Functional Stroke Assessment of the Post-Stroke Hemiplegic Patient

Description

Fugl-Meyer et al developed a protocol for physical and functional assessment of a hemiplegic patient following a stroke. The examination is divided into various sections, including an assessment of the hip, knee and ankle of the lower extremity. The authors are from the University of Goteborg in Sweden.

Parameters:

(1) reflex activity of flexors while supine

(2) reflex activity of extensors while supine

(3) hip flexion while supine

(4) knee flexion while supine

(5) ankle dorsi-flexion while supine

(6) hip extension while supine

(7) hip adduction while supine

(8) knee extension while supine

(9) ankle plantar flexion while supine

(10) knee flexion while sitting

(11) ankle dorsiflexion while sitting

(12) knee flexion while standing

(13) ankle dorsiflexion while standing

(14) muscle reflex activity (done if points for 12 + 13 = 4)

Groupings:

(E.I) 1 and 2

(E.IIa, flexor synergy) 3, 4, 5: The patient is in a supine position and tries to flex hip, knee and ankle joints maximally. The hip will usually abduct and show outward rotation. The distal tendon of the knee should be palpated to to make sure that active flexion of the knee is occurring.

(E.IIb, extensor synergy) 6, 7, 8, 9: The patient is in a supine position and tries to extend the hip, knee and ankle joints with resistance applied to eliminate gravitational fascilitation.

(E.III) 10, 11

(E.IV) 12, 13

(E.V) 14

Parameter	Finding	Points
reflex activity flexors supine	absent	0
	decreased	1
	normal	2
reflex activity extensors supine	absent	0
	decreased	1
	normal	2
hip flexion supine	unable to perform	0
	partially performed	1
	normal	2
knee flexion supine	unable to perform	0
	partially performed	1
	normal	2
ankle dorsiflexion supine	unable to perform	0
	partially performed	1
	normal	2
hip extension supine	cannot be performed	0
	some little strength	1
	normal or near normal strength	2
hip adduction supine	cannot be performed	0
	some little strength	1
	normal or near normal strength	2
knee extension supine	cannot be performed	0
	some little strength	1
	normal or near normal strength	2
ankle plantar flexion supine	cannot be performed	0
	some little strength	1
	normal or near normal strength	2
knee flexion while sitting	no active motion	0
	active flexion but not beyond 90°	1
	knee flexed beyond 90•	2
ankle dorsiflexion while sitting	no active motion	0
	impaired	1
	normal	2
knee flexion while standing	unable to flex knee if hip not simultaneously flexed	0
	knee cannot be flexed to 90° or hip must be flexed	1
	knee flexed to 90° without flexing hip	2
ankle dorsiflexion while standing	unable to dorsiflex	0
	impaired	1
	normal	2
muscle reflex activity (if items 12 and 13 are normal)	all or most hyperactive	0
	1 hyperactive or 2+ lively	1
	none hyperactive, no more than one lively	2

where:

• According to the text the maximum score for item 14 should be 4, which would give a maximum score for section E as 30. However, later on the total of the lower extremity (E + F) is 34. If section F is worth 6 points then section E must be worth 28.

• Active motion is compared to that seen on the unaffected side.

total score =

= SUM(points for all 14 parameters)

Interpretation:

• minimum score: 0

• maximum score: 28 or 30 (depending on the scoring of E.V. (see note above)

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Description

Specialty

Objective

ICD-10

Protocol for Assessment of Post Stroke Hemiplegic Patient: Hip, Knee and Ankle (E)

Purpose: To exam the hip, knee and ankle of a post-stroke hemiplegic patient as part of the protocol developed by Fugl-Meyer.

Description

Specialty

Objective

ICD-10