|
I Muscle weakness
| | | | | |
| Upper limbs: | | | | | |
| Holding or keeping a pencil (between thumb and index) | Y | N | | Y | N |
| Holding a glass | Y | N | | Y | N |
| Wrist flexion | Y | N | | Y | N |
| Elbow flexion (in supination) | Y | N | | Y | N |
| Elbow flexion (in pronation) | Y | N | | Y | N |
| Elbow extension | Y | N | | Y | N |
| Lower limbs: | | | | | |
| Toes movements | Y | N | | Y | N |
| Ankle dorsiflexion | Y | N | | Y | N |
| Plantar flexion | Y | N | | Y | N |
| Knee flexion | Y | N | | Y | N |
| Hip flexion | Y | N | | Y | N |
| Maintainance of legs against gravity (Mingazzini test) | Y | N | | Y | N |
| Rising on toes | | Y | | N | |
| Rising on heels | | Y | | N | |
| Rising from chair (without any support) | | Y | | N | |
| Walking alone (without any support) | | Y | | N | |
| M = number of nos: /28 |
|
II Reflexes
| | | | | |
| Biceps | Y | N | | Y | N |
| Triceps | Y | N | | Y | N |
| Supinator (radial periosteal) | Y | N | | Y | N |
| Pronator | Y | N | | Y | N |
| Knee | Y | N | | Y | N |
| Ankle | Y | N | | Y | N |
| R = number of nos: /12 |
|
III Sensory function
| | | | | |
| Abnormal sensations: | | | | | |
| Paraesthesiae (tingling numbness, pins and needles) | | | | | |
| In the hand | Y | N | | Y | N |
| Between wrist and elbow | Y | N | | Y | N |
| Above elbow | Y | N | | Y | N |
| In the foot | Y | N | | Y | N |
| Between ankle and knee | Y | N | | Y | N |
| Above knee | Y | N | | Y | N |
| Dysaesthesiae (pain, burning, “electric discharge”) | | | | | |
| In the hand | Y | N | | Y | N |
| Between the wrist and elbow | Y | N | | Y | N |
| On the elbow | Y | N | | Y | N |
| In the foot | Y | N | | Y | N |
| Between ankle and knee | Y | N | | Y | N |
| On the knee | Y | N | | Y | N |
| Is there inability to feel the floor? | Y | N | | Y | N |
| Do you feel tightness? | | | | | |
| In the wrist | Y | N | | Y | N |
| In the ankle | Y | N | | Y | N |
| Examination: | | | | | |
| Joint position sense problems | | | | | |
| Upper limbs | Y | N | | Y | N |
| Lower limbs | Y | N | | Y | N |
| Vibratory sense problems | | | | | |
| Upper limbs | Y | N | | Y | N |
| Lower limbs | Y | N | | Y | N |
| Pinprick test problems | | | | | |
| Upper limbs | Y | N | | Y | N |
| Lower limbs | Y | N | | Y | N |
| Thermal sensation problems | | | | | |
| Upper limbs | Y | N | | Y | N |
| Lower limbs | Y | N | | Y | N |
| Are there difficulties in identifying objects with fingers (astereognosis)? | Y | N | | Y | N |
| Hand tremor | Y | N | | Y | N |
| Ataxia (Romberg’s sign) | | Y | | N | |
| Gait instability | | | | | |
| Using a walking stick | | Y | | N | |
| Without a walking stick | | Y | | N | |
| S = number of yes: /53 |
|
IV Subjective assessment
| | | | |
| From the beginning of the treatment what are the changes in the following symptoms: | | | | |
| Paraesthesiae | −2: major improvement |
| Dyaesthesiae | −1: slight improvement |
| Inability to feel the floor | 0: no change |
| Tightness | +1: slight worsening |
| Walking problems | +2: major worsening |
| SA = (from −10 to +10) |
| For the initial score, SA = 0 |
| Score: M+R+S+SA = /103 |