ICF check list for right side weekness stroke patients
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ICF International Classification of Functioning checklist stroke rehabilitation hemiplegia
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right sided weakness hemiparesis stroke assessment body functions activities participation
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Here is a comprehensive ICF Checklist for Right-Sided Weakness (Hemiparesis/Hemiplegia) Post-Stroke, structured across all ICF domains as per the International Classification of Functioning, Disability and Health framework applied to motor rehabilitation after stroke (Motor Rehabilitation After Stroke, p. 4).
ICF Framework Overview for Stroke with Right-Sided Weakness
The ICF conceptualizes functioning across three interacting domains:
- Body Functions & Structures — physiological and anatomical impairments
- Activities — task execution limitations
- Participation — life situation restrictions
- Environmental & Personal Factors — barriers or facilitators
1. BODY FUNCTIONS & STRUCTURES
1a. Neuromusculoskeletal Functions
| ICF Code | Item | Assessment Tool |
|---|---|---|
| b710 | Muscle tone (spasticity/flaccidity) — right UE & LE | Modified Ashworth Scale (MAS) |
| b730 | Muscle power — right UE & LE | MRC grading (0–5) |
| b735 | Muscle endurance | Functional task performance |
| b760 | Control of voluntary movement | Fugl-Meyer Assessment (FMA) |
| b765 | Involuntary movement (synergy patterns) | Brunnstrom Stages |
| b770 | Gait pattern functions | Gait analysis, 10MWT |
| b715 | Stability of joint functions — right shoulder subluxation | Clinical exam |
1b. Sensory Functions
| ICF Code | Item | Assessment Tool |
|---|---|---|
| b265 | Touch/proprioception — right side | Sensory testing battery |
| b270 | Sensory functions related to temperature/pain | Pin-prick, temperature test |
| b280 | Pain (shoulder-hand syndrome, central post-stroke pain) | VAS / NRS |
1c. Mental Functions
| ICF Code | Item | Assessment Tool |
|---|---|---|
| b110 | Consciousness level | GCS |
| b114 | Orientation | MMSE / MoCA |
| b117 | Intellectual functions / cognition | MoCA |
| b122 | Psychosocial functions | Behavioral observation |
| b126 | Temperament / emotional stability | Clinical interview |
| b130 | Energy and drive (fatigue, motivation) | Fatigue Severity Scale |
| b140 | Attention | Trail Making Test |
| b144 | Memory | MMSE memory subtest |
| b167 | Language functions (aphasia — left hemisphere stroke causing right-side weakness) | NIHSS language item, Boston Diagnostic Aphasia Exam |
| b152 | Emotional functions (depression, anxiety) | PHQ-9, GAD-7 |
1d. Cardiovascular & Respiratory
| ICF Code | Item | Notes |
|---|---|---|
| b410 | Heart function | BP monitoring, cardiac history |
| b440 | Respiration | SpO₂, respiratory rate |
| b455 | Exercise tolerance | 6-Minute Walk Test |
1e. Body Structures
| ICF Code | Item |
|---|---|
| s110 | Structure of brain (lesion site — left MCA territory common) |
| s720 | Structure of shoulder region (subluxation risk, right side) |
| s730 | Structure of upper extremity (right arm) |
| s750 | Structure of lower extremity (right leg) |
2. ACTIVITIES
2a. Mobility
| ICF Code | Item | Assessment Tool |
|---|---|---|
| d410 | Changing body position (bed mobility) | Functional Independence Measure (FIM) |
| d415 | Maintaining body position (sitting balance) | Trunk Impairment Scale |
| d420 | Transferring (bed ↔ chair) | FIM transfer item |
| d450 | Walking | 10MWT, FAC, 6MWT |
| d455 | Moving around (stairs, uneven ground) | Berg Balance Scale |
| d460 | Moving in different locations | Clinical observation |
2b. Upper Extremity Use
| ICF Code | Item | Assessment Tool |
|---|---|---|
| d430 | Lifting and carrying objects | FIM |
| d440 | Fine hand use (right hand) — grip, pinch, manipulation | Box & Block Test, Purdue Pegboard |
| d445 | Hand and arm use — reaching, grasping (right UE) | Action Research Arm Test (ARAT), Wolf Motor Function Test |
2c. Self-Care
| ICF Code | Item | Assessment Tool |
|---|---|---|
| d510 | Washing oneself | FIM / Barthel Index |
| d520 | Caring for body parts (grooming) | Barthel Index |
| d530 | Toileting | FIM |
| d540 | Dressing | Barthel Index |
| d550 | Eating | FIM eating item |
| d560 | Drinking | FIM |
2d. Communication (Critical for Left Hemisphere Stroke)
| ICF Code | Item | Assessment Tool |
|---|---|---|
| d310 | Communicating — receiving spoken messages | NIHSS |
| d330 | Speaking | Western Aphasia Battery |
| d345 | Writing messages (right-hand dominant patient) | Clinical assessment |
2e. Domestic Life
| ICF Code | Item |
|---|---|
| d620 | Acquisition of goods and services |
| d640 | Doing housework |
| d650 | Caring for household objects |
3. PARTICIPATION
| ICF Code | Item | Assessment Tool |
|---|---|---|
| d620–d699 | Domestic life roles | Stroke Impact Scale (SIS) |
| d710–d799 | Interpersonal interactions | SIS — Social participation domain |
| d820–d839 | Education | Vocational rehab assessment |
| d840–d859 | Work / employment | Return-to-work assessment |
| d910–d930 | Community life, recreation, leisure | Reintegration to Normal Living Index (RNL) |
| d940–d960 | Civic and social life | Patient interview |
4. ENVIRONMENTAL FACTORS
| ICF Code | Item | Barrier (−) / Facilitator (+) |
|---|---|---|
| e110 | Products for personal use (assistive devices — AFO, wheelchair, splints) | + |
| e115 | Assistive technology for daily living | + |
| e120 | Products for mobility (walking aids) | + |
| e150 | Design of buildings / home accessibility | − or + |
| e310 | Immediate family support | + |
| e320 | Friends/social network | + |
| e355 | Health professionals | + |
| e410 | Individual attitudes of family members | + or − |
| e580 | Health services and policies | + or − |
5. PERSONAL FACTORS
(Not formally coded in ICF but assessed clinically)
| Factor | Relevance |
|---|---|
| Age | Older age — poorer neuroplasticity |
| Handedness | Right-hand dominant patients — greater functional loss with right hemiplegia |
| Pre-stroke level of function | Baseline for goal setting |
| Motivation / self-efficacy | Stroke Self-Efficacy Questionnaire |
| Coping style | Psychological adjustment |
| Socioeconomic status | Influences rehab access |
| Comorbidities (DM, HTN, AF) | Affect recovery |
| Prior stroke history | Cumulative deficit |
Key Clinical Notes for Right-Sided Stroke Weakness
- Left hemisphere lesion — right hemiplegia is almost always associated with aphasia (expressive/receptive/global depending on lesion extent). Communication assessment is mandatory.
- Dysphagia — assess swallowing (b510) using NIHSS or bedside swallow screen, as pseudobulbar involvement is possible.
- Neglect — right-sided neglect is less common than left neglect, but spatial and attentional deficits must still be screened.
- Shoulder subluxation — right shoulder at high risk; preventive positioning and support essential.
- Dominant hand involvement — loss of right hand function has significant impact on writing, self-care, and vocational activities for right-hand-dominant patients.
Recommended Assessment Battery Summary
| Domain | Tool |
|---|---|
| Neurological severity | NIHSS |
| Motor — UE | Fugl-Meyer (UE), ARAT, Wolf Motor Function Test |
| Motor — LE | Fugl-Meyer (LE), FAC, 10MWT, 6MWT |
| Spasticity | Modified Ashworth Scale |
| Balance | Berg Balance Scale, Trunk Impairment Scale |
| Functional independence | FIM, Barthel Index |
| Cognition | MoCA |
| Language/aphasia | Western Aphasia Battery |
| Depression | PHQ-9 |
| Quality of life | Stroke Impact Scale |
| Participation | Reintegration to Normal Living Index |
Source: Motor Rehabilitation After Stroke, p. 4 — ICF framework for stroke motor rehabilitation.
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