Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023)
Chapter: Appendix B: Selected Functional Assessments for Debilitating Neurologic Conditions
Appendix B
Selected Functional Assessments for Debilitating Neurologic Conditions
Functional Tests for Stroke
| Name of Test | Area of Assessment (Specific Conditions) | International Classification of Functioning, Disability and Health (ICF) Domain | Level of Evidence |
|---|---|---|---|
| 6-Minute Walk Test | Tests aerobic capacity and endurance (arthritis/joint, MS, pain, PD/neuro; SCI; stroke) | Activity | 4 |
| Berg Balance Scale | Objective balance scale (14 items, predetermined tests) [NINDS CDE; peds, stroke, SCI, CP, MS, exploratory for aneurysm and subarachnoid hemorrhage) | Body structures and function | 4 |
| Dynamic Gait Index | Clinical tool to assess gait, balance, fall risk; likelihood of falling [NINDS CDE, sport-related concussion, ALS, MS, PD/neuro, stroke, vestibular] | Activity | 4 |
| Fugl-Meyer Assessment of Motor Performance | Stroke-specific, performance-based assessment of motor function, balance, sensation, joint function [stroke recovery] | Body Structures and Function | 4 |
| Name of Test | Area of Assessment (Specific Conditions) | International Classification of Functioning, Disability and Health (ICF) Domain | Level of Evidence |
|---|---|---|---|
| Functional Reach | Ascertaining dynamic balance (also used in SCI), vestibular function, functional mobility [NINDS CDE, PD/neuro, SCI, stroke, vestibular, CP w/supplement] | Body Structures and Function | 4 |
| Motor Activity Log | Quality and amount of movement of paretic arm [stroke] | Body Structures and Function | 4 |
| Stroke Impact Scale | Self report questionnaire; evaluates disability and HRQOL after stroke | Participation | 4 |
| Timed Up and Go | Mobility, balance, walking ability, fall risk in older adults [arthritis, joint conditions, CP, MS, PD, SCI, Stroke, Vestibular] | Activity | 4 |
| 10-Meter Walk Test | Functional mobility, gait, vestibular [BI, amputation, MS, PD, SCI, Stroke] | Activity | 4 |
| Modified Ashworth Scale | Spasticity/antispasticity drugs [MS, SCI, CP, ALS, peds] | Body Structures and Function | 3 |
| NIH Stroke Scale | Quantifies stroke; 15-item neuro exam; eval effect of acute stroke on consciousness, language, neglect, visual field cut, extraocular movement, motor, ataxia, dysarthria, sensation) [stroke recovery] | Participation | 3 |
| Activity Balance Confidence Scale | Balance, vestibular function, mobility [MS, PD, stroke, vestibular] | Participation | 3 |
| 5 Times Sit to Stand | functional mobility, strength [CP, PD, stroke, vestibular] | Body Structures and Function | 3 |
| Modified Rankin Scale Score (mRS) | measures degree of disability/dependence in daily activities after stroke [BI, stroke recovery] | ||
| Trunk Impairment Scale (TIS) | balance [BI, CP, MS, PD/neuro, stroke] |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: ALS = amyotrophic lateral sclerosis; BI = Barthel Index; CDE = Common Data Elements; CP = Cerebral Palsy; HRQOL = health-related quality of life; MS = multiple sclerosis; NINDS = National Institute of Neurological Disorders and Stroke; PD = Parkinson’s Disease; SCI = spinal cord injury.
Levels of Evidence: 4 = highly recommended; the outcome measure has excellent psychometric properties and clinical utility; 3 = recommended; the outcome measure has good psycho-
metric properties and good clinical utility; 2 = unable to recommend at this time; there is insufficient information to support a recommendation of this outcome measure; 1 = not recommended; the outcome measure has poor psychometric properties and/or poor clinical utility.
Functional Tests for Spinal Cord Injury
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| International Standards for the Neurological Classification of Spinal Cord Injury (ASIA Impairment Scale) | Classifies motor and sensory impairment [SCI] AIS Classifications: AIS A (complete absence of motor or sensory function); AIS B (incomplete sensory function); AIS C and D (incomplete motor function); and AIS E (no detectable neurological deficits). | Body Structures and Function | 4 |
| 6-Minute Walk Test | For incomplete motor AIS C and D [see above] | Activity | 4 |
| 10-Meter Walk Test | For incomplete motor AIS C and D [see above] | Activity | 4 |
| Walking Index for Spinal Cord Injury (WISCI, WISCI II) | For acute motor incomplete AIS C and D [SCI] | Activity | 4 |
| TUG | For acute and subacute motor incomplete AIS C and D for chronic issues lasting >6 mo [see above] | Activity | 4 |
| World Health Organization Quality of Life-BREF (WHOQOL-BREF) | For motor incomplete and complete chronic issues lasting >6mo | Participation | 4 |
| Manual Muscle Test | Muscle strength and function [ALS, NMD, MD, CP, SMA, SCI] | Body Structures and Function | 3 |
| Spinal Cord Independence Measures (SCIM-III) | ADLs, coordination, mobility, incontinence, respiratory function [SCI] | Activity | 3 |
| Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) | Walking/functional mobility in ambulatory [SCI] | Activity | 3 |
| Wheelchair Users Shoulder Pain Index (WUSPI) | Self-report, upper extremity function and pain [SCI] | Body Structures and Function | 3 |
| Capabilities of the Upper Extremity (CUE) | Upper extremity functional limitations [SCI] |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: AIS = ASIA Impairment Scale; ASIA = American Spinal Injury Association; ADL = Activities of daily living; ALS = Amyotropic lateral sclerosis; CP = Cerebral Palsey; MD = Muscular Dystrophy; NMD = Neuromuscular disorder; SCI = Spinal cord injury; SMA = Spinal muscular atrophy.
Levels of Evidence: 4 = highly recommended; the outcome measure has excellent psychometric properties and clinical utility; 3 = recommended; the outcome measure has good psychometric properties and good clinical utility; 2 = unable to recommend at this time; there is insufficient information to support a recommendation of this outcome measure; 1 = not recommended; the outcome measure has poor psychometric properties and/or poor clinical utility.
Functional Tests for Multiple Sclerosis
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| EDSS (Expanded Disability Status Scale) and Kurtzke Functional Systems Score (FSS) | Coordination, gait, mental health, vision/perception [MS] EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability. EDSS steps 1.0 to 4.5 refer to people with MS who are able to walk without any aid and is based on measures of impairment in eight functional systems (pyramidal, cerebellar, brainstem, sensory, bowel and bladder function, visual function, cerebral functions, other). EDSS steps 5.0 to 9.5 are defined by the impairment to walking. | ||
| 12-Item Multiple Sclerosis Walking Scale (MSWS-12) | For EDSS level of disability from 0 to 7.5; Gait [MS] | Activity | 4 |
| 6-Minute Walk Test | For EDSS level of disability from 0 to 5.5 [see above] | Activity | 4 |
| 9-Hole Peg Test | For EDSS level of disability 0–7.5; Measures finger dexterity [BI, stroke recovery] | Activity | 4 |
| Timed 25-Foot Walk | For EDSS level of disability 0–7.5 | Activity | 4 |
| TUG with Cognitive and Manual | For EDSS level of disability 0–7.5 [see above] | Activity | 4 |
| Berg Balance Scale | For EDSS level of disability 0–7.5 [see above] | Body Structures and Function | 4 |
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| Box and Block Test | For all EDSS levels of disability; ADLs, coordination, dexterity, upper extremity function [BI, limb loss, MS, pain, PD/neuro, stroke] | Activity | 3 |
| Dynamic Gait Index | For EDSS level of disability 0–5.5; balance, functional mobility, gait [NINDS CDE; sports-related concussion, ALS] | Activity | 3 |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: ALS = Amyotropic lateral sclerosis; BI = Barthel Index; MS = multiple sclerosis; NINDS CDE = National Institute of Neurological Disorders and Stroke Common Data Elements.
Levels of Evidence: 4 = highly recommended; the outcome measure has excellent psychometric properties and clinical utility; 3 = recommended; the outcome measure has good psychometric properties and good clinical utility; 2 = unable to recommend at this time; there is insufficient information to support a recommendation of this outcome measure; 1 = not recommended; the outcome measure has poor psychometric properties and/or poor clinical utility.
Functional Tests for Parkinson’s Disease
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| UPDRS (Unified Parkinsons Disease Rating Scale) Rev | Measure severity and progression PD | ||
| Hoehn and Yahr (H&Y) scale | Progression of PD; staging of the functional disability associated with Parkinson’s disease. Stage 1: Unilateral involvement only usually with minimal or no functional disability. Stage 2: Bilateral or midline involvement without impairment of balance. Stage 3: Bilateral disease; mild to moderate disability with impaired postural reflexes; physically independent. Stage 4: Severely disabling disease; still able to walk or stand unassisted. Stage 5: Confinement to bed or wheelchair unless aided. | ||
| 6-Minute Walk Test | [see above] | Activity | 4 |
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| Functional Gait Assessment | For H&Y score I–IV; Postural stability, ability to perform motor tasks while walking (mod of Dynamic Gait Index) [PD/neuro, SCI, stroke, vestibular] | Activity | 4 |
| 10-Meter Walk Test | For H&Y score I-III [see above] | Activity | 4 |
| Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Rev (MDS-UPDRS revision) | Comprehensive assessment of burden of PD [PD] | Participation | 4 |
| Mini Balance Evaluation Systems Test | For H&Y scores I-IV; Balance, mobility [BI, MS, PD/Neuro, stroke, vestibular] | Activity | 4 |
| Montreal Cognitive Assessment (MoCA) | For H&Y scores I–IV; cognition [cardiac, PD/neuro, stroke; Huntington’s disease, mitochondrial disease, PD, stroke, epilepsy, aneurysm, subarachnoid hemorrhage supplements] | Activity | 4 |
| Parkinson’s Disease Questionnaire-39 | For all H&Y scores | Participation | 4 |
| 2-Minute Walk Test | For H&Y scores I–IV; aerobic capacity, mobility [BI, limb loss, MS, pulmonary, SCI, stroke] | Activity | 3 |
| 9-Hole Peg Test | For H&Y scores I–IV; QO [PD/neuro] | Activity | 3 |
| Freezing of Gait Questionnaire | For H&Y scores II–IV [PD] | Activity | 3 |
| Fatigue Severity Scale | For H&Y scores I–III [cancer, MS, PD/neuro, stroke, SCI] | Body Structures and Function | 3 |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: BI = Barthel Index; MS = multiple sclerosis; PD = Parkinson’s disease; SCI = Spinal cord injury.
Levels of Evidence: 4 = highly recommended; excellent psychometrics in target population AND excellent clinical utility; 3 = Recommended; good psychometrics in target population AND good clinical utility; 2 = Reasonable to use, but limited study in target group; good or excellent psychometric data demonstrated in at least one population, but insufficient study in target population to support a stronger recommendation; good clinical utility; no negative psychometric data; 1 = Do not recommend; poor psychometrics OR limited clinical utility (extensive testing time, unusual or expensive equipment, ongoing costs to administer, etc.)
Functional Tests for Traumatic Brain Injury
| Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|
| Coma Recovery Scale-Revised | Cognition, language, vision/perception, communication, functional mobility [NINDS CDE; BI] | Body Structures and Function | 4 |
| High Level Mobility Assessment (HiMAT) | For complete to mild independence—functional mobility [BI, PD/neuro, pediatrics, sports medicine] | Activity | 4 |
| 6-Minute Walk Test | For complete to mild independence [see above] | Activity | 3 |
| Dizziness Handicap Inventory (DHI) | [BI, MS, vestibular] | Body Structures and Function | 3 |
| Functional Assessment Measure (FAM) | For complete independence through severe dependence; 12 items added to FIM [BI, MS, stroke] | Activity | 3 |
| Berg Balance Scale | [see above] | Body Structures and Function | 3 |
| Quality of Life after Brain Injury (QOLIBRI) | Participation | 3 | |
| Rancho Los Amigos Levels of Cognitive Function | Pattern of recovery after BI [BI] | Body Structures and Function | 3 |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: BI = Barthel Index; FIM = functional independence measure; MS = multiple sclerosis; NINDS CDE = National Institute of Neurological Disorders and Stroke Common Data Elements; PD = Parkinson’s disease.
Levels of Evidence: 4 = highly recommended; the outcome measure has excellent psychometric properties and clinical utility; 3 = recommended; the outcome measure has good psychometric properties and good clinical utility; 2 = reasonable to use, but limited study in target group; the outcome measure has good or excellent psychometric properties and clinical utility in a related population, but insufficient study in target population to support higher recommendation; 1 = do not recommend; the outcome measure has poor psychometric properties and/or poor clinical utility.
Functional Tests for Vestibular Dysfunction
| Diagnosis | Name of Test | Area of Assessment [Specific Conditions] | ICF Domain | Level of Evidence |
|---|---|---|---|---|
| Acute | DGI | [see above] | Activity | 3 & 4 |
| Dix-Hall Pike Maneuver | Benign paroxysmal positional vertigo [BI, vestibular] | Body Structures and Function | 3 & 4 | |
| Chronic | DGI | Activity | 3 & 4 | |
| FGA | Activity | 3 & 4 | ||
| Dix-Hall Pike | Body Structure and Function | 3 & 4 | ||
| Dizziness Handicap Inventory | Participation | 3 & 4 | ||
| Central | DGI | Activity | 3 & 4 | |
| FGA | Activity | 3 & 4 | ||
| Dizziness Handicap Inventory | Participation | 3 & 4 | ||
| BPPV | Dix–Hallpike | Body Structure and Function | 3 & 4 | |
| Dizziness Handicap Inventory | Participation | 3 & 4 | ||
| Other | Dizziness Handicap Inventory | Participation | 3 & 4 |
SOURCE: https://www.sralab.org/rehabilitation-measures; APTA condition specific task forces.
NOTES: BI = Barthel Index.
Levels of Evidence: 4 = Highly Recommended; this outcome measure has excellent psychometric properties and clinical utility, AND this measure is free or reasonably accessible to the broad community of providers; 3 = Recommended; this outcome measure has good psychometric properties and good clinical utility, OR this measure has excellent psychometric properties and clinical utility; however, it is not free and may require access to specialized testing equipment that is beyond the means of many clinicians or clinics; 2 = Reasonable to Recommend at this time; This measure has adequate to good psychometric properties and clinical utility; however, it is not free and may require access to specialized testing equipment that is beyond the means of many clinicians or clinics, OR this measure has been validated in other patient populations but not in persons with vestibular deficits OR this measure has only adequate clinical utility; 1 = Not Recommended; this outcome measure has poor psychometric properties, OR this measure has poor clinical utility.
