Outcome measures/ special scales

Ottawa knee rules

• A knee x-ray is indicated if there is pain over the patella or fibular head with any of these findings

  • Pt. is >/= 55 y/o

  • Isolated tenderness of the patella

  • Tenderness at the head of the fibula

  • Inability to flex the knee to 90 degrees

  • Inability to WB for at least 4 steps both immediately after injury and at the time of the eval

Ottawa Ankle rules

• An ankle x-ray should be performed if there is pain in the malleolar region with any of the following

  • Bone tenderness at the posterior edge of the distal 6 cm or the tip of the lateral malleolus

  • Bone tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus

  • Inability w/ weight bearing for at least 4 steps both immediately after injury and at time of eval

Ottawa Ankle rules: foot

• A foot x-ray should be performed if there is pain in the midfoot region with any one of the following

  • Bone tenderness at the navicular bone

  • Bone tenderness at the base of the 5th metatarsal

  • Inability with WB for at least 4 steps, both immediately after injury and at time of eval

Ranchos Los Amigos (RLA) levels → First 3 R = response

• 1 → No Response- Coma

• 2 → Generalized Response- non-purposeful, whole body, vocal, inconsistent

• 3 → Local Response- Purposeful, local, and specific inconsistent

  • Follows simple commands: close/ open eyes, squeeze hand

Ranchos Los Amigos (RLA) levels → Next 3 (RCA) C= confused

• 4 → Confused and Agitated

  • Behavior: heightened activity, aggressive, confabulation, does not cooperate, verbalizes, but is incoherent → Establish routine, do not confront (closed environment), orient patient, give options

  • Attention: non-selective

  • Memory: no short-term or long-term

• 5 → Confused Inappropriate

  • Behavior: responds consistently to simple commands, responds inconsistently to complex commands, with structure able to socialize for short periods

  • Memory: impaired, inappropriate use of objects → can’t learn new task

• 6 → Confused Appropriate

  • Behavior: follows simple instructions consistently, goal-oriented behavior with external input

  • Memory: carryover of previous skills present (self- care)

Ranchos Los Amigos (RLA) levels → Next 2 (RCA) A= Appropriate

• 7 → Automatic Appropriate

  • Oriented in home/ hospital

  • Daily routine- automatic but robot-like

  • judgment impaired

  • Able to initiate social or recreational activity w/ structure

• 8 → Purposeful Appropriate

  • Carryover of new skills present

  • Impaired judgement in an emergency situation, abstract reasoning and reduced tolerance for stress

Brunnstrom stages of stroke recovery

• Stage 1: Flaccidity (cerebral shock)

  • No active limb movement

• Stage 2: beginning of minimal voluntary mvmt

  • in synergy, with associated reactions

  • increase tone

• Stage 3: voluntary control of mvmt synergy (spasticity at peak)

  • Further increase tone to peak level

• Stage 4: movement outside of synergy

  • Decrease tone

• Stage 5: increase complex mvmt, greater independence from limb synergies

• Stage 6: Individual joint movement, coordinated mvmt

• Stage 7: Normal fxn

MMT Grading

• 0 → no contraction

• 1 → Palpable contraction

• 1+ → Gravity eliminated < 50% ROM

• 2- → Gravity eliminated, 50% ROM

• 2 → Gravity eliminated, full ROM

• 2+ → Gravity eliminated, full ROM, minimal resistance

• 3- → Gravity, 50% ROM no resistance

• 3 → Gravity, full ROM

• 3+ → Gravity, full ROM, slight resistance

• 4- → Gravity, full ROM, nearly moderate resistance

• 4 → Gravity, full ROM, moderate resistance

• 4+ → Gravity, full ROM, nearly full resistance

• 5 → Gravity, full ROM, full resistance

DTR- reflex grading

• 0- Absent

• 1+ Decreased

• 2+ normal

• 3+ Hyperactive

• 4+ Hyperactive with clonus

Modified Ashworth Scale

• 0: no increase in muscle tone

• 1: slight increase in muscle tone, manifested by a release or by minimal resistance at the end of the motion when the affected parts are moved in extension (catch and release)

• 1+: slight increase in muscle tone, manifested by catch, followed by minimal resistance throughout (less than half) of ROM (does not fully go away)

• 2: more marked increase in muscle tone through most of ROM, but affected portion is easily moved

• 3: Considerable increase in muscle tone, passive movement difficult

• 4: Affected parts rigid in flexion or extension