stroke assessment tools

7/29/2019 Stroke Assessment Tools

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Assessment Tools in Stroke


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F.A.S.T.


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(Or Cincinnati stroke score)


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Glasgow Coma Scale

Most widely used neurological assessmenttool.

Originally designed for traumatic brain

injury patients. Limited to: eye opening/motor

response/verbal response

Scores 3-15 with


7/21

Oxfordshire Stroke Classification

Useful at bedside to predict:outcomesfunction

mortalityrisk of recurrence.

Classify patient from clinical pattern attime ofmaximal deficit following event.


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TACI: Total Anterior Circulation Infarct.(dysphasia/dyscalculia/visuospatial disorder),

homonymous visual field/ipsilateral motor and/orsensory deficit of at least two areas- face arm orleg.

PACI: two of the three components of TACI.

LACI: pure motor/pure sensory/sensory-motor,or ataxic hemiparesis.

POCI: cerebellar/brainstem a wide range ofcomponents


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Oxfordshire (Bamford)


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The Bamford Classification of Stroke: (Bamford et al; Lancet 1991;337:1521-6)

For first stroke. Assess at point of maximum impairment.

Why classify?Stroke heterogeneous. Natural history very different.

- dependency- death- recurrenceStroke treatment and trials of treatment direct therapies at subgroups

Why this classification?- simple- easy (relatively)- widely applicable esp for narrow therapeutic time window/community based studiesAlternative classification: by size and site of infarct (commonly used).

Bamford acronymsS =stroke H haemorrhage I infarct

TACS PACS LACS POCSTACH PACH LACH POCH

TACI PACI LACI POCI

Total Anterior Circulation Infarct (TACI) 20% of strokes/would benefitfrom thrombolysis/thrombotic

Partial Anterior Circulation Infarct (PACI) 35% of strokes/occludedbranches of the MCA/mostly embolic.

Lacunar Infarct (LACI) 20% of stroke/often silent and underdiagnosed/need MRI/HTN bleeds/embolic.

Posterior Circulation Infarcts (POCI) 25% of stroke/brainstem, cerebellaror occipital lobes/complex presentations/thrombosis embolism.

TACI PACI LACI POCI30 days Dead 40% 5 5 5

Dependent 55 40 30 30Independent 5 55 65 65

1 year Dead 60 15 10 20Dependent 35 30 30 20Independent 5 55 60 60


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ABCD

A =Age > or = 60yrs 1 point

B = BP > or = 140/90 1 point

C =Clinical findings: unilateral weakness =2 ptsSpeech impairment =1 pt

(with no weakness)

D =Duration > 60 mins =2 points10-59 mins =1 point

D = Diabetes =1 point

Tool Interpretation:

>4 High risk < or = 4 Low risk

Maximum score7


12/21

FIM

Functional Independence Measure

Only used by us as a baseline for

rehabilitation.

Becoming more popular


13/21

We dont use:

NIHSS too lengthy/training reqd

Intracerebral Haemorrhage score mainlyaround mortality scores in

intraparenchymal ICBs. Barthel very broad disability measure of

10 items.

Rankin 8 items


14/21

My own personal:

Coma/LOC

Pupillary disturbances

Cheyne-Stokes respirations

Paralysis of conjugate gaze Continence

Dysphagia

= poor outcome


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The End


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Assessment tools in therehab & community setting

Anna Reed

CNS- Older Persons Health &Rehabilitation

Wairarapa DHB


18/21

Functional Independence Measure(FIM)

Consistent data collection

Measures rehabilitation outcomes

Used across a continuum of care

Tracks changes in functional & cognitivestatus

Assesses degree of disability & burden of

care


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Depression, apathy & mooddisorders in stroke

Strong relationship between post-strokedepression & functional or cognitiveimpairment

Structured interviews Geriatric depression scale

Hamilton rating scale for depression

0-6months MinD

6months + MDD


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Impact of stroke onfamily/carers

Assessment of caregiver needs is oftenneglected by health professionals

Caregiver Needs & Concerns Checklist

MDT approach to support the transition Formal

Informal

Semi formal


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stroke assessment tools

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