MND I: Week 1, 2 & 3 - Grading Scales

Week 1: MMTs, Sensory Modality Testing / Week 2: Modified Ashworth Scale / Week 3: FIM and GG Codes

Determine the Mod AS Score:

“No increase in tone”

0

Determine the Mod AS Score:

“Slight increase in muscle tone manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension”

1

Determine the Mod AS Score:

“Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM”

1+

Determine the Mod AS Score:

“More marked increase in tone through most of the ROM, but the affected part(s) easily moved”

2

Determine the Mod AS Score:

“Considerable increase in muscle tone, passive movement difficult”

3

Determine the Mod AS Score:

“Affected part(s) rigid in flexion or extension”

4

T/F: The Modified Ashworth Scale is a test for hypertonicity

FALSE. It is a test for spasticity as the grading requires the clinician to elicit a quick stretch response

Determine the MMT Grade:

“No observable or palpable contraction”

0

Determine the MMT Grade:

“Can palpate contraction; no joint movement; may see tendon or palpate tendon movement”

1

Determine the MMT Grade:

“Movement of joint through less than (<50%) of available AROM, no resistance in the gravity eliminated position”

1+

Determine the MMT Grade:

“At least 50% available AROM but not full, gravity minimized (eliminated), no resistance”

2-

Determine the MMT Grade:

“Movement of joint through full available AROM in gravity-eliminated position. No resistance”

2

Determine the MMT Grade:

“Full available AROM in gravity eliminated position, can take slight manual resistance in that same position”

2+

Determine the MMT Grade:

“Less than (<50%) of AROM in the against-gravity position”

2+ (per Dr. Morgan)

Determine the MMT Grade:

“At least 50% but not full AROM against gravity, no resistance”

3-

Determine the MMT Grade:

“Full available AROM against-gravity, will not take manual resistance.”

3

Determine the MMT Grade:

“Full available AROM against-gravity; holds against slight manual resistance (QUICK catch and release).

3+

Determine the MMT Grade:

“Full AROM against-gravity; holds against minimal (slight) to moderate manual resistance (PROLONGED catch and release?).

4-

Determine the MMT Grade:

“Full available AROM, against gravity, moderate manual resistance (they are fighting you but giving away through the whole ROM).

4

Determine the MMT Grade:

“Full available AROM, against gravity, moderate to maximal (nearly strong) manual resistance.

4+

Determine the MMT Grade:

“Full available AROM, against gravity, maximal/strong manual resistance.'“

5

What is the purpose, method, and neuro structures tested in the light touch test?

• Purpose: Detect gross touch sensation (not localized)

• Method: Determine intact site → Wispy cotton swab used to do light touch in different dermatome/nerve distribution patterns → Compare intact site

  • Patient must have eyes closed and NOT guess

• Structure: Mainly Anterior STT and some DCML involvement 

What is the purpose, method, and neuro structures tested in the pinprick test?

• Purpose: Detect sharp sensation 

• Method: Determine intact site → Touch patient with sharp or dull object → patient must be able to state “sharp” vs dull (OTHERWISE, MARKED AS ABSENT) → Compare intact site (if not the same, marked as “impaired/altered”)

  • Patient must have eyes closed and NOT guess, dull is NOT documented, just used as control

• Structure: Lateral STT  

What are the 2 components that make up propioception?

1. Joint position sense (static)

2. Kinesthesia

What is the purpose, method, and neuro structures tested in the position sense test?

• Purpose: Detect static joint position (part of propioception)

• Method: Check PROM first and determine end ranges→ move the joint several times and then stop → ask the patient about the position of their joint   

  • Patient must have eyes closed and NOT guess

• Structure: DCML 

What is the purpose, method, and neuro structures tested in the kinestetic awareness test?

• Purpose: Detect joint motion (part of propioception)

• Method: Check PROM first and determine end ranges→ move the joint several times → ask the patient to detect if movement has occured and in which direction 

  • Patient must have eyes closed and NOT guess

• Structure: DCML 

During a propioception examination, you have determine that kinesthetic awareness is impaired in the toes. Now, you have tested ankle in all 4 directions and the examination was normal, what do you do now?

You may stop the propioception test as the proximal joint was clear

Determine what the test protocol is examining and the name of the test:

“Apply the stem of the activated tuning fork to the distal interphalangeal joint of the fingers and of the great toe, elbow, and wrist. Start distally and keep working until a normal proximal area is found. Ask when first felt and then when the vibration stops.”

Vibration test examining DCML

Less than _____ of 2-point discrimination is considered normal at the hand.

6 mm

Patients under ______ y/o are not reliable for the ASIA testing

5

The sensory dermatomes S2, S3 and S4-5 in the ASIA form can be examined where?

• S2: Popliteal area

• S3: Ischial tuberosity

• S4-5: Anal area

Describe the FIM Score:

7 - Total Independence

No helper is needed and the person performs the task safely and timley, without ADs or aids

Describe the FIM Score:

6 - Modified Independence

No help is needed, but the person takes too long to complete the task/does it unsafely OR uses an AD

Describe the FIM Score:

5 - Supervision

Needs standby to cue without physical contact OR needs help to setup items/ADs

Describe the FIM Score:

4 - Minimal Assistance

Client can do 75% or MORE by themselves, no more help than touching (SBA)

Describe the FIM Score:

3 - Moderate Assistance

Client can do 50% to 74% by themselves, no more than helping or touching

Describe the FIM Score:

2 - Maximal Assistance

Client can do 25% to 49% by themselves

Describe the FIM Score:

1 - Total Assistance

Client can do <25% independently

Determine the GG Score:

“Independent” (regardless of AD use)

6

Determine the GG Score:

“Set up or clean assistance (before or after)”

5

Determine the GG Score:

“Supervision or touching assistance”

4

The FIM equivalent is also a “4” = SBA/Min A

Determine the GG Score:

“Partial/moderate assistance, helper does <50% of effort” (51%> by client)

3

Determine the GG Score:

“Substantial/max assist, helper does EQUAL or >50% of the effort”

2

Determine the GG Score:

“Dependent; helper does all of the effort OR needs 2+ to complete activty’

1

Determine the GG Score:

“Patient refused”

7

Determine the GG Score:

“N/A - Will not perform this activity”

9

Determine the GG Score:

“Not attempted due to environmental limitations”

10

Determine the GG Score:

“Not attempted due to medical condition/safety concern”

88