berg balance barthel, ashworth mini mental

1. FUNCTIONAL
ASSESSMENT SCALES
Dr. Arwa Sinnarwala
(Neurophysiotherapy PT)

2. OBJECTIVES:
• Understand what are the different types of functional
assessment scales
• Method of performing the scale
• Scoring of the scale
• Interpretation of the result
• Uses of the scale

3. BERG BALANCE SCALE

4. • It is a multitask test 14 balance task ( 6 static and 6 dynamic )
• Focused on
• Maintenance of position
• Postural adjustment to voluntary movement
• Simple and easy to administer
• Patient should be able to stand
• Provide baseline and outcome data

5. • Equipment's needed
• Stopwatch
• Ruler
• Chair with back support and armrest
• Chair without arm rest.
• Object like a shoe or slipper
• Bench or stool (6 inch height)

6. • Scoring
• 5 point ordinal scale with specific criteria
• 0 – Lowest level of function
• 4 = highest level of function
• Highest possible score = 56
• score of <45 indicates a greater risk of falling
• 41-56 = low fall risk
• 21-40 = medium fall risk
• 0-20 = high fall risk

7. • Limitation
• It lacks items requiring postural response to external stimuli
or uneven support surface
• The use of the BBS as an outcome measure is compromised
when participants score high on in initial trails

8. BARTHEL INDEX

9. • Barthel index is an ordinal scale used to measure performance
in activities of daily living
• The Barthel index measures the degree of assistance required by
an individual on 10 items of mobility and self care ADL
• Area of assessment : Activities of daily living functional
mobility gait
• Time taken to assess : 10 min
• Can be administered by : any member of the multidisciplinary
team eg nurses , OT, PT .

10. • The Barthel includes 10 personal activities
• Feeding
• Personal Toileting
• Bathing
• Dressing and undressing
• Getting on and off a toilet
• Controlling bladder and bowel
• Moving from wheelchair to bed and returning,
• Walking on level surface (or propelling a wheelchair if unable to walk )
• Ascending and descending stairs

11. • Scoring :
0= unable
1 = needs assistance/help,
2 = independent.
• Interpretation
• 0-20 : Total dependency
• 21-60 : Severe dependency
• 61-90: moderate dependency
• 91-99: Slight dependency
• Uses : stroke, Parkinson
• Barthel index should not be used alone for predicting outcomes.

12. • Limitation
• They do not account for situational or environmental factors
such as ramps, stair climbing , bed adjustments, etc.

13. MINI TEST:

14. Glasgow Coma scale

15. OBJECTIVES:
• Explain the value of the Glasgow Coma Scale for patient care.
• Outline the three areas the Glasgow Coma Scales assesses.
• Summarize the severity findings for each range of the Glasgow
Coma Scale.
• Review how the interprofessional team can use the Glasgow
Coma Scale to communicate regarding a patients condition.

16. • Published by neurosurgery professors Graham Teasdale and
Bryan Jennett.
• The Glasgow Coma Scale (GCS) is used to objectively describe
the extent of impaired consciousness in all types of acute
medical and trauma patients.
• The scale assesses patients according to three aspects of
responsiveness: eye-opening, motor, and verbal responses.

17. • Components and Scoring :
• best eye response (E), best verbal response (V) and best motor response
(M).
• The levels of response in the components of the Glasgow Coma
Scale are ‘scored’ from 1, for no response, up to normal values
of 4 (Eye-opening response) 5 ( Verbal response) and 6 (Motor
response)
• We can abbreviate the GCS score using letter/number
combinations.
• A score of 15 would be “E4V5M6.” A score of 3 would be
“E1V1M1.”

20. • Limitation or problems with assessing.
1. Pre existing factors
2. Language barriers
3. Hearing or speech barriers
4. Other medical intervention like intubation or sedation
• Uses of the scale
1. Early management of patients with a head injury or other
kind of acute brain injury.
2. Monitoring the clinical course of a patient and guiding
changes in management.

21. • Interpretation
Classification of acute traumatic brain injury:
• Severe, GCS 3 to 8
• Moderate, GCS 9 to 12
• Mild, GCS 13 to 15

22. Modified Ashworth Scale

23. • Modified Ashworth scale is the most universally accepted
clinical tool used to measure the increase of muscle tone.
• Spasticity - velocity-dependent increase in muscle stretch
reflexes associated with increased muscle tone as a component
of upper motor neuron syndrome.
• No special equipment is required for the examination, but
special attention should be paid to the position of the assessed
limb. When examining the flexor muscles, the limb should be in
the position of maximal flexion, then within 1 second it should
be moved to the position of maximal extension. When
examining the extensor muscles, the limb should be in the in the
position of maximal extension, then within 1 second it should
be moved to the position of maximal flexion.

24. • The modified Ashworth scale purpose is to grade muscle
spasticity. The scale is as follows:
• 0: No increase in muscle tone
• 1: Slight increase in muscle tone, with a catch and release or
minimal resistance at the end of the range of motion when an
affected part(s) is moved in flexion or extension
• 1+: Slight increase in muscle tone, manifested as a catch,
followed by minimal resistance through the remainder (less
than half) of the range of motion
• 2: A marked increase in muscle tone throughout most of the
range of motion, but affected part(s) are still easily moved
• 3: Considerable increase in muscle tone, passive movement
difficult
• 4: Affected part(s) rigid in flexion or extension

26. • Uses : in stroke , MS
• Benefits :The MAS is the current standard for clinical
assessment of extremity spasticity, and the most commonly
used tool to evaluate the efficacy of pharmacologic and
rehabilitation interventions for the treatment and management
of spasticity among patients with SCI.
• Limitations :
a) poor interrater and intra rater reliability.

27. MINI MENTAL SCALE

28. • The mini mental state examination is a cognitive test used to
screen for the presence of cognitive impairment.
• It is a 30 point questionnaire
• It was developed by Dr Marshall Folstein in the year 1975.
• Time take – 10 15 min to administer

29. Uses of MMSE
• It provides measure of orientation registration and short term
memory, attention, voluntary movement and language
functioning.
• The shortened version is an accurate predictor of dementia.

30. Scoring
• It is a reliable test with a score of 25- 30 considered normal,
18-24 indictive of mild cognitive impairment
10-18 moderate cognitive impairment ,
scores of 17 or less correlate with substantial impairment in
activities of daily living.
• Social Background , educational level and verbal ability can
influence results and should be taken into account in their
interpretation.

31. Components of MMSE
• Orientation – temporal and geographical
• Registration – comprehension
• Attention - repetition and Names
• Calculation – Mental reversal
• Recall – First recall and second recall
• Language - reading writing
• Construction praxis – copying a figure( visio spatial task )

32. Guidelines of administering MMSE
• Try to get person down facing you
• Assess the person ability to hear and understand simple
conversation
• If person uses hearing aid provide these before starting.
• Before you begin get patient permission to ask question,
• Ask each question a maximum of three times.
• If the person answers incorrectly give score zero.

33. Advantage of MMSE.
• Relatively Quick and easy to perform
• Requires no additional equipment
• Can provide a method of monitoring deterioration over time.

34. Disadvantages of MMSE
• Biased against people with poor education due to elements of
language and mathematical testing
• Bias against visually impaired .
• Limited examination of visuospatial cognitive ability
• Poor sensitivity at detected mild/early dementia
• Patients new to a region may not geographic orientation aspect
of the test.
• False positives can lead to anxiety ,labelling and stigma

35. REFRENCES:
• O Sullivan
• National institute of health

36. THANK YOU !!!