Chedoke-McMaster Stroke Assessment

Objective

The CMSA is a screening and assessment tool utilized to measure physical impairment and disability of an individual following a stroke. The CMSA consists of two inventories. First is the Impairment Inventory, which assesses 6 domains (shoulder pain, postural control and arm, hand, leg and foot movement). Each domain is scored on a 7-point scale (Stage 1 through 7, with 1 most impairment and 7 normal). Second is the Activity Inventory, formerly Disability Inventory, which assesses gross motor and walking function. There are 15 items and is scored on a 7-point scale (1 through 7, complete dependence to independent, respectively).

Purpose

The CMSA has three overall purposes:

1. Stage motor recovery to classify individuals in terms of clinical characteristics
2. Predict rehabilitation outcomes
3. Measure clinically important change in physical function

Intended Population

The CMSA was initially developed for the assessment of patients with stroke, its application has been more widely demonstrated, specifically for the Activity Inventory.

Methods of Use

Users of the CMSA should read the manual prior to administration for the measures and be familiar with relevant administration, scoring and interpretation. No special training is required.

Administration

Physical Setting, Environment and Clothing

• Ensure patient feels comfortable and at ease during administration of assessment
• Distractions kept to a minimum
• Testing room should be comfortable warm and large enough to accommodate a low plinth (large enough to allow patient to roll from supine to sidelying), floor mat and wheelchair
• Access to full flight of stairs and outdoors required for Activity Inventory
• Patients should wear comfortable clothing (i.e., shorts and tank top) exposing knees and elbows
• During testing of shoulder pain, shoulder region should be free of clothing
• Shoes and orthoses not worn during Physical Impairment Inventory, but worn for Activity Inventory

Equipment

All equipment should be assembled ahead of time.

• Foot stool
• Pillows
• 2 meter line marked on the floor
• Chair with armrest
• Adjustable table
• Plastic measuring cup (250 ml)
• Wide, low plinth
• Stop watch
• Floor mat
• Ball, 6.5 cm (2.5 in) in diameter
• 1 liter plastic pitcher with water

Testing

Testing takes approximately 45 to 60 minutes to complete an assessment. It may not be feasible to complete the entire test in one session, however, effort should be made to complete the assessment within 2 days. Prior to assessment, the therapist should check relevant medical history and identify any condition(s) that may put a patient at risk.

During assessment, the physiotherapist's instruction, whether words or gestures, should be clear and concise. To ensure thorough understanding, a movement task may be demonstrated, a patient's limb may be passively moved through a task or patient may be asked to perform a task on the uninvolved side. Once the patient understands, test instructions are given and movement task is observed. Tasks can only be attempted twice in the Impairment Inventory and once in the Activity Inventory.

The following are reasons to end a task or assessment:

• Neither safe nor prudent
• Activity may worsen patient’s condition (i.e., rolling onto painful shoulder)
• Patient becomes excessively fatigued or apprehensive

Scoring and Interpreting the Chedoke-McMaster Stroke Assessment 

Impairment Inventory

Shoulder Pain

When assessing stage of shoulder pain, consider any pain that is present and its relationship to functional activities, even those not involving the shoulder or arm.
Steps in the Shoulder Assessment are as follows:

1. Ask questions regarding pain and function
2. Test ROM
3. Examine shoulder and scapula

Ensure prognostic indicators are noted that assist in predicting shoulder pain. The following indicators are most significant:

• Arm is in low stage of recovery, Stage 1 or 2
• Scapula is misaligned. It can be elevated, depressed, abducted or adducted
• Loss of ROM with flexion or abduction < 90˚ or external rotation < 60˚

Motor Recovery for Postural Control, Arm, Hand, Leg and Foot

Principles of Motor Recovery:

• Motor recovery from hemiplegia follows a stereotyped sequence of events
• Performance of selected motor tasks, requiring increased complex motor control, indicates central nervous system recovery
• In the early stages, movement first occurs in limb synergy patterns. As stages progress, movement patterns out of the synergy in more complex and independent patterns.
• Postural control, arm, hand, leg and foot may recover at different rates. The stage of recovery of the proximal part of the limbs is often in a higher stage than the distal. Movements involving flexion are at a different stage of recovery than movements involving extension.
• Stages of Motor Recovery measure the amount of neurological impairment