Name

Age

Sex

Occupation

Address

Dominance

Diagnosis

Reffered by

Chief complaints

Relevant history

Family history

Social history

Medical history

Etiological category: Infarction, Intracerebral Hemorrhage, subarachnoid hemorrhage, arteriovenous

malformation

Risk factors present: TIA, hypertension, atrial fibrillation, left ventricular hypertrophy, congestive heart
failure, cigarette smoking, alcohol consumption, tobacco use, obesity, diabetes mellitus, high serum
cholesterol

Secondary damage to brain: due to increase in intracranial pressure, brainstem herniation

Vascular syndrome: anterior cerebral artery syndrome, middle cerebral artery syndrome, internal
carotid artery syndrome, posterior cerebral artery syndrome, vertebrobasilar artery syndrome, locked-in
syndrome

Diagnostic tests: blood analysis, urine analysis, ct, mri, xray, other,

Sensorymotor deficits:

Pain: type of pain, dermatomal distribution of pain,

Visual defects/deficits:

Recovery stage
Alteration in tone: hypotonia, hypertonia (ashworths scale), rigidity (lead-pipe, cog-wheel)

Abnormal synergy pattern:

Reflexes

Associated reactions

Paresis and altered muscle activation patterns

Motor programming deficits

Disturbances in postural control and balance

Speech and language disorders

Dysphagia

Perceptual dysfunction

Cognitive dysfunction

Affective disorders

Behavioral hemispheric differences

Seizures

Bladder and bowel dysfunction

Indirect impairment and complications: DVT, skin breakdown, decreased flexibility, shoulder subluxation
and pain, rsd, deconditioning

Functional disabilities

Medical management

Level of consciousness: GCS and mini mental scale

Speech and language deficits

Cranial nerve integrity

Cognitive dysfunction

Sensory integrity: superficial, deep & cortical

Disorders of vision

Perceptual dysfunction
Joint integrity and mobility

Motor deficits

Disturbances in postural control and balance

Stroke assessment instruments

Functional assessment

Berg balance scale

Gait assessment

Reflex grading

Bowel and bladder grading

Katz index

Edema rating scale

Modified Ashworth Scale  Bohannon & Smith

Score Ashworth Scale  (1964)
(1987)
0 (0) No increase in tone No increase in muscle tone
Slight increase in muscle tone, manifested by a catch
Slight increase in tone giving
and release or by minimal resistance at the end of the
1 (1) a catch when the limb was
range of motion when the affected part(s) is moved in
moved in flexion or extension
flexion or extension.
Slight increase in muscle tone, manifested by a catch,
followed by minimal resistance throughout the
1+(2)
reminder (less than half) of the ROM (range of
movement).
More marked increase in tone More marked increase in muscle tone through most of
2 (3)
but limb easily flexed. the ROM, but affected part(s) easily moved.
Considerable increase in tone Considerable increase in muscle tone passive,
3 (4)
- passive movement difficult. movement difficult.
Limb rigid in flexion or
4 (5) Affected part(s) rigid in flexion or extension.
extension.