Neuro Rehabilitation Scales and MS Lecture Notes Review

Flashcards covering key neurological assessment scales, their populations, measures, interpretations, PT uses, and types/stages of Multiple Sclerosis as discussed in the lecture.

Rancho Los Amigos Scale (RLA) Level I – No Response

Patient is unresponsive to any stimuli. PT involves total assist, positioning, and PROM.

Rancho Los Amigos Scale (RLA) Level II – Generalized Response

Patient shows inconsistent, non-purposeful responses to stimuli. PT involves total assist and sensory stimulation.

Rancho Los Amigos Scale (RLA) Level III – Localized Response

Patient reacts specifically but inconsistently, e.g., turns head to sound. PT involves total assist and beginning structured stimulation.

Rancho Los Amigos Scale (RLA) Level IV – Confused-Agitated

Patient is alert but aggressive/agitated, with no short-term memory. PT involves max assist, keeping the environment calm, and short sessions.

Rancho Los Amigos Scale (RLA) Level V – Confused-Inappropriate

Patient can follow simple commands inconsistently and is easily distracted. PT involves max assist, structured repetition, and safety emphasis.

Rancho Los Amigos Scale (RLA) Level VI – Confused-Appropriate

Patient is goal-directed with cues, some carryover, but has impaired memory. PT involves mod assist and structured functional tasks.

Rancho Los Amigos Scale (RLA) Level VII – Automatic-Appropriate

Patient performs daily routine automatically, but has poor judgment and decreased awareness. PT involves min assist, community re-entry, and ADLs.

Rancho Los Amigos Scale (RLA) Level VIII – Purposeful-Appropriate

Patient is oriented and independent, but may need standby assist in stressful/unfamiliar situations. PT involves SBA to Mod I, problem-solving, and higher-level activities.

RLA Quick Study Cue I–III

Indicates low arousal requiring total assist and stimulation.

RLA Quick Study Cue IV–VI

Indicates a confused state requiring structure, safety, and cues.

RLA Quick Study Cue VII–VIII

Indicates a more appropriate state, focusing on increasing independence and community skills.

Glasgow Coma Scale (GCS)

A scale used for TBI and acute neuro populations, measuring Eye (4), Verbal (5), and Motor (6) responses for a total score of 3–15. Scores of 13–15 = mild, 9–12 = moderate, and ≤ 8 = severe brain injury/coma. PT uses it to determine arousal/need for stimulation and predict prognosis.

Rancho Los Amigos (RLA) Scale for TBI

A scale used for TBI patients, measuring cognitive/behavioral recovery through Levels I–VIII (sometimes X). I–III = low response, IV–VI = confused, VII–VIII = appropriate. PT uses it to guide interaction and progression of therapy.

Fugl-Meyer Assessment (FMA)

An assessment used for stroke recovery, measuring motor, balance, sensation, and joint function. Scores range from 0–226 points, with higher scores indicating better recovery, based on Brunnstrom's motor recovery stages. PT uses it for motor recovery stages.

Functional Independence Measure (FIM)

A measure used in neuro rehab and inpatient settings to track independence in self-care, transfers, locomotion, and cognition. Scoring ranges from 1 (total assist) to 7 (independent). PT uses it to track independence and determine discharge needs.

Barthel Index

An assessment used for stroke and general neuro populations to measure ADLs like feeding, bathing, grooming, toileting, and walking. Scores range from 0–100, with higher scores indicating more independence. PT uses it for ADL progression and discharge planning.

Berg Balance Scale (BBS)

A scale used for stroke, Parkinson's Disease, elderly, and those with balance impairments, measuring 14 tasks of static/dynamic balance. Scores range from 0–56, with <45 indicating a fall risk. PT uses it for balance deficits, but it may have a ceiling effect in high-functioning patients.

Tinetti Performance-Oriented Mobility Assessment (POMA)

An assessment for elderly and those with balance/gait disorders, measuring balance (sitting, standing, nudging) and gait. A maximum score of 28, with <19 indicating high fall risk. PT uses it for balance and gait screening.

Functional Reach Test

A quick fall screening test for elderly individuals with balance deficits, measuring the maximum distance one can reach forward. A cutoff of <6 inches indicates a high fall risk. PT uses it for quick fall screening.

Timed Up and Go (TUG)

A quick mobility test for elderly, PD, stroke, and MS populations measuring the time to sit-to-stand, walk 3m, turn, and return. Cutoffs include

ASIA Impairment Scale (AIS)

A scale used for Spinal Cord Injury (SCI) patients, measuring motor (key muscles) and sensory (light touch, pinprick). Grading includes A=Complete, B=Sensory incomplete, C=Motor incomplete (MMT <3), D=Motor incomplete (MMT ≥3), E=Normal. PT uses it to determine the level of injury and prognosis.

Hoehn & Yahr Staging

A staging system for Parkinson's Disease (PD) that measures disease progression. Stages range from I (unilateral symptoms) to V (wheelchair/bed-bound). PT uses it for quick staging.

SF-36

A general health/Quality of Life (QOL) measure assessing physical and mental health domains. PT uses it to track broad QOL outcomes.

Patient-Specific Functional Scale (PSFS)

An individualized, patient-centered outcome measure for any neuro/MSK condition, where patients rate their ability on 3–5 chosen activities (0–10 per activity). PT uses it for individualized outcomes.

Relapsing-Remitting MS (RRMS)

The most common type of Multiple Sclerosis (~85% at onset), characterized by clearly defined relapses (flare-ups) followed by periods of partial or full recovery (remission). PT focuses on adapting therapy to current status, energy conservation, and fatigue management.

Secondary Progressive MS (SPMS)

MS that starts as RRMS but then transitions into a progressive decline, with or without relapses. PT focuses on maintaining mobility and preventing secondary complications like spasticity and contractures.

Primary Progressive MS (PPMS)

A type of MS (~10–15% of cases) characterized by a steady worsening from onset with no distinct relapses/remissions. PT notes slower response to therapy and a higher risk of disability progression, emphasizing compensatory strategies and gait aids.

Progressive-Relapsing MS (PRMS)

MS with a progressive course from onset but with acute relapses. It is now grouped under PPMS in updated classifications.

Expanded Disability Status Scale (EDSS)

A severity staging scale for Multiple Sclerosis. 0=Normal neurological exam, 1–4.5=Fully ambulatory/mild disability, 5–6.5=Ambulation impaired, 7–9.5=Primarily wheelchair or bedbound, 10=Death due to MS. It quantifies disability and ambulation.