Assessing Motor Deficits in Neurological Rehabilitation: Patterns of Instrument Usage

Abstract

To describe current patterns in the use of clinical scales and measurement tech nology for the assessment of motor deficits in neurological rehabilitation. Question naire, sent to the 2,556 members of the World Forum for Neurological Rehabilita tion, distributed over 75 countries. Sixty-eight questionnaires were returned. Generally, participants indicated that the centres where they were based used a num ber of different clinical assessment scales (median, three), most frequently with a small proportion of patients. The (Modified) Ashworth Scale, the FIM, and the Fugl-Meyer were used most frequently. Only 35 respondents stated that their centre used one or more scales in >75% of their patients, but the choice of such routinely applied in struments varied between centres. The application of measurement technology was re stricted, with video and goniometry being used most frequently. The main barriers to more frequent use of assessment tools were perceived to be a lack of resources, infor mation, and training. The (albeit limited) results from this survey suggest that the assessment of motor deficits in neurological rehabilitation is currently mostly qualita tive and lacks standardisation. More resources and education are required to support a more routine application of assessment tools and to integrate measurement tech nology further in neurological rehabilitation to assist in the process of quantification of outcomes. Key Words: Motor deficits—Neurological rehabilitation—Outcome as sessment—Standardisation—Measurement technology.

References

Bower E. , Ashburn A. Principles of physiotherapy assessment and outcome measures. In: Stokes M , ed. Neurological physiotherapy . London: Mosby, 1998:43-55.

Wade DT Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992.

European Federation of Neurological Societies Task Force. Standards in neurological rehabilitation. Eur J Neurol 1997;4:325-31.

Mayo N. , Cole B. , Dowler J. , Gowland C. , Finch E. Use of outcome measures in physiotherapy: survey of current practice . Can J Rehabil 1993;7:81-2.

Tumer-Stokes L. The use of standardised outcome measures in rehabilitation centres in the UK. Clin Rehabil 1997;11:306-13.

World Health Organization. International classification of impairment, disabilities and handicaps: a manual of classification relating to the consequences of disease. Geneva: World Health Organisation, 1980.

World Health Organization. ICIDH-2: International Classification of Functioning and Disability. Beta-2 Draft, Short Version . Geneva: World Health Organization , 1999.

Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964;192:540-2.

Bohanon RW , Smith MB Interrater reliability of a modified Ashworth scale of muscle spasticity . Phys Ther 1987;67:206-7.

10.

Granger CV , Hamilton BB , Sherwin FS Guide for the use of the Uniform Data System for Medical Rehabilitation . New York: Uniform Data System for Medical Rehabilitation Project Office, Buffalo General Hospital, New York 14203, USA, 1986.

11.

Fugl-Meyer AR , Jaasko L. , Leyman I. , Olsson S. , Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand. J Rehabil Med 1975;7:13-31.

12.

Mahoney Fl, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965,14:61-5.

13.

Lyle RC A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int Rehabil Res 1981 ;4:483-92.

14.

Whiting S. , Lincoln N. An ADL assessment for stroke patients. Br J Occup Ther 1980;43:44-6.

15.

Carr JH , Shepherd RB , Nordholm L. , Lynne D. Investigation of a new motor assessment scale for stroke patients . Phys Ther 1985;65: 175-80.

16.

American Spinal Injury Association. Standards for neurological and functional classification of spinal cord injury . Chicago: American Spinal Injury Association, 1992.

17.

Demeurisse G. , Demol O. , Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol 1980;19;382-9.

18.

Chino N. , Sonoda S. , Domen K. , Saitoh E. , Kimura A. Stroke Impairment Assessment Set (SIAS). In: Chino N , Melvin JL , eds. Functional evaluation of stroke patients. Tokyo: Springer-Verlag, ' 1996:19-31.

19.

Domen K. , Sonoda S. , Saitoh E. , Kimura A. Evaluation of motor function in stroke patients using the Stroke Impairment assessment Set (SIAS). In: Chino N , Melvin JL , eds. Functional evaluation of stroke patients. Tokyo: Springer-Verlag , 1996:33-44.

20.

Collin C. , Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Nerosurg Psychiatry 1990;53:576-9.

21.

Medical Research Council. Aids to the investigation of peripheral nerve injuries . In: War memorandum. London: HMSO, 1943:11-46.

22.

Law M. , Baptiste S. , McColl M. , Opzoomer A. , Polataijko H. , Pollock N. The Canadian Occupational Performance Measure: an outcome measure for occupational therapy. Can J Occup Ther 1990;57:82-7.

23.

Lang Aet , Fahn S. Assessment of Parkinson's disease. In: Munsat TL , ed. Quantification of neurologic deficit. Boston: Butterworth Publishers, 1989:285-309.

24.

Wade DT Walking after stroke: measurement and recovery over the first three months . Scand J Rehabil Med 1987;19:25-30.

25.

Robinson SE , Fisher AG A study to examine the relationship of the Assessment of Motor and Process Skills (AMPS) to other tests of cognition and function. Br J Occup Ther 1996;59:260-3.

26.

Wade DT The Barthel ADL Index: A standard measure of physical disability? Int Disabil Studies 1988;10:64-7.

27.

Kidd D. , Stewart G. , Baldry J. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil 1995;17:10-4.

28.

Pandyan AD , Johnson GR , Price Cim , Curless RH , Barnes MP. Rodgers H. A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity. Clin Rehabil 1999;13:373-83.

29.

Durward B. , Baer GB , Rowe P. Measurement and analysis of functional human movement: state of the art. In: Durward B , Baer GB , Rowe P , eds. Functional human movement, measurement and analysis. Oxford : Butterworth Heinemann, 1999:219-25.