Abstract
The Locomotor Capability Index (LCI) is widely used for assessing goals and achievements of patients receiving prostheses. The Stanmore-Kingston Splat method for graphical display of the results has previously been described and is based on four levels of achievement for each of the 14 tasks in the index. Recently a modified version of the LCI with five levels for each task has been described (LCI-5). We have thus developed and applied the system for graphical display of the LCI-5 in Splat form. The new Splat can help to highlight the difference in ability of the prosthetic user who can achieve tasks without a walking aid compared to those using a walking aid.
Background
The Locomotor Capability Index (LCI) is a widely used system for assessing the goals and achievements of patients receiving prostheses; originally the LCI consisted of assessment of 14 commonly encountered tasks each rated on a four point scale 1 from 0 to 3. A method for displaying the results in graphical form (the Stanmore-Kingston Splat) in order to provide an easily assimilated display of the scores has previously been described 2 ; thus it can help in setting goals and assessing outcome in accordance with Royal College of Physicians (UK) recommendations 3 . Recently it has been proposed that a five point scale (LCI-5) for each task may be more appropriate 4 as this has greater resolution and is better suited for assessing more able people who have amputation.
Aim
The aim of this study was to develop a modified version of the Splat with a scale from 0 to 4 to represent LCI-5.
Description
The Splat was developed with Excel (Microsoft Corporation, USA). There are three stages of scoring:
At delivery of prosthesis and start of rehabilitation programme Goal set jointly with patient Level achieved at assessment after therapy programme
At each stage the patient's abilities are assessed on a 5 point scale for each of the fourteen tasks. The scoring of each task is as follows:
In the 4 point scale (0 to 3) a score of 3 represents ability to complete task independently. The scoring is displayed graphically on the Splat with coloured/shaded areas indicating the level of achievement in relation to the rehabilitation goals set.
The following example shows how the modifications can help demonstrate the difference in ability for a patient with unilateral transtibial amputation. The original LCI (Fig. 1) shows almost a complete circle on the Splat indicating that the patient has a score of 41/42 and is able to complete most tasks independently but gives no indication of whether a walking aid was used.
Locomotor Capability Index 4 Diagram.
Figure 2 using the LCI-5 demonstrates the variation in the Splat produced when the top level is split into level 3 (ability to complete the task with a walking aid) and level 4 (ability to compete the task without a walking aid). The combined score is now 48/ 56. It shows that the goals of walking outside unaided and stepping up and down a sidewalk kerb unaided have not been met. It also highlights that the more advanced activities on the left hand side of the Splat are still scored at level 3 and are achieved but with the use of a walking aid; hence the advanced activities are now not at the maximum value that can be shown on the diagram.
Locomotor Capability Index 5 Diagram.
Conclusion
In conclusion the LCI-5 in Splat form clearly highlights the difference in ability of the prosthetic user who can achieve tasks without a walking aid compared to those that continue to use a walking aid. The LCI-5 Splat compensates for the lower ceiling effect seen in the original Splat and allows use of the walking aid to be noted. The new Splat may help to promote the use of LCI-5 by providing an easily understood means of presenting the assessment scores.
Footnotes
Acknowledgements