1. Basic Components:
    1. Pt. Hx
    2. Systems Review
      1. Neuromuscular; Musculoskeletal; Cardiopulmonary; Integumentary
    3. Tests & Measures
      1. Level of Consciousness; Emotional Stat; Behavioral Style; Communication & Lang; Ventilation & Respiration; Anthropomerics; Integumentary Integrity; Pain; CN & PN & sensory integrity; Perceptual fnx; Jt integrity & mobility; Posture; Motor Function; Muscle Performance; Postural control & bal; Gait & locomotion;W/C mgmt & mobility; Aerobic capacity & endurance; orthotics; Fnxal stat & activity level; Work/Community/Leisure activities
  2. Hx
  3. Levels of Consciousness
    1. Normal, Lethargy, Obtundation, Stupor, Coma
  4. Communication
  5. Cognitive, Emotional & Behavioral States
    1. Orientation: Person, Place, Time
    2. Attention: Selective, Sustained, Alternating, Divided
    3. Memory: Immediate, STM, LTM
    4. Ability to follow commands: 1, 2, & 3 level commands
    5. To assess higher cortical fnx:
      1. tests of simple arithmetic & abstract reasoning
    6. Mini-Mental Status Examination (MMSE)
      1. valid & reliable quick screen of cognitive fnx
    7. The Beck Depression Inventory
      1. 21 statements; scored on scale 0-3; short version=13 questions; 5 mins to complete
  6. CN & Sensory Integrity; Jt Integrity & Mobility
  7. Perception
    1. Body scheme/image; Apraxia; Agnosia, Spatial Relations; Unilateral Neglect etc
  8. Tone/Reflexes
    1. Modified Ashworth Scale
  9. Voluntary Movement Patterns
    1. Abnormal; Obligatory Synergies etc
    2. Coordination Tests to examine Control
      1. focus: speed/rate control, steadiness, response orientation, RT & MT
    3. Fine motor control & dexterity
  10. Strength
    1. if pt's spasticity doesn't pose validity issues: MMT, handheld or isokinetic dynamometry etc
  11. Postural Control & Balance
    1. in sitting & standing
    2. Reactive Postural Control & Anticipatory Postural Control
    3. Performance Based Tests
      1. BBS
        1. • 14 functional tasks scored using a 5 point ordinal scale • Examines unsupported sitting & standing, transfers, functional reach, picking objects off floor, turning, single leg stance & stepping • Score4 = independent function while a score 0 = unable to perform • Max score 56 • High intrarater & interrater reliability
      2. Fugl-Meyer Test
        1. • For acute stroke patients • Includes items of unsupported sitting, standing (with & without support), parachute reactions to both sides, & single limb stance both sides • Scored using 3 point ordinal scale
      3. Postural Assessment Scale for Stroke Patients (PASS)
        1. • Examines postural abilities of acute stroke patients • 12 items examines sitting & standing without support, standing on paretic LE, & changing posture (supine to affected side, supine to unaffected side, supine to sitting, sitting to standing, & standing at taking a pencil off floor) • Scored using ordinal scale with descriptors ranging from can’t perform to perform with little help, to perform without help • Good construct validity; high intrarater & interrater reliability
      4. Others:
        1. Functional Reach Test; Performance-Oriented Mobility Assessment--Tinetti (POMA), Timed Up & Go Test, Clinical Test of SEnsory Interaction & Balance; Dynamic Posturography: LOS Test
  12. Ambulation & Functional Mobility
    1. Observational Gait Analysis
    2. Performance-Based Gait Tests=determine gait fnx following stroke incld:
      1. 10 Meter Walk Test
      2. 6-Minute Walk Test
      3. Energy Expenditure
      4. Emory Functional Ambulation Profile
      5. Walkie-Talkie Test
  13. Functional Status
    1. Instruments incld item to examine: Functional Mobility Skills; Basic ADL & IADL skills
    2. The Barthel Index
    3. Functional Independence Measure (FIM)
  14. Disability-Specific Instruments
    1. Fugl-Meyer Assessment of Physical Performance (FMA)
      1. • An impairment-based test with items organized by sequential recovery stages • Three point ordinal scale measuring impairments of volitional movement with grades ranging from 0 – 2 • Subtests exist for UE & LE fnx, Bal, Sensation, ROM, & Pain • Total = 226 • Good construct validity & high reliability for determining motor function & balance • 30-40 mins to administer'
    2. National Institute of Health Stroke Scale (NIHSS)
      1. • For initial & serial exam of impairments following acute stroke11 item impairment-based test; uses a variable ordinal scale • Some items scored 0 – 2 or 0 – 3 (level of consciousness, best gaze, visual fields, facial palsy, limb ataxia, sensory, best language, dysarthria, extinction, &inattention) other items scored 0 – 4 (motor arm & motor leg)
    3. Stroke Rehabilitation Assessment of Movement (STREAM)
      1. • Clinical measure of voluntary movements & basic mobility following stroke • 30 items distributed equally among 3 subscales: UL mvmts, LL mvmt & basic mobility items voluntary movement items explored out of synergy control & scored using 3 point ordinal scale (unable to perform, partial performance, complete performance) • Basic mobility includes variety of items (rolling, bridging, sit to stand, standing, stepping, walking & spares) & scored using 4 point ordinal scale (unable, partial, complete/with aid, complete/no eight) • Maximum = 70 w/ea limb subscore worth 20 & fnxal mobility subscore worth 30 pts • Good construct validity & high reliability • Been used to dock motor recovery over time & predict discharge destination following stroke
    4. Motor Assessment Scale (MAS)
      1. • Examines functional mobility skills following stroke • 6 point ordinal scale with descriptors • 8 items of motor function including the movement transitions (supine to sideline, supine to sit, sit to stand), balanced sitting, walking, upper arm function, hand movements & advanced hand function • The 9th item = impairment item examining muscle tone • High reliability & high concurrent validity w/FMA • Can be used to document motor recovery over time