Stroke Evaluation – Reasoning Form

The following are the areas to be taken into consideration during evaluation of
Stroke with reasoning for the same
1. Age:
2. Gender:
3. Diagnosis:
4. History :
5. Higher mental functions:
6. Perceptual deficits:
7. Cranial nerve evaluation :
8. Posture observation :
9. Range of Motion :
10. Muscle tone :
11. Sensory evaluation :
12. Involuntary movement :
13. Muscle strength :
14. Voluntary Control Grading :
15. Hand function :
16. Reflex evaluation :
17. Balance :
18. Coordination :
19. Endurance :
20. Ambulation :
21. Aerobic capacity and endurance :
22. Transfers :
23. Functional activity :
24. Orthotic devices and assistive aids been used for all functional
activity,ambulation and others.:
25. Condition specific outcome measures:
26. Therapy recreation:
27. Home evaluation:

PROGRESS REPORT FORM

In the progress report form the following has to be mentioned in relation to the
baseline measurements, which is taken at the time of admission.

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 Stroke Evaluation – Reasoning Form

1. CROMS/FIM status
2. Cognitive and Perceptual measurements
3. HMF status:
4. Tonal changes
5. Hand function
6. Balance and coordination
7. Ambulation status
8. Medication and nutritional status
9. Therapy recreation status
10. Home evaluation report
11. Orthotics and assistive devices use.

DISCHARGE SUMMARY FORM

The discharge summary should include the status of the patient at the time of
admission and weekly goals set and achieved and the status of patient at the
time of discharge.
It should also have the HEP (Home Exercise Programme) status, Care takers
education material and review dates for follow up.

1. Age:  It matters as it will signify the ADL

dependence
 To plan for the new job responsibilities

2. Gender Consideration to be taken during Personal hygiene-

Menstrual cycle

3. Diagnosis  Type of stroke- Hemorrhagic or

Ischemic (Gives the status of prognosis)
 Location Of stroke (Will signify the
impairment and functional loss both
physically and psychologically)

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 Stroke Evaluation – Reasoning Form

4. History The following details are must from the history

 Date of onset of signs and symptoms
 Progression of the condition (any signs
of recovery)
 Medical management and surgical
management for the same (If done
surgery the type of surgery burr hole
and flap removal will tell the prognosis
and stay in ICU and Hospital)
 Medicational status: Need to check
pharmacokinetics of the drug and
window period to schedule the therapy.
Importance to be given for any
antiepileptic drugs and drugs taken to
reduce spasticity.
 Nutrition and feeding status (Any
presence of NSG tube or PEG will
suggest non intact ness of gag reflex)
also persistence of cough and altered
breathing pattern may suggest
aspirational pneumonia.
 Results of specific investigations
(Radiological reports)
 Co Morbidities (DM, HTN, Obesity,
Seizures, renal and hepatic status, any
others)
 Status of speech
o Normal
o Aphasia (Sensory, Motor,
Global)
o Dysarthria (Labial, Lingual.
Spastic)
 Use of any specific equipment
o Suction kit to remove secretions

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from NSG or Tracheostomy

tubes,
o Type of mattress using on the bed
which can relieve the pressure
o Any orthotics like Bobath sling,
AFO
 Technological assistance
o Consideration to be given if
patient is using any pacemakers,
hearing aids.
 Old surgery which is relevant for
present status eg:Joint replacement
surgery’s
 Risk factors eg: Balance. Cognitive and
Cardiovascular status
o Balance: premorbid status of
balance
o Cognitive: Any signs of dementia
can affect the motor learning
component.
CVS: Any signs of BP changes, Postural hypotension
5. Family  Vocational demand
background  Family support and Bread winners of
the family
 Expense of the family
 Expectation of the family or care takers
 Whether they are able to understand the
nature of disease and importance of the
treatment.

6. House and  Accessibility to home and work place

work place (Which also includes Number of rooms,
evaluation Width of passage, Type and condition
of flooring staircase details, Kitchen
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 Stroke Evaluation – Reasoning Form

and toilet accessibility and use. Position

of lights, switches, power points)
 In work place to know whether the
client c continue the job or does he/she
requires a change)

7. Problem  Does the patient understands step by

solving skills step explanation
 Does the patient require major guide
stops

8. Affective  Patient understanding of his disability

component  Does the patient have Realistic goals
 Does the patient accept his or her
responsibility
 Emotional status of the patient

9. Sleep  Any change in the sleeping pattern due

disturbance to pain, emotional disturbance or others
as it will affect the rehabilitation

10. Skin  Vulnerable skin over bony prominences

evaluation  Scar tissue break downs

11. Higher mental  Orientation, memory and attention (for

functions immediate memory and attention use
(Should Digit span test)
consider the  Other functions to be considered are
following ) Calculation, Abstract thinking and
Insight and judgment
 Objective scale: MOCA in Native
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 Stroke Evaluation – Reasoning Form

language: MOCA scale will screen an

individual’s cognitive dysfunction.
(The values obtained from the scale will
signify the cognitive impairment of the
individual and will affect the physical
activity as there will be lack in the
motor learning component. Assessment
of cognitive function could enhance
decision making in what rehabilitation
strategy might be potentially useful )

12. Perceptual The perceptual deficits will affect the physical

deficits functioning of the individual in turn will affect the
rehabilitation. Identification of the same is important
in planning the success of rehabilitation.
 Body scheme and body image
disorders:
o Anosognosia, Somatoagnosia (
The patient will point to the body
parts named by tester or imitate
the movements of the therapist)
o Right and left discrimination ,
o Unilateral neglect ( For unilateral
neglect- Therapist needs to
observe an individual’s ADL and
can also use Line bisection test,
Figure cancellation test , Copying
and drawing test )
 Agnosia: Visual object, Auditory and
Tactile (Test used are Good glass and
Kaplan test)
 Spatial relation disorders: Figure
ground discrimination, Topographic
discrimination, depth and distance
perception, vertical disorientation,

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 Stroke Evaluation – Reasoning Form

position in space ( The test used are

Ayres Figure ground test, Observation
of the functional task, RPAB, A-ONE)
Apraxia : Ideomotor, Ideational and Buccofacial :
Objective way to measure it is by Using Apraxia Screen of
Tulia (AST)
13. Cranial nerve  All the 12 pairs of cranial nerve
evaluation evaluation to be done including the
reflexes.
o Olfactory Nerve:
 Has to correlate the diagnosis, blood
supply of the brain affected and to
determine the cranial nerves that would
have damaged.
 Facial palsy origin is it central or
peripheral

14. Posture  Alignment of the shoulder to be noted

observation in static and dynamic postures
 Palpation to be done with any presence
of sulcus sign. ( Palpate between
acromion and superior aspect of
humeral head )
 Can also use Verniar caliper for the
measurement of Finger width scale
 X ray of the shoulder.
 Grading of shoulder subluxation by Van
Langenberghe and Hogan Scale
 Use of any orthotic devices (Bobath
sling) to be noted
 Any signs of unilateral neglect to be
noted
 Listing phenomenon to be noted ( Loss
of lateral balance and fall towards the
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 Stroke Evaluation – Reasoning Form

paralyzed side )
 Attitude of the limbs

15. Range of  Of all available joints

Motion  Any signs of tightness, Contracture to
be noted
 Any immobilization device used (Other
orthotics)

16. Muscle tone  Quality

(To be o Is the tone same always, or
compared with fluctuating, happens during
normal side) change in the position
o Is it symmetrical
o Is it dependent on time – Day or
night it changes
o Is it activity based.
 Quantity:
o MAS or TARDUE scale to be
taken if there is Hypertonia-
Spasticity ( MAS Is simple ,
reliable test done near bed side
where as TARDUE scale is more
valid and reliable but takes more
time to do on patient)

17. Sensory 28. The sensory evaluation depends upon the status of
evaluation: HMF of the individual .If the patient has issues in
HMF therapist cannot do the sensory evaluation as
the values of the sensory evaluation is highly
subjective .
 The superficial, Deep and Cortical
sensation to be taken with use of
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standard equipment’s

18. Involuntary  Presence of nay involuntary movements

movement like Tremor, Clonus, Chorea

19. Muscle 29. ( The therapist should remember the following No

strength isolation of movement will happen till stage 6,
Synergy will dominate, MMT is done at its best if
isolation of movement is present )
 Of all available muscle of both sides
 Any trick movements
 Any immobilization device being used
 Can use hand held dynamometer-
Group muscle strength

20. Voluntary 30. : To Use Brunnstrom VCG for UE, LE and Hand
Control
Grading

21. Hand function  Use of ART

 Power and precision grip
 Recovery of hand functions.

22. Reflex  Note that the position of the patient,

evaluation Correct tapping site and adequate
tapping stimulus should be given and
the results to be compared with normal
side.
 If needed facilitation for the reflex to be
given by Clenching the teeth, Gripping
of an object or Jendrassiks maneuver
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 Stroke Evaluation – Reasoning Form

 DTR and grading for UL and LL

 Pathological reflex:
o Babinski sign ( Extensor
response suggest Pyramidal tract
involvement)
o Oppenheim reflex,
o Chaddock sign
o Hoffmann’s reflex.(Presence of
the same indicate pyramidal tract
involvement)

23. Balance  Presence of protective extension

reaction
 Presence of equilibrium reaction
 Presence of static and dynamic balance
reaction
 BBS scale : Is a 14 item objective
performance measure that assesses
static balance and fall risk in adults

24. Coordination  Coordination skill prior injury

 Kinesthetic awareness
 Timing
 Accuracy of movement

25. Endurance  EEI to be taken

 Screening for CV system to be done

26. Ambulation  Wheel chair or walking

 If walking how many people assistance
to be noted.

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 If walking to do video graphic

evaluation
 Use of Functional gait scales
 Observe the associated movements
(Trunk rotation, arm swing, pelvic
rotation, Hip hiking, Hip rotation)
 Use of hemi walker or any other
assistive device for ambulation to be
noted
 Indoor and outdoor ambulation (Even
and uneven surface)
Dual task ambulation
27. Aerobic  Treadmill
capacity and  Fatigue level
endurance  Rest period

28. Transfers  Indoor: Mat, Chair, Bath bench,

Commode
 Car transfers

29. Functional  CROMS/ FIM

activity

30. Orthotic been used for all functional activity, ambulation and other
devices and
assistive aidss.

31. Condition  Modified ashworth scale

specific  CROMS/FIM
outcome  BBS

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measures  Fugyl Mayer Assessment of motor

recovery
 ART
 Community balance and mobility scale

32. Therapy 31. Therapy recreation will be either indoor or outdoor.

recreation: The activity will be decided on basis of need for the
patient which will assist in achieving the goals stated
by patient or decided by rehab team.

33. Home 32. Home evaluation will be done to assess the

evaluation: facilitators and barriers which will affect the
functional activity of the patient.
The areas to be considered are
 Pathway from road to house
 Any obstacles in the main door, rear
door for entry and exit of the patient
with and without wheel chair.
 Access and safety of living room, bed
room, kitchen, toilets and other areas
where the person uses.

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