ICF Checklist for Right-Sided Weakness (Stroke / Right Hemiplegia)

1. BODY FUNCTIONS (Impairments)

Neuromuscular / Movement-Related

• Muscle weakness — right upper limb (shoulder, elbow, wrist, hand/grip)
• Muscle weakness — right lower limb (hip, knee, ankle, foot)
• Muscle tone abnormality — spasticity or flaccidity (right side)
• Abnormal synergy patterns — flexor synergy (UL), extensor synergy (LL)
• Coordination impairment — ataxia, dysmetria (right side)
• Reflex abnormalities — hyperreflexia, clonus, Babinski sign (right)
• Balance impairment — static and dynamic sitting/standing balance
• Gait impairment — hemiparetic gait pattern (circumduction, foot drop)

Sensory Functions

• Superficial sensation — touch, pain, temperature (right hemibody)
• Proprioception/Kinesthesia — position sense (right limbs)
• Stereognosis / Graphesthesia — cortical sensory loss

Cognitive Functions (left hemisphere stroke — right-sided weakness)

• Aphasia — expressive (Broca's), receptive (Wernicke's), or global
• Reading/Writing — alexia, agraphia
• Apraxia — ideomotor, ideational
• Memory impairment — short-term, working memory
• Attention deficits — sustained, selective, divided
• Executive function — planning, problem-solving

Other Body Functions

• Dysphagia — swallowing difficulty
• Dysarthria — speech motor control
• Visual field defect — right homonymous hemianopia
• Bladder/bowel dysfunction — incontinence or retention
• Fatigue — post-stroke fatigue
• Mood/Affect — post-stroke depression, emotional lability
• Pain — central post-stroke pain, shoulder pain (subluxation), spasticity pain

Body Structures

• Right upper extremity (shoulder subluxation, hand edema)
• Right lower extremity (foot drop, equinovarus deformity)
• Brain lesion site (documented on imaging — MCA territory most common)

2. ACTIVITIES (Limitations)

Mobility

• Rolling in bed (toward right/left)
• Bridging
• Sit-to-stand transfer
• Standing balance — static and dynamic
• Walking — indoor, outdoor, stairs, uneven surfaces
• Wheelchair mobility (if applicable)
• Reaching and grasping — with right hand
• Object manipulation — grip, pinch, fine motor tasks

Self-Care (ADL)

• Feeding — holding utensils, self-feeding
• Grooming — combing, shaving, brushing teeth
• Bathing/Showering — bathing right side of body
• Dressing — upper and lower body, fastening buttons/zippers
• Toileting — transfers, hygiene
• Functional mobility — bed, chair, toilet, car transfers

Communication & Cognition in Activities

• Reading (if aphasia/alexia present)
• Writing (dominant hand affected if right-handed — significant impact)
• Verbal communication — expressing needs, conversation
• Using a phone/computer — typing, calling

Instrumental ADL (IADL)

• Meal preparation
• Household management
• Managing finances
• Driving / community transportation
• Shopping

3. PARTICIPATION (Restrictions)

• Return to work or previous occupation
• Social relationships — family roles, friendships
• Leisure and recreational activities
• Community mobility — using public transport
• Driving (right limb control, cognitive capacity)
• Religious / cultural participation
• Caregiver roles — parenting, spousal duties
• Civic/volunteer activities

4. ENVIRONMENTAL FACTORS (Barriers / Facilitators)

5. PERSONAL FACTORS

• Age, sex, handedness (right-handed patients — dominant hand affected, greater ADL impact)
• Pre-stroke functional level
• Comorbidities (diabetes, hypertension, AF)
• Motivation and health beliefs
• Coping strategies
• Education and literacy level
• Cultural background and values

Key Assessments Mapped to ICF Domains

Clinical Note: Right-sided weakness from stroke typically indicates a left hemisphere lesion (most commonly middle cerebral artery territory). This co-localizes with language areas in the dominant hemisphere, making aphasia and apraxia particularly important additions to the ICF checklist compared to left-sided weakness stroke. Motor functions are closely influenced by sensation, pain, cognition, mood, and fatigue — all must be assessed together (Motor Rehabilitation After Stroke, p. 4).