Neurological Assessment Study Guide PDF

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Neurological Assessment Study Guide Includes Lab, Student led presentations, and Sarah’s PPT that we did not go over in class Neurological Assessments – Assessment of client factors – Fugl-Meyer Assessment (FMA) – Assessment of performance skills – Arm Motor Ability Test (AMAT) – Action Research Arm Test (ARAT) – Motor Assessment Scale (MAS) Fugl-Meyer Assessment (FMA)Lab Overview: Test of motor and sensory impairment after stroke using 5 domains: motor function, sensory function, balance, joint ROM, joint pain 0 = cannot be performed 1 = performed partially 2 = performed faultlessly Time to Administer: 35-110 mins for total FMA; 30-45 mins for UE and LE subsets; 8-12 mins for UE subtest alone Materials (UE testing only): evaluation form, pen/pencil, tennis ball, small circular shaped container, reflex hammer Strengths: provides information about the motor and sensory function of the affected limb; assists in determining progress over time and therapy effectiveness; evidence supports its reliability, validity, and sensitivity. Weaknesses: administration time for full FMA is lengthy; items have little relevance to everyday activities; finger movement is not assessed in this test; UE scores are more heavily weighted than LE scores. FMA-UE Refer to your Critical Review of Assessment Tools Handout for the Fugl-Meyer Assessment while watching the videoWatch the video: https://youtu.be/m1tpCDHaWlQ * This video only shows the UE portion Fugl-Meyer Assessment Student Led Purpose & Population Purpose is to examine/determine:

▪ Severity of disease ▪ Recovery of motor skills ▪ Treatment plan Population: ▪ Individuals who experienced a stroke resulting in hemiplegia Format Assessment is measured through observation. Assessment based on 5 domains: ▪ Motor function (Upper and Lower extremities) ▪ Sensation ▪ Balance ▪ Joint ROM ▪ Joint pain Administration ▪ With all domains, the administer provides in layman’s terms what task the tester should complete. ▫ Upper extremity & lower extremity (reflex, mixing synergies, grasps, etc.) Scoring ▪ 0 = cannot perform ▪ 1 = performs partially ▪ 2 = performs fully Scoring - Possible Points: 226 ▪ Motor function: 100 ▪ Upper extremity: 66 ▪ Lower extremity: 34 ▪ Sensory function: 24 ▪ Light touch: 8 ▪ Position: 16 ▪ Balance: 14 ▪ Sitting: 6 ▪ Standing: 8 ▪ Joint ROM: 44 ▪ Joint pain: 44 Clinical Utility ▪ Cost = FREE (sort of) ▫ Must have access to numerous pieces of equipment Psychometric Properties Reliability: ▪ Interrater reliability: ▫ Upper extremity (.96)

▫ Lower extremity (.97) ▫ Balance (.93) ▫ ROM (.85) ▪ Intrarater reliability: r = .98-.99 Validity: ▪ Construct validity: established with the motor subscales ▪ Concurrent validity: established high degree of validity with Chedoke (0.95) and Motor Assessment Scale (0.88) Responsiveness: ▪ Has received little attention ▪ Scale may be most responsive to changes in patients with severe and moderate deficits Strengths & Weaknesses Strengths: ▪ Has international acceptance as a feasible and appropriate assessment of motor recovery in stroke rehabilitation ▫ Used in numerous clinic settings ▪ Ease of assessment Weaknesses: ▪ Weighing of the upper extremities more than the lower extremities ▪ Ceiling effect ▪ Lacks inclusion of other motor functions Fugl-Meyer Assessment of motor recovery after stroke (Fugl-Meyer et al 1975) – sarah’s ppt • Based on Twichell’s and Brunnstrom’s models of motor recovery after stroke • Reliable, valid, and responsive physical performance skill evaluation • Provides numerical scoring, which can be used to assess treatment efficacy and measure change over time • Even though we know much more about stroke recovery now than we did in the 1970s due to the discovery of neuroplasticity, the Fugl-Meyer is still widely used and informative today. • Upper extremity Subtests A. Shoulder/Elbow/Forearm (36 points) I. Reflex activity II. Volitional movements within the synergy patterns III. Volitional movements with mixed flexion and extension synergies IV. Volitional movements with little or no synergy dependence V. Normal Reflex Activity B. Wrist (10 points) C. Hand (14 points) D. Coordination/Speed (6 points)

Starts with the most basic tasks and moves to more complex/challenging tasks 1. Are reflexes present at flexors and extensors? 2. Can they do a flexor synergy movement or an extensor synergy movement? 3. Can they do movements that require a combination of flexor synergy and extensor synergy? (hand to lumbar spine, shoulder at 90 with elbow/wrist in neutral, pronation/supination with elbow at 90) 4. Can they do movements outside the synergies? (shoulder abducted with wrist pronated, shoulder flexion >90 with elbow extended, pronation/supination with shoulder flexed) 5. Do they demonstrate hyperactive reflexes? Only do this section if subject gets full points on the prior section Wrist – flexion/extension/circumduction assessed Hand – assesses mass flexion/extension, flexion of IP joints, adduction of thumb, opposition of thumb, cylinder grip, and spherical grip Coordination/Speed – finger to nose x5, scored on tremor, dysmetria, and time to complete • •

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Scoring the AMFM Scoring reflex testing: • 0 – no reflex • 2 – reflex elicited Scoring all other sections: • 0 – unable to complete • 1 – completes partially • 2 – completes fully Total score out of 66 points Arm Motor Ability Test (AMAT) Lab

Overview: thirteen unilateral and bilateral functional tasks scored on performance time, functional ability, and quality of movement Time to Administer: 30-45 minutes Materials: Sturdy chair without armrest and no wheels, table, plate, fork, knife, spoon, container of play-doh, sponge, bowl, 3 kidney beans, plastic comb, small mason jar with a lid, tennis shoe, telephone, jacket-style button down sweater, v-neck t-shirt Strengths: use of functional tasks; excellent reliability; evidence of validity Weaknesses: kit must be self made, ceiling and floor effects for performance time, time consuming, numerous versions AMAT Refer to your Critical Review of Assessment Tools Handout for the Arm Motor Ability Test

while watching the videoWatch the video: https://youtu.be/cwKl18Fw_lo This video shows an adapted 9 item version. AMAT – Student led Purpose, Format, and Population ● Evaluates disabilities in the upper extremity functions in activities of daily living using both qualitative and quantitative measures ● Observational ● 13 compound ADL task activities with 1-3 subcomponents being measured ● Adults ● Commonly used for stroke recovery Scoring Time required to complete the task with a 1-2 minute time limit ● Scale of the quality of the movement and the ability to perform each component of a compound task Administration ● Have client sit at standard table with task items laid out ● Each task should be modeled three times by the examiner ● The client should use their paretic arm when performing unilateral tasks ● When the client is ready, the examiner will say “go” and start the time Interpretation ● The scores represent a benchmark for the client to see if progress is being made throughout therapy, a higher score represents improvement ● There are not norms available for the test Clinical Utility Cost - $25 plus materials Clarity- Clear script provided Ease of Admin- Easy but requires ability to multitask Examiner qualifications: Must read manual Overall rating: Significant Time – 60 min Psychometric Properties ● Excellent interrater reliability (rs=0.97-0.99) ● Excellent test-retest reliability (r= 0.93-0.99) ● Excellent internal consistency (K=0.94-0.99)

● Adequate concurrent validity (rs= 0.45-0.61) in 1997 when using Motricity Index ● Excellent concurrent validity (rs= 0.92-0.94) when using FMA in 2003 ● High sensitivity to change ● Scores of the AMAT showed significant improvement after only 1-2 weeks of intensive therapy Strengths ● Directions can be repeated and cues can be given throughout the assessment as it does not measure cognitive ability ● Uses functional tasks to evaluate the client ● Has excellent reliability and validity Weaknesses ● Client must have some active mobility in the arm that was affected ● Client must be able to cognitively follow multi-step directions ● Lengthy to administer for the full 13 categories ● Ceiling and floor effects for performance time ● Not as natural as most functional assessments Arm Motor Abilities Test (AMAT) Sarah’s ppt (McCulloch et al, 1988) • Developed to measure quantitative and qualitative aspects of a variety of ADL tasks • Rated on 2 scales: Functional Ability and Quality of Movement • Bilateral tasks: affected upper extremity used in same role as pre-CVA • Standardized administration procedures Functional Ability Scale (AMAT) 0. Does not attempt 1. Attempt is made; unaffected UE may help move the affected UE. 2. Does; but requires assistance of unaffected UE for minor adjustments 3. Does; but slowly or with effort 4. Does; but may lack coordination, precision, or fluidity. 5. Movement appears to be normal. • Quality of Movement (AMAT) 0. No movement initiated 1. Partial range of movement 2. Movement is accomplished but influenced by synergy or accompanied by excessive compensatory movements 3. Some isolated movement but performed slowly or incoordinated. 4. Movement is close to normal 5. Normal movement • AMAT Properties

Reliability • N=33 tested at 1 week and 2 weeks by 2 trained examiners (Kopp et al, 1997) • Inter-rater: correlation coefficient 0.97 to 0.99 • Intra-rater: correlation coefficient 1.0 • Concurrent (Chae, Labatian, & Yang, 2003) • N=30; Fugl Meyer Assessment • All components of AMAT exhibited high correlation with the Fugl-Meyer • Time of performance demonstrated significant ceiling and floor effects. Modified AMAT • No recording of time, but cannot exceed time limit • Scored on Functional Ability scale only. • Some items omitted from original version AMAT Tasks • 13 ADL tasks (28 task components) • Cut “meat” • Eat “sandwich” • Eat with spoon • Drink from mug • Comb hair • Open jar • Tie shoelace • Use telephone • Wipe up spilled water • Put on cardigan sweater • Put on t-shirt • Prop on elbow • Light switch and door • Materials needed • Tabletop template • Plate, fork, knife • Sponge • Spoon, bowl • Comb • Mason-type jar • Shoe for shoelace tying, 45° platform • Push button desk phone • Cardigan sweater • T-shirt • Content validity – who really uses a pushbutton desk phone these days? •

Action Research Arm Test (ARAT) Lab Overview: 19 items are grouped into four subtests (grasp, grip, pinch, and gross movement) to assess UE performance (coordination, dexterity, and functioning). Items are rated on a 4-point scale. 0 = no movement 1= movement task is partially performed 2 = movement task is completed but takes abnormally long 3 = movement is performed normally Time to Administer: 20 minutes (if all 19 items are performed) Materials: paper, pencil, chair without armrests, table, wooden blocks of various sizes, cricket ball, alloy tubes, washer and bolt, 2 glasses, marbles, ball bearings, tin lid, stopwatch Strengths: accurately measures moderate to high degrees of motor impairments; evidence supports reliability and validity Weaknesses: scoring is subjective; lack of standardization regarding the weight, size and source of testing materials may result in variability in scoring; poor sensitivity for measuring mild impairments; factors that decrease the comprehension of the instructions, such as cognitive impairments or aphasia, may affect the quality of the results. – ARAT- Refer to your Critical Review of Assessment Tools Handout for the Action Research Arm Test while watching the videos Watch the videos: https://youtu.be/bhkCB0qojZk https://youtu.be/avZkBk3PfEY ARAT Student Led The Action Research Arm Test, based on Carroll’s Upper Extremity Function Test, was developed by Ronald Lyle, and was devised to evaluate upper extremity function in adults with neurologic dysfunction. Purpose of the ARAT is to assess UE performance particularly with dexterity and coordination. Assess ability to handle and manipulate objects different in size, weight, and shape. Format: The test is observational and made of 19 items. 4 subtests – grip, grasp, pinch, gross arm movement , progresses from Most difficult --> least difficult task Population:

• 13+ • Brain Injury • Multiple Sclerosis • Stroke • Parkinson's disease Administration: Simple instructions, takes 5-15 min to complete • Supplies needed: test kit, scoring booklet, pencil, chair, and table • 4 subjects: grasp, grip, pinch, gross movement 1. Set up supplies 2. Position client 3. Administrator directs client on how to complete the first subtest 4. This is repeated for all 4 subtests, until all tasks are completed To administer the ARAT you need the test kit which includes 2 glasses, a washer and a bolt, marbles, ball bearings, a tin lid, wooden blocks, a cricket ball, alloy tubes, and a sharpening stone. Other than the test kit you will need a pencil, chair, and table to properly give the assessment. The assessment is fairly simple and only takes 5-15 minutes to administer depending on the client's performance. Both upper extremities should be tested, beginning with the non-affected hand to explain how the assessment will work and determine baseline scores. To position the client correctly make sure they are seated upright in a chair with a firm back but no armrests and their feet are flat on the ground. The client needs to begin with both forearms pronated and their hands resting on the table. Then the administrator follows the instructions on the scoring booklet to tell the client exactly how to perform each subtest. The client will be asked to complete between 4 and 19 tasks depending on their performance. The tasks in each subcategory are arranged in order of decreasing difficulty. So if the client passes the first task they would receive the top score and not need to complete the rest of the tasks in that subcategory, as they were able to complete the most difficult tasks with normal movement. If they fail the first, then you go to the second task and score them on that task. If they fail the first and second task they are given the low score and they do not need to complete the rest of the tasks as they will likely be unable to complete the remaining tasks in that section. Scoring and Interpretation: the ARAT is scored on a 4-point ordinal scale, with ratings from 0-3 for each task. 0 is no movement, 1 is movement task is partially performed, 2 is movement task is completed but takes abnormally long, and 3 is normal movement. Each subcategory has a varying number of tasks, and not all tasks will need to be completed depending on the client's performance. Each subcategory is given a score by adding up the scores from all of it's tasks, and then the total score is calculated by adding up the scores from each of the 4 subcategories. The total score can range from 0-57, with 57 being the highest performance possible.

When interpreting these scores, there are no cut off scores as the ARAT is a continuous assessment based on the client's observed mobility of the upper extremity. The scores can predict functional recovery of the upper extremity in stroke rehabilitation and determine if there is likely to be poor, moderate, or good functional recovery of the client's upper extremity but these scores cannot be used to classify the clients into categories such as severely limited, mildly limited, or normal upper extremity movement. Clinical Utility: • Cost and availability: $525, can be purchased online • Clarity of instructions: clear instructions on scoring sheet • Time: 5-15 min, depends on client performance • Ease of administration: simple, follow given directions • Examiner qualifications: no additional training required • Overall rating of Clinical Utility: good Psychometrics: • Reliability • Test-Retest (mixed population) : 0.965-0.968 (excellent) • Inter-Rater (mixed population): 0.996-0.998 (excellent) • Test-Retest (Parkinson’s population) : • Total Score: .0.99 (very high) • All items: 0.93 (grip) to 0.99 (gross movement) (excellent) • Validity • Construct (mixed population) : High • Predictive (Stroke patients) : Moderate to Excellent • Concurrent: Excellent • Responsiveness • High • Detect changes in UE motor functioning Strengths • • • • • Weaknesses • • • •

Simple to administer Time effective A variety of practitioners can give this assessment Provides clues for level of functional recovery Results provide information for further interventions Scoring is subjective Poor sensitivity for measuring mild impairments Results are affected by comprehension of the instructions Expensive

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Large test kit Difficult to use with symptoms such as spasticity

Action research arm test – Sarah’s PPT • Assessment designed for use in populations with hemiplegia • Examines use of upper extremity in functional tasks • Administration requires standardized materials and setup, standardized cues • Can be difficult to locate all needed materials, such as cricket ball • Test kit available for purchase, but can make your own following standardized instructions • ARAT • Four subtests, each with several tasks • Grasp • Pick up varying sizes of wood block, stone, ball • Grip • Pour water from glass, 2 sizes of tube, washer • Pinch • Pick up varying sizes of ball bearing and marble • Gross movement • Place hand behind head, on top of head, and to mouth • Scoring the arat • 0 – performs no part of task • 1 – performs task partially • 2 – performs task with greatly increased time or difficulty • 3 – performs task normally • Most difficult task completed first; easiest task completed second • If the subject performs the first task correctly, they get full points and do not need to perform any other task in that section • If the subject cannot perform the first or second task correctly, they get no points and do not need to perform any other task in that section • Click for video

Motor Assessment Scale(MAS) Lab Overview: eight areas of motor function are rated on a 7 point hierarchical scale; 0 = easiest task, 6 = hardest task Time to Administer: 15 minutes

Materials: evaluation form, pen/pencil, paper, stopwatch, 8 jellybeans, cup, rubber ball, stool, comb, spoon, 2 teacups, water, table, cylindrical object Strengths: items are functionally relevant; administration time is short; evidence supports its reliability, validity, and sensitivity Weaknesses: sequence of the scoring hierarchy of the hand function and advanced hand activities scale is questioned, numerous tools required to perform test MAS Refer to your Critical Review of Assessment Tools Handout for the Motor Assessment Scale while watching the video Watch the video: https://youtu.be/qiWaUe8wsz8 Motor Assessment Scale (MAS) student led Purpose and Population ● Published in 1985 by Janet H. Carr and Roberta B. Shepherd ● Purpose: Evaluate motor function required for everyday activities ○ Assesses activities of daily living (ADLs) and functional mobility ○ Task oriented approach ○ Based on therapist observation ● Population: Individuals recovering from stroke ○ Can be used with adults or elderly adults ○ Ages 18+ ● Versions ○ Modified Motor Assessment Scale (1988) ○ Upper Limb/Extremity Motor Assessment Scale Format ● Observational ● 8 subtests ○ 1) Supine to sidelying to intact side ○ 2) Supine to sitting on edge of bed ○ 3) Balanced sitting ○ 4) Sitting to standing ○ 5) Walking ○ 6) Upper arm function ○ 7) Hand movements ○ 8) Advanced hand activities ● General tonus Administration ● Administered by a rehabilitation therapist (PT or OT) ● Materials required ○ Copy of the assessment, pencil, stopwatch, 8 jellybeans, polystrene cup, rubber ball, stool, comb, spoon, 2 tea cups, pen, water, piece of paper for drawing lines, cylindrical shaped object (i.e. jar), and a table

Client can perform each task 3 times and attempt the most difficult task first Successful completion of higher level task, indicates client can perform lower-level tasks Should be administered in a quiet space when the patient is maximally alert All items should be completed independently by patient unless stated o...