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Thread: Anoxic Brain Injury Evaluations

  1. #1

    Anoxic Brain Injury Evaluations

    I have a client at the facility where I work who has an Anoxic Brain Injury. His parents are going to have him get botox injections for many of the muscles in his upper extremities to try to loosen them up to see if he can get more use out of his arms. His father said they have not had much success with botox before, but now that he is doing intensive exercise and rehabilitation (both in and outside of our facility) they think the botox might make a difference.

    My question is, is there a standard scale that is used to measure the functionality of someone with a brain injury, anoxic or otherwise? We have our own evaluation system at our facility but all it really measures is voluntary strength at each joint in the body, which is hard to get for someone like this client because he has so many contractures to begin with.

    I know that spinal cord injury has things like the WISCI scale, Funtional Independence Measure, and the NRN evaluation system. If anyone could steer me towards a standard functional test for those with anoxic brain injuries that would be a big help so we could do pre- and post-botox evaluations.

  2. #2
    The FIM is used for all major disability functional status evaluation, not just SCI...in fact it was originally designed for stroke rehab, not SCI, and doesn't really work all that well for SCI rehab. Of course it would be important to have the person(s) doing the FIM evaluation be UDS certified in the use of the FIM tool. The FIM is generally used to measure "activity" (formerly called disability by WHO), not impairment, which is the extent to which the impairment or disability effects self care and activities of daily living. In reality, the FIM measures "burden of care", or how much help from another the person requires for the 18 items scored.

    I am a little confused about what you are trying to measure. If you are trying to measure impairment (the extent to which body functions or structure are effected by the medical condition or disability) then that is not measured by the FIM. In SCI we use the ISCSCI (International Standards for the Classification of Spinal Cord Injury), which was formerly called the ASIA exam. For MS, the EDSS is usually used. I am not familiar with a single standardized tool used for measurement of impairment in TBI, although a number of cognitive and motor impairment tools commonly used in clinical rehabilitation have been applied to those with TBI. I would suggest doing a literature search for "TBI impairment tools". Here is an article I found with a quick search:

    http://www.nhchc.org/wp-content/uplo...alingHands.pdf


    (KLD)

  3. #3
    Thanks for the reply KLD. What I'm really interested in measuring is how much functionality he does/doesn't get back in his upper body after the botox injections combined with his regular PT and exercise sessions. I could measure simple things like joint ROM, grip strength, strength at his upper body joints, and other random functional skills (for instance, he cannot cycle and arm ergometer right now on his own, but maybe more flexibility and ROM in his arms would allow for enough coordination to do so?) I was just wondering if there is any standard tests/measures for fine and gross motor skills in people with TBI.

  4. #4
    I would recommend talking to an OT and PT who work in a major TBI rehab center for information on which of these tests are used. I know in SCI we used a standardized test for hand dexterity called the "SCI Pick-up test"...I would be surprised if there are not similar CVA or TBI tests used.

    (KLD)

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