A NEUROLOGICAL ASSESSMENT CHART 75

A NEUROLOGICAL ASSESSMENT CHART

MRS. B. ALEXANDER, M.A.P.A.

for
The Neurological Study Group

A uniform meth<>d of assessing patients as it is quite impossible to grade a patient's

with neurological disorders is a growing prob.. functional ability on the same scale as his
Iern. So often patients transfer from one hos.. reflex activity, co-ordination, and muscle
pital to another and the progress notes which power, and so on.
are forwarded are too scant, non-existent, or
meaningless because of differing grading sys- It is suggested that the letters on the chart
tems for assessment. As more knowledge is should he used and "Normal" he indicated in
gained about neurological disorders it has red so that the chart is easily read.
become more apparent that a uniform chart Space is provided for three assessments and
or grading system would be of great value. of course the frequency of doing these assess..
During the last two years the Neurological ments depends on the type of patient and the
Study Group of the Victorian Physio therapy1
progress or regression he may be showing. It
l)ostgraduate Society has compiled this neuro- is not expected that the chart could he com..
l'ogical assessment chart in an effort to solve pIe ted in one session, particularly when assess-
rhe problem. ing a patient with gross neurological involve-
lnent.
AI IV£S
I. To provide a uniform method of assess- As the chart is designed to cover a wide
ment throughout the neurological field
range of conditions-for example, cerebral
of physiotherapy. palsy, multiple sclerosis, Parkinson's disease,
cerebral vascular accident-not all sections
2. To provide a concise form of assess- will he relevant for all patients. If, however,
ment. further comment on a particular section is
3. To provide an accurate neuromuscular necessary, additional spaces have been pro..
assessment, on the results of which a vided.
treatment can he based. (It must be
emphasised that this is not a diagnostic An A.D.L. (activities of daily living) chart
chart.) has not been included because if the patient is
in hospital' the occupational therapist is re..
4. To provide a means for re..assessment sponsible for this assessment, but if, as some-
and re.. appraisal of treatment. times is the case, the physiotherapist is respon-
5. To provide a basis on which future re- sible, there are a number of very good A.D.L.
search and study of various conditions charts available.
might be conducted.
EXPLANATION OF EACH SECTION
GENERAL COMMENTS ON THE USE OF THE
CHART
At the beginning a short history of the
patient is made when he presents for treat..
Although the aim has been to make the mente This preliminary examination is con..
chart simple and easy to use, a few comments cerned with his general state of health and
on the setting out may be of benefit. his general capabilities. Any alteration of the
Different keys are used for grading in each patient in these regards would he included in
section and in some instances, within sections, the progress notes.
Aust. J. Physiother., XVI, 2, June, 1970
76 THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY

Section 1 Athetosis indicates corpus striatum

The level of functional development is lesion.
identical to the level of functional ability of Choreaform indicates corpus striatum
the patient and are therefore tested simul. movement lesion.
taneously. The Key is the ability of the Tremor (at rest) indicates extrapyramidal
patient to perform and maintain the position. system lesion.
For example, B (poor) indicates that a
patient would need maximum assistance to get Tremor (intention) indicates cerebellum
into a position and maximum assistance to lesion.
hold that given position. There is extra space Ataxia (sensory) indicates lesion of the sen-
provided for further conllnent if required. sory columns of the
spinal cord.
Section 2
The method of transfer is dependent on the Ataxia (central) indicates cerebellum
patient's functional ability and only a sholt lesion.
note would be necessary. Fasiculation indicates slow degenerwl-
ing lower motor neur..
Section 3
one disorder.
Locomotion is also dependent on functional
ability but a short note on, for example, the Section 7
type of wheelchair proplulsion and/or gait The tests for co-ordination are all very
analysis is required. simple and the I(ey needs no explanation.
Section 4 Serction 8
Again short comUlents are all that are re- This seotion is intended for the patient with
quired. If there is a particular j oint which an upper motor neurone lesion. In cases of
requires weekly measurements, these measure- lower motor neurone lesion a detailed muscle
ments would be included in the progress chart would have to he attached. The Key
notes. indicates the voluntary muscle power present
Section 5 in a seleoted group of lTIuscles and five grades
of power are listed. Normal means no spasm
This section can serve as a basis of ex.. and normal strength. B indicates slight volun-
planation of the abnormalities which a patient tary power masked by spasticity. It must be
may display in Section 1, as the level of func.. stressed that it is movement rather than in-
tional development is directly affected by the dividual muscles that are being tested" The
reflex activity of. a patient. The reflexes listed position of testing must remain constant.
are those with which a physiotherapist is
chiefly concerned. Other reflexes may be pre- Section 9
sent but are only significant for diagnostic By testing these five sensations sufficient
purposes. The I(;ey indicates the degree of information is gained of the patient's sensi-
reflex activity, A indicates absenrt lor hypotonia, tivity in order to make use of one or more of
B. C. D and E progressive degrees of hyper- the stimuli during treatment. This section also
tonia. In testing the stretch reflexes the same has its own I(ey. It is necessary for the physio..
positions should always be used. Two sug- therapist to attach a diagram of the areas of
gested joints are listed for which flexion and abnormal sensation.
extension reflexes of muscle groups can be
tested and space is p·rovided for other areas The last four phenolnena listed do not re-
thart need to be included. The Key is changed quire grading and in some instances are out-
within this section for the testing of the right.. side our field of treatment, but an abnormal-
ing and equilibrium reactions. ity in anyone must demand a modification
in a physiotherapist's approach and treat-
Section 6 ment. Body image and stereognosis are well
The abnormal motor activity should be known, but visuo-motor and visual perception
noted as this indicates the level of involvement defects are more uncomU1on. The most simple
within the central nervous system. and effective test on which to base a comment
Aust. J. Physiothero, XVI, 2, June, 1970
 A NEUROLOGICAL ASSESSMENT CHART 77

on suspected defect is, that within the age and area and has been found to be adequate in
physical capabilities of the patient, he is asked providing a uniform, accurate and concise
to dra,~ a diamond. If he is unable to draw method of assessing patients with neurological
one, but can see that it is wrong he is likely disorders. It also has been useful in providing
to have a visuo~motor defect. However, if, he a basis for planning a treatment programme
cannot see that it is wrong when drawn by him and a means of re..assessing a patient after a
or for him then he may have a visual percep-
period of time.
tion defect. Obviously these two types of de~
feet could affeot a patient's performance in If it can be of any significance in herping
copying exercises and following instructions. to compile information for further research
Space is provided at the end of the chart for into neurological disorders it must be used
further comments and progress notes. for a longer time.
CONCLUSION Only with further use in more hospitals
This chart has been used in a number of and by more physiotherapists can a final
physiotherapy departments in the Melbourne judgment be made of this chart.

NEUROLOGICAL ASSESSMENT CHART

NAME: DOCTOR:
ADDRESS: DIAGNOSIS:
Date of Birth: 6. Speech:
Date of Onset: a. Sucking:
b. Swallowing:
1. Intellectual State: 7. Feeding:
2. Emotional State: 8. Eyesight:
3. Other Medical Disabilities: 9. Hearing:
4. Splints and Aids: 10. Continent:
5. Respiration: 11. Dominance:
12. Dressing:
Comments: 13. Exercise Tolerance:

1. LEVEL OF FUNCTIONAL DEVELOPMENT KEY-Ability A. Absent

B. Poor
C. Fair
D. Good
DNormal

II DATE
HEAD CONTROL:
ROLLING:
SITTING BALANCE:
4 FT. KNEELING:
KNEEL STAND:

! KNEEL STAND:

CRAWLING:
STANDING FRAME:
WALKING:

COMMENTS:

2. TRANSFERENCE.

3. LOCOMOTION. Including Gait Analysis.

4. RANGE OF MOVEMENT.
FIXED DEFORMITIES: SOFT TISSUE TIGHTNESS:

Aust. 1. Physiother., XVI, 2, June, 1970

78 THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY

0
REFLEXES.
TYPE: Claspknife 0 Cogwheel Lead Pipe 0
KEY
o
A Absent
Normal
B +
C++
D + + +
E + + + +
A. SPINAL.
a. Stretch Reflex. Position for Testing:
LEFT RIGHT

~I
EXTENSION FLEXION FLEXION EXTENSION

ELBOW

F
ANKLE
-,...-

DATE
b. Withdrawal:
c. Extensor Thrust:
d. + Supporting Reaction:
B. TONIC

a. Tonic Neck. Symmetrical:

Asymmetrical:
b. Tonic Labyrinthine:

KEY A Absent
B
o Transitional
Narmal

C. RIGHTING REACTIONS
II II
D. EQUILIBRIUM REACTIONS

E OTHER REFLEXES TO BE NOTED

II DATE 11=======1:========1======11
Mora:
Babinski:
Protective Extension of Arms:
Associated Reactions:

6 ABNORMAL MOTOR ACTIVITY TO BE NOTED

II DATE
Athetosis:
Choreaform Movement:
Tremor-at rest:
-intention:
Ataxia:
Fasciculation:

Aust. I. Physiother., XVI, 2, June, 1970

 A NEUROLOGICAL ASSESSMENT CHART 79

7. CO-ORDINATION KEY Defect

DNormal
A Slight
B Moderate

1t§3
C Severe
LEFT TEST RIGHT
II

FINGER TO NOSE
HEEL TO PATELLA
TAPPING CIRCLE

RHOMBERG:
WRITE NAME:
8. VOLUNTARY MUSCLE POWER KEY Power A Not Detectable
B Masked by Spasticity
C Weak
D Functional
DNormal

nJl ~
POSITION
LEFT SELECTED MUSCLE GROUP RIGHT FOR TESTING

9. SENSATION (Attach Diagram) KEY

I~ o Absent
- Diminished
DNormai
+ Hypersensitive
++
LEFT RIGHT SITE
Ir DATE JJI I

VIBRATION
HEAT
COLD
t PROPRIOCEPTION
t PAIN

TO BE NOTED.
BODY IMAGE:
STEREOGNOSIS:
VISUO-PERCEPTUAL DEFECT:
VISUO-MOTOR DEFECT:

COMMENTS AND PROGRESS NOTES

DATE

Aust. J. Physiother., XVI, 2, June, 1970