Outcome Measures Flashcards
Hunt and Hess Scale
- Used with __ population
- Scored from __-__, with high scores being [better / worse]
Hunt and Hess Scale
- Used with SUBARACHNOID HEMORRHAGE
- Scored from 1-5, higher score = WORSE
1: No or Minimal HA, mild neck stiffness (70% survival)
2: Mod/Severe HA, Neck stiff, ?CN palsy (60% survival)
3: Drowsy, min neuro deficit (50% survival)
4: Stupor, Mod/severe hemiparesis (20% survival)
5: Deep coma, Decerebrate posturing, (10% survival)
Modified Fisher Scale
- Used with __ population
- Scored from __-__, with high scores being [better / worse]
Modified Fisher Scale
- Used with SUBARACHNOID HEMORRHAGE, severity scale based on imaging
- Scored from GRADE 0 - GRADE 4 with high scores being WORSE
Grade 0:
No SAH
No IVH
0% incidence of symptomatic vasospasm
Grade 1:
Thin focal or diffuse SAH
No IVH
24% incidence of symptomatic vasospasm
Grade 2:
Thin focal or diffuse SAH
+IVH
33% incidence of symptomatic vasospasm
Grade 3:
Thick focal or diffuse SAH
No IVH
33% incidence of symptomatic vasospasm
Grade 4:
Thick focal or diffuse SAH
+IVH
40% incidence of symptomatic vasospasm
Glasgow Coma Scale
Scoring from __-__, with higher score = [more / less] impaired.
What’s on it?
Give scores suggestive of…
Severe = ____
Moderate = ___
Mild = ___
What score denotes coma?
Glasgow Coma Scale
Scoring from 3-15 with higher score = LESS impaired.
Severe: <=8
Moderate: 9-12
Mild: 13-15
What’s on it?
Eye opening (max 4)
- –> Spontaneous - 4
- –> To Speech - 3
- –> To pain - 2
- –> None - 1
Verbal response (max 5)
- –> Oriented - 5
- –> Confused conversation - 4
- –> Words (inapprop) - 3
- –> Sounds (incomprehensible) - 2
- –> None - 1
Best motor Response (max 6)
- –> Obeys commands - 6
- –> Localizes to pain - 5
- –> Flexion - Normal - 4
- –> Flexion - abnormal - 3
- –> Extensor posturing - 2
- –> None - 1
COMA = <8
Coma Recovery Scale - Revised (CRS-R)
Who is it used with / why to use it?
What’s on it?
Score range?
What qualifies as a …
… Vegetative State?
… Minimally conscious state?
… Emergence from minimally conscious state (MCS+)?
Coma Recovery Scale - Revised (CRS-R)
Who is it used with/ why to use it?
- Assists with DDx, prognosticating, and treatment planning in patients with DOCs
- Can discern between VS, MCS, and emerging from MCS!
- 26 items, 6 subscales: Auditory, Visual, Motor, Oral Motor, Communication, Arousal
Scored from 0 (Severe Vegetative State) -> 23 (Normal fxning) Lowest scored items for each are reflexive activity, higher scores require cognitive mediation
What qualifies as a …
… Vegetative State?
Requires ALL of the following:
—–> NO command following; can localizes or startles to sound (<=2 auditory)
—-> NO visual fixation (<=1 visual)
—-> NO localization to noxious stim; can be posturing or have +flexor withdrawal (reflexive; <=2 motor)
—-> NO intelligent verbalization (though can have vocalization; <=2 oral motor/verbal)
—-> NO attempts to communicate (0)
—-> Arousal doesn’t matter much for this
… Minimally conscious state?
Any one of the following would qualify:
—> Reproducible (>75% of trials) or consistent movement to command
—-> Visual fixation, pursuit, localizing + reaching to or recognizing objects
—-> Localizing to noxious stim, manipulating object, automatic motor responses (e.g. waves when I wave, opens mouth when spoon approaches) (but NOT yet using objects functionally)
—-> Intelligible verbalizations
—-> Non-functional but intentional communication (head shake/nod, thumbs up/down in response to a ?, regardless of accuracy)
… Emergence from minimally conscious state (eMCS)?
Needs higher scores in motor and communication subscales, including:
- FUNCTIONAL object use…
OR…
- Accurate functional communication (yes/no answers to questions)
Rancho Los Amigos Levels of Cognition
- No response: No response to external stim
- Generalized response: Reacts to external stim in non-specific and inconsistent ways, not purposeful
- Localized Response : Responds specifically and inconsistently to stim, may follow simple commands for motor actions
- Confused, Agitated : Bizarre, non-purposeful, incoherent or inappropriate behaviors and has no short-term recall, attention is short and non-selective
- Confused, Inappropriate, Not Agitated : Random, fragmented responses to stimuli, simple commands followed consistently, new info not retained, memory and attention impaired
- Confused, Appropriate response: Gives appropriate responses that are depended on external input. Carry over for relearned but not for new things.
- Automatic, Appropriate response : Daily routine automatic, appropriate behaviors in familiar settings, shows carryover for new learning, judgment impaired.
- Purposeful, Appropriate Response: Oriented and responds to the environment, abstract reasoning abilities lower than before injury
Modified Ashworth Scale
Scoring (taken from Bohannon and Smith, 1987):
0 = No increase in muscle tone
1 = Slight increase in muscle tone; catch and release or MIN resistance at the end ROM when the affected part(s) is moved in
flexion or extension
1+ = Slight increase in muscle tone, manifested by a catch -> minimal resistance
throughout the remainder (<50%) of the ROM
2 = More marked increase in muscle tone through >50% of the ROM, but affected part(s) easily moved
3 = CONSIDERABLE increase in muscle tone, passive movement difficult
4 = Affected part(s) rigid in flexion or extension
Prognostic indicators surrounding CRS-R:
Patients in a vegetative state who clear to MCS in ___ weeks to resolve MCS
>___ weeks to clear confusional state/post traumatic amnesia
- Mean CRS-R change > [#] /week = high likelihood of resolving MCS
- Mean CRS-R change > [#] /week = high likelihood of clearing confusional state/post traumatic amnesia
CRS-R related prognostic indicators:
*Used in TBI!
Patients in a vegetative state who clear to MCS in < 8 weeks are more likely to recover to higher levels of function (including household independence)
POOR chance of recovery to household independence or better if it takes:
> 12 weeks to resolve MCS
> 16 weeks to clear confusional state/post traumatic amnesia
- Mean CRS-R change >2/week = high likelihood of resolving MCS
- Mean CRS-R change >3/week = high likelihood of clearing confusional state/post traumatic amnesia
Motor and communication subscale score at 3 months post injury is most predictive of outcome at 12 months; auditory subscale is most predictive at 6 months post
Source: Katz 2009: Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up
Galveston Orientation and Amnesia Test (GOAT)
Measure of __ and __, especially to see if a patient has recovered
from ___ after a TBI.
Scoring?
A score >___ for 3 consecutive days is considered the threshold for emergence from __.
Measure of ATTENTION and ORIENTATION, especially to see if a patient has recovered
from post-traumatic amnesia (PTA) after a TBI (first measure created to test PTA and is still the most widely used test). Used in TBI.
Maximum Score (100 – Error Score) this number can be a negative (deduct points for each error)
○ <66 is Impaired,
○ 66-75 is Borderline,
○ 75-100 Normal
o A score > 78 for three consecutive days is considered the threshold for emergence from PTA (vs score of > 60 for two consecutive days is considered
emergence from PTA on the modified GOAT for individuals with expressive language difficulties or those who are intubated).
Agitated Behavior Scale (ABS)
Purpose: Developed to assess the nature and extent of agitation during the acute phase of recovery from ____
14 items, scored from 1-4, with lower scores meaning [ more / less] agitated.
Score range: \_\_\_ Cutoff scores: \_\_\_\_: normal \_\_\_: mild agitation \_\_\_: moderate agitation \_\_\_: severe agitation
Predictors? Can predict change in ___ status and differentiate between __ and ___
Agitated Behavior Scale (ABS)
Purpose: Developed to assess the nature and extent of agitation during the acute phase of recovery from ABI
14 items, scored from 1-4
Low score = NO agitation
Higher score = HIGH agitation
Score range: 14 (not agitated) -> 56 (v agitated) Cutoff scores: <21: normal 22-28: mild agitation 29-35: moderate agitation >35: severe agitation
Predictors? Can predict change in COGNITIVE status and differentiate between CONFUSION and INATTENTION
- Short attention span, easy distractibility, inability to concentrate.
- Impulsive, impatient, low tolerance for pain or frustration.
- Uncooperative, resistant to care, demanding.
- Violent and or threatening violence toward people or property.
- Explosive and/or unpredictable anger.
- Rocking, rubbing, moaning or other self-stimulating behavior.
- Pulling at tubes, restraints, etc.
- Wandering from treatment areas.
- Restlessness, pacing, excessive movement.
- Repetitive behaviors, motor and/or verbal.
- Rapid, loud or excessive talking.
- Sudden changes of mood.
- Easily initiated or excessive crying and/or laughter.
- Self-abusiveness, physical and/or verbal.
Moss Attentional Rating Scale (MARS)
Observational rating scale, quantitative measure of attention-related behavior after ___
Appropriate for what level of functioning in patients? [ VS / MCS / MCS+ / Rancho Level(s) ___] ??
Scoring: 22 items, 5pt likert scale (but some are flipped, so weird scoring), but range is 22-110, with higher scores indicating [better / worse ] attention
Observational rating scale, quantitative measure of attention-related behavior after TBI
NOT appropriate for use with patients in MCS or VS; validation studies have been in patients at Rancho level IV or higher
Scoring: 22 items, 5pt likert scale (but some are flipped, so weird scoring), but range is 22-110, with higher scores indicating BETTER attention
Disability Rating Scale (DRS)
Observer rated, 30-point continuous scale
that provides quantitative information to
document the progress of patients with
___ injury from coma to ___.
What does it look at (subscales)? Impairment, activity, participation?
High score = [better / worse]?
DRS can predict outcomes in [what settings?] as well as return to ___!
Disability Rating Scale (DRS)
Observer rated, 30-point continuous scale
that provides quantitative information to
document the progress of patients with
moderate-severe head injury from coma to community reintegration
Valid and reliable. DRS can predict inpatient and long-term outcomes and return to work!
8 Subscales:
○ Eye Opening (0-3)
○ Communication Ability (0-3)
○ Motor Response (0-5)
○ Feeding (Cognitive Ability Only) (0-3)
○ Toileting (Cognitive Ability Only) (0-3)
○ Grooming (Cognitive Ability Only) (0-3)
○ Level of Functioning (Physical, Mental, Social, Emotional) (0-5)
○ Employability (as Full-time worker, homemaker, student) (0-3)
Scoring: low is better, 0 (Normal Functioning) to 29 (Severe Vegetative State)
This scale does not distinguish MCS from VS because it was constructed prior to the development of MCS criteria (Whyte 2009)
Determinants of independent walking ability at 6 months post stroke?
- 25 points on Trunk Control Test (TCT) AND
-Motricity Index ≥25 OR
-Fugl-Meyer Assessment for LE ≥19
(above assessed 1-2 days post-CVA)
*Per Veerbeck Guidelines
*Patients with unfavorable outcomes should continue to be assessed;
-weekly for the first month
-monthly for first 6 months
However, only Level 4 evidence
- Also: (Smith, Barber, Stiner 2017: TWIST Algorithm)
- Trunk Ctrl Test score >40 at 1 week = walking indep at 6 wks
- Trunk Ctrl Test <40 ONLY achieved indep walking at 12wks IF HIP EXTENSION STRENGTH >=3/5
Determinants of UE Dexterity at 6 months post stroke?
Functional recovery is highly associated with:
-finger extension of the Fugl-Meyer ≥1
-Shoulder ABD on Motricity Index ≥9
-initial dexterity
-motor evoked potentials w/TMS
-somatosensory-evoked potentials
(Above should be recorded 1-2 days post-stroke)
*Patients with unfavorable outcomes should continue to be assessed;
-weekly for the first month
-monthly for first 6 months
However, only Level 4 evidence
Independence with Basic ADL Activities 6 months post-stroke?
Barthel Index, day 5
Factors associated with poor outcomes in individuals after CVA?
- Coma at onset
- Poor cognitive fxn
- Severe aphasia
- Severe hemiparesis/no motor return within 1 month of onset
- Visual perceptual spatial disorders
- Inability to sit unsupported
- Depression
- Incontinence 2 wks post CVA
6MWT
Description: Measure of gait velocity and endurance; distance walked in 6 minutes. Sub max, can use asst device.
ICF Domain: Activity
Populations: MS, PD, SCI (higher level), Stroke, HD (may modify to 2MWT in stages IV and V)
MDC: Geri 34m, PD 82 m, SCI 46 m, Chronic CVA: 36; Subacute CVA: 61
MCID 50 meters for geriatrics and CVA
Scoring based on age (averages exist, look em up! No real cutoffs, but…) <200m associated with increased mortality in COPD pts
Normal values (healthy)
- 60-69 yrs: M 572 m, F 538 m
- 70-79 yrs: M 527 m, F 471 m
- 80-89 yrs: M 417 m, F 392 m
Berg Balance Scale
Description: 14 item test (each scored 0-4) of static balance, 20 minutes to administer
ICF Domain: Activity
Scoring: 0 (worst) -> 56 (best)
Cutoff:
Elderly and CVA:
- <45= greater risk of falling
- <51 and +Hx of falls is predictive of falls vs…
- <42 and NO Hx falls predictive of falls
- <40 = almost 100% fall risk
(Not great predictive value in SCI; has ceiling effects; <40 is also fall risk cutoff in HD)
MDC/MCID:
Elderly: ranges from 3.3-6.3
Parkinson: 5
Stroke: ranges from 6-8.1 (MCID is at least 7, MDC 6); other study chronic stroke 2.5-4.6
Fugl-Meyer Assessment of Motor Performance
Description: 45 mins (good test, takes a while); looks at UE and LE motor, sensation, balance (sitting and standing) and joint mobility/pain; uses chair, bedside table, reflex hammer, cotton ball, stop watch, blindfold, tennis ball, scrap of paper, pencil, small can.
ICF domain: Body function/structure
Scoring: 0 - 226 points, higher = independent / less impaired. Each item scored 0-2 (0=cannot perform, 1=performs partially, 2=performs fully)
Cutoffs: (Fugl-Meyer et al 1975 and 1980) <50 = Severe 50-84 = Marked 85-95 Moderate, hemiplegia 95-99 = Slight discoordination
(More recent data Duncan 1994 suggests: 0-35 Very severe 35-55 Severe 56-79 Moderate >79 Mild) UE Motor: standardized response mean =1.42; MDC=5.2 LE Motor: MDC = >5 pts Balance: critical value of change = 4pts
Functional Reach Test
Description: with shoulder flexed to 90 deg and hand fisted, “Reach as far as you can forward without taking a step,” measured at 3rd metacarpal.
ICF: Activity level
MDC: 6.79cm, no MCID for CVA
Cutoffs:
Stroke: <15cm (5.9”) = falls
Community-dwelling elderly: < 7 inches (other studies say <6”) are unable to leave neighborhood without help, limited in mobility skills, and most restricted in ADLs; <7.2” = fall risk
Motor Activity Log
(IPR & OP)
Description: Semi-structured interview, pts rate the quality of movement (QOM) and amount of Movement (AOM) during daily tasks – original version is 30 tasks, but there are shorter versions with 28 or 14 items.
Includes object manipulation (fork, comb, cup) and gross motor use of UE (car tf, pulling up a chair while standing). 20 minutes to administer original 30 item test. Examines pt’s PERCEPTION of arm function.
ICF: Activity level
Scoring: Scored on a 6 point ordinal scale; 0=weaker arm is NEVER used for the task to
5=the weaker arm functions at pre-morbid levels
MCID/MDC: not established for stroke
Postural Assessment Scale for Stroke Patients
Postural Assessment Scale for Stroke Patients
Description: Quick/easy test to assess basic sitting and standing balance (static sit, stand, SLS) and ability to complete transitional movements (rolling, supine<>sit, sit<>stand, pick up object off floor)
ICF: Activity
Scoring: 0 to 3 for 12 items, quality of movement matters; points = 0-36 max (total; higher = better performance). Mean in healthy older adults is 35.7.
Cutoff:
<3.5 on static PASS, <8.5 on dynamic pass, and <12.5 total PASS predicts non-ambulatory on d/c from rehab (positive predictive value of these is ~0.6, which is meh)
MDC: 3.2 points
Stroke Rehabilitation Assessment of Movement (STREAM)
Description: 15-20 mins, 30 total items with subscales of UE, LE, and basic mobility items (includes supine limb movements, sitting, standing, toe tap on step, and walking backward/sideways, down stairs)
Look at QUALITY and EXCURSION of movement between involved vs uninvolved sides
No cutoff scores available
ICF: Body structure/fxn
Scoring: 3 pt ordinal scale, max = 70
MCID: UE: 2.2, LE: 1.9, Mobility: 4.8
Timed Up and Go (TUG)
Description: from sitting in chair, time to stand up, walk 3m, turn around, walk back to chair and sit.
Can be performed with cognitive or manual dual task (counting backwards by 3’s, walk holding glass of water)
Scoring: Timed
MCID: not established for stroke
MDC: 2.9sec
CUTOFF: >15 seconds to complete in elderly subjetucts indicates high fall risk
- One study shows >13.5 as cut off score to predict falling in community dwelling adults
- Older stroke patients, ALS, HD >14
- Older stroke patients in fall clinic >15
- Frail elderly 32.6 s
- PD >7.95 s
- Vestibular >11.1 s
If TUG Manual (carrying cup of water) is >4.5 sec slower= increased risk of falls next 6 months
<10 sec completely indep
10-20 sec independent for most transfers
>20 dependent in most activities
10MWT
Description: gait velocity at preferred and fast speeds (average 3 trials)
ICF: Activity
Populations: Recommended in CVA, SCI, and TBI (also ok with TBI, Geriatrics, Hip fx, Amputee, Movement disorders, MS, PD, SCI, CVA)
Scoring: Timed
MDC:
- PD: Comfortable gait speed: 0.18; Fast speed 0.25m/s
- SCI: 0.09, 0.16
- TBI: 0.05
MCID: SCI 0.06; Stroke 0.16m/s; TBI 0.15-0.25m/s
CUTOFFS: in Stroke population: <0.4m/s were more likely to be household ambulators 0.4-0.8m/s limited community ambulators >0.8m/s community ambulators 1.2m/s to cross a street
Functional Independence Measure
(CVA Quality recommendations: IPR 4, acute and OP 2)
Description: 18 items assessing domains of motor (self care, sphincter control, transfers, locomotion) and cognition (communication and social cognition). 30-45 minutes to complete, but required in IPR setting for Medicare reimbursement.
ICF: Activity
Scoring: 7 point ordinal scale, 1= total assistance and 7 = independence. Range of 18-128.
**Scores of…
37-40: Not likely to gain independence; likely not to benefit from IPR, typically DCed to nursing home type setting
41-79: Most likely to benefit from IPR
80-96: Most likely to be DCed home/to community to receive home health/OP services
MCID: In stroke population, MCID for:
Total FIM score: 22 point
FIM Motor subscale: 17 points
FIM cognitive subscale: 3 points
Orpington Prognostic Scale
Description: Copyrighted, 15 min test, 4 domains:
- Motor (MMT in affected limb, but simplified w/no +/-)
- Proprioception (find your thumb)
- Balance (walks 10ft > stands > sits)
- Cognition (orientation ?s).
Population: Best for patients <2weeks post stroke (acute and rehab; NOT OP). Requires training to administer.
Scoring: from 1.6 to 6.8; higher = GREATER DEFICIT
MCD/MCID: not established for stroke
**Cutoffs:
<3.2 = high likelihood of returning home, mild to moderate deficit
Score from 3.2 -5.2 respond better to rehabilitation; moderate to severe deficit
>5.2 dependent; increased risk of institutionalization
Stroke Impact Scale
Description: Self report questionnaire that evaluates disability and health-related QOL after stroke (with higher scores = “I’m functioning 100% at my normal! Stroke not affecting me!”) May be completed by mail or phone. 15-20 mins to administer the 59 items, 8 domains:
- Strength
- Hand function
- ADL
- Mobility
- Communication
- Emotion
- Memory and thinking
- Participation/role function
SIS-16 assesses only strength, hand function, mobility and ADLs for physical dimension score.
ICF: Activity
Scoring: 5 point ordinal scale; scoring follows SF-36. Low summative score for each domain is 0 (high impact of stroke/ more impaired) -> 100 (low impact of stroke impairment)
Predictive of QoL post CVA; well correlated with Barthel Index
MDC: (Strength subscale: 24, ADL: 17.3, Mobility: 15.1, Hand function 25.9)
MCID: (Strength subscale: 9.2, ADL: 5.9, Mobility: 4.5, Hand function: 17.8)
EuroQOL
Description: Simple descriptive profile and index value for health status. Domains: - Mobility - Self-care - Usual activities - Pain/discomfort - Anxiety/depression
Population: Stroke (rehab, SNF, OP; but NOT acute)
Scoring: pts rate each item as “none” mild/mod” and “severe”, which then yields an index score from 0.000 (Death) -> 1.000 (perfect health)
No cutoffs; fair to good predictive validity w/FIM and Stroke Impact Scale
5x Sit to Stand
(CVA: 3 in acute, IPR, and OP)
Description: 5 time sit to stand from chair with armrest (43-45 cm) not against wall, arms across chest, if use arms then failure of test. Designed to measure an individual’s LE strength and endurance to go from sit to stand. NOT great for someone who is really low level (use 30 sec sit<>stand)
ICF: Activity
Populations: CP, Geriatrics, PD, Stroke, vestibular (NOT tested for MS), HD (most stages)
CUTOFFS:
>12 = need further assessment of fall risk in elderly
>15 = risk of recurrent/ predicts falls in elderly
PD: >16 = risk of falls
CVA: >12 divides stroke from healthy elderly; correlates with mm strength in CVA!
Vestibular: >13 balance dysfunction
Young Adults: >10sec differentiates btwn those w/ and w/out balance dysfunction
MDC Healthy elderly: 4.2 sec, Stroke: 3.6 sec, CP 0.06
MCID vestibular: >/= 2.3 sec
Tardieu Spasticity Scale (Modified Tardieu)
Description: Measures spasticity, takes into account resistance to passive movement at slow and fast speeds. Looks at full ROM (“R2” when done slowly) and angle of “catch” or clonus (R1; found w/quick stretch/mvmt).
ICF: Body Structure/fxn
Populations: Recommended (3) in CVA (3 in acute, IPR, and OP); NOT MS
Scoring:
Grade 0 = No resistance t/o mvmt
1 = Slight resistance t/o, followed by release
2 = Clear catch, then release
3 = Fatiguable clonus (<10 sec) at precise angle
4 = Non-fatiguing clonus (>10 sec)
Dynamic Gait Index
Description: 8 gait tasks; even surface, changing speed, head turns, stepping over and around objects, pivot turns, stairs; 10-15 minutes to administer
ICF: Activity
Population: CVA, PD, vestibular, MS
Scoring: each item 0-3, 0 (severe impairment) -> 24 (normal)
Cutoff: <19 = increased risk for falls
Chedoke McMaster Stroke Assessment
Description: 45-60 min, copyrighted test. 2 big parts:
(1) Impairment inventory. Looks at recovery stage based on 7-point scale (corresponds with Brunnstrom’s stages of recovery!). Stage/# assigned based on motor control in that arm, or pain. 6 dimensions, each look at movement in/out of synergy then more functional movements (e.g. supine->sit, standing, decreasing support, hopping!, rolling, pouring water, etc)
Recovery stage of the…
- Arm, hand, leg, foot
- Postural control ( Sitting static -> leaning/dynamic; Standing: static bilaterally then SLS -> stepping/weight shifts, karaoke, tandem walking, walking on toes)
- Shoulder Pain
Activity Inventory:
- Gross motor fxn index (supine<>sit, rolling to/from strong side, sit<>stand, transfers)
- Walking index (walking indoors; outdoors over varied surfaces/ramps, outdoors several blocks; stairs; walking distance in 2 mins)
ICF: Impairment + Activity level
Scoring: 14 (greatest disability) -> 100 (Maximum Activity Inventory score)
*Remember, each Impairment item is scored based on Brunnstrom 7 stages of motor recovery:
1= flaccid paralysis
2= spasticity present (“resistance to passive mvmt”)
3= Marked spasticity, voluntary mvmt within synergistic patterns
4=Spasticity decreases
5= Spasticity wanes, but is evident w/rapid movements at extreme ranges
6= Near normal coordination and mvmt patterns
7= Normal mvmt
Each Activity Item is scored like the FIM! 1= dependent/total asst 2=MaxA 3=ModA 4=MinA 5=Supervision 6=ModI (device asst) 7=Safe, timely, independent!
CUTOFFS: >9 on combined leg + postural control score = independent ambulation!
MCID: 7
MDC: not established for stroke
