration-Sphincter’’ showed Cronbach’s a value of 0.63,
which is similar to that found in the original validation and also in
the validity studies of the tool [20,22,23]. Despite the relevance of
the assessment of the item ‘‘Respiration’’ in patients with spinal
cord injury, the results show that this item is not clearly related to
the ‘‘Sphincter Management’’ item, and does not contribute to the
internal consistency of this subscale [10,23]. This was also
confirmed by the increased Cronbach’s a value observed after
elimination of the ‘‘Respiration’’ item. This exception had no
influence on the internal consistency of SCIM III [22,24].
With regard to the validity study, it is important to notice that
an attempt has been made to keep the idiomatic, semantic and
conceptual equivalence with the original version during the
translation and cross-cultural adaptation processes, in order to
maintain the appearance and content of the new version of the
tool. The validity of the eSCIM III is supported by the close
correlation observed between this scale and FIM, a correlation
previously reported [19,20]. However, higher values to those
reported for the original version were found [10].
In our study, values probably could be affected by the small
sample size used; however, it must be said that the adaptation and
validation of SCIM to other countries have been performed using
similar samples [19]. Other factor to take into account is the
uniformity of the population in our study, with a large proportion
of neurologically complete injuries. The neurological deficit of
the patients, nearly 43.8% of the population presented a complete
injury, while 56.2% had incomplete injury. In addition, a more
proportional distribution was evidenced in comparison with
previous studies [19,25], which might reasonably explain the
same distribution as breathing–sphincter subscale.
Despite the good correlation observed between FIM and
SCIM III scales, differences between both tools should be
considered.
Disabil Rehabil, 2014; 36(19): 1644–1651
However, analysis of the validity of a tool should be regarded
as a successive verification, as one measurement is only
considered valid after accumulation of the evidences was
obtained, and needs to be fulfilled. New studies demonstrating
the validity of the Spanish version of the SCIIM III are required,
which has been already assessed in the original tool [26].
Our work has some limitations. The first is the small sample
used, although a similar sample size was used for the adaptation
of this tool to other cultures [19]. Lack of variability within the
sample is another possible limitation, which may determine data
generation. It could increase the reliability values. However, other
published studies have also used samples with a similar distribu-
tion to ours [21]. In addition, in our work, the rater’s bias has been
controlled because in the reliability study each patient was
evaluated by two evaluators belonging to the same profession
(physicians) and who knew the tool. The agreement between
raters was confirmed in our results.
Conclusion
The Spanish version of SCIM III is a tool culturally equivalent to
the original version. The validity and reliability of the eSCIM III
version have been demonstrated. The Spanish version of the
SCIM III can be used as a tool for functional assessment of
patients with spinal cord injury in our country (see Appendix).
Declaration of interest
The authors report no conflicts of interest.
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Development of the Spanish version SCIM version III 1649
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Appendix
SPANISH VERSION OF THE SPINAL CORD INDEPENDENCE MEASURE VERSION III (eSCIM III)
Unidad de Lesionados Medulares. Hospital Universitario Virgen del Rocı́o, Sevilla
CUIDADO PERSONAL
1. ALIMENTACIÓN œœœœœœ
(Cortar, abrir envases, servirse, llevarse la comida a la boca, sostener una taza con lı́quido)
For personal use only.

0. Requiere nutrición parenteral, gastrostomı́a o asistencia total para la alimentación oral.

1. Requiere ayuda parcial para comer y/o beber, o para utilizar ayudas técnicas.
2. Come independientemente; necesita ayudas técnicas o asistencia sólo para cortar los alimentos y/o servir y/o abrir recipientes.
3. Come y bebe independientemente; no requiere asistencia o ayudas técnicas.

2. BAÑO
(Enjabonarse, lavarse, secarse cuerpo y cabeza, manejar el grifo)
A. Parte superior del cuerpo œœœœœœ
0. Requiere asistencia total.
1. Requiere asistencia parcial.
2. Se lava de forma independiente con ayudas técnicas o accesorios especı́ficos (por ej. silla, barras. . .).
3. Se lava de forma independiente; no requiere ayudas técnicas o accesorios especı́ficos (no habituales para personas sanas).

B. Parte inferior del cuerpo œœœœœœ

0. Requiere asistencia total.
1. Requiere asistencia parcial.
2. Se lava de forma independiente con ayudas técnicas o accesorios especı́ficos.
3. Se lava de forma independiente; no requiere ayudas técnicas o accesorios especı́ficos.

3. VESTIDO
(Ropa, zapatos, ortesis permanentes: ponérselos, llevarlos puesto y quitárselos)
A. Parte superior del cuerpo œœœœœœ
0. Requiere asistencia total.
1. Requiere asistencia parcial con prendas de ropa sin botones, cremalleras o cordones.
2. Independiente con prendas de ropa sin botones, cremalleras o cordones; requiere ayudas técnicas y/o accesorios especı́ficos.
3. Independiente con prendas de ropa sin botones, cremalleras o botones; no requiere ayudas técnicas ni accesorios especı́ficos; requiere asistencia o
ayudas técnicas o accesorios especı́ficos sólo para botones, cremalleras o cordones.
4. Se pone (cualquier prenda) independientemente; no requiere ayudas técnicas o accesorios especı́ficos.

B.Parte inferior del cuerpo œœœœœœ

0. Requiere asistencia total
1. Requiere asistencia parcial con prendas de ropa sin botones, cremalleras o cordones.
2. Independiente con prendas de ropa sin botones, cremalleras o cordones; requiere ayudas técnicas y/o accesorios especı́ficos.
3. Independiente con prendas de ropa sin botones, cremalleras o botones sin ayudas técnicas ni accesorios especı́ficos; requiere asistencia o ayudas
técnicas o accesorios especifico sólo para botones, cremalleras o cordones.
4. Se pone (cualquier prenda) independientemente; no requiere ayudas técnicas o accesorios especı́ficos.
 1650 M. J. Zarco-Periñan et al. Disabil Rehabil, 2014; 36(19): 1644–1651

4. CUIDADOS Y APARIENCIA œœœœœœ

(Lavarse las manos y la cara, cepillarse los dientes, peinarse, afeitarse, maquillarse)
0. Requiere asistencia total.
1. Requiere asistencia parcial.
2. Se arregla independientemente con ayudas técnicas.
3. Se arregla independientemente sin ayudas técnicas.

SUBTOTAL (0–20) œœœœœœ

RESPIRACIÓN Y MANEJO ESFINTERIANO
5. RESPIRACIÓN œœœœœœ
0. Requiere cánula de traqueostomı́a y ventilación asistida permanente o intermitente.
2. Respiración espontánea con cánula de traqueostomı́a; requiere oxı́geno, gran asistencia para toser o para el manejo de la cánula de traqueostomı́a.
4. Respiración espontánea con cánula de traqueostomı́a; requiere pequeña asistencia para toser o para el manejo de la cánula de traqueostomı́a.
6. Respiración espontánea sin cánula de traqueostomı́a; requiere oxı́geno, gran asistencia para toser, mascarilla (p.e. máscara de presión positiva
espiratoria (PPE) o ventilación asistida intermitente (BiPAP).
8. Respiración espontánea sin cánula de traqueostomı́a; requiere pequeña asistencia o estimulación para toser.
10. Respiración espontánea sin asistencia ni dispositivos.

6. MANEJO ESFINTERIANO - VEJIGA œœœœœœ

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0. Sonda permanente.
3. Volumen de orina residual 4100 cc; no cateterismo regular o cateterismo intermitente asistido.
6. Volumen de orina residual 5100 cc o autocateterismos intermitentes; necesita asistencia para utilizar los instrumentos de drenaje.
9. Autocateterismos intermitentes; usa instrumentos de drenaje externo; no necesita asistencia para colocárselos.
11. Autocateterismos intermitentes; continente entre sondajes; no utiliza instrumentos de drenaje externos.
13. Volumen de orina residual 5100 cc; necesita únicamente instrumento de drenaje externo de orina; no requiere asistencia para el drenaje.
15. Volumen urinario residual 5100 cc; continente; no utiliza instrumento de drenaje externo.

7. MANEJO ESFINTERIANO - INTESTINO œœœœœœ

0. Cadencia irregular o frecuencia muy baja (menos de una vez cada 3 dı́as) de deposiciones.
5. Cadencia regular pero requiere asistencia (por ej. para aplicarse un supositorio); accidentes esporádicos (menos de dos al mes).
For personal use only.

8. Evacuación regular, sin asistencia; accidentes esporádicos (menos de dos al mes).

10. Evacuación regular, sin asistencia; no accidentes.

8. WC - INODORO œœœœœœ
(Higiene perineal, ajuste de prendas antes/después, uso de compresas o pañales)
0. Requiere asistencia total.
1. Requiere asistencia parcial: no se limpia solo.
2. Requiere asistencia parcial: se limpia independientemente.
4. Usa el WC de forma independiente en todas las tareas pero necesita ayudas técnicas o accesorios especı́ficos (por ej. barras).
5. Usa el WC de forma independiente; no requiere ayudas técnicas o accesorios especı́ficos.

SUBTOTAL (0–40) œœœœœœ

MOVILIDAD (DORMITORIO Y BAÑO)
9. MOVILIDAD EN CAMA Y ACTIVIDADES DE PREVENCIÓN DE ÚLCERAS POR PRESIÓN œœœœœœ
0. Necesita asistencia en todas las actividades: voltear la parte superior del cuerpo en la cama, voltear la parte inferior del cuerpo en la cama, sentarse
en la cama, pulsarse de la silla de ruedas, con o sin ayudas técnicas, pero no con adaptaciones eléctricas.
2. Realiza una de las actividades sin asistencia.
4. Realiza dos o tres de las actividades sin asistencia.
6. Realiza todas las movilizaciones en la cama y las actividades de liberación de presión de forma independiente.

10. TRANSFERENCIAS CAMA - SILLA DE RUEDAS œœœœœœ

(Frenar silla de ruedas, subir reposapiés, retirar y ajustar reposabrazos, transferirse, subir los pies)
0. Requiere asistencia total.
1. Necesita asistencia parcial y/o supervisión, y/o ayudas técnicas (por ej. tabla de transferencias).
2. Independiente (o no requiere silla de ruedas).
11. TRANSFERENCIAS SILLA DE RUEDAS - WC - BAÑERA œœœœœœ
(Si utiliza silla con inodoro: realizar transferencias a y desde ella; si usa silla de ruedas convencional: frenar la silla de ruedas, subir reposapiés, retirar y
ajustar reposabrazos, transferirse, subir los pies)
0. Requiere asistencia total.
1. Necesita asistencia parcial y/o supervisión, y/o ayudas técnicas (por ej. barras de baño).
2. Independiente (o no requiere silla de ruedas).
MOVILIDAD (INTERIORES Y EXTERIORES, EN CUALQUIER SUPERFICIE)
12. MOVILIDAD EN INTERIORES œœœœœœ
0. Requiere asistencia total.
1. Necesita silla de ruedas eléctrica o asistencia parcial para utilizar silla de ruedas manual.
2. Se desplaza de forma independiente con silla de ruedas manual.
3. Requiere supervisión mientras camina (con o sin ayudas).
 DOI: 10.3109/09638288.2013.864713 Development of the Spanish version SCIM version III 1651
4. Deambula con andador o muletas (marcha pendular).
5. Deambula con muletas o dos bastones (marcha recı́proca).
6. Deambula con un bastón.
7. Necesita solamente ortesis de miembro inferior.
8. Deambula sin ayudas para la marcha.
13. MOVILIDAD EN DISTANCIAS MODERADAS (10–100 METROS) œœœœœœ
0. Requiere asistencia total.
1. Necesita silla de ruedas eléctrica o asistencia parcial para utilizar silla de ruedas manual.
2. Se desplaza de forma independiente con silla de ruedas manual.
3. Requiere supervisión mientras deambula (con o sin ayudas).
4. Deambula con andador o muletas (marcha pendular).
5. Deambula con muletas o dos bastones (marcha recı́proca).
6. Deambula con un bastón.
7. Necesita solamente ortesis de miembro inferior.
8. Deambula sin ayudas para la marcha.
14. MOVILIDAD EN EXTERIORES (MÁS DE 100 METROS) œœœœœœ
0. Requiere asistencia total.
1. Necesita silla de ruedas eléctrica o asistencia parcial para utilizar silla de ruedas manual.
2. Se desplaza de forma independiente con silla de ruedas manual.
3. Requiere supervisión mientras deambula (con o sin ayudas).
4. Deambula con andador o muletas (marcha pendular).
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5. Deambula con muletas o dos bastones (marcha recı́proca).

6. Deambula con un bastón.
7. Necesita solamente ortesis de miembro inferior.
8. Deambula sin ayudas para la marcha.
15. MANEJO EN ESCALERAS œœœœœœ
0. Incapacidad para subir o bajar escaleras.
1. Sube y baja al menos 3 escalones con soporte o supervisión de otra persona.
2. Sube y baja al menos 3 escalones con soporte de barandilla y/o muleta o bastón.
3. Sube y baja al menos 3 escalones sin ningún soporte ni supervisión.

16. TRANSFERENCIAS SILLA DE RUEDAS - COCHE œœœœœœ

For personal use only.

(Acercarse al coche, frenar la silla de ruedas, retirar reposabrazos y reposapiés, realizar transferencias a y desde el coche, introducir la silla de ruedas
dentro y fuera del coche)
0. Requiere asistencia total.
1. Necesita asistencia parcial y/o supervisión y/o ayudas técnicas.
2. Se transfiere de forma independiente; no requiere ayudas técnicas (o no requiere silla de ruedas).

17. TRANSFERENCIAS SUELO - SILLA DE RUEDAS œœœœœœ

0. Requiere asistencia total.
1. Se transfiere de forma independiente con o sin ayudas técnicas (o no requiere silla de ruedas).

SUBTOTAL 0–40 œœœœœœ

TOTAL PUNTUACIÓN SCIM (0–100) œœœœœœ