EVALUATION METHODS,

SPECIAL TESTS AND SCALES

USED IN NEUROLOGICAL
DISORDERS
Presented by-
Manish kumar
Prabhat Ranjan
Amisha Rani

Guide- DR Manish Kumar Jha

 Neurological assessment
The basic neurological assessment contains the following:
1. Subjective assessment
• Demographic data
• History of symptoms, other health conditions, trauma and medical history
2. Objective assessment
• on observation
• on palpation
• on examination
 Higher mental function
 Cranial nerve examination
 Sensory examination
 Motor examination
 Coordination examination
 Balance Assessment
3. Functional examination
4. Investigation findings
 Commonly used special tests
Kernig’s sign
Brudenzki sign

Bell’s
phenomenon

Tinel’s sign
Gower’s sign

Sunset sign

Glabellar tap sign

Hoffman sign

Pronator drift test

lhermitte’s test
 Outcome scales

Scale for stroke

Fugl-Meyer Assessment of Motor Recovery after Stroke
The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based
impairment index. It is designed to assess motor functioning, balance, sensation
and joint functioning in patients with post-stroke hemiplegia. It is applied clinically
and in research to determine disease severity, describe motor recovery, and to plan
and assess treatment.
The scale is comprised of five domains and there are 155 items in total:
1. Motor functioning (in the upper and lower extremities)
2. Sensory functioning (evaluates light touch on two surfaces of the arm and leg,
and position sense for 8 joints)
3. Balance (contains 7 tests, 3 seated and 4 standing)
4. Joint range of motion (8 joints)
5. Joint pain
 Scoring
• Points are divided among the domains as follows:

• Motor score: ranges from 0 (hemiplegia) to 100 points (normal

motor performance). Divided into 66 points for upper extremity
and 34 points for the lower extremity.
• Sensation: ranges from 0 to 24 points. Divided into 8 points for
light touch and 16 points for position sense.
• Balance: ranges from 0 to 14 points. Divided into 6 points for
sitting and 8 points for standing.
• Joint range of motion: ranges from 0 to 44 points.
• Joint pain: ranges from 0 to 44 points.
 Traumatic brain injury
• Rancho Los Amigos level of cognitive function
Rancho Los Amigos level of cognitive function (RLAS),
also known as ranchos scale, is a widely used accepted
medical scale used to describe the cognitive and
behavioural patterns found in brain injury patients as they
recover from injury.
RLAS describes both cognition and dependence level of
the patient.
It has 10 levels, level 1 indicates patient with no
response and complete dependence and level 10
indicates purposeful understanding and need minimal
 Bells palsy
• House-Brackmann Facial Paralysis Scale
• The House-Brackmann Scale is one of the most
commonly used tool for the clinical evaluation of facial
nerve function.The scale is based upon functional
impairment, ranging between I (normal) and VI (no
movement). This classification system was first described
in 1985 by Dr John W. House and Dr Derald E.
Brackmann, otolaryngologists in Los Angeles.
 UPDRS SCALE
• The UPDRS scale includes series of ratings for typical Parkinson’s
symptoms that cover all of the movement hindrances of Parkinson’s
disease. The UPDRS scale consists of the following six segments of
individual subscores :
1) Mentation ,Behavior and Mood (3/16): Intellectual impairment,
Thought disorder etc.
2) ADL (24/52): Speech, Salivation, Cutting food and handling utensils
3) Motor Examination (25/56): Speech, Facial expressions, tremor at
rest, rigidity
4) Complications of therapy in the past week (11/23) : dyskinesia
5) Modified Hoehn and Yahr Scale (3/5)
6) Schwab and England ADL scale. (70/100 percentile)
Score – 66/152 representing moderate disability.
• Scoring:
• Parts 1 to 3 are scored on a 0-4 rating scale. Part 4 is
scored with yes and no ratings. Higher scores show
increased severity. Then the administrator rates the
patient on the H and Y Scale and the Schwab and
England Activities of Daily Living Scale.

*0 represents no disability ,higher the limit it indicates the

severity of disability.
 Scale for the Assessment and Rating of Ataxia
(SARA)
• SARA is a clinical scale developed by Schmitz-Hübsch et al which
assesses a range of different impairments in cerebellar ataxia. The
scale is made up of 8 items related to gait, stance, sitting, speech,
finger-chase test, nose-finger test, fast alternating movements and
heel-shin test.
• Currently, the following types of Ataxia have been investigated:

• Spinocerebellar Ataxia
• Ataxic Stroke
• Friedreich’s Ataxia
 METHOD OF USE
• The SARA is a tool for assessing ataxia. It has eight categories with
accumulative score ranging from 0 (no ataxia) to 40 (most severe ataxia).
When completing the outcome measure each category is assessed and scored
accordingly. Scores for the eight items range as follows:

• Gait (0-8 points),

• Stance (0-6 points),
• Sitting (0-4 points)
• Speech disturbance (0-6 points)
• Finger chase (0-4 points)
• Nose-finger test (0-4 points)
• Fast alternating hand movement (0-4 points)
• Heel-shin slide (0-4 points)

• Once each of the 8 categories have been assessed, the total is calculated to
• Each test yields a score, which is an estimate based on
a scoring system designed to compare how close the
movements/speech are to a person who does not have
ataxia. Once a combined score is calculated, doctors
will have an idea of how severe the disease is in the
patient. A higher SARA score generally indicates more
severe disease. This is used not only for diagnosis, but
also to track how the severity of a patient’s ataxia
symptoms changes over time. SARA scores can also
be used to predict short-term patient outlook.
 Boston carpal tunnel syndrome
questionnaire (BCTQ)
• The Boston questionnaire was developed by Levine et
al. at the Brigham & Women’s hospital as an assessment
tool for clients with carpal tunnel syndrome.
• It is also called Brigham and women’s carpal tunnel
questionnaire or The Brigham (carpal tunnel )
questionnaire .
• The Boston carpal tunnel syndrome is a patient reported
questionnaire that examines symptom severity and
overall functional status of patients with carpal tunnel
syndrome .
• BCTQ has two separate scales .
1) Symptom severity scale (SSS) – it includes 11 questions .
2) Functional status scale (FSS) – it includes 8 questions .
Questions is scored from 1-5 with 1 as no difficulty and 5 as
difficult .
So the minimum score for SSS is 11 and maximum score is 55 .
For FSS minimum score is 8 and maximum score is 40 .

The final score is calculated for each scale – The sum of the
individual scores divided by the number of items .
The final score ranges from 1-5 with a higher score indicating a
more severe condition .
 American spinal injury association (ASIA) impairment scale
• ASIA impairment scale is used in the case of spinal cord injury
SCI .

• The aim of the ASIA scale is to provide

1) Standard and detailed documentation of the SCI neurological
level of injury .
2) Guidance for radiographic assessment and treatment .
3) To determine if the SCI is complete or incomplete .

• The ASIA scale physical examination consisting .

1) Myotomal based motor examination
• An acute SCI present with spinal shock which is
an acute state of diminished spinal function
characterised by loss of all sensorimotor
functions caudal to the site of injury .
• Spinal shock is a transient condition . Therefore
the initial neurological examination can be
misleading . Continual and ongoing assessment
over the days following the initial injury is vital to
determine the true extent of a patient’s SCI .
THANK YOU
FOR YOUR
ATTENTION