While the following list is not intended to be comprehensive, it represents many of the tools commonly used in rehabilitation assessment of patients with MS.
Ashworth and Modified Ashworth Spasticity Scale: These are ordinal scales of tone intensity. The Ashworth rates tone on a scale of 0–4, while the Modified Ashworth was developed to further define the lower end of the scale making it more discrete by adding the grade 1+ (Lee KC, Carson L, Kinnin E, and Patterson V. The Ashworth Scale: A reliable and reproducible method of measuring spasticity. J Neuro Rehab 1989; 3:205–209.
Barthel Index: An ordinal scale of function in ten areas encompassing mobility, ADL function, and continence (Mahoney & Bartehl, 1965).
Berg Balance Scale: An ordinal scale of balance that is sensitive to change (Berg et al., 1992.
The Dallas Pain Questionnaire: The Dallas Pain Questionnaire was developed to assess the amount of chronic spinal pain that affects daily and work activities, leisure activities, anxiety-depression, and social interest (Lawlis et al., 1989).
Functional Independence Measure (FIM): An ordinal scale of functioning in multiple areas including feeding, grooming, bathing, dressing, toileting, transferring, locomotion, comprehension, expression, social interaction and problem solving. Information about obtaining the FIM may be obtained from Uniform Data for Medical Rehabilitation UB Foundation Activities, Inc. at (716) 817-7800 or www.udsmr.org.
Health Status Questionnaire (SF-36): This is a 36-item patient self-report regarding the patient’s perception of health and physical limitations. It is widely used in the US. It is a component of the MSQLI. It is a registered trademark of the Medical Outcomes Trust, Inc. (20 Park Plaza, Suite 1014, Boston, Massachusetts 02116) Additional references: http://www.mcw.edu/midas/health/SF-36.html and http://www.nationalmssociety.org/MUCS_health.asp.
Kurtzke Functional System Scores (FSS) and Expanded Disability Status Scale (EDSS): The FSS and EDSS constitute one of the oldest and probably the most widely utilized assessment instruments in MS. Based on a standard neurological examination, the 7 functional systems (plus “other”) are rated. These ratings are then used in conjunction with observations and information concerning gait and use of assistive devices to rate the EDSS. Each of the FSS is an ordinal clinical rating scale ranging from 0 to 5 or 6. The EDSS is an ordinal clinical rating scale ranging from 0 (normal neurologic examination) to 10 (death due to MS) in half-point increments.
Minimal Assessment of Cognitive Function in MS (MACFIMS): An expert panel convened by the Consortium of MS Centers in 2001 developed this 90-minute neuropsychological assessment for patients with MS (Benedict et al., 2002), consisting of 7 neuropsychological tests covering processing speed/working memory, learning and memory, executive function, visual-spatial processing and word retrieval.
Modified Fatigue Impact Scale (MFIS): Consists of 21 items to determine the effects of fatigue in terms of cognitive, physical, and psychosocial functioning. An abbreviated version consists of 5 items. The MFIS is part of the MSQLI.
MS Functional Composite (MSFC): Includes the Timed 25-foot walk (T25-FW), 9-hole peg test (9HPT), and the Paced Auditory Serial Addition Test (PASAT).
MS Quality of Life-54 (MSQOL-54): A multidimensional health-related quality of life measure that combines the SF-36 and 18 MS-specific items, including fatigue and cognitive function.
MS Quality of Life Inventory (MSQLI): A structured self report encompassing the following components: SF-36, Modified Fatigue Impact Scale, Pain Effects Scale (PES), Sexual Satisfaction Scale (SSS), Bladder Control Scale (BLCS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS).
Range of Motion (ROM) and Manual Muscle Test (MMT) and Grasp Dynamometry: Range of Motion at selected joints is assessed using a goniometer that measures the angle of the joint through its range. Manual Muscle testing uses a 6 point grading system (0 = no contractile ability; 5 = strength through full ROM with maximum resistance) to assess strength where the patient has selective joint control. Grasp Dynamometer Testing uses a dynamometer to measure grasp and pinch strength in pounds.
Tinetti Assessment Tool: Easily administered test that measures gait and balance (Tinetti, 1986). The test is scored on a three-point scale to assess the patient’s ability to perform specific tasks. Scores are combined to form three measures—an overall gait assessment score, an overall balance assessment score, and a gait and balance score. The scores can be interpreted with regard to risk for falls (Lewis C. Balance, gait test proves simple yet useful. PT Bulletin 1993; 2/10:9, 40).