Handbook of Neuro Outcome Measures

THE HONG KONG POLYTECHNIC UNIVERSITY
DEPARTMENT OF REHABILITATION SCIENCES
RS 3730 & 3731 - Commonly Used Outcome Measures

in Neurological Physiotherapy
Prepared by Curtis Wong

(With contribution from Prof. Magaret Mak)
August 2023
1
Table of Contents
1. INITIAL ASSESSMENT OF NEUROLOGICAL PATIENTS .................................................................................... 4
2. COGNITION & AROUSAL............................................................................................................................... 8
GLASGOW COMA SCALE (GCS) ........................................................................................................................... 8
MINI-MENTAL STATE EXAMINATION (MMSE; ENG VER.)..................................................................................... 8
MINI-MENTAL STATE EXAMINATION (MMSE; HONG KONG VER.) ....................................................................... 10
ABBREVIATED MENTAL TEST (AMT; ENG VER.) .................................................................................................. 11
ABBREVIATED MENTAL TEST (AMT; HONG KONG VER.) ...................................................................................... 12
MONTREAL COGNITIVE ASSESSMENT (MOCA; ENG VER.) .................................................................................. 13
MONTREAL COGNITIVE ASSESSMENT (MOCA; HONG KONG VER. 2010) ............................................................. 14
MONTREAL COGNITIVE ASSESSMENT (MOCA; HONG KONG VER. 2018) ............................................................. 15
3. MUSCLE TONE ............................................................................................................................................ 17
MODIFIED ASHWORTH SCALE (MAS) ............................................................................................................... 17
4. SENSORIMOTOR FUNCTION ....................................................................................................................... 18
FUGL-MYER ASSESSMENT – UPPER EXTREMITY (FMA-UE) .............................................................................. 18
FUGL-MYER ASSESSMENT – LOWER EXTREMITY (FMA-LE) .............................................................................. 21
5. BALANCE AND MOBILITY ........................................................................................................................... 23
CLINICAL TEST OF SENSORY INTERACTION AND BALANCE (CTSIB) ................................................................... 23
FUNCTIONAL REACH TEST (FRT) ....................................................................................................................... 24
TIMED-UP-AND-GO TEST (TUGT) ..................................................................................................................... 25
BERG’S BALANCE SCALE (BBS) .......................................................................................................................... 26
BALANCE EVALUATION SYSTEMS TEST (BESTEST) ............................................................................................. 30
MINI-BESTEST.................................................................................................................................................... 40
ACTIVITIES OF BALANCE CONFIDENCE SCALE (ABC SCALE; ENG VER.) ................................................................. 43
ACTIVITIES OF BALANCE CONFIDENCE SCALE (ABC SCALE; HONG KONG VER.) ..................................................... 44
6. FUNCTIONAL ACTIVITY/ MOBILITY ............................................................................................................. 45
BARTHEL ADL INDEX (BI) .................................................................................................................................. 45
MODIFIED BARTHEL ADL INDEX (MBI) .............................................................................................................. 46
FUNCTIONAL INDEPENDENCE MEASURE (FIM) ................................................................................................ 48
ELDERLY MOBILITY SCALE (EMS) ...................................................................................................................... 52
MODIFIED RIVERMEAD MOBILITY INDEX (MRMI) ............................................................................................ 53
7. GAIT AND MOBILITY................................................................................................................................... 54
MODIFIED FUNCTIONAL AMBULATION CLASSIFICATION (MFAC) .................................................................... 55
10-METER WALK TEST ...................................................................................................................................... 56
DYNAMIC GAIT INDEX (DGI) ............................................................................................................................. 57
FUNCTIONAL GAIT ASSESSMENT (FGA) ............................................................................................................ 59
8. UPPER LIMB FUNCTION AND COORDINATION ........................................................................................... 61
JEBSEN TAYLOR HAND FUNCTION TEST ........................................................................................................... 61
ACTION RESEARCH ARM TEST .......................................................................................................................... 62
PURDUE PEGBOARD TEST ................................................................................................................................ 63
MINNESOTA MANUAL DEXTERITY TEST ........................................................................................................... 63
9. DISEASE SPECIFIC ....................................................................................................................................... 64
MODIFIED HOEHN AND YAHR STAGING ........................................................................................................... 64
AMERICAN SPINAL INJURY ASSOCIATION (ASIA) .............................................................................................. 65
INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY (ISNCSCI) ...... 65
SPINAL CORD INDEPENDENCE MEASURE III (SCIM III) ...................................................................................... 67
SUNNYBROOK FACIAL GRADING SYSTEM ........................................................................................................ 70
2
MOTION SENSITIVITY QUOTATION .................................................................................................................. 71
DIZZINESS HANDICAP INVENTORY (DHI; ENG VER.) ........................................................................................... 72
DIZZINESS HANDICAP INVENTORY (DHI; CHI VER.) ............................................................................................ 73
10. QUALITY OF LIFE....................................................................................................................................... 74
SHORT FORM-36 (SF-36) .................................................................................................................................. 74
SHORT FORM-12 (SF-12) .................................................................................................................................. 75
WHO QUALITY OF LIFE-BREF ............................................................................................................................ 76
3
1. Initial Assessment of Neurological Patients
Date of assessment: _______________________________
Name:_____________________________Sex/Age_________________________
Ward/Bed no.:____________________Therapist's name ____________________
Diagnosis: _________________________________________________________________
HPI:_______________________________________________________________________
PMH:______________________________________________________________________
Social history:_______________________________________________________________
Family support:______________________________________________________________
Cognitive/psychological state: __________________________________________________
Communication:
Hearing: ________________________________
Visual: _________________________________
Speech: ________________________________
General Observation:_________________________________________________________
___________________________________________________________________________
General tonus:
Trunk: _______________________________________
UL: _________________________________________
LL: __________________________________________
Pain: ________________________________________________________________
Sensation:
LUL LLL RUL RLL
Tactile
Proprioception (JPS)
Proprioception
(kinaesthesia)
4
Voluntary control
Date Testing position Active control / any abnormal movement
Hip flexion
Hip extension
Hip abduction
Knee flexion
Knee extension
Ankle DF
Trunk flex/extension
Trunk elongation
Trunk rotation
Sh protraction
Sh flexion
Sh abduction
Elbow flexion
Elbow extension
Forearm sup/pron
Wrist flex/ext
Thumb opposition
Finger flexion/extension
Balance
Sitting
Time to maintain sitting unsupported: ___________________________________
Sitting posture/base of support: ________________________________________
Reaching sideways : ________________Reaching forward:__________________
Bend down, touch feet and return:_______________________________________
Response to perturbation:_____________________________________________
Standing
Time to maintain standing with feet together, tandem, single leg stance:_________
Standing posture/base of support:_______________________________________
Reaching sideways: __________________Reaching forward:_________________
Turning: __________________________________________________________
5
Response to perturbation: _____________________________________________
High level balance activities: __________________________________________
Functional activities
Bridging: __________________________________________________________
Rolling (affected side):________________________________________________
Rolling (unaffected side):______________________________________________
Sitting over to side of bed (affected side):________________________________
__________________________________________________________________
Sitting over to side of bed (unaffected side):______________________________
__________________________________________________________________
Sitting to standing:___________________________________________________
__________________________________________________________________
Transfer:___________________________________________________________
Walking:___________________________________________________________
__________________________________________________________________
Walking speed/stride length: ___________________________________________
Advanced gait activities:______________________________________________
Gross and fine hand functions:
Grasp/release different objects/hand grip force :____________________________
Reach out for a cup: _________________________________________________
Drinking from a glass: _______________________________________________
Thumb opposition to individual fingers:__________________________________
Use of spoon, chopsticks: _____________________________________________
Using two hands together: ____________________________________________
6
Orofacial function:
Swallowing:________________________________________________________
Lip and jaw closure: _________________________________________________
Facial movement:____________________________________________________
Coordination (if applicable)
left right
Finger/nose
Pronation/supination
Heel/shin
Foot tapping
Major Problems
Functional limitations Impairments
Short and long term functional goals:
Treatment plan:
Signature of therapist:
7
2. Cognition & Arousal
GLASGOW COMA SCALE (GCS)

(ICF Domain: Body Structure/Function - Impairment)
Eye Opening spontaneous 4

to speech 3
to pain 2
no response
1
Best Motor Response To Verbal Command: obeys 6
To Painful Stimulus:
localizes pain 5
flexion-withdrawal 4
flexion-abnormal 3
extension 2
no response
1
Best Verbal Response oriented and converses 5
disoriented and converses 4
inappropriate words 3
incomprehensible sounds 2
no response 1
Reference: Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness:
a practical scale. The Lancet, 304(7872), 81-84.
8
MINI-MENTAL STATE EXAMINATION (MMSE; Eng Ver.)
Maximu Score
m score
ORIENTATION
5 ( ) What is the year season date day month?
5 ( ) Where are we? state country town hospital floor
3 REGISTRATION
( ) Name 3 objects: 1 second to say each. Then ask the patient all 3
after you have said them. Give 1 point for each correct answer.
Then repeat them until he learns all 3.
Count trials and record.
5 Serial 7’s minus from 100. 1 point for each correct. Stop after 5
( ) answers.
Alternately spell “world” backward
3 RECALL
( ) Ask for the 3 objects repeat above. Give 1 point for each correct.
9 LANGUAGE
( ) Name a pencil, and watch (2 points
Repeat the following “no, ifs, ands or buts” (1 point)
Follow a 3-stage commands: Take a paper in your right hand,
fold it half, and put it on the floor (3 points)
Read and obey the following:
CLOSE YOUR EYES (1 point)
Write a sentence (1 point)
Copy design (1 point)
Total ( )
Reference: Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a
practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric
research, 12(3), 189-198.
9
MINI-MENTAL STATE EXAMINATION (MMSE; Hong Kong Ver.)
簡短智能測驗
最高分數分
數
5 依家係乜野日子(年份)(季節)(月份)(幾號)(星期幾)?
5 我地依家係邊喥？
(九龍/新界/香港)(九龍/新界/香港既邊度)(醫院)(邊層樓)(病房)
或: (九龍/新界/香港) (九龍/新界/香港既邊度)(邊一科診所)(診
所名字)(邊層樓)
或: (九龍/新界/香港) (九龍/新界/香港既邊度)(邊條街)(邊一
座)(邊層樓)
或: (九龍/新界/香港) (九龍/新界/香港既邊度)(邊個屋村)(中心
名字)(邊層樓)
3 我依家會講三樣野既名, 講完之後, 請你重複一次.
請記住佢地, 因為幾分鐘後, 我會叫你再講番俾我聽。
(蘋果)、 (火車) 、 (報紙). 依家請你講番哩三樣野俾我聽.
(以第一次講的計分, 一個一分; 然後重複物件, 直至全部三樣都
記住.)
5 請你用一百減七, 然後再減七, 一路減落去, 直至我叫你停為止.
(減五次後便停)
( )
或: 依家我讀幾個數目俾你聽, 請你倒轉頭講番出黎.
( ) (4 2 7 3 1 )
3 我頭先叫你記住既三樣野係乜野呀?
9 哩樣野係乜野? (鉛筆)(手錶). (2)
請你跟我講句說話(姨丈買魚腸).(1)
依家檯上面有一張紙. 用你既右手拿起張紙, 用兩隻手一齊將
紙摺成一半, 然後放番張紙檯上面.(3)
請你講任何一句完整既句子俾我聽。例如: (我係一個人)、(今
日天氣好好)。(1)
哩處有幅圖, 請你照住黎畫啦。
總分 :
拍手
Reference: Chiu, H. F., Lee, H. C., Chung, W. S., & Kwong, P. K. (1994). Reliability and validity
of the Cantonese version of Mini-Mental State Examination. East Asian Archives of
Psychiatry, 4(2), 25. 10
ABBREVIATED MENTAL TEST (AMT; Eng Ver.)
The abbreviated mental test is to access elderly patients for the possibility of cognitive
impairment/dementia. The following 10 questions are put to the patient. Test includes short
term memory (Q3) and long term memory (Q1,7,8,9), attention (Q10) and orientation
(Q2,4,5,6). Each question correctly answered scores 1 point.
Questions Scores
1. What is your age?
2. What is the time to the nearest hour?
3. Give the patient an address, and ask him or her to repeat it at the
end of the test e.g. 42 West Street
4. What is the year?
5. What is the name of the hospital or number of the residence

where the patient is situated?
6. Can the patient recognize two persons (the doctor, nurse, home
help, etc.)
7. What is your date of birth? (day and month sufficient)
8. In what year did World War 1 begin? (Other dates can be sued,
with a preference for dates some time in the past)
9. Name the current President/ Prime Minister/ Monarch.
10. Count backward from 20 down to 1.
Total Scores
Cut-off Value (Jitapunkul et al., 1991):

<8 = considered abnormal cognitive function
Reference: Hodkinson, H. M. (1972). Evaluation of a mental test score for assessment of mental
impairment in the elderly. Age and ageing, 1(4), 233-238.
Jitapunkul, S., Pillay, I., & Ebrahim, S. (1991). The abbreviated mental test: its use and
validity. Age and ageing, 20(5), 332-336.
11
ABBREVIATED MENTAL TEST (AMT; Hong Kong Ver.)
Questions Scores
(Please circle:
0 = incorrect
answer 1 =
correct
answer)
1. Age (+/- 5 years) 0/1
請講出你的年齡
2. Time (nearest hour, or am/pm/night) 0/1
現在是什麼時間
3. Address for recall at the end of the test: 42 Shanghai Street 0/1
我告訴你一個地址，請你緊記。這地址是「上海街四十二號」
4. Year (+/- 1 year) 0/1
今年是甚麼年份
5. Place name 0/1
這裏是什麼地方
6. Recognition of two persons (doctor, nurse, etc.) 0/1
你認識這兩位人士嗎（在周圍任何兩位人士）
7. Date of birth (day and month) 0/1
請講出你的出生日期
8. Date of mid-Autumn festival 0/1
請講出中秋節的日期
9. Name of present Governor or Chinese leader 0/1
請講出香港特首的名字
10. Count 20-1 backwards 0/1
請由二十倒數至一
Total Scores
Communication barriers present at the time of test: Y/N
Deafness ____ Depression ____ Dysphasia ____ Language barriers ____
Others: ______________
Cut-off Value:
<6 = suggest abnormal cognitive function (e.g. delirium, dementia) (Chu et al., 1995)
<7 = considered impaired cognition in residential care setting (Lam et al., 2010)
Reference: Chu, L. W., Pei, C. K. W., Ho, M. H., & Chan, P. T. (1995). Validation of the
abbreviated mental test (Hong Kong version) in the elderly medical patient. Hong Kong Medical
Journal, 1, 207-211.
Lam, S. C., Wong, Y. Y., & Woo, J. (2010). Reliability and validity of the abbreviated mental test
(Hong Kong version) in residential care homes. Journal of the American Geriatrics
Society, 58(11), 2255-2257.
12
MONTREAL COGNITIVE ASSESSMENT (MoCA; Eng Ver.)
Reference: Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V.,
Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA:
a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 13
53(4), 695-699.
MONTREAL COGNITIVE ASSESSMENT (MoCA; Hong Kong Ver. 2010)
Reference: You, J. S., Chen, R. Z., Zhang, F. M., Zhou, Z. Y., Cai, Y. F., & Li, G. F. (2011). The
chinese (cantonese) montreal cognitive assessment in patients with subcortical ischemic vascular
dementia. Dementia and Geriatric Cognitive Disorders Extra, 1(1), 276-282.
14
MONTREAL COGNITIVE ASSESSMENT (MoCA; Hong Kong Ver. 2018)
15
Reference: Wong, A., Law, L. S., Liu, W., Wang, Z., Lo, E. S., Lau, A., Wong, L. K. & Mok, V. C.
(2015). Montreal cognitive assessment: one cutoff never fits all. Stroke, 46(12), 3547-3550. 16
3. Muscle Tone
MODIFIED ASHWORTH SCALE (MAS)

0 = No increase in muscle tone
1 = Slight increase in muscle tone, manifested by a catch and release or by

minimal resistance at the end range of motion when the part is moved in
flexion or extension/abduction or adduction, etc.
1+ = Slight increase in muscle tone, manifested by a catch, followed by

minimal resistance throughout the remainder (less than half) of the ROM
2 = More marked increase in muscle tone through most of the ROM, but the
affected part is easily moved
3 = Considerable increase in muscle tone, passive movement is difficult
4 = Affected part is rigid in flexion or extension (abduction or adduction etc)
Reference: Bohannon, R. W., & Smith, M. B. (1987). Interrater reliability of a modified Ashworth
scale of muscle spasticity. Physical therapy, 67(2), 206-207.
17
4. Sensorimotor Function
FUGL-MYER ASSESSMENT – UPPER EXTREMITY (FMA-UE)

A. UPPER EXTREMITY, sitting position

I. Reflex activity none can be elicited
Flexors: biceps and finger flexors (at least one) 0 2
Extensors: triceps 0 2
Subtotal I (max 4)
II. Volitional movement within synergies, without gravitational help none partial full
Flexor synergy: Hand from contralateral Shoulder retraction 0 1 2
knee to ipsilateral ear. From extensor elevation 0 1 2
synergy (shoulder adduction/ internal abduction (90°) 0 1 2
rotation, elbow extension, forearm external rotation 0 1 2
pronation) to flexor synergy (shoulder Elbow flexion supination 0 1 2
abduction/ external rotation, elbow flexion,
Forearm 0 1 2
forearm supination).
Extensor synergy: Hand from ipsilateral Shoulder adduction/internal rotation 0 1 2
ear to the contralateral knee Elbow extension 0 1 2
Forearm pronation 0 1 2
Subtotal II (max 18)
III. Volitional movement mixing synergies, without compensation none partial full
Hand to lumbar spine cannot perform or hand in front of ant-sup iliac spine hand 0
hand on lap behind ant-sup iliac spine (without compensation) hand to 1
lumbar spine (without compensation) 2
Shoulder flexion 0°- 90° immediate abduction or elbow flexion abduction or 0
elbow at 0° elbow flexion during movement 1
pronation-supination 0° flexion 90°, no shoulder abduction or elbow flexion 2
Pronation-supination no pronation/supination, starting position impossible 0
elbow at 90° limited pronation/supination, maintains starting position full 1
shoulder at 0° pronation/supination, maintains starting position 2
Subtotal III (max 6)
IV. Volitional movement with little or no synergy none partial full
Shoulder abduction 0 - 90° immediate supination or elbow flexion supination 0
elbow at 0° or elbow flexion during movement 1
forearm neutral abduction 90°, maintains extension and pronation 2
Shoulder flexion 90° - 180° immediate abduction or elbow flexion abduction or 0
elbow at 0° elbow flexion during movement 1
pronation-supination 0° flexion 180°, no shoulder abduction or elbow flexion 2
Pronation/supination no pronation/supination, starting position impossible 0
elbow at 0° limited pronation/supination, maintains start position full 1
shoulder at 30°- 90° flexion pronation/supination, maintains starting position 2
Subtotal IV (max 6)
V. Normal reflex activity assessed only if full score of 6 points is achieved in part IV;
hyper lively normal
compare with the unaffected side
2 of 3 reflexes markedly hyperactive 0
Biceps, triceps,
1 reflex markedly hyperactive or at least 2 reflexes lively 1
finger flexors 2
maximum of 1 reflex lively, none hyperactive
Subtotal V (max 2)
Total A (max 36)
18
B. WRIST support may be provided at the elbow to take or hold the starting position, no
none partial full
support at wrist, check the passive range of motion prior testing
Stability at 15° dorsiflexion elbow less than 15° active dorsiflexion dorsiflexion 0
at 90°, forearm pronated shoulder at 15°, no resistance tolerated maintains 1
0° dorsiflexion against resistance 2
Repeated dorsifexion / volar flexion cannot perform volitionally 0
elbow at 90°, forearm pronated limited active range of motion 1
shoulder at 0°, slight finger flexion full active range of motion, smoothly 2
Stability at 15° dorsiflexion elbow less than 15° active dorsiflexion dorsiflexion 0
at 0°, forearm pronated slight 15°, no resistance tolerated maintains 1
shoulder flexion/abduction dorsiflexion against resistance 2
Repeated dorsifexion / volar flexion cannot perform volitionally 0
elbow at 0°, forearm pronated slight limited active range of motion 1
shoulder flexion/abduction full active range of motion, smoothly 2
Circumduction cannot perform volitionally jerky 0
elbow at 90°, forearm pronated movement or incomplete 1
shoulder at 0° complete and smooth circumduction 2
Total B (max 10)
C. HAND support may be provided at the elbow to keep 90° flexion, no support at the
none partial full
wrist, compare with unaffected hand, the objects are interposed, active grasp
Mass flexion
from full active or passive extension 0 1 2
Mass extension
from full active or passive flexion 0 1 2
GRASP
a. Hook grasp cannot be performed 0
flexion in PIP and DIP (digits II-V), can hold position but weak 1
extension in MCP II-V maintains position against resistance 2
b. Thumb adduction cannot be performed 0
1-st CMC, MCP, IP at 0°, scrap of paper can hold paper but not against tug can 1
between thumb and 2-nd MCP joint hold paper against a tug 2
c. Pincer grasp, opposition cannot be performed 0
pulpa of the thumb against the pulpa of 2- can hold pencil but not against tug can 1
nd finger, pencil, tug upward hold pencil against a tug 2
d. Cylinder grasp cannot be performed 0
cylinder shaped object (small can) can hold cylinder but not against tug can 1
tug upward, opposition of thumb and fingers hold cylinder against a tug 2
e. Spherical grasp cannot be performed 0

fingers in abduction/flexion, thumb can hold ball but not against tug can 1
opposed, tennis ball, tug away hold ball against a tug 2
Total C (max 14)
D. COORDINATION/SPEED, sitting, after one trial with both arms, eyes

marked slight none
closed, tip of the index finger from knee to nose, 5 times as fast as possible
Tremor 0 1 2
Dysmetria pronounced or unsystematic slight 0
and systematic 1
no dysmetria 2
≥ 6s 2 - 5s < 2s
Time 6 or more seconds slower than unaffected side 2-5 0
start and end with the hand seconds slower than unaffected side 1
on the knee less than 2 seconds difference 2
Total D (max 6)
19
H. SENSATION, upper extremity anesthesia
hypoesthesia or
normal
eyes closed, compared with the unaffected side dysesthesia
upper arm, forearm 0 1 2
Light touch palmary surface of the hand 0 1 2
less than 3/4 3/4 correct or correct 100%,
correct or considerable little or no
absence difference difference
shoulder 0 1 2
Position
elbow 0 1 2
small alterations in the
wrist 0 1 2
position thumb (IP-joint) 0 1 2
Total H (max12)
I. PASSIVE JOINT MOTION, upper extremity, sitting J. JOINT PAIN during passive motion,
position, compare with the unaffected side upper extremity
only few pronounced pain during
degrees movement or very marked some no
decreased normal
(less than 10° in pain at the end of the pain pain
shoulder) movement
Shoulder
Flexion (0° - 180°) 0 1 2 0 1 2
Abduction (0°-90°) 0 1 2 0 1 2
External rotation 0 1 2 0 1 2
Internal rotation 0 1 2 0 1 2
Elbow
Flexion 0 1 2 0 1 2
Extension 0 1 2 0 1 2
Forearm
Pronation 0 1 2 0 1 2
Supination 0 1 2 0 1 2
Wrist
Flexion 0 1 2 0 1 2
Fingers
Flexion 0 1 2 0 1 2
Total (max 24) Total (max 24)
A. UPPER EXTREMITY /36
B. WRIST /10
C. HAND /14
D. COORDINATION / SPEED /6
TOTAL A-D (motor function) /66

H. SENSATION /12
I. PASSIVE JOINT MOTION /24
J. JOINT PAIN /24
Reference: Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., & Steglind, S. (1975). The
post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian 20
journal of rehabilitation medicine, 7(1), 13–31.
FUGL-MYER ASSESSMENT – LOWER EXTREMITY (FMA-LE)
E. LOWER EXTREMITY
I. Reflex activity, supine position none can be elicited
Flexors: knee flexors 0 2
Extensors: patellar, achilles (at least one) 0 2
Subtotal I (max 4)
II. Volitional movement within synergies supine position none partial full
Flexor synergy: Maximal hip flexion Hip flexion 0 1 2
(abduction/external rotation), maximal flexion in knee Knee flexion 0 1 2
and ankle joint (palpate distal tendons to ensure active
knee flexion). Ankle dorsiflexion 0 1 2
Extensor synergy: From flexor synergy to the hip Hip extension 0 1 2
extension/adduction, knee extension and ankle plantar
flexion. Resistance is applied to ensure adduction 0 1 2
active movement, evaluate both movement and strength Knee extension 0 1 2
(compare with the unaffected side) Ankle plantar flexion 0 1 2
Subtotal II (max 14)
III. Volitional movement mixing synergies none partial full

sitting position, knee 10cm from the edge of the chair/bed
Knee flexion from no active motion 0
actively or passively less than 90° active flexion, palpate tendons of hamstrings more 1
extended knee than 90° active flexion 2
Ankle dorsiflexion no active motion 0
compare with limited dorsiflexion 1
unaffected side complete dorsiflexion 2
Subtotal III (max 4)
IV. Volitional movement with little or no synergy none partial full

standing position, hip at 0°
Knee flexion to 90° hip no active motion or immediate, simultaneous hip flexion less 0
at 0°, balance support is than 90° knee flexion and/or hip flexion during movement at least 90° 1
allowed knee flexion without simultaneous hip flexion 2
Ankle dorsiflexion no active motion 0

compare with limited dorsiflexion 1
unaffected side complete dorsiflexion 2
Subtotal IV (max 4)
V. Normal reflex activity supine position, assessed only if full score of 4 points is
hyper lively normal
achieved in part IV, compare with the unaffected side
Reflex activity 2 of 3 reflexes markedly hyperactive 0
knee flexors, 1 reflex markedly hyperactive or at least 2 reflexes lively 1
Patellar, Achilles, maximum of 1 reflex lively, none hyperactive 2
Subtotal V (max 2)
Total E (max 28)
21
F. COORDINATION/SPEED, supine, after one trial with both legs, eyes closed,
marked slight none
heel to knee cap of the opposite leg, 5 times as fast as possible
Tremor 0 1 2
pronounced or unsystematic slight 0
Dysmetria
and systematic 1
no dysmetria 2
≥ 6s 2 - 5s < 2s
6 or more seconds slower than unaffected side 2-5 0
Time seconds slower than unaffected side 1
less than 2 seconds difference 2
Total F (max 6)
H. SENSATION, lower extremity hypoesthesia or
eyes closed, compare with the unaffected side anesthesia normal
dysesthesia
leg 0 1 2
Light touch foot sole 0 1 2
less than 3/4 3/4 correct or correct 100%,
correct or considerable little or no
absence difference difference
hip 0 1 2
Position
knee 0 1 2
small alterations in the
ankle 0 1 2
position great toe (IP-joint) 0 1 2
Total H (max12)
I. PASSIVE JOINT MOTION, lower extremity J. JOINT PAIN during passive motion,
supine position, compare with the unaffected side lower extremity
only few decreased normal pronounced pain during some no
degrees movement or very marked pain at pain pain
(<10° hip) the end of the movement
Flexion 0 1 2 0 1 2
Hip Abduction 0 1 2 0 1 2
External rotation 0 1 2 0 1 2
Internal rotation 0 1 2 0 1 2
Knee Flexion 0 1 2 0 1 2
Ankle Dorsiflexion 0 1 2 0 1 2
Plantar flexion 0 1 2 0 1 2
Foot Pronation 0 1 2 0 1 2
Supination 0 1 2 0 1 2
Total (max 20) Total (max 20)
E. LOWER EXTERMTY /28
F. COORDINATION / SPEED /6
TOTAL E-F (motor function) /34
H. SENSATION /12
I. PASSIVE JOINT MOTION /20
J. JOINT PAIN /20

22
Reference: Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., & Steglind, S. (1975). The post-
stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian
journal of rehabilitation medicine, 7(1), 13–31.
5. Balance and Mobility
CLINICAL TEST OF SENSORY INTERACTION AND BALANCE (CTSIB)

This test is a clinical version of the Computerized Dynamic Posturography for measuring
sensory organization. It measures the way that vision, vestibular and somatosensory
interaction for maintaining balance in standing.
Equipment: Timer, 3” high density foam, dome
General instructions: Ask the subject to remove their shoes. The subject should stand erect
without moving, feet together, looking straight ahead with arms crossed. Instruct the subject
to stand as long as possible or until the trial is over. Each trial is 30 seconds and there are 6
testing conditions (see below). Each condition is performed once. Stop timing when the
subject’s arms moved from the original position, the foot moved, the subject opened his/her
eyes during an eyes closed trial, or fall.
1. Firm surface, eyes opened 2. Firm surface, eyes closed 3. Firm surface, eyes
opened, dome
4. Soft surface, eyes opened 5. Soft surface, eyes closed 6. Soft surface, eyes opened,
dome
Refer to lecture/practical notes for interpretation of results.
Reference: Shumway-Cook, A., & Horak, F. B. (1986). Assessing the influence of sensory 23
interaction on balance: suggestion from the field. Physical therapy, 66(10), 1548-1550.
FUNCTIONAL REACH TEST (FRT)
(ICF Domain: Activity – Functional Limitation)
Purpose:
The Functional Reach Test is a single-item test developed as a quick screen for balance
problems and falls risk in older adults.
Equipment:
- A yard stick/ruler
- A wall
Set-up:
Attached the yard stick to a wall at shoulder height. The subject stands along the length of the
yard stick, with feet shoulder distance apart, and with one arm (hand in a fist) flexed to 90°.
The examiner takes an initial reading on the yard stick from 5-10 feet away from the patient
and views the patient from the side.
Instructions:
After obtaining an initial reading, the examiner instructs the subject to reach as far forward
along the yard stick without moving the feet and without losing balance. Record the farthest
reach attained by the subject and subtracted the final reading from the initial reading to obtain
a distance. There should be 2 practice trial, followed by 3 test trials.
Interpretation:
FR norm as reported in Duncan et al. (1990):
20-40 years old: female=15 inches male=17 inches
Reference: Duncan, P. W., Weiner, D. K., Chandler, J., & Studenski, S. (1990). Functional reach:
a new clinical measure of balance. Journal of gerontology, 45(6), M192-M197.
24
TIMED-UP-AND-GO TEST (TUGT)
Purpose:
The Timed-Up-and-Go test (TUG) was developed as a quick screening tool for detecting
balance problems affecting daily mobility in elderly individuals.
Equipment:
- Arm chair
- Tape measure
- Tape
- Stop watch
Set-up:
Positioned the chair on a stable surface or against a wall that it will not move when the
subject moves from sitting to standing. Attached a piece of tape on the floor 3 meters (10
feet) away from the chair. The subject should wear regular footwear and may use any gait
assistive device that they normally use.
Instructions:
Begin the test with the subject sitting in the chair; the subject’s back should be resting on the
back of the chair. The examiner gives the following instructions: “On the word Go you will
stand up, walk to the line on the floor, turn around and walk back to the chair and sit down.
Walk at your regular pace”. The examiner starts timing on the word “Go” and stops timing
when the subject is seated with their back on the back of the chair. An un-timed practice trial
should be given to the subject, followed by 3 test trials.
Interpretation:
Interpretations based on different resources. Some examples are:
≤ 10 seconds = Normal, very fit
11-30 seconds = Good mobility, can go out alone, mobile without an assistive device
> 30 seconds = Problems, cannot go outside alone, requires an assistive device
sit-to-stand
>
-
Reference: Mathias, S., Nayak, U. S., & Isaacs, B. (1986). Balance in elderly patients: the" get-up
and go" test. Archives of physical medicine and rehabilitation, 67(6), 387-389.
25
BERG’S BALANCE SCALE (BBS)
Name Date
Location Rater
ITEM DESCRIPTION SCORE (0-4)
1. Sitting to standing
2. Standing unsupported
3. Sitting unsupported
4. Standing to sitting
5. Transfers
6. Standing with eyes closed
7. Standing with feet together
8. Reaching forward with outstretched arm
9. Retrieving object from floor
10. Turning to look behind
11. Turning 360 degrees
12. Placing alternate foot on stool
13. Standing with one foot in front
14. Standing on one foot
Total
General Instructions
Please demonstrate each task and/or give instructions as written. When scoring, please
record the lowest response category that applies for each item.
In most items, the subject is asked to maintain a given position for specific time.
Progressively more points are deducted if the time or distance requirements are not met, if the
subject’s performance warrants supervision, or if the subject touches an external support or
receives assistance from the examiner. Subjects should understand that they must maintain
their balance while attempting the tasks. Poor judgment will adversely influence the
performance and the scoring.
Equipment required for testing includes a stopwatch or watch with a second hand, and a ruler
or other indicator of 2, 5 and 10 inches (5, 12 and 25 cm). Chairs used during testing should
be of reasonable height. Either a step or a stool (of average step height) may be used for
item#12.
26
Scoring Criteria
1. SITTING TO STANDING
INSTRUCTIONS: Please stand up. Try not to use your hands for support.
( )4 able to stand without using hands and stabilize independently
( )3 able to stand independently using hands
( )2 able to stand using hands after several tries
( )1 needs minimal aid to stand or to stabilize
( )0 needs moderate or maximal assist to stand
2. STANDING UNSUPPORTED
INSTRUCTIONS: Please stand for two minutes without holding.
( )4 able to stand safety 2 minutes
( )3 able to stand 2 minutes with supervision
( )2 able to stand 30 seconds unsupported
( )1 needs several tries to stand 30 seconds unsupported
( )0 unable to stand 30 seconds unassisted
If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item#4.
3. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL

INSTRUCTIONS: Please sit with arms folded for 2 minutes.
( )4 able to sit safely and securely 2 minutes
( )3 able to sit 2 minutes under supervision
( )2 able to sit 30 seconds
( )1 able to sit 10 seconds
( )0 unable to sit without support 10 seconds
4. STANDING TO SITTING
INSTURCTIONS: Please sit down.
( )4 sits safety with minimal use of hands
( )3 controls descent by using hands
( )2 uses back of legs against chair to control descent
( )1 sits independently but has uncontrolled descent
( )0 needs assistance to sit
* Do in both directions
e .
g
.
Plinth/chair
Two chairs (Ix armchair + 1 without armrests
5. TRANSFERS ~ x
INSTRUCTIONS: Arrange chairs(s) for a pivot transfer. Ask subject to transfer one way toward a seat
with armrests and one way towards a seat without armrests. You may use two chairs (one with and one
without armrests) or a bed and a chair.
( )4 able to transfer safely with minor use of hands
( )3 able to transfer safely definite need of hands
( )2 able to transfer with verbal cuing and/or supervision
( )1 needs one person to assist
( )0 needs two people to assist or supervise to be safe
6. STANDING UNSUPPORTED WITH EYES CLOSED

INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.
comfortable
( )4 able to stand 10 seconds safety standing position
( )3 able to stand 10 seconds with supervision
( )2 able to stand 3 seconds
( )1 unable to keep eyes closed 3 seconds but stays steady
( )0 needs help to keep from falling
27
7. STANDING UNSUPPORTED WITH FEET TOGETHER
INSTRUCTIONS: Place your feet together and stand without holding.
( )4 able to place feet together independently and stand 1 minutes safely
( )3 able to place feet together independently and stand for 1 minutes
with supervision
( )2 able to place feet together independently but unable to hold for 30 seconds
( )1 needs help to attain position but able to stand 15 seconds feet together
( )0 needs help to attain position and unable to hold for 15 seconds
>
-
8. REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING
INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you
can. (Examiner places a ruler at end of fingertips when arm is at 90 degrees. Fingers should not touch
the ruler while reaching forward. The recorded measure is the distance forward that the finger reaches
while the subject is in the most forward lean position. When possible, ask subject to use both arms
when reaching to avoid rotation of the trunk).
( )4 can reach forward confidently > 25 cm (10 inches)
( )3 can reach forward > 12cm safely (5 inches)
( )2 can reach forward >5cm safety (2 inches)
( )1 reaches forward but needs supervision
( )0 loses balance while trying/requires external support
9. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION

INSTRUCTIONS: Pick up the shoe/slipper which is placed in front of your feet.
( )4 able to pick up slipper safely and easily
( )3 able to pick up slipper but needs supervision
( )2 unable to pick up but reaches 2-5cm (1-2 inches) from slipper and
keeps balance independently
( )1 unable to pick up needs supervision while trying
( )0 unable to try/needs assist to keep from losing balance or falling
10. TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING
INSTRUCTIONS: Turn to look directly behind you over toward left shoulder. Repeat to the right.
Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.
( )4 look behind from both sides and weight shifts well
( )3 looks behind one side only, other side shows less weight shift
( )2 turns sideways only but maintains balance
( )1 needs supervision when turning
( )0 needs assists to keep from losing balance or falling
both directions
TURN 360 DEGREES ~ Turn
in
11.
INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other
direction.
( )4 able to turn 360 degrees safely in 4 seconds or less each side
( )3 able to turn 360 degrees safely one side only in 4 seconds or less
( )2 able to turn 360 degrees safely but slowly
( )1 needs close supervision or verbal cuing
( )0 needs assistance while turning
-
~ The
step should be arranged in front of the
furniture
12. PLACING ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED
INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the
>
A
-
safety
step/stool four times. & whole feet on the step
( )4 able to stand independently and safely and complete 8 steps in 20 seconds
( )3 able to stand independently and complete 8 steps >20 seconds
( )2 able to complete 4 steps without aid with supervision
( )1 able to complete >2 steps needs minimal assist
( )0 needs assistance to keep from falling/unable to try
28
side
good in front ; badside at the back
~ : we
usually keep balance with the leg at the back
13. STANDING UNSUPPORTED ON FOOT IN FRONT
INSTURCTIONS: (DEMONSTRATE TO SUBJECT) ESE mark YAP
Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front,
try to step far enough ahead that the heel of your forward foot is ahead of the toes of other foot. (To
score 3 points, the length of the step should exceed the length of the other foot and the width of the
stance should approximate the subject’s normal stride width)
(
(
(
)4
)3
)2
able to place foot tandem independently and hold 30 seconds
able to place foot ahead of other independently and hold 30 seconds
able to take small step independently and hold 30 seconds
a
DID 3
DID
add
( )1 needs help to step but can hold 15 seconds
( )0 loses balance while stepping or standing n
14. STANDING ON ONE LEG - >

stand affected leg
on mark P
INSTRUCTIONS: Stand on one leg as long as you can without holding.
( )4 able to lift leg independently and hold > 10 seconds
( )3 able to lift leg independently and hold 5-10 seconds
( )2 able to lift leg independently and hold = or >3 seconds
( )1 tries to lift leg unable to hold 3 seconds but remains standing independently
( )0 unable to try or needs assist to prevent fall
6- 8 ich
D
( ) TOTAL SCORE (Maximum =56) steps :
high
Cut-off scores for the elderly (Berg et al., 1992)
56 = Functional balance
<45 = Individuals may be at greater risk of falling
Reference: Berg, K., Wood-Dauphine, S., Williams, J. I., & Gayton, D. (1989). Measuring balance
in the elderly: preliminary development of an instrument. Physiotherapy Canada, 41(6), 304-311.
Berg, K., Wood-Dauphine, S., Williams, J. I., & Maki, B. (1993). Measuring balance in the elderly:
Validation of an instrument (Dissertation). Montreal, Canada: McGill University.
29
BALANCE EVALUATION SYSTEMS TEST (BESTest)
(ICF Domains: Body Structure/Function & Activity – Impairment & Functional Limitation)
BESTest
Balance Evaluation – Systems Test
Fay Horak PhD Copyright 2008
TEST NUMBER/SUBJECT CODE DATE
EXAMINER NAME
EXAMINER Instructions for BESTest

1. Subjects should be tested with flat heeled shoes or with shoes and socks off.
2. If subject must use an assistive device for an item, score that item one category lower
Tools Required
 Stop watch
 Measuring tape mounted on wall for Functional Reach test
 Approximately 60 cm x 60 cm (2 X 2 ft) block of 4-inch, medium-density, Tempur® foam
 10 degree incline ramp (at least 2 x 2 ft) to stand on
 Stair step, 15 cm (6 inches) in height for alternate stair tap
 2 stacked shoe boxes for obstacle during gait
 2.5 Kg (5-lb) free weight for rapid arm raise
 Firm chair with arms with 3 meters in front marked with tape for Get Up and Go test
 Masking tape to mark 3 m and 6 m lengths on the floor for Get Up and Go
SUMMARY OF PERFORMANCE: CALCULATE PERCENT SCORE
Section I: /15 x 100 = Biomechanical Constraints

Section II: /21 x 100 = Stability Limits/Verticality
Section III: /18 x 100 = Transitions/Anticipatory
Section IV /18 x 100 = Reactive
Section V: /15 x 100 = Sensory Orientation
Section VI: /21 x 100 = Stability in Gait
TOTAL: /108 points = Percent Total Score
30
31
32
33
34
35
36
37
38
Reference: Horak, F. B., Wrisley, D. M., & Frank, J. (2009). The balance evaluation systems test
(BESTest) to differentiate balance deficits. Physical therapy, 89(5), 484-498.
39
MINI-BESTest
(ICF Domains: Body Structure/Function & Activity – Impairment & Functional Limitation)
g
do on both sides ,
do two trials for each side ,
score with better performance
between both side)
Total score with poor performance : Left .
vs Right /compared
buse
poorer performance K5s
R .: 21s
↳
tAPI-IEE E-AGP tipAD/EB E
·
= #D E
D V
I marks
=
X realignment
40
demonstrate
Isinch
9 inch ! I4inch
either 8 or 10 inch
At
41
↳
Reference: Franchignoni, F., Horak, F., Godi, M., Nardone, A., & Giordano, A. (2010). Using
psychometric techniques to improve the Balance Evaluation System’s Test: the mini-
BESTest. Journal of rehabilitation medicine: official journal of the UEMS European Board of
Physical and Rehabilitation Medicine, 42(4), 323. 42
ACTIVITIES OF BALANCE CONFIDENCE SCALE (ABC Scale; Eng Ver.)
(ICF Domain: Participation – Participation Restriction)
Instructions: For each of the following activities, please indicate your level of balance
confidence by choosing one of the points on the scale below from 0% to 100%.
If you do not currently do the activity, try and imagine how confident you would be if you
had to do the activity. If you normally use a walking aid to do the activity or hold onto
someone, rate your confidence as if you were using these supports. If you have any
questions, please ask the administrator.
0% 10 20 30 40 50 60 70 80 90 100%
No Confidence Completely Confident
"How confident are you that you can maintain your balance and remain steady when
you....
1. walk around the house? ____%
2. walk up or down stairs? ____%
3. bend over and pick up a slipper from the front of a closet floor? ____%
4. reach for a small can off a shelf at eye level? ____%
5. stand on your tip toes and reach for something above your head? ____%
6. stand on a chair and reach for something? ____%
7. sweep the floor? ____%
8. walk outside the house to a car parked in the driveway? ____%
9. get into or out of a car? ____%
10. walk across a parking lot to the mall? ____%
11. walk up or down a ramp? ____%
12. walk in a crowded mall where people rapidly walk past you? ____%
13. are bumped into by people as you walk through the mall? ____%
14. step onto or off of an escalator while holding onto a railing? ____%
15. step onto or off an escalator while holding onto parcels such that you cannot hold onto
the railing? ____%
16. walk outside on icy sidewalks? ____%
Scoring: Total the ratings (possible range = 0 to 1600) and divide by 16 (or the number of
items completed; minimum of 12) to get each person’s ABC score. If a person qualifies
his/her response to items #2, #9, #11, #14, or #15 (e.g., "up" versus "down"), use the lowest
confidence rating of the two (as this will limit the entire activity). Total scores can be
computed if a person answers at least 12 of the 16 items (Myers et al., 1998).
To examine change, the scale must be administered at least twice (e.g, pre/post therapy) and
scores compared. Do not simply ask clients if their confidence has increased or decreased.
Reference: Myers, A. M., Fletcher, P. C., Myers, A. H., & Sherk, W. (1998). Discriminative and
evaluative properties of the activities-specific balance confidence (ABC) scale. The Journals of
Gerontology Series A: Biological Sciences and Medical Sciences, 53(4), M287-M294.
Powell, L. E., & Myers, A. M. (1995). The activities-specific balance confidence (ABC) scale. The
Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50(1), M28-M34.
43
ACTIVITIES OF BALANCE CONFIDENCE SCALE (ABC Scale; Hong Kong
Ver.)
(ICF Domain: Participation – Participation Restriction)
ABC 活動平衡信心評分表
0% 10 20 30 40 50 60 70 80 90 100%
無信心絕對信心
計分表
當你做下面嗰啲活動嘅時候，你有幾多信心你可以保持平衡同埋穩定
日期
活動項目分數
1. 喺屋裡面行嚟行去
2. 上落樓梯
3. “嗚”低身喺地下度執起隻拖鞋
4. 喺個架度，攞一個擺喺你頭咁高嘅罐頭
5. 趷高腳，去攞高過你頭頂Ｄ嘢
6. 企喺櫈上面攞嘢
7. 掃地
8. 行出屋企，去附近搭車
9. 上落你搭慣嘅交通工具
10. 穿過停車場去商場
11. 行上或者行落條短斜坡
12. 喺一個好迫，同埋周圍Ｄ人又行得好快嘅商場裡面行
13. 喺商場度行嘅時侯，俾人撞落你度
14. 捉住條扶手，踏入或者踏出扶手電梯
15. 拎住Ｄ嘢，手又冇得扶住，踏入或者踏出扶手電梯
16. 行出出便，濕滑嘅地面
總分
訪問員
Reference: Mak, M. K., Lau, A. L., Law, F. S., Cheung, C. C., & Wong, I. S. (2007). Validation of the
Chinese translated activities-specific balance confidence scale. Archives of physical medicine and
rehabilitation, 88(4), 496-503.
44
6. Functional Activity/ Mobility
BARTHEL ADL INDEX (BI)
Bowels
0 = incontinent (or needs to be given enemata)
1 = occasional accident (once a week)
2 = continent
Bladder
0 = incontinent, or catheterized and unable to manage alone
1 = occasional accident (maximum once per 24 hours)
2 = continent
Grooming
0 = needs help with personal care
1 = independent face/hair/teeth/shaving (implements provided)
Toilet use
0 = dependent
1 = needs some help, but can do something alone
2 = independent (on and off, dressing, wiping)
Feeding
0 = unable
1 = needs help cutting, spreading butter, etc.
2 = independent
Transfer (bed to chair and back)

0 = unable, no sitting balance
1 = major help me (one or two people physical), can sit
2 = minor help (verbal or physical)
3 = independent
Mobility
0 = immobile
1 = wheelchair independent, including corners
2 = walks with help of one person (verbal or physical)
3 = independent (but may use any aid; for example, stick)
Dressing
0 = dependent
1 = needs help but can do about half unaided
2 = independent (including buttons, zips, laces, etc.)
Stairs
0 = unable
1 = needs help (verbal, physical, carrying aid)
2 = independent
Bathing
0 = dependent
1 = independent (or in shower)
Total 0-20
Reference: Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: the Barthel Index: a
simple index of independence useful in scoring improvement in the rehabilitation of the chronically
ill. Maryland state medical journal. 45
MODIFIED BARTHEL ADL INDEX (mBI)
Activity Score Description

0 The patient is bowel incontinent.
2 The patient needs help to assume appropriate position, and with bowel movement facilitatory
techniques.
5 The patient can assume appropriate position, but cannot use facilitatory techniques or clean self
Bowel without assistance and has frequent accidents. Assistance is required with incontinence aids
Control such as pad, etc
8 The patient may require supervision with the use of suppository or enema and has occasional
accidents.
10 The patient can control bowels and has no accidents, can use suppository, or take an enema
when necessary.
0 The patient is dependent in bladder management, is incontinent, or has indwelling catheter.
2 The patient is incontinent but is able to assist with the application of an internal or external
device.
5 The patient is generally dry by day, but not at night and needs some assistance
Bladder
with the devices.
Control 8 The patient is generally dry by day and night, but may have an occasional accident or need
minimal assistance with internal or external devices.
10 The patient is able to control bladder day and night, and/or is independent with
internal or external devices.
0 The patient is unable to attend to personal hygiene and is dependent in all aspects
1 Assistance is required in all steps of personal hygiene, but patient able to make
some contribution.
Personal 3 Some assistance is required in one or more steps of personal hygiene.
4 Patient is able to conduct his/her own personal hygiene but requires minimal
Hygiene assistance before and/or after the operation.
(Grooming) 5 The patient can wash his/her hands and face, comb hair, clean teeth and shave. A male patient
may use any kind of razor but must insert the blade, or plug in the razor without help, as well as
retrieve it from the drawer or cabinet. A female patient must apply her own make-up, if used,
but need not braid or style her hair.
0 Fully dependent in toileting.
2 Assistance required in all aspects of toileting.
5 Assistance may be required with management of clothing, transferring, or
washing hands.
Toilet
8 Supervision may be required for safety with normal toilet. A commode may be
Transfer used at night but assistance is required for emptying and cleaning.
10 The patient is able to get on/off the toilet, fasten clothing and use toilet paper
without help. If necessary, the patient may use a bed pan or commode or urinal at
night, but must be able to empty it and clean it.
0 Dependent in all aspects and needs to be fed, nasogastric needs to be administered.
2 Can manipulate an eating device, usually a spoon, but someone must provide
active assistance during the meal.
5 Able to feed self with supervision. Assistance is required with associated tasks
such as putting milk/sugar into tea, salt, pepper, spreading butter, turning a plate or other “set
Feeding up” activities.
8 Independence in feeding with prepared tray, except may need meat cut, milk
carton opened or jar lid etc. The presence of another person is not required.
10 The patient can feed self from a tray or table when someone puts the food within
reach. The patient must put on an assistive device if needed, cut food, and if
desired use salt and pepper, spread butter, etc.
0 The patient is dependent in all aspects of dressing and is unable to participate in
Dressing the activity.
2 The patient is able to participate to some degree, but is dependent in all aspects of dressing.
46
5 Assistance is needed in putting on, and/or removing any clothing.
8 Only minimal assistance is required with fastening clothing such as buttons, zips, bra, shoes,
etc.
10 The patient is able to put on, remove, corset, braces, as prescribed.
0 Total dependence in bathing self.
1 Assistance is required in all aspects of bathing, but patient is able to make some
contribution.
3 Assistance is required with either transfer to shower/bath or with washing or
drying; including inability to complete a task because of condition or disease, etc.
Bathing 4 Supervision is required for safety in adjusting the water temperature, or in the
transfer.
5 The patient may use a bathtub, a shower, or take a complete sponge bath. The
patient must be able to do all the steps of whichever method is employed without another person
being present.
0 Unable to participate in a transfer. Two attendants are required to transfer the
patient with or without a mechanical device.
3 Able to participate but maximum assistance of one other person is require in all
aspects of the transfer.
8 The transfer requires the assistance of one other person. Assistance may be
Chair/ Bed required in any aspect of the transfer.
Transfer 12 The presence of another person is required either as a confidence measure, or to
provide supervision for safety.
15 The patient can safely approach the bed walking or in a wheelchair, lock brakes, lift footrests, or
position walking aid, move safely to bed, lie down, come to a sitting position on the side of the
bed, change the position of the wheelchair, transfer back into it safely and/or grasp aid and
stand. The patient must be independent in all phases of this activity.
0 Dependent in ambulation.
3 Constant presence of one or more assistant is required during ambulation.
8 Assistance is required with reaching aids and/or their manipulation. One person is required to
offer assistance.
Ambulation 12 The patient is independent in ambulation but unable to walk 50 metres without
help, or supervision is needed for confidence or safety in hazardous situations.
15 The patient must be able to wear braces if required, lock and unlock these braces assume
standing position, sit down, and place the necessary aids into position for use. The patient must
be able to crutches, canes, or a walkarette, and walk 50 metres without help or supervision.
0 Dependent in wheelchair ambulation.
Wheelchair 1 Patient can propel self short distances on flat surface, but assistance is required for all other
(Score only steps of wheelchair management.
if ambulation 3 Presence of one person is necessary and constant assistance is required to
manipulate chair to table, bed, etc.
= 0 and
4 The patient can propel self for a reasonable duration over regularly encountered
patient terrain. Minimal assistance may still be required in “tight corners” or to negotiate a kerb 100mm
trained in high.
wheelchair 5 To propel wheelchair independently, the patient must be able to go around corners, turn around,
management) manoeuvre the chair to a table, bed, toilet, etc. The patient must be able to push a chair at least
50 metres and negotiate a kerb.
0 The patient is unable to climb stairs.
2 Assistance is required in all aspects of chair climbing, including assistance with
walking aids.
5 The patient is able to ascend/descend but is unable to carry walking aids and needs supervision
Stairs and assistance.
Climbing 8 Generally no assistance is required. At times supervision is required for safety due to morning
stiffness, shortness of breath, etc.
10 The patient is able to go up and down a flight of stairs safely without help or
supervision. The patient is able to use hand rails, cane or crutches when needed
and is able to carry these devices as he/she ascends or descends.
Total 0-100
Reference: Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel
Index for stroke rehabilitation. Journal of clinical epidemiology, 42(8), 703-709. 47
FUNCTIONAL INDEPENDENCE MEASURE (FIM)
Self-Care ADMISSION DISCHARGE

A. Eating
B. Grooming
C. Bathing
D. Dressing-Upper Body
E. Dressing-Lower Body
F. Toileting
Sphincter Control
G Bladder Management
H Bowel Management
Transfers
I Bed, Chair, Wheelchair
J Toilet
K Tub, Shower
Locomotion
Walk
L Walk/Wheelchair Wheelchair
Both
M Stairs
Motor Subtotal Score
Communication
Auditory
N Comprehension Visual
Both
Vocal
O Expression Nonvocal
Both
Social Cognition
P Social Interaction
Q Problem Solving
R Memory
Cognitive Subtotal Score
Total Motor and Cognitive Score
48
DESCRIPTION OF THE LEVELS OF FUNCTION AND THEIR SCORES
INDEPENDENT Another person is not required for the activity (NO HELPER).
7 Complete Independence – All of the tasks described as making up the

Complete activity are typically performed safely, without modification, assistive
Independence devices, or aids, and within a reasonable amount of time.
(Timely, safely)
6 Modified Independence – One or more of the following may be true:

Modified the activity requires and assistive device; the activity takes more than
Independence reasonable time, or there are safety (risk) considerations.
(Device)
DEPENDENT Subject requires another person for either supervision or physical

assistance in order for the activity to be performed, or it is not
performed (REQUIRES HELPER).
Modified Dependence – The subject expends half (50%) or more of the effort. The levels
of assistance required are:
5 Supervision or Setup – Subject requires no more help than standby,

Supervision cuing or coaxing, without physical contact, or, helper sets up needed
items or applies orthoses.
4 Minimal Contact Assistance – Subject requires no more help than

Minimal Assistance touching, and expends 75% or more of the effort.
(Subject=75%+)
3 Moderate Assistance – Subject requires more help than touching, or
Moderate Assistance expends half (50%) or more (up to 75%) of the effort.
(Subject=50%+)
Complete Dependence – The subject expends less than half (less than 50%) of the effort.
Maximal or total assistance is required, or the activity is not performed. The levels of
assistance required are :
2 Maximal Assistance – Subject expends less than 50% of the effort, but
Maximal at least 25%.
Assistance
(Subject=25%+)
1 Total Assistance – Subject expends less than 25% of the effort.
Total Assistance
(Subject=0%+)
Reference: Dodds, T. A., Martin, D. P., Stolov, W. C., & Deyo, R. A. (1993). A validation of the
functional independence measurement and its performance among rehabilitation
inpatients. Archives of physical medicine and rehabilitation, 74(5), 531-536.
49
50
51
ELDERLY MOBILITY SCALE (EMS)
Date
Item
Lying to sitting
Sitting to lying
Sitting to standing
Standing
Gait
Timed walk (xTVG)
f Functional reach
Total score
6-meter walk
Key to score:
Lying to sitting Sitting to lying

2 Independent (without verbal or physical help) 2 Independent (without verbal or physical help)
1 Needs help of 1 person 1 Needs help of 1 person
0 Needs help of 2 + people 0 Needs help of 2+ people
Sitting to standing
3 Independent in under 3 seconds (whether or not the upper limbs are used)
2 Independent in over 3 seconds
1 Needs help of 1 person (verbal or physical help, uses assisting device, pulls up using upper limb)
0 Needs help of 1 person
Standing Gait
3 Stand without support and able to reach 3 Independent (include using sticks/quadripod)
2 Stand without support but needs to reach 2 Independent with frame
1 Stand but need support 1 Mobil with walking aid but erratic/unsafe
0 Stand only with physical support 0 Needs physical help to walk or supervision
Timed walk (6 meters) Functional reach

3 Under 15 seconds 4 Over 20 cm (8”)
2 16-30 seconds 2 10-20 cm (4-8”)
1 Over 30 seconds 0 Under 10 cm (4”) or unable to reach
0 Unable to cover 6 meters
Cut-off Scores - Level of independence (Smith, 1994)

>14 = independent in basic ADLs
10-13 = borderline in terms of safe mobility and impendence in ADLs (require some help
with some mobility manoeuvres)
<10 = dependent (require help with mobility and ADLs)
Reference: Smith, R. (1994). Validation and reliability of the Elderly Mobility Scale. Physiotherapy,
52
80(11), 744-747.
MODIFIED RIVERMEAD MOBILITY INDEX (MRMI)
Scoring: 0 = unable to perform

1 = assistance of two people
2 = assistance of one person
3 = requires supervision or verbal instruction
4 = requires an aid or an appliance
5 = independent
Not in EMS
Item Score
1. Turning over
______
Please turn over from your back to your ______ side
2. Lying to sitting ______

Please sit up on the side of the bed
3. Sitting balance ______

Please sit on the edge of the bed
(The assessor times the patient for 10 seconds)
4. Sitting to standing ______

Please stand up from your chair
(The patient takes less than 15 seconds)
5. Standing ______
Please remain standing
(The assessor times the patient for 10 seconds)
6. Transfers ______
Please go from your bed to the chair and back again
(The assessor places the chair on the patient’s unaffected side)
7. Walking indoors ______

Please walk for 10 meters in your usual way
8. Stairs ______
Please climb up and down this flight of stairs in your usual way
OVERALL SCORE
Comments: _____________________________________________________
________________________________________________________________
53
Scoring Instructions
Modified Rivermead Mobility Index

Preparation Environment preparation
 a stopwatch
 a tape measure
 a chair with seat height of around 45 cm
 a plinth / bed with the height of around 45 cm
 a flight of stairs with 8 – 14 steps (step height ~15cm)
Patient preparation
 Wear in usual clothes & footwear.
General  The patient should be instructed to perform each item independently
guidelines  The assessor should provide assistance only if safety is at risk.
 The assessor should not facilitate the patient’s performance to improve its quality.
 The assessor should provide verbal instruction as recommended, supplemented by demonstration when
necessary
Scoring Scoring scale Supplementary notes

0 – unable to perform  Score 0 if the patient shows no active
1 – assistance of two people participation
2 – assistance of one person  Score 1 if the patient shows active participation,
3 – requires supervision or verbal instruction but still requires 2 assistants to complete the task
4 – requires an aid or an appliance  Score 1 instead of 2 if safety to either the patient
5 – independent or the assistant is at risk with 1 assistant
 Supervision or verbal instruction excludes any
physical contact
 The use of hand to hold constitutes an aid
 Score the highest score for measurement of
functional independence (e.g. if the patient is able
to walk unaided under supervision while walking
independent with a frame, score 4 instead of 3)
Items 1. Turning over  Assess both sides and score the highest one
(Verbal Please turn over from your back to your ___ side
instruction) 2. Lying to sitting  Assess both sides and score the highest one
Please sit up on the side of the bed
3. Sitting for 10 seconds  Score 5 if the patient is able to sit on the edge of
Please sit on the edge of the bed the bed without hand support for 10 seconds
 Score 4 if the patient is able to sit on the edge of
the bed with hand support on the bed / thigh, but
not on the bed rail
4. Sitting to standing within 15 seconds  Score 5 if the patient is able to stand up from a
Please stand up from your chair chair without hand support for less than 15
seconds, score 4 if takes 15 seconds or longer
 Score 4 if the patient pushes up to stand with
hands
5. Standing for 10 seconds
Please remain standing
6. Transfers
Please go from your bed to the chair & back again
7. Walking indoors  Patient is allowed to walk with multiple turns if a
Please walk for 10 meters in your usual way straight pathway is not available
8. Stairs - 1 flight of stairs up & down  Assess this item only if the patient score 2 or
Please climb up & down this flight of stairs in your above in Item#7
usual way
Reference: Lennon, S., & Johnson, L. (2000). The modified rivermead mobility index: validity and
reliability. Disability and rehabilitation, 22(18), 833-839. 54
7. Gait and Mobility
MODIFIED FUNCTIONAL AMBULATION CLASSIFICATION (MFAC)
Categories Stage Definition

Patient cannot ambulate and requires manual assistance to
sit, or is unable to sit for 1 minute without back or hand for
I Lyer
support, with the bed/plinth height allowing hips, knees, and
ankles positioned at 900, and both feet flat on floor.
Patient is able to sit for 1 minute without back or hand
II Sitter support and is unable to ambulate with the help of only one
person.
Patient requires manual contacts of no more than one person
during ambulation on level surfaces to prevent falling.
Dependent
III Manual contacts are continuous and necessary to support
Walker
body weight as well as to maintain balance and/or assist
coordination.
Patient requires manual contacts of no more than one person
Assisted during ambulation on level surfaces to prevent falling.
IV
Walker Manual contacts are continuous or intermittent light touch
to assist balance and/or coordination.
Patient can ambulate on level surfaces without manual
Supervised contact of another person, but for safety reason s/he requires
V
Walker standby guarding or verbal cuing of no more than one
person.
Patient can transfer, turn and walk independently on level
Indoor ground, but requires supervision or physical assistance to
VI
Walker negotiate any of the followings: stairs, inclines or uneven
surfaces.
Outdoor Patient can ambulate independently on level and non-level
VII
Walker surfaces, stairs, and inclines.
Note: This classification does not take account of any aid used
Reference:
Coordinating Committee in Physiotherapy Hospital Authority (2007). Validation study of Modified
Rivermead Mobility Index and Modified Functional Ambulation Classification for stroke patients
[Unpublished data], Hospital Authority.
Holden, M. K., Gill, K. M., & Magliozzi, M. R. (1986). Gait assessment for neurologically impaired
patients: standards for outcome assessment. Physical therapy, 66(10), 1530-1539.
55
10-METER WALK TEST
• Time taken to walk 10 meters
• Allow for 2-meter acceleration and deceleration phase (i.e., total 14 m walkway)
• Calculate gait speed:
10 / time taken = m/s
0m 2m 12m 14m
Cut-off Scores:
• < 0.4 m/s were more likely to be household ambulators
• 0.4 - 0.8 m/s limited community ambulators
• > 0.8 m/s were community ambulators
(Perry et al., 1995; Schmid et al., 2007; Bowden et al., 2008)
Reference: Bohannon, R. W. (1997). Comfortable and maximum walking speed of adults aged
20—79 years: reference values and determinants. Age and ageing, 26(1), 15-19.
56
DYNAMIC GAIT INDEX (DGI)
Description:
Developed to assess the likelihood of falling in older adults. Designed to test eight facets of gait.
Equipment needed: Stopwatch, Box (Shoebox), Cones (2), Stairs, 20-ft walkway with 15-in wide
Completion:
Time: 15 minutes
Scoring: A four-point ordinal scale, ranging from 0-3. “0” indicates the lowest level of
function and “3” the highest level of function.
Total Score = 24
Interpretation: < 19/24 = predictive of falls in the elderly
> 22/24 = safe ambulators
1. Gait level surface _____

Instructions: Walk at your normal speed from here to the next mark (20’)
Grading: Mark the lowest category that applies.
(3) Normal: Walks 20’, no assistive devices, good sped, no evidence for imbalance, normal gait pattern
(2) Mild Impairment: Walks 20’, uses assistive devices, slower speed, mild gait deviations.
(1) Moderate Impairment: Walks 20’, slow speed, abnormal gait pattern, evidence for imbalance.
(0) Severe Impairment: Cannot walk 20’ without assistance, severe gait deviations or imbalance.
2. Change in gait speed _____

Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for 5’).
When I tell you “slow,” walk as slowly as you can (for 5’).
(3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a
significant difference in walking speeds between normal, fast and slow speeds.
(2) Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or not gait deviations
but unable to achieve a significant change in velocity, or uses an assistive device.
(1) Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in
speed with significant gait deviations, or changes speed but has significant gait deviations, or changes
speed but loses balance but is able to recover and continue walking.
(0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.
3. Gait with horizontal head turns _____

Instructions: Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but
turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and
turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight,
but return your head to the center.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor
disruption to smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down,
staggers but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers
outside 15” path, loses balance, stops, reaches for wall.
57
4. Gait with vertical head turns _____
Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip
your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down.
Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the
center.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor
disruption to smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down,
staggers but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers
outside 15” path, loses balance, stops, reaches for wall.
5. Gait and pivot turn _____

Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to
face the opposite direction and stop.
(3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.
(2) Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance.
(1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch
balance following turn and stop.
(0) Severe Impairment: Cannot turn safely, requires assistance to turn and stop.
6. Step over obstacle ____

Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it,
and keep walking.
(3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.
(2) Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box safely.
(1) Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal
cueing.
(0) Severe Impairment: Cannot perform without assistance.
7. Step around obstacles _____

Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the
right side of it. When you come to the second cone (6’ past first cone), walk around it to the left.
(3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance.
(2) Mild Impairment: Is able to step around both cones, but must slow down and adjust steps to clear
cones.
(1) Moderate Impairment: Is able to clear cones but must significantly slow, speed to accomplish task, or
requires verbal cueing.
(0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical
assistance.
8. Steps _____
Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn
around and walk down.
(3) Normal: Alternating feet, no rail.
(2) Mild Impairment: Alternating feet, must use rail.
(1) Moderate Impairment: Two feet to a stair, must use rail.
(0) Severe Impairment: Cannot do safely.
TOTAL SCORE: ___ / 24
Reference: Shumway-Cook, A., Baldwin, M., Polissar, N. L., & Gruber, W. (1997). Predicting the
probability for falls in community-dwelling older adults. Physical therapy, 77(8), 812-819.
58
FUNCTIONAL GAIT ASSESSMENT (FGA)
Description:
This test is modified from DGI to improve reliability and reduce the ceiling effect. It is used to assess postural
stability during gait tasks.
Equipment needed: Stopwatch, 4.5” Box (Shoebox) x2 , Stairs, 20’(6-m) walkway with 12”(20.48-cm) wide
Interpretation: < 22/30 = predictive of falls in the elderly (Wrisley & Kumar, 2010)
59
Reference: Wrisley, D. M., Marchetti, G. F., Kuharsky, D. K., & Whitney, S. L. (2004). Reliability,
internal consistency, and validity of data obtained with the functional gait assessment. Physical
therapy, 84(10), 906-918.
Wrisley, D. M., & Kumar, N. A. (2010). Functional gait assessment: concurrent, discriminative, and
predictive validity in community-dwelling older adults. Physical therapy, 90(5), 761-773. 60
8. Upper Limb Function and Coordination
JEBSEN TAYLOR HAND FUNCTION TEST
The Jebsen Taylor Hand Function Test (JTHFT) is a standardized measure of functional hand
motor skills. It consists of 7 items that measure fine motor skills, weighted functional tasks
and non-weighted functional tasks. The 7 items are:
 Writing a short sentence of 24 letters of 3rd grade reading difficulty

 Turning over a 3x5 inch card
 Picking up small common objects
 Simulated feeding
 Stacking checkers
 Picking up large light cans
 Picking up large heavy cans
Each item is scored based on the time taken to complete the task. The scores for all 7 items
are summed for a total score. Shorter times indicate better performance. The dominant hand
is tested. Reading glasses are allowed.
Since the writing subset of the test can be affected by hand dominance, modified JTHFT can
be administered. Modified JTHFT has the same sub-tests as JTHFT without writing. It has
been reported to have strong enough correlation with activities of daily living (Davis &
Chung, 2010)
Reference: Jebsen, R. H., Taylor, N., Trieschmann, R. B., Trotter, M. J., & Howard, L. A. (1969).
An objective and standardized test of hand function. Archives of physical medicine and
rehabilitation, 50(6), 311–319.
Davis Sears E., & Chung K. C. (2010) Validity and responsiveness of the Jebsen-Taylor Hand
Function Test. The journal of hand surgery, 35(1), 30–37 61
standardized outcome measure tools are needed
>
-
ACTION RESEARCH ARM TEST
This test on the functional ability of the upper extremity has 19 tasks assigned to 4 subtests.
The method of scoring is described below:
Score: 0 cannot perform any part of the test

1 can perform test partially
2 can complete test but with an abnormally long time or great difficulty
3 can perform test normally
The first task in each subtest is the most difficult, the second task is the least demanding, the
remaining tasks are in ascending order of difficulty. With the subject in sitting position, start
with task 1 of each subtest. If the subject attains full score in task 1 (the most difficult task),
the whole subtest will be given full score. On the other hand, if the subject scores 0 in task 1,
and again scores 0 in task 2 (easiest task), the whole subtest will score 0. Otherwise, continue
to test all the remaining tasks of the subtest to generate a subtest score.
Subtest 1: Grasp (6 tasks)

Lift the designated object over 37 cm from the lower shelf to the top shelf
(1) 10.0 cm wooden cube
(5) cricket ball
(6) sharpening stone
Subtest 2: Grip (4 tasks)

(7) pour water from one glass into another
(8) displace an alloy tube (2.5 cm in diameter) from one side of the table to the other
(9) displace an alloy tube (1 cm in diameter) from one side of the table to the other
(10) put a washer over a bolt
Subtest 3: Pinch (6 tasks)

Pick up a marble or ball bearing (indicated below) from the lower shelf, and lift it over 37 cm to put it
on the top shelf using the fingers as follow:
(11) a 6-mm ball bearing between ring finger and thumb
(12) a marble between index finger and thumb
(13) a 6-mm ball bearing between middle finger and thumb
(14) a 6-mm ball bearing between index finger and thumb
(15) a marble between ring finger and thumb
(16) a marble between middle finger and thumb
Subtest 4: Gross Movement (3 tasks)

(17) place hand behind head
(18) place hand on top of head
(19) bring hand to mouth
Total ARAT score: __________________

62
Reference: Lyle, R. C. (1981). A performance test for assessment of upper limb function in
physical rehabilitation treatment and research. International journal of rehabilitation research, 4(4),
483-492
PURDUE PEGBOARD TEST
The Purdue Pegboard Test measures gross movements of the fingers, hands, and arms, as
well as fine fingertip dexterity necessary in assembly tasks.
Access the complete manual of Purdue Pegboard Test for test procedures, equipment and
scoring interpretation and references at:
http://www.limef.com/downloads/MAN-32020A-forpdf-rev0.pdf
MINNESOTA MANUAL DEXTERITY TEST

The Minnesota Manual Dexterity Test is used to evaluate a subject’s simple but rapid eye-
hand coordination and arm-hand dexterity by assessing their abilities to move small objects
of various distances. It is a test of gross motor skills.
Access the complete manual of Minnesota Manual Dexterity Test for test procedures,
equipment and scoring interpretation and references at:
https://www.rehabmart.com/pdfs/141_2_n.pdf
63
Model 32025 User’s Manual
Model 32025
GROOVED PEGBOARD TEST

USER INSTRUCTIONS
3700 Sagamore Parkway North

P.O. Box 5729 • Lafayette, IN 47903 USA
Tel: 765.423.1505 • 800.428.7545
Fax: 765.423.4111
E-mail: info@lafayetteinstrument.com
www.lafayetteinstrument.com
© 2002 by Lafayette Instrument Company, Inc. All Rights Reserved- Rel. 9.2.03
Fax: 765-423-4111 . www.lafayetteinstrument.com . E-mail: info@lafayetteinstrument.com

2 Lafayette Instrument Grooved Pegboard Test
Table of Contents:
System Description 3
Instructions to the Test 3
Supplementary Instructions (Adult, Adolescent): 4
Supplementary Instructions (Kiddie): 4
Scoring: 4
Interpretation: 5
Norms:
Norms by Age and Sex Kiddie-Adolescent 6
Age Curve Reference Points (Trites) Scores 7
Reference Data (Misc.) Scores 8
References: 9
Ordering Information: 10
2 3700 Sagamore Parkway North . PO Box 5729 . Lafayette, IN 47903 USA . Ph: 765-423-1505
Model 32025 User’s Manual 3
Description:
The following administrative instructions and age curve data are taken from the
Neuropsychological Test Manual developed by Dr. Ronald Trites, Royal Ottawa Hospital,
Ottawa, Ontario, Canada.
Three batteries of tests have been defined for the normative data obtained by Trites.
Adult: Age 15 years 0 months and above

Adolescent: Age 9 years 0 months to 14 years 12 months
Kiddie: Age 5 years 0 months to 8 years 12 months
The Grooved Pegboard is a manipulative dexterity test. This unit consists of 25 holes with
randomly positioned slots. Pegs, which have a key along one side, must be rotated to match the
hole before the can be inserted. This test requires more complex visual-motor coordination than
most pegboards.
Instructions to the Test:

The pegboard is placed in mid-line with the subject so that the board is at the edge of the table
and peg tray immediately above the board. The examiner explains the test:
“This is a pegboard and these are the pegs. (Examiner points out each and then picks up
one of the pegs and continues.)
All the pegs are the same. They have a groove, that is, a round side and a square side
and so do the holes in the boards. What you must do is match the groove of the peg with
the groove of the board and put these pegs into the holes like this. (The examiner dem-
onstrates by filling the top row. Remove the pegs, putting them back into the tray.)
When I say go, begin here and put the pegs into the boards as fast as you can, using only
your (dominant) hand. Fill the top row completely from this side to this side. Do not
skip any; fill each row the same way you filled the top row. Any questions? Ready, as
fast as you can, go.”
Fax: 765-423-4111 . www.lafayetteinstrument.com . E-mail: info@lafayetteinstrument.com 3

Supplementary Instructions (Adult, Adolescent):

For the right hand trial, the examiner demonstrates that the pegs are placed from subject’s left to right, and
from right to left for the left hand trial. The dominant hand trial is administered first, followed by the non-
dominant hand trial.
The examiner encourages the subject to perform the task as quickly as possible, telling him or her to speed
up if necessary. The pegs must be put in the board in the exact order and in the correct direction.
Frequently, it will be necessary to point out the first hole of a new row, particularly during the non-
dominant hand trial. Only one peg is to be picked up at a time and the subject should immediately be told if
ore than one is picked up.
Also, only one hand is to be used. Occasionally, a subject will attempt to use his or her other hand to help
turn the peg around. It may be necessary to tell the subject to keep the hand on his or her lap, or for the
examiner to hold it. If necessary, the board should be held steady for the patient. In the case of severe
motor impairment, the subject should attempt the task just to see if any of the pegs can be put in. Any factor
that may effect the subject’s performance should be noted, e.g. sore finger, bandage, etc.
If a peg is dropped to the floor, the examiner should not make an attempt to pick it up during the trial;
rather, one of the pegs correctly placed should be taken out and used again. (Usually, the first or second
peg.)
Supplementary Instructions (Kiddie):

The description, materials needed, instructions and scoring for the Kiddie version are identical in all aspects
to the Adult version, with the following exception. Only the first two rows of the Pegboard are to be filled,
thus totaling 10 pegs. Particular care is necessary in pointing out the correct direction, as well as the correct
sequential order. If a child uses the wrong order (puts 10 pegs in randomly because he is unable to put them
in the correct order), the test should be given a “D” flag for a non-standard administration.
Scoring:
⑮
Record, in seconds, the length of time required to perform each trial beginning when the subject starts the
task until the last peg is put in, or the test is discontinued. A trial may be discontinued after five minutes. In
such cases, the difficulty is described and the scores are given “A” flags indicating an incomplete test.
⑪d
The second score is the number of “drops” made during each trial. A “drop” is any unintentional drop of a
peg from the time the subject attempts to pick up the peg from the try until it is placed correctly in the hole.
If more than one peg is picked up from the tray and the subject intentionally discards all but one of the pegs,
it is not considered a drop. If a peg is intentionally laid down on the side of the tray or table, in order to
purposefully manipulate the peg, it is not considered a drop. If one peg is turned with the hand not being
Scoring (continued):
tested, this is noted. If, however, this occurs more than once, the score is given a “D” flag for a
nonstandard assessment.
③
The third score is the number of pegs correctly placed in the holes for each trial. The task is performed
once with the dominant and then once with the non-dominant hand. For each hand, the three scores are
summed (the total time, total number of drops and the total number of pegs correctly placed in the board)
to get complete score.
Interpretation:
When a test such as the Grooved Pegboard test is to be used for personnel selection, the ideal procedure
is to establish its validity locally, by testing all newly hired employees and correlating scores with their
subsequent performance (supervisor ratings or time they remain employed). This approach to validation
requires that test scores should not be used to select employees until evidence has accumulated of its
validity, and that test scores be inaccessible to supervisors or others who affect the worker’s ratings or
job longevity. An alternative validation procedure is to administer the test to all present employees and
correlate scores with ratings or with subsequent performance (Anastasi, 1982, pp. 65-101). The
Grooved Pegboard test should correlate most highly with those jobs, which require speed, finger
dexterity, and manual dexterity. It should be of relevance to performance on assembly and machine
operating jobs. We at Lafayette Instrument Company are always interested in validation data, which you
may collect in various industrial settings or academic studies.
Of course, scores on such a test are of diagnostic utility in Neuropsychological practice only within the
context of an extensive sampling of medical, cognitive, motor, sensory and personality factors. Keeping
this provision in mind, it should be noted that Matthews, Cleeland & Hopper (1970) found that patients
with multiple sclerosis (MS) were significantly slower than “control” patients with other central nervous
system impairments. MS patients (N = 30) had a mean of 323.40 seconds (S.D. = 176.98) while
controls (N = 30) had a mean of 171.77 seconds (S.D. = 48.20). The difference was significant (t =
5.13, p. = .01, r = .690). Out of 24 tests in the study, those “of considerable utility in inter-group
discrimination p. 6) were Grooved Pegboard Test, the Static Steadiness Test (equivalent to Lafayette
#32011), the Maze Coordination Test (similar to Lafayette #20015) and measure of Finger Tapping
speed.

Norms by Age and Sex Kiddie-Adolescent

(Total test time in seconds)
Male Female
Dominant Non-Dominant Dominant Non-Dominant
Age M SD M SD M SD M SD
5 70 33.9 75 38.1 66 32.3 73 36.8
6 58 26.1 64 33.9 63 31.2 65 30.1
7 48 24.6 51 22.0 53 24.8 58 19.9
8 38 9.02 41 14.6 38 10.4 47 26.8
9 84 19.5 92 23.8 90 54.0 96 50.6
10 83 36.5 90 28.9 84 18.1 92 24.4
11 76 18.1 86 31.0 79 17.0 92 24.8
12 78 24.4 85 32.2 80 19.5 87 21.6
13 78 40.5 81 23.8 81 52.6 84 42.4
14 79 25.2 86 44.5 77 54.3 78 17.6
Grooved Pegboard
Age Curve Reference Points (Trites)
Male Female
Dominant Non-Dominant Dominant Non-Dominant
Age M Low/High M Low/High M Low/High M Low/High

15 80 36/103 82 49/119 82 28/117 82 59/97
16 81 35/105 82 48/120 83 27/122 82 57/98
17 82 35/107 82 47/122 84 26/127 82 55/102
18 82 36/110 82 47/123 84 26/131 82 53/105
19 83 37/113 83 46/124 84 25/134 83 52/109
20 83 38/117 85 45/127 85 25/137 83 50/113
21 84 39/121 86 45/129 85 25/141 84 49/118
22 84 40/125 87 45/131 85 26/143 85 48/121
23 85 41/128 87 44/134 85 27/144 86 47/124
24 85 41/131 89 44/135 85 28/143 87 47/127
25 86 42/133 90 45/137 84 30/142 88 47/129
26 87 42/134 92 45/139 84 32/140 89 45/131
27 87 43/135 93 46/141 84 34/139 90 46/133
28 87 44/136 94 46/143 84 36/137 102 45/135
29 88 44/136 95 47/145 84 37/135 92 45/137
30 88 45/137 96 48/146 83 39/132 93 45/138
31 89 45/137 98 48/148 83 40/130 93 45/139
32 90 46/137 99 49/150 83 41/127 94 45/142
33 90 46/137 100 49/152 83 43/126 95 45/143
34 91 46/137 101 50/153 83 44/123 95 45/144
35 91 46/137 102 50/155 83 45/121 96 45/147
36 91 46/137 103 50/157 83 46/120 97 46/148
37 92 46/138 105 51/159 83 46/120 98 46/149
38 92 46/138 105 52/160 83 47/119 99 47/151
39 93 46/138 106 52/161 85 48/121 101 47/152
40 94 46/139 108 52/162 86 48/123 102 47/154
41 95 46/138 108 51/163 89 48/125 103 47/156
42 95 46/138 108 51/163 90 48/129 105 48/158
43 95 46/140 109 51/165 92 47/134 106 48/160
44 96 47/140 109 51/165 94 46/140 107 49/162
45 97 47/141 109 52/166 98 45/145 109 49/164
46 97 47/142 109 52/166 101 44/151 111 50/166
47 97 47/143 110 52/167 106 43/158 113 50/169
48 98 47/144 110 52/169 108 43/164 114 50/172
49 98 49/156 110 52/170 111 42/166 117 50/174
50 99 50/158 110 52/170 113 41/170 119 51/180
The above scores were obtained by adding: time (in seconds) required to fill pegboard, number of “drops” and number of pegs placed in the board.

Reference Data (Misc.)

Dominant Non-Dominant
Age Mean SD Mean SD N

9 74.39 15.47 80.77 15.91 56
10 71.88 9.39 76.65 11.75 66
11 68.07 8.64 71.50 10.00 56
12 65.07 8.55 68.94 9.44 53
13 60.96 6.54 65.61 9.38 41
14 65.88 11.88 70.66 8.31 300
15 – 19 66.05 10.40 70.50 11.10 172
20 – 29 63.40 7.90 69.10 18.70 --
30 – 39 62.95 8.40 67.15 12.20 319
40 – 49 63.50 7.20 69.05 9.80 319
50 – 59 68.10 9.42 74.70 10.51 134
60 + 82.70 18.70 87.95 26.20 100
10 - 59 65.13 9.19 69.99 10.31 1460
Above scores derived without adding number of pegs dropped and number of pegs correctly placed in board to the subject’s time.
References:
Anastasi, Anne. Psychological Testing. (5th ed.). New York: Macmillan, 1982.
Haaland, K. York, Cleelan, Charles S., & Carr, Daniel. Motor performance after unilateral
hemisphere damage in patients with tumor. Archives of Neurology, 1977, 34, pp. 556-559.
Heaton, R.K., Grant, I., & Matthews, C.G., “Differences in neuropsychological test performance
associated with age, education, and sex,” Neuropsychological Assessment of
Neuropsychiatric Disorders. New York: Oxford, 1986.
Klouoff, H. & Low, M. “Disordered brain function in young children and early adolescents:
Neuropsychological and EEG correlates,” Clinical Neuropsychology. New York: Wiley,
1974.
Knights, R.M. & Moule, P.D., “Normative data on the motor steadiness battery for chidren,”
Perceptual and Motor Skills, 26, 1968, 643-650.
Matthews, Charles, Cleeland, Charles S., & Hopper, Cornelius L. Neurological patterns in multiple
sclerosis. Diseases of the Nervous System, 1970, 31, pp. 161-170.
Matthews, C.G. & Healand K., “The effect of symptom duration on cognitive and motor
performance in Parkinsonism,” Neurology, 29, 1979, 951-956.
Trites, Ronald L. Neuropsychological Test Manual. Ottawa, Ontario, Canada: Royal Ottawa
Hospital, 1977.

Lafayette Instrument Grooved Pegboard Test
Lafayette Instrument Grooved Pegboard Test
Model 32025 User’s Manual
Ordering Information:
All phone orders must be accompanied by a hard copy of value, and returned along with a cover letter explaining the
your order. All must include the following information: malfunction. Please also state the name of the Lafayette
1) Complete billing and shipping addresses Instrument representative authorizing the return. An estimate
2) Name and department of end user of repair will be given prior to completion ONLY if requested
3) Model number and description of desired item(s) in your enclosed cover letter. We must have a hard copy of
4) Quantity of each item desired your purchase order by mail or fax, or repair work cannot
5) Purchase order number or method of payment commence.
6) Telephone number
WARRANTY
DOMESTIC TERMS Lafayette Instrument guarantees its equipment against all defects
There is a $50 minimum order. Open accounts can be extended in materials and workmanship to the ORIGINAL PURCHASER
to most recognized educational institutions, hospitals and for a period of one (1) year from the date of shipment, unless
government agencies. Net amount due 30 days from the date otherwise stated. During this period, Lafayette Instrument will
of shipment. Enclose payment with the order; charge with repair or replace, at its option, any equipment found to be
VISA, MasterCard, American Express; or pay COD. We must defective in materials or workmanship. If a problem arises,
have a hard copy of your order by mail or fax. Students, please contact our office for prior authorization before returning
individuals and private companies may call for a credit the item. This warranty does not extend to damaged equipment
application. resulting from alteration, misuse, negligence or abuse, normal
wear or accident. In no event shall Lafayette Instrument be
INTERNATIONAL PAYMENT INFORMATION liable for incidental or consequential damages. There are no
There is a $50 minimum order. Payment must be made in implied warranties or merchantability of fitness for a particular
advance by: draft drawn on a major US bank; wire transfer to use, or of any other nature. Warranty period for repairs or
our account; charge with VISA, MasterCard, American used equipment purchased from Lafayette Instrument is 90 days.
Express; or confirmed irrevocable letter of credit. Proforma
invoices will be provided upon request. DAMAGED GOODS
Damaged equipment should not be returned to Lafayette
RETURNS Instrument prior to thorough inspection.
Equipment may not be returned without first receiving a Return
Goods Authorization Number (RGA). When a shipment arrives damaged, note damage on delivery
bill and have the driver sign it to acknowledge the damage.
When returning equipment for service, please call Lafayette Contact the delivery service, and they will file an insurance
Instrument to receive a RGA number. Your RGA number will claim. When damage is not detected at the time of delivery,
be good for 30 days. Address the shipment to: Lafayette contact the carrier and request an inspection within 10 days of
Instrument Company, 3700 Sagamore Parkway North, the original delivery. Please call the Lafayette Instrument
Lafayette, IN 47904, U.S.A. Shipments cannot be received at Customer Service Department for a return authorization for
the PO Box. The items should be packed well, insured for full repair or replacement of the damaged merchandise.
Lafayette Instrument Co. Europe

3700 Sagamore Parkway North 4 Park Road, Sileby,
P.O. Box 5729 • Lafayette, IN 47903 USA Loughborough, Leics., LE12 7TJ. UK.
Tel: 765.423.1505 • 800.428.7545 Tel: +44 (0)1509 817700
Fax: 765.423.4111 Fax: +44 (0)1509 817701
E-mail: lic@lafayetteinstrument.com E-mail: EUsales@lafayetteinstrument.com
www.lafayetteinstrument.com
3700 Sagamore Parkway North . PO Box 5729 . Lafayette, IN 47903 USA . Ph: 765-423-1505
9. Disease Specific
MODIFIED HOEHN AND YAHR STAGING

(Disease Rating Scale)
Stage 0 = No signs of disease.

Stage 1 = Unilateral disease.
Stage 1.5 = Unilateral plus axial involvement.
Stage 2 = Bilateral disease, without impairment of balance.
Stage 2.5 = Mild bilateral disease, with recovery on pull test.
Stage 3 = Mild to moderate bilateral disease; some postural instability;
physical independent.
Stage 4 = Severe disability; still able to walk or stand unassisted
Stage 5 = Wheelchair bound or bedridden unless aided.
Reference: Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: onset, progression and
mortality. Neurology, 17(5), 427–442.
64
AMERICAN SPINAL INJURY ASSOCIATION (ASIA)
INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF
SPINAL CORD INJURY (ISNCSCI)
65
Reference: https://asia-spinalinjury.org/international-standards-neurological-
classification-sci-isncsci-worksheet/
66
SPINAL CORD INDEPENDENCE MEASURE III (SCIM III)
SCIM is a disability scale developed specifically for the SCI population to access various
activities of daily living. It is sensitive enough to detect important functional changes in
individuals with SCI over time.
Self Care
1. Feeding (cutting, opening containers, pouring, bringing food to mouth, holding cup
with fluid)
0. Needs parenteral, gastrostomy or fully assisted oral feeding
1. Needs partial assistance for eating and/or drinking, or for wearing adaptive devices
2. Eats independently; needs adaptive devices or assistance only for cutting food and/or pouring
and/or opening containers
3. Eats and drinks independently; does not require assistance or adaptive devices
2. Bathing (soaping, washing, drying body and head, manipulating water tap)
A. Upper Body
0. Requires total assistance
1. Requires partial assistance
2. Washes independently with adaptive devices or in a specific setting (e.g. bars, chair)
3. Washes independently; does not require adaptive devices or specific setting (not customary for
healthy people) (adss)
B. Lower Body
2. Washes independently with adaptive devices or in a specific setting (adss)
3. Washes independently; does not require adaptive devices (adss) or specific setting
3. Dressing
A. Upper Body
1. Requires partial assistance with clothes without buttons, zippers or laces (cwobzl)
2. Independent with cwobzl; requires adaptive devices and/or specific settings (adss)
3. Independent with cwobzl; does not require adss; needs assistance or adss only for bzl
4. Dresses (any clothes) interpedently; does not require adaptive devices or specific setting
B. Lower Body
1. Requires partial assistance with clothes without buttons, zippers or laces (cwobzl)
2. Independent with cwobzl; requires adaptive devices and/or specific settings (adss)
3. Independent with cwobzl without adss; needs assistance or adss only for bzl
4. Dresses (any clothes) interpedently; does not require adaptive devices or specific setting
4. Grooming (washing hands and face, brushing teeth, combing ahir, shaving,
applying makeup)
2. Grooms interpedently with adaptive devices
3. Grooms independently without adaptive devices
Self Care Subtotal (0-20)
67
Respiration and Sphincter Management
5. Respiration
0. Requires tracheal tube (TT) and permanent or intermittent assisted ventilation (IAV)
2. Breathes interpedently with TT; requires oxygen, much assistance in coughing or TT
management
4. Breathes independently with TT; requires little assistance in coughing or TT management
6. Breathes independently without TT; requires oxygen, much assistance in coughing, a mask (e.g.
peep) or IAV (bipap)
8. Breathes independently without TT; requires little assistance or stimulation for coughing
10. breathes indepdently without assistance or device
6. Sphincter Management – Bladder
0. Indwelling catheter
3. Residual urine volume (RUV) > 100cc; no regular catheterization or assisted intermittent
catheterization
6. RUV <100cc or intermittent self-catheterization; needs assistance for applying drainage
instrument
9. Intermittent self-catheterization; uses external drainage instrument; does not need assistance for
applying
11. Intermittent self-catheterization; continent between catheterizations; does not use external
drainage instrument
13. RUV <100cc; needs only external urine drainage; no assistance is required for drainage
15. RUV <100cc; continent; does not use external drainage instrument
7. Sphincter Management – Bowel
0. Irregular timing or very low frequency (less than once in 3 days) of bowel movements
5. Regular timing, but requires assistance (e.g. for applying suppository); rare accidents (less than
twice a month)
8. Regular bowel movements, without assistance; rare accidents (less than twice a month)
10. Regular bowel movements, without assistance; no accidents
8. Use of Toilet (perineal hygiene, adjustment of clothes before/after, use of napkins
or diapers)
1. Requires partial assistance; does not clean self
2. Requires partial assistance; cleans self independently
4. Uses toilet independently in all tasks but needs adaptive device or special setting (e.g. bars)
5. Uses toilet independently; does not require adaptive devices or special setting
Respiration and Sphincter Management Subtotal (0-40)
Mobility (room and toilet)
9. Mobility in Bed and Action to Prevent Pressure Sores
0. Needs assistance in all activities: turning upper body in bed, turning lower body in bed, sitting
up in bed, doing push-ups in wheelchair, with or without adaptive devices, but not with electric
aids
2. Performs one of the activities without assistance
4. Performs two or three of the activities without assistance
6. Performs all the bed mobility and pressure release activities independently
10. Transfers: bed-wheelchair (locking wheelchair, lifting footrests, removing and
adjusting arm rests, transferring, lifting feet)
1. Needs partial assistance and/or supervision, and/or adaptive devices (e.g. sliding board)
2. Independent (or does not require wheelchair)
11. Transfers: wheelchair-toilet-tub (if uses toilet wheelchair: transfers to and from;
if uses regular wheelchair: locking wheelchair, lifting footrests, removing and
adjusting armrests, transferring, lifting feet)
1. Needs partial assistance and/or supervision, and/or adaptive devices (e.g. grab-bars)
2. Independent (or does not require wheelchair)
68
Mobility (indoors and outdoors, on even surface)
12. Mobility Indoors
1. Needs electric wheelchair or partial assistance to operate manual wheelchair
2. Moves independently in manual wheelchair
3. Requires supervision while walking (with or without devices)
4. Walks with a walking frame or crutches (swing)
5. Walks with crutches or two canes (reciprocal walking)
6. Walks with one cane
7. Needs leg orthosis only
8. Walks without walking aids
13. Mobility for Moderate Distances (10-100 meters)
2. Moves independently in manual wheelchair
3. Requires supervision while walking (with or without devices)
5. Walks with crutches or two canes (reciprocal walking)
14. Mobility Outdoors (more than 100 meters)
2. Move independently in manual wheelchair
3. Requires supervision while walking (with or without evices)
5. Walks with crutches or two canes (reciprocal walking
15. Stair Management
0. Unable to ascend or descend stairs
1. Ascends and descends at least 3 steps with support or supervision of another person
2. Ascends and descends at least 3 steps with support of handrail and/or crutch or cane
3. Ascends and descends at least 3 steps without any support or supervision
16. Transfers: wheelchair-car (approaching car, locking wheelchair, removing arm
and footrests, transferring to and from car, bringing wheelchair inot and out of car)
1. Needs partial assistance and/or supervision and/or adaptive devices
2. Transfers independent; does not require adaptive devices (or does not require wheelchair)
17. Transfers: ground-wheelchair
0. Requires assistance
1. Transfers independent with or without adaptive devices (or does not require wheelchair)
Mobility Subtotal (0-40)
Total SCIM Score (0-100)
Reference: Catz, A., Itzkovich, M., Steinberg, F., Philo, O., Ring, H., Ronen, J., Spasser, R.,
Gepstein, R., & Tamir, A. (2001). The Catz-Itzkovich SCIM: a revised version of the Spinal Cord
Independence Measure. Disability and rehabilitation, 23(6), 263–268.
69
SUNNYBROOK FACIAL GRADING SYSTEM
Reference: Ross, B. G., Fradet, G., & Nedzelski, J. M. (1996). Development of a sensitive clinical
facial grading system. Otolaryngology—Head and Neck Surgery, 114(3), 380-386. 70
MOTION SENSITIVITY QUOTATION
Reference: Akin, F. W., & Davenport, M. J. (2003). Validity and reliability of the Motion Sensitivity
Test. The Journal of Rehabilitation Research and Development, 40(5), 415.
Shepard, N. T., Smith-Wheelock, M., Telian, S. A., & Raj, A. (1993). Vestibular and balance
rehabilitation therapy. Annals of Otology, Rhinology, and Laryngology, 102(3), 198–205.
71
DIZZINESS HANDICAP INVENTORY (DHI; Eng Ver.)
(ICF Domain: Activity – Functional Limitation & Participation – Participation Restriction)
Reference: Jacobson, G. P., & Newman, C. W. (1990). The development of the dizziness
handicap inventory. Archives of Otolaryngology–Head & Neck Surgery, 116(4), 424-427.
72
DIZZINESS HANDICAP INVENTORY (DHI; Chi Ver.)
(ICF Domain: Activity – Functional Limitation & Participation – Participation Restriction)
Reference: Poon, D. M. Y., Chow, L. C. K., Hui, Y., Au, D. K. K., & Leung, M. C. P. (2004).
Translation of the dizziness handicap inventory into Chinese, validation of it, and evaluation of the
quality of life of patients with chronic dizziness. Annals of Otology, Rhinology &
Laryngology, 113(12), 1006-1011.
73
10. Quality of Life
SHORT FORM-36 (SF-36)
(ICF domain: Participation – Participation Restriction)
Short Form-36 (SF-36) is a generic patient-report measure for the assessment of health-
related quality of life. There are 36 items in the measure and they are divided into 8
subscales:
 Physical functioning
 Role limitation due to physical problems
 Role limitations due to emotional problems
 Vitality (Energy/fatigue)
 Emotional well-being
 Social functioning
 Bodily pain
 General health
 Health change
Scores are transformed onto a scale from 0 (negative health) to 100 (positive health).
Each subscales score contributes to the Physical Component Summary (PCS) and Mental
Component Summary (MCS) scores.
For the survey and the scoring instruction of SF-36, please visit: https://www.rand.org/health-
care/surveys_tools/mos/36-item-short-form.html
For the online version, please visit: https://orthotoolkit.com/sf-36/
For the Hong Kong version, please visit:
https://bmjopen.bmj.com/content/suppl/2015/03/17/bmjopen-2014-006521.DC1/bmjopen-
2014-006521supp_appendix.pdf
Reference: Ware Jr, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey
(SF-36): I. Conceptual framework and item selection. Medical care, 473-483. 74
SHORT FORM-12 (SF-12)
Short Form-12 (SF-12) is a generic patient-report measure for the assessment of health-
related quality of life. SF-12 is a shortened version of SF-36. It was designed to reduce the
burden of response. There are 12 items in the measure and they are divided into 8 subscales
as same as SF-36. Each subscales score contributes to the Physical Component Summary
(PCS) and Mental Component Summary (MCS) scores.
SF-12 is not available for free by its authors, due to a scoring programme.
For purchasing the survey and detail reference, please visit

https://www.qualitymetric.com/health-surveys/the-sf-12v2-pro-health-survey/
For the online version, please visit https://orthotoolkit.com/sf-12/
Reference: Ware Jr, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health
Survey: construction of scales and preliminary tests of reliability and validity. Medical care, 220-
233. 75
WHO QUALITY OF LIFE-BREF
The WHOQOL-BREF is a shorter version of the WHOQOL-100. It is a self-administered

questionnaire comprising 26 questions on the individual’s perceptions of their health and
well-being over the previous two weeks.
76
77
Reference: Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004). The World Health
Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of
the international field trial. A report from the WHOQOL group. Quality of life Research, 13, 299- 78
310.

Handbook of Neuro Outcome Measures

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Handbook of Neuro Outcome Measures

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THE HONG KONG POLYTECHNIC UNIVERSITY

DEPARTMENT OF REHABILITATION SCIENCES

RS 3730 & 3731 - Commonly Used Outcome Measures

Prepared by Curtis Wong

Date of assessment: _______________________________

Ward/Bed no.:____________________Therapist's name ____________________

Cognitive/psychological state: __________________________________________________

Time to maintain sitting unsupported: ___________________________________

Sitting posture/base of support: ________________________________________

Reaching sideways : ________________Reaching forward:__________________

Bend down, touch feet and return:_______________________________________

Standing posture/base of support:_______________________________________

Reaching sideways: __________________Reaching forward:_________________

High level balance activities: __________________________________________

Rolling (affected side):________________________________________________

Rolling (unaffected side):______________________________________________

Sitting over to side of bed (affected side):________________________________

Sitting over to side of bed (unaffected side):______________________________

Walking speed/stride length: ___________________________________________

Advanced gait activities:______________________________________________

Gross and fine hand functions:

Grasp/release different objects/hand grip force :____________________________

Reach out for a cup: _________________________________________________

Drinking from a glass: _______________________________________________

Thumb opposition to individual fingers:__________________________________

Use of spoon, chopsticks: _____________________________________________

Using two hands together: ____________________________________________

Lip and jaw closure: _________________________________________________

Coordination (if applicable)

Functional limitations Impairments

Short and long term functional goals:

GLASGOW COMA SCALE (GCS)

Eye Opening spontaneous 4

1. What is your age?

2. What is the time to the nearest hour?

4. What is the year?

5. What is the name of the hospital or number of the residence

7. What is your date of birth? (day and month sufficient)

9. Name the current President/ Prime Minister/ Monarch.

10. Count backward from 20 down to 1.

Cut-off Value (Jitapunkul et al., 1991):

Communication barriers present at the time of test: Y/N

Deafness ____ Depression ____ Dysphasia ____ Language barriers ____

MODIFIED ASHWORTH SCALE (MAS)

0 = No increase in muscle tone

1 = Slight increase in muscle tone, manifested by a catch and release or by

1+ = Slight increase in muscle tone, manifested by a catch, followed by

3 = Considerable increase in muscle tone, passive movement is difficult

4 = Affected part is rigid in flexion or extension (abduction or adduction etc)

FUGL-MYER ASSESSMENT – UPPER EXTREMITY (FMA-UE)

A. UPPER EXTREMITY, sitting position

Total A (max 36)

Total B (max 10)

e. Spherical grasp cannot be performed 0

Total C (max 14)

D. COORDINATION/SPEED, sitting, after one trial with both arms, eyes

Total (max 24) Total (max 24)

A. UPPER EXTREMITY /36

TOTAL A-D (motor function) /66

I. PASSIVE JOINT MOTION /24

J. JOINT PAIN /24

III. Volitional movement mixing synergies none partial full

IV. Volitional movement with little or no synergy none partial full

Ankle dorsiflexion no active motion 0

Ward/Bed no.:Therapist's name

Reaching sideways : Reaching forward:__

Reaching sideways: __Reaching forward:_

Deafness Depression Dysphasia Language barriers