康復評定-英語-留學生課程課件

REHABILITATION

ASSESSMENTPingMiao,MDDepartmentofRehabilitationmedicineThesecondaffiliatedhospitalofGuangzhouMedicalUniversityREHABILITATION

ASSESSMENTPing1ContentsIntroductionMeasuresofimpairment(muscle,joint,cognitive...)Measuresofdisability(activityofdailylife...)MeasuresofhandicapContentsIntroduction2TofindtheproblemsWhatkindofdysfunctioncongenital：heartproblems，etc.postnatal：CP，stroke，SCI,TBI,etcsecodary：contracturefollowingfracture，muscleatrophyafterperipheralnerveinjury,andsoonHowmanydysfunctionsPhysically,speech,psychological,socialaspectHowseverityofdysfunctionsOnpatientandhis/herfamilyTofindtheproblemsWhatkind3Tosettreatmentgoalsshort-termgoalsCanbetouchedbyeffortswithinafewdaysorweekslong-termgoalsCanbeachievedforlongtime(terminal)Fromshort-termgoalstolong-termoneMustconsiderthefactorsage、profession、culturalbackgroud、familyconditionsTosettreatmentgoalsshort-te4AssesstreatmenteffectsIsourtreatmentplaneffective?Yes/NoShouldthetreatmentplanbecontiniunedorshouldbeadjustedaccordingtomeasurementsYes/NoAssesstreatmenteffectsIsour5

Physicalexaminationandrehabilitationmeasurementhavesomethingincommonbutnotthesame.PurposeTimesWaysIntroductionIntroduction6康復評定-英語-留學生課程課件7康復評定-英語-留學生課程課件8ObjectivesofMeasurementTofindproblemsTosettreatmentgoalsToplantreatmentschedulesToassesstheeffectivenessTopredictoutcomesToanalyzethecost-effecitveReasonsforassessingObjectivesofMeasurementTofi9LevelsshouldbemeasuredimpairmentdisabilityhandicapLevelsshouldbemeasuredimpai10DevelopmentofICIDHInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH)

1980，WHOdiseaseimpairmentdisabilityhandicap疾病病損殘疾殘障

(器官水平)(個體水平)(社會水平)

structure

abilityactivity/participation

TraditionalModelofMedicine:Etiology

Pathology

clinicalfeaturesLevelsDevelopmentofICIDHInternat11ApplicationofICIDHDifferentcousesAmputeeinthelowerlimbCan`twalkCan`tgotoschool/workimpairmentdisabilityhandicapOrgansADLSocialactivityAtthelevelofApplicationofICIDHDifferent12ApplicationofICIDHStroke/TBIHemiplagiaCan`tlookafterHim-/her-selfCan`twork/Jointhesociallife

impairmentdisabilityhandicaporgansADLSociallifeAtthelevelofApplicationofICIDHStroke/TBI13康復評定-英語-留學生課程課件14IntroductionPurposePlanatreatmentprogramandestablishoutcomesEvaluateresultsoftreatmentprogramModifytreatmentprogramIntroductionPurpose15IntroductionGoodassessmentisdependentupon:KnowledgeoffunctionalanatomyHistoryCompleteexaminationIntroductionGoodassessmentis16ClinicalEvaluationSequenceHistoryInspectionPalpationFunctionalTestingNeurologicalTestingClinicalEvaluationSequenceHi17categoryofmeasurmentRatioScalesInervalScalesOrdinalScalesNorminalScalescategoryofmeasurmentRatioSc18RatioScalesFeaturesHasazeropointthatreprestnsthecompletabsenceofthequatityrepresented.TheintervalsamongallsuccessiveunitsonthescalemustbeequalinsizeCan`thaveaminusornegativevalue.%isaformofratioExamplesROMLimblengthTimetocompletanactivityVitalcapacityNerveconductionvelocityRatioScalesFeatures19InervalScalesFeaturesLackofazeropointTheunitmustbeequalsizeExamplesBodytemperatureFunctinalscalesPsychologicaltestsInervalScalesFeatures20OrdinalScalesFeaturesMayhaveonly2categoriesPresent/absentDependent/independentExamplesMMTADLFugle-Meyer`sscaleOrdinalScalesFeatures21NorminalScalesFeaturesTheunitsarecategorywithoutindicatingtheorderorrankofthedifferencesMaybelabeledwithnumberals,letters,orwords,butthelablesdonotidicateorderorrankExamplesClassificationofgenders,diseaseStroke,CerebralpalsyNorminalScalesFeatures22QuantitativeandQualitativeScalesUnitsareassumedtobeofequalsizeAcontinuousscaleEqualsizesubunitsDistance:m,cm,mm,etcExamplesRatioscalesIntervalscalesCategorieshavenosizeCan`tbedivisibleintoequal-sizedsubcategoriesTendonreflexSittingbalanceExamplesNominalscalesQuantitativeandQualitativeS23validsensitivespecificreliable(inter-rater,test-retest)appropriateacceptablevalid24ProcedureswhentomeasurewhattobemeasuredhowtomeasureProcedureswhentomeasurewhat25WhentomeasureInitialstageMiddlestageTerminalstageAtfollow-upDuringthetreatmentandtraining,evaluationcanberepeatedbyseveraltimes.Itusuallystartfromtheevaluationandendontheevaluation.WhentomeasureInitialstageMi26Initialstage（firstmeasurement)WhenshouldbeconductedBeforephyiotherapyobjectivesFindtheproblemsanditsstatusInvestigatethepotentialofrehabilitationandrelatedfactorsAsevidenceofthetreatmentplanningAsthebaselineofreassessmentInitialstage（firstmeasuremen27Middlestage(repeatedmeasurements)WhenshouldberepeatedOnceat1-2wksforthosewithquickrecoveryEarlyphaseorinpatientsOnceat3-4wksforthosewithslowrecoveryChronicphaseoroutpatientsobjectivesTofindanyimprovementanditsextendTodecideifanyadjustmentisneededMiddlestage(repeatedmeasureme28Terminalstage（final）WhenshouldbemeasuredBeforefinishingthephysiotherapyoratdischargeobjectivesToinvestigatetherehabeffectivenessAchivementshasbeenreachedToplandischageprogramContinuinetreatmentReferedtooutpatientorcommunityTerminalstage（final）Whensho29Follow-upWhenshouldbeVariationamongpatientsanddiseasesEachmonth,2-3monthsor6monthsobjectivesDeterminethefunctionofpatientDecidewhetherpatientneedstofuthertreatmentFollow-upWhenshouldbe30specificPhysicalfunctioncognitionlanguageSocialactivitiespsychologyglobalimpairmentdisabilityhandicapWhattobemeasuredspecificPhysicalfunctioncogni31PhysicalfunctionMuscletoneROMBalanceMMTWalking???AschworthSpasticityScaleWhatshouldbemeasuredinneurorehabMotorAssessmentScaleBergBalanceScaleCompositeSpasticityScaleTheTimed“Up&Go”testFugle-MeyerMovementAssessmentReachTestBrunnstroumRoveryStagesPhysicalfunctionMuscletoneRO32DatacollectionMedicalhistoryMedicalnotesFindtheproblemsassessmentDecidewhattoandhowtoassessStarttoassessDatarecordingDataanalysisFunctinaldiagnosisSettreatmentgoalsTreatmentplanAssessmentproceduesDatacollectionMedicalhistory33Evaluation效度信度sensitivetyvalidreliabilityIntra-raterInter-ratercriterion-relatedvalidation

content-relatedvalidationconstruct-relatedvalidationToevaluatethemethodologybeingusedEvaluation效度信度sensitivetyvalid34

RulesofS.O.A.Parewidelyuseallovertheworld:S(subjectivedata)：maincomplaintandsymptomofthepatients;O(objectivedata)：objectivesymptomandfunctionalbehaviorofthepatientsA(assessment)：analyzeandclassifytheabove-mentionedmaterials;P(plan)：setatreatmentplan.

Ⅱ.MethodsofevaluationRulesofS.O.A.Parewidel35

Ⅱ.MethodsofevaluationⅡ.Methodsofevaluation36SpecificEvaluationSpecificEvaluation37SpecificEvaluation-MotorabilityevaluationMusclestrengthRangeofmotionMusculartoneMuscularenduranceGaitanalysisBalanceCoordinationSpecificEvaluation-Motorabil38Manualmuscletest

(MMT)Manualmuscletest

(MMT)39ManualMuscleTesting(MMT)Definition:subjectivetestingdonebythetherapisttoassessapatientsmusclestrength.Themusclestrengthisgradedtobeeithernormal,good,fair,poor,traceorzero.ManualMuscleTesting(MMT)Def40MuscleGradesNormal:patientholdscontractionagainstmaximalresistanceatendrangeGood:patientholdscontractionagainstmoderateresistanceatendrangeFair:patientmovesthroughfullrangeofmotionagainstgravitybutunabletoholdagainstresistanceatendrangePoor:patientmovesthroughfullrangeofmotioninagravityminimizedpositionTrace:therapistpalpatesmusclecontractionaspatientattemptstomoveZero:therapistisunabletopalpateanymusclecontractionaspatientattemptstomoveMuscleGradesNormal:patienth41MuscleGradesNormal= 5/5Good= 4/5Fair= 3/5Poor = 2/5Trace= 1/5Zero= 0/5MuscleGradesNormal= 5/542ImportantpointsonmanualmuscletestingNeedtoplacepatientinstandardizedpositionIsolateonlyonejointmotionDon’tallowpatienttocompensateforweaknessComparesamemusclebilaterallyBeconsistentandreliablewithtestingImportantpointsonmanualmus43ManualResistanceStabilizelimbproximallyResistanceprovideddistallyonbonetowhichmuscleattachesWatchforcompensationManualResistance44康復評定-英語-留學生課程課件45VIDEODEMOPRACTICEQ&A康復評定-英語-留學生課程課件46AttentionduringtheMMT1.Correctposture,limbpositionandnecessarysettlement.2.Makesurethepatientsunderstandtherequestandpurposeofmovement,sothatavoidingthefakemovementorcompensation.3.Whilethemusclestrengthreachthelevel4,resistanceisprovidedtothedistalareaofthelimb.AttentionduringtheMMT474.KeepavoidingtheMMTafterlongtimeexercisesormeals.5.Thepositionwhichismeasuredshouldbeexposedtothetherapistsordoctors.6.Remembertocomparewiththecontralaterallimb.康復評定-英語-留學生課程課件48MuscletestMeasurebyequipments1.GeneralequipmenttestGrippingtestPinchingtestDorsalmuscletestⅡ.MethodsofEvaluation-MuscletestMuscletestⅡ.MethodsofEvalu49Muscletone

(ModifiedAshworthScale)Muscletone

(ModifiedAshworth50康復評定-英語-留學生課程課件51Rangeofmotion

(ROM)Rangeofmotion

(ROM)52RangeofMotion

(ROM)RangeofMotion

(ROM)53MeasuringToolsGoniometerInclinometerElectrogoniometerMeasuringToolsGoniometer54康復評定-英語-留學生課程課件55HowtomeasuretheROMofupperlimbs/lowerlimbs/trunk?Ⅱ.MethodsofEvaluation-ROMThreefactors(1)Axis(2)Stationaryarm(3)MovingarmHowtomeasuretheROMofuppe56康復評定-英語-留學生課程課件57ROMMeasurementInformedconsentPositionthepatientPlacejointinzerostartingpositionStabilizeproximalsegmentofthejointMovepatientpassivelythroughavailableROMDetermineend-feelPalpatelandmarksAligngoniometerPassivelyoractivelytakepatientthroughavailableROMCheckalignmentReadgoniometer58ROMMeasurementInformedconsen康復評定-英語-留學生課程課件59Shoulderflexion(180°)Supinewitharmsatsides-liftoverheadStationaryarm-lateralmidlineofthoraxAxis-midpointoflateralaspectofacromionprocessMovingarm:lateralmidlineofthehumerustowardlateralhumeralepicondyleShoulderflexion(180°)60ShoulderExtension(60)Pronewitharmsatsides-trytoraisearmStationaryArm:lateralmidlineofthoraxAxis:midpointoflateralaspectofacromionprocessMovingArm:lateralmidlineofhumerustowardlateralhumeralepicondyleShoulderExtension(60)61ShoulderAbductionSupinewithshoulderatsideinanatomicalposition-raisearmoverheadStationaryArm:ParalleltosternumAxis:AnterioraspectofacromionprocessMovingArm:AnteriormidlineofhumerustowardmedialhumeralepicondyleShoulderAbduction62External/LateralRotation

Internal/MedialRotationExternal/LateralRotation

Inte63ElbowFlexionSupinewithhandsbysideswithtowelunderarm-flexelbowStationaryarm:lateralmidlineofhumerustowardacromionprocessAxis:LateralepicondyleofHumerusMovingArm:LateralmidlineofradiustowardradialstyloidprocessElbowFlexion64康復評定-英語-留學生課程課件65康復評定-英語-留學生課程課件66康復評定-英語-留學生課程課件67康復評定-英語-留學生課程課件68康復評定-英語-留學生課程課件69康復評定-英語-留學生課程課件70RangeofMotion(ROM)HelpstoassessfunctionalstatusComparebilaterallyTestjointsproximalanddistaltoinjuredareaOnlyperformifdonotsuspectafractureRangeofMotion(ROM)Helpsto71ImportantpointsonGoniometricmeasurementMotionsmeasuredcanbeeitheractiveorpassiveStandardizedtechniquesareusedforeachjointJointsshouldbeadequatelystabilizedduringmeasurementImportantpointsonGoniometri72PassiveRangeofMotion(PROM)ClinicalDefinition:Therapistmovesselectedjoint(s)throughfullrangeofmotionwithnoassistancefromthepatientActiveRangeofMotion(AROM)PassiveRangeofMotion(PROM)73ImportantpointsonpassiverangeofmotionAdequatelystabilizepatientsjointsasyoumovethem.(somepatientsmayhavenoactivemovement)Don’tcausepainotherthanstretchingPerform5-10motionsperjointmovementFamiliarizeyourselfwithnormaldirectionsanddegreesofmovementforeachjointListentopatientImportantpointsonpassivera74ContraindicationsPatientisunabletovoluntarilycontractinjuredmusclePatientisunabletoperformAROMUnderlyingfracturesiteisnothealedInvolvedtissuesarenotyethealedContraindications75Ⅱ.MethodsofEvaluation-ROMⅡ.MethodsofEvaluation-ROM76

Elbowflexion0°to160°extension145°to0°Forarmpronation(rotationinward)0°to90°supination(rotationoutward)0°to90°Ⅱ.MethodsofEvaluation-ROME77Wristflexion0°to90°extension0°to70°abduction0°to25°adduction0°to65°Ⅱ.MethodsofEvaluation-ROMWristⅡ78

Hipflexion0°to125°extension115°to0°hyperextension(straighteningbeyondnormalrange0°to15°abduction0°to45°adduction45°to0°lateralrotation(rotationawayfromcenterofbody)0°to45°medialrotation(rotationtowardscenterofbody)0°to45°Hip79Kneeflexion0°to130°extension120°to0°Knee80Ankleplantarflexion(movementdownward)0°to50°dorsiflexion(movementupward)0°to20°Ankl81Mini-MentalState

Examination

(MMSE)Mini-MentalState

Examination82The

mini–mentalstate

examination

(MMSE)

isa30-pointquestionnairethatisusedextensivelyinclinicalandresearchsettingstomeasurecognitiveimpairment.Itiscommonlyusedin

medicine

andalliedhealthtoscreenfor

dementia.ItisalsousedtoestimatetheseverityandprogressionofcognitiveimpairmentandtofollowthecourseofcognitivechangesinanindividualovertimeThe

mini–mentalstateexaminat83Administrationofthetesttakesbetween5–10minutesandexaminesfunctionsincluding

registration,

attentionandcalculation,

recall,

language,abilitytofollowsimplecommands

and

orientation.Administrationofthetesttak84AdvantagestotheMMSEincluderequiringnospecializedequipmentortrainingforadministration,andhasbothvalidityandreliabilityforthediagnosisandlongitudinalassessmentofAlzheimer'sDisease.ThemostfrequentlynoteddisadvantageoftheMMSErelatestoitslackofsensitivitytomildcognitiveimpairmentAdvantagestotheMMSEinclude85Anyscoregreaterthanorequalto27points(outof30)indicatesanormalcognition.Belowthis,scorescanindicatesevere(≤9points),moderate(10–18points)ormild(19–24points)cognitiveimpairment.Therawscoremayalsoneedtobecorrectedforeducationalattainmentandage.Anyscoregreaterthanorequa86Activityofdailylife

(ADL)Activityofdailylife

(ADL)87Bathing:includesgroomingactivitiessuchasshaving,andbrushingteethandhairDressing:choosingappropriategarmentsandbeingabletodressandundress,havingnotroublewithbuttons,zippersorotherfastenersEating:beingabletofeedoneselfBathing:includesgroomingact88Transferring:beingabletowalk,or,ifnotambulatory,beingabletotransferoneselffrombedtowheelchairandbackContinence:beingabletocontrolone’sbowelsandbladder,ormanageone’sincontinenceindependentlyToileting:beingabletousethetoiletTransferring:beingabletowa89ModifiedBarthelIndexScore(MBI)TheMBIisameasureofactivitiesofdailyliving,whichshowsthedegreeofindependenceofapatientfromanyassistance.Itcovers10domainsoffunctioning(activities):bowelcontrol,bladdercontrol,aswellashelpwithgrooming,toiletuse,feeding,transfers,walking,dressing,climbingstairs,andbathing.

Totalscoresmayrangefrom0to100,withhigherscoresindicatinggreaterindependence.ModifiedBarthelIndexScore(90OthersOthers91BalanceDefinition:MaintainingcenterofmasswithinyourbaseofsupportOtherTerminologyusedtodescribebalance:CenterofGravityEquilibriumConeofStabilityBalanceDefinition:Maintaining92

Ⅱ.MethodofevaluationⅡ.Methodofevaluation93GaitOthertermsusedtodescribegait:Ambulation/LocomotionControlledmovementofyourbaseofsupport.GaitOthertermsusedtodescri94GaitAssessmentsGaitAssessments95康復評定-英語-留學生課程課件96Measuresofperception-cognition感知、認知評價Measuresofanxietyanddepression焦慮和憂郁評估MeasuresofTraumaticbraininjury腦外傷(TBI)評估Self-assessmentandself-efficacyscales自我評價（生活質(zhì)量評價）Measuresofperception-cogniti97coordinationcoordination98UnilateralneglectUnilateralneglect99康復評定-英語-留學生課程課件100DISCUSSIONHowtoassesstheswellingofthehandafterinjury?Howtoassessthepatientwithstroke?DISCUSSIONHowtoassessthesw101Assessment

ofPatientswithStroke

Assessment

ofPatientswithS102Assessmentofpatientswithstrokeincludes:LevelofconsciousnessCognitivefunction

Speechandlanguage

Cranialnerveintegrity

Sensoryintegrity

Jointintegrity

MusclestrengthAssessmentofposturePosturalcontrolandbalance(includingposturalreactions)Assessmentofpatientswithst103MuscletoneassessmentDeeptendonreflexesClonusandBabinskitestingPresenceofprimitivereflexesAssessmentofassociatedreactionsAssessmentofabnormalsynergyAssessmentofcoordinationGaitassessmentAssessmentofperceptionEndurancetestingFunctionalassessment康復評定-英語-留學生課程課件104Mini-MentalStateExamination(MMSE)Pain–VAS/othersTen-meterwalktest:goodtestforgaitspeedTimedUpandGo(TUG)BergBalanceScale(BBS)TinettiFallsEfficacyScaleActivities-specificBalanceConfidenceScale(ABC)DynamicGaitIndex(DGI):gaitspeedFunctionalGaitAssessment(FGA):gaitspeed康復評定-英語-留學生課程課件105Five-timesittostand:quadstrength,functionalabilityandendurancetesting30-secondsittostandSix-minutewalkingtest(2-minutewalk,BorgScaleofPerceivedExertion)Hand-helddynamometerMotoricityIndexShortForm36(SF-36):qualityoflifeTheBarthelIndex:ADLRivermeadMotorAssessmentFunctionalIndependenceMeasures(FIM)康復評定-英語-留學生課程課件106CanadianNeurologicalScale(Stroke)Chedoke-McMasterStrokeAssessmentFugel-MeyerAssessmentofMotorRecoveryAfterStrokeMotorAssessmentScale(MAS)NIHStrokeScale(NIHSS)StrokeImpactScale(SIS)StrokeRehabilitationAssessmentofMovement(STREAM)30itemsscaleClinicalMeasureofvoluntarymovementsandbasicmobilityfollowingstroke康復評定-英語-留學生課程課件107

Mahalo!multumescMahalo!multumesc108REHABILITATION

ASSESSMENTPingMiao,MDDepartmentofRehabilitationmedicineThesecondaffiliatedhospitalofGuangzhouMedicalUniversityREHABILITATION

ASSESSMENTPing109ContentsIntroductionMeasuresofimpairment(muscle,joint,cognitive...)Measuresofdisability(activityofdailylife...)MeasuresofhandicapContentsIntroduction110TofindtheproblemsWhatkindofdysfunctioncongenital：heartproblems，etc.postnatal：CP，stroke，SCI,TBI,etcsecodary：contracturefollowingfracture，muscleatrophyafterperipheralnerveinjury,andsoonHowmanydysfunctionsPhysically,speech,psychological,socialaspectHowseverityofdysfunctionsOnpatientandhis/herfamilyTofindtheproblemsWhatkind111Tosettreatmentgoalsshort-termgoalsCanbetouchedbyeffortswithinafewdaysorweekslong-termgoalsCanbeachievedforlongtime(terminal)Fromshort-termgoalstolong-termoneMustconsiderthefactorsage、profession、culturalbackgroud、familyconditionsTosettreatmentgoalsshort-te112AssesstreatmenteffectsIsourtreatmentplaneffective?Yes/NoShouldthetreatmentplanbecontiniunedorshouldbeadjustedaccordingtomeasurementsYes/NoAssesstreatmenteffectsIsour113

Physicalexaminationandrehabilitationmeasurementhavesomethingincommonbutnotthesame.PurposeTimesWaysIntroductionIntroduction114康復評定-英語-留學生課程課件115康復評定-英語-留學生課程課件116ObjectivesofMeasurementTofindproblemsTosettreatmentgoalsToplantreatmentschedulesToassesstheeffectivenessTopredictoutcomesToanalyzethecost-effecitveReasonsforassessingObjectivesofMeasurementTofi117LevelsshouldbemeasuredimpairmentdisabilityhandicapLevelsshouldbemeasuredimpai118DevelopmentofICIDHInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH)

1980，WHOdiseaseimpairmentdisabilityhandicap疾病病損殘疾殘障

(器官水平)(個體水平)(社會水平)

structure

abilityactivity/participation

TraditionalModelofMedicine:Etiology

Pathology

clinicalfeaturesLevelsDevelopmentofICIDHInternat119ApplicationofICIDHDifferentcousesAmputeeinthelowerlimbCan`twalkCan`tgotoschool/workimpairmentdisabilityhandicapOrgansADLSocialactivityAtthelevelofApplicationofICIDHDifferent120ApplicationofICIDHStroke/TBIHemiplagiaCan`tlookafterHim-/her-selfCan`twork/Jointhesociallife

impairmentdisabilityhandicaporgansADLSociallifeAtthelevelofApplicationofICIDHStroke/TBI121康復評定-英語-留學生課程課件122IntroductionPurposePlanatreatmentprogramandestablishoutcomesEvaluateresultsoftreatmentprogramModifytreatmentprogramIntroductionPurpose123IntroductionGoodassessmentisdependentupon:KnowledgeoffunctionalanatomyHistoryCompleteexaminationIntroductionGoodassessmentis124ClinicalEvaluationSequenceHistoryInspectionPalpationFunctionalTestingNeurologicalTestingClinicalEvaluationSequenceHi125categoryofmeasurmentRatioScalesInervalScalesOrdinalScalesNorminalScalescategoryofmeasurmentRatioSc126RatioScalesFeaturesHasazeropointthatreprestnsthecompletabsenceofthequatityrepresented.TheintervalsamongallsuccessiveunitsonthescalemustbeequalinsizeCan`thaveaminusornegativevalue.%isaformofratioExamplesROMLimblengthTimetocompletanactivityVitalcapacityNerveconductionvelocityRatioScalesFeatures127InervalScalesFeaturesLackofazeropointTheunitmustbeequalsizeExamplesBodytemperatureFunctinalscalesPsychologicaltestsInervalScalesFeatures128OrdinalScalesFeaturesMayhaveonly2categoriesPresent/absentDependent/independentExamplesMMTADLFugle-Meyer`sscaleOrdinalScalesFeatures129NorminalScalesFeaturesTheunitsarecategorywithoutindicatingtheorderorrankofthedifferencesMaybelabeledwithnumberals,letters,orwords,butthelablesdonotidicateorderorrankExamplesClassificationofgenders,diseaseStroke,CerebralpalsyNorminalScalesFeatures130QuantitativeandQualitativeScalesUnitsareassumedtobeofequalsizeAcontinuousscaleEqualsizesubunitsDistance:m,cm,mm,etcExamplesRatioscalesIntervalscalesCategorieshavenosizeCan`tbedivisibleintoequal-sizedsubcategoriesTendonreflexSittingbalanceExamplesNominalscalesQuantitativeandQualitativeS131validsensitivespecificreliable(inter-rater,test-retest)appropriateacceptablevalid132ProcedureswhentomeasurewhattobemeasuredhowtomeasureProcedureswhentomeasurewhat133WhentomeasureInitialstageMiddlestageTerminalstageAtfollow-upDuringthetreatmentandtraining,evaluationcanberepeatedbyseveraltimes.Itusuallystartfromtheevaluationandendontheevaluation.WhentomeasureInitialstageMi134Initialstage（firstmeasurement)WhenshouldbeconductedBeforephyiotherapyobjectivesFindtheproblemsanditsstatusInvestigatethepotentialofrehabilitationandrelatedfactorsAsevidenceofthetreatmentplanningAsthebaselineofreassessmentInitialstage（firstmeasuremen135Middlestage(repeatedmeasurements)WhenshouldberepeatedOnceat1-2wksforthosewithquickrecoveryEarlyphaseorinpatientsOnceat3-4wksforthosewithslowrecoveryChronicphaseoroutpatientsobjectivesTofindanyimprovementanditsextendTodecideifanyadjustmentisneededMiddlestage(repeatedmeasureme136Terminalstage（final）WhenshouldbemeasuredBeforefinishingthephysiotherapyoratdischargeobjectivesToinvestigatetherehabeffectivenessAchivementshasbeenreachedToplandischageprogramContinuinetreatmentReferedtooutpatientorcommunityTerminalstage（final）Whensho137Follow-upWhenshouldbeVariationamongpatientsanddiseasesEachmonth,2-3monthsor6monthsobjectivesDeterminethefunctionofpatientDecidewhetherpatientneedstofuthertreatmentFollow-upWhenshouldbe138specificPhysicalfunctioncognitionlanguageSocialactivitiespsychologyglobalimpairmentdisabilityhandicapWhattobemeasuredspecificPhysicalfunctioncogni139PhysicalfunctionMuscletoneROMBalanceMMTWalking???AschworthSpasticityScaleWhatshouldbemeasuredinneurorehabMotorAssessmentScaleBergBalanceScaleCompositeSpasticityScaleTheTimed“Up&Go”testFugle-MeyerMovementAssessmentReachTestBrunnstroumRoveryStagesPhysicalfunctionMuscletoneRO140DatacollectionMedicalhistoryMedicalnotesFindtheproblemsassessmentDecidewhattoandhowtoassessStarttoassessDatarecordingDataanalysisFunctinaldiagnosisSettreatmentgoalsTreatmentplanAssessmentproceduesDatacollectionMedicalhistory141Evaluation效度信度sensitivetyvalidreliabilityIntra-raterInter-ratercriterion-rela