Scales in Neurology & Physiotherapy

1. Stroke & Neurological Severity

Glasgow Coma Scale (GCS)

• Assesses level of consciousness across three domains: Eye opening (1–4), Verbal response (1–5), Motor response (1–6)
• Total score: 3–15 (≤8 = severe, 9–12 = moderate, 13–15 = mild)
• Used in acute stroke, TBI, ICU monitoring
• — Bradley and Daroff's Neurology in Clinical Practice

NIH Stroke Scale (NIHSS)

• 15-item scale assessing stroke severity: consciousness, gaze, visual fields, facial palsy, limb motor, ataxia, sensation, language, dysarthria, neglect
• Score: 0–42 (0 = no deficit; ≥25 = severe stroke)
• Guides thrombolysis decisions and predicts outcome
• Also available as modified NIHSS

Hunt and Hess Scale

• Grades subarachnoid haemorrhage (SAH) severity (I–V)
• Used alongside the World Federation of Neurological Surgeons (WFNS) grading scale for SAH
• Predicts surgical risk and prognosis
• — Morgan and Mikhail's Clinical Anesthesiology

ASIA Impairment Scale (AIS)

• American Spinal Injury Association scale for spinal cord injury
• Grades A–E: A = complete (no motor/sensory below level), E = normal
• Documents sensory/motor levels and zone of partial preservation
• — Tintinalli's Emergency Medicine; Rockwood & Green's Fractures in Adults

2. Disability & Functional Independence

Barthel Index (BI)

• Measures Activities of Daily Living (ADL): feeding, bathing, grooming, dressing, bowel/bladder control, transfers, ambulation, stair climbing
• Score: 0–100 (0 = fully dependent; 100 = fully independent)
• Widely used in stroke rehabilitation and geriatrics

Modified Rankin Scale (mRS)

• Grades disability post-stroke from 0 (no symptoms) to 6 (death)
• Primary outcome measure in stroke clinical trials
• Simple but sensitive to global functional change

Functional Independence Measure (FIM)

• 18 items across motor (13) and cognitive (5) domains
• Score: 18–126 — higher = more independent
• Used in inpatient rehabilitation settings

3. Motor Function & Spasticity

Ashworth Scale / Modified Ashworth Scale (MAS)

• Assesses spasticity/tone on a 0–4 scale (0 = no increase in tone; 4 = rigid)
• Modified version adds a "1+" grade
• Used post-stroke, in cerebral palsy, MS, spinal cord injury

Brunnstrom Stages of Recovery

• 6 stages of motor recovery post-stroke (1 = flaccidity → 6 = near-normal)
• Describes emergence of synergy patterns and their resolution
• Used by physiotherapists to guide treatment progression

Fugl-Meyer Assessment (FMA)

• Gold standard for sensorimotor function post-stroke
• Domains: Upper extremity (66 pts), Lower extremity (34 pts), balance, sensation, ROM/pain
• Total max: 226 points

4. Balance & Gait

Berg Balance Scale (BBS)

• 14 tasks assessing static and dynamic balance
• Score: 0–56 (≤45 = risk of falls)
• Used in elderly, stroke, Parkinson's, vestibular disorders

Timed Up and Go (TUG) Test

• Time taken to rise from chair, walk 3m, turn, return, and sit

• 12 seconds indicates fall risk

• Simple, widely applicable in physiotherapy

Tinetti Performance-Oriented Mobility Assessment (POMA)

• Assesses gait (12 pts) and balance (16 pts)
• Total: 28 points — lower score = higher fall risk

6-Minute Walk Test (6MWT)

• Measures functional exercise capacity
• Distance walked in 6 minutes; used in neurological, cardiac, and pulmonary conditions

10-Metre Walk Test (10MWT)

• Measures gait speed — comfortable and maximum speed
• Key outcome in stroke rehabilitation

5. Spinal Cord & Pain

Visual Analogue Scale (VAS) / Numeric Rating Scale (NRS)

• Self-reported pain intensity: 0–10 (NRS) or 100mm line (VAS)
• Used across all neurological and musculoskeletal conditions

Oswestry Disability Index (ODI)

• Condition-specific measure for low back pain disability
• 10 sections, score 0–100% (higher = greater disability)

6. Parkinson's Disease

Unified Parkinson's Disease Rating Scale (UPDRS) / MDS-UPDRS

• Comprehensive 4-part scale: Non-motor (Ia, Ib), Motor examination (III), Motor complications (IV)
• Motor part (Part III): 0–108
• Gold standard for Parkinson's severity and treatment response

Hoehn and Yahr Scale

• Stages Parkinson's severity from 1–5 (or 0–5 modified version)
• Simple staging: 1 = unilateral; 5 = wheelchair-bound/bedridden

7. Multiple Sclerosis

Expanded Disability Status Scale (EDSS)

• 10-point scale (0–10) assessing neurological function in MS
• Integrates 8 functional systems: pyramidal, cerebellar, brainstem, sensory, bowel/bladder, visual, cerebral, other
• 0 = normal neurological exam; 10 = death due to MS

8. Cognitive & Depression Scales (Neurology-specific)

Mini-Mental State Examination (MMSE) / MoCA

• Screens for cognitive impairment and dementia
• MMSE: 30 points (≤23 = impairment); MoCA: 30 points (≤25 = mild impairment)

Geriatric Depression Scale (GDS)

• Designed specifically for elderly patients with neurological illness
• Avoids somatic items that overlap with neurological syndromes
• — Bradley and Daroff's Neurology in Clinical Practice

Summary Table