Objective : To evaluate the reliability and the validity of the Japanese version of the Spinal Cord Independence Measure (SCIM) in patients with cervical spinal cord injury. Design : Cross-sectional, observational study. Setting : Rehabilitation ward for spinal cord injury in Japan. Patients and Methods : 26 inpatients with traumatic and non-traumatic cervical spinal cord injury, with an average age of 60.3, were included to examine the internal consistency of the subscales (subscores in each domain) and the whole scale, and to determine concurrent validity of the SCIM and the Functional Independence Measure (FIM) motor subscores. To examine interrater reliability, 12 of these patients were assessed by 2 physiatrists independently and intraclass correlation coefficients (ICC) for total scores and weighted kappas for individual item scores were calculated. Results : The ICC for total SCIM score was 0.99, and the weighted kappas for individual item scores showed moderate to strong agreement (kappa=0.54-1.00). The Cronbach's alpha coefficients for domain subscores and total score were above 0.71, demonstrating appropriate internal consistency of the SCIM. The total SCIM scores significantly correlated with the FIM motor subscores (Spearman's rho=0.95), however, there were some variations with the SCIM scores in patients who were rated as 6 (modified independence) with the FIM in such items as bladder management and indoor mobility. Conclusion : The results supported the internal consistency, interrater reliability and concurrent validity of the SCIM in patients with cervical spinal cord injury. The SCIM may be a potential measure to evaluate certain functional aspects that cannot be assessed by the FIM alone.

A 59-year-old man was admitted for treatment of Stanford type B acute dissecting aneurysm with acute renal failure. He had begun hemodialysis one month after onset, because digital subtraction angiography (DSA) revealed that the truelumen was narrowed by a dilated false channel just above the renal artery. Initially axillo-femoral bypass was performed to treat renal failure, and the patients was easily weaned from hemodialysis. Eight months after the first operation, descending thoracic aorta replacement was performed. The patient is doing well one year after operation. In conclusion, axillo-femoral bypass yielded good results because our patient recovered from renal failure and could undergo radical operation safely. Axillo-femoral bypass allowed evaluation of the hemodynamic study before radical operation.