Neurorehab Assessment

Categories of Neurorehab Scales (with published validity/reliability studies)

• Acute Assessment (e.g., for Admission/Screening):
  • Consciousness/cognition (e.g., Glasgow Coma Scale, Mini-Mental State Exam (MMSE))
  • Stroke deficit (e.g., NIH Stroke Scale, Candian Neurological Scale)
  • Global disability (e.g., Rankin Scale)
  • ADL/outcomes (e.g., Barthel, FIM, SIS- see below)
  • Health outcomes, physical & mental (e.g., Health Survey SF-36, on web)
  • Screening for rehab adherence (cognition, motivation, depression)
• Rehab Admission/Monitoring/Outcomes:
  • General scales such as ADLs (Bathel, FIM) or various QOL (quality of life)
  • Targeted functional assessment scales such as for balance, mobility, language/speech, dysphagia, hand function, cognition, depression, continence
• See also summary at http://www.strokecenter.org/trials/scales/

Example - Scales Used in Telerehab & Performance Assessment Lab (e.g., MS research project of Adenine Stanislaus):

• Functional Impairment:
  • Fugl-Meyer Assessment: A systematic suite of tests using a 3-point ordinal scale that quantify motor recovery stages based on the scales of Brunnstrom and Twitchell (ontogenetic concept of motor recovery). In addition to motor recovery (100 points), balance (14 points), sensation, range of motion (44 points), sensation (24 points) and pain (44 points) are also assessed (total maximum score is 226). Movement is examined in and out of synergies. It is widely used for research studies. We tend to use the 66-point upper extremity portion of the assessment.
• General ADL/Independence:
  • Functional Independence Measure (FIM): An 18-item test using a seven level ordinal scale that targets functional assessemnt andn independence. Roughly 2/3 of items target motor function, 1/3 cognitive function. Documentation consists of observing and recording what a person actually does. It can be completed in approximately 15 minutes. Includes a very large national database, with strong federal buy-in (e.g., NIDRR funding, participation by VA hospitals).
  • Barthel Index: A widely used 100-point assessment of independence in ten daily activities (10 points for feeding, 5 for bathing, 5 for grooming, 10 for dressing, 10 for bowels, 10 for bladder, 10 for toilet use, 15 for transfers, 15 for mobility, 10 for stairs), originally designed for use with people with neuromuscular or musculoskeletal disorders. It is normally completed within 5-10 minutes.
• Daily Activity:
  • Motor Activity Log (MAL): This is a "real world" measure of 30 different functional tasks, scored by self-report during a structured interview in terms of "how often" and "how well" they are performed (both on 0-5 scales in 0.5 increments), typically applied to the previous week. Developed by the group responsible for constraint-induced movement therapy. It can be completed in roughly 30 min.
• Targeted Functional Performance:
  • Nine-Hole Peg Test: The 9 hole peg test is a simple timed test of fine motor coordination, involving placing dowels (9 mm in diameter and 32 mm long) in 9 holes. Subjects are scored on the amount of time it takes to place and remove all 9 pegs. Two scores are collected, one for each hand. Takes several minutes.
  • Jebson-Taylor Hand Function Test: Timed performance of seven test items designed to represent various aspects of hand function, using common activities such as writing, simulated feeding, holding objects, turning cards or pages as in reading, etc. The dimension used to measure each function is the length of time taken to complete each of the tasks. Performed in 10-15 minutes for both hands.
  • Wolf Motor Function Test: A lab-based test focusing on arm function that involves 15 timed measures and 2 force-based measures which progress in complexity from engaging individual joints to use of the total arm. For the 15 timed tests, an ordinal score elated to the quality of movement is also scored. All are goal-directed, and several are functional (e.g., raising a can to the mouth). It can be completed in roughly 30 min.