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What assessment tools are useful for determining prognosis and progress in brain injury?

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Physical Therapist

Answer transcribed from Brightway's interview with physical therapist Susan Little:

From a PT point of view, all assessments are really our standard. You probably have heard therapists talk. We're very goal-driven, where we'll talk with you about what your goals are and we will establish goals. All of that starts with assessment tools, where we will evaluate impairments and strength in endurance, balance, and coordination to find a baseline of what problems need to be addressed and to also provide a starting line. Those evaluation tools will then be repeated at intervals to see if we're making progress and if what we're doing is the right thing or if we need to change up what we're doing. I could go on and on about the names and I'm not sure you want to be burdened with all of the names of those assessment tools, but do know that therapists have a tremendous toolbox of assessment tools that can be utilized.


I would certainly encourage that if you know your family member is having difficulty with balance and that is their chief difficulty, ask the therapist what assessment tool they plan on using, at what intervals they will repeat that tool, and what that tool tells you for balance. Most of our assessment tools will predict a probability of having a fall and that's something you might want to know. If grandma is 90-likely to have a fall, you know that you're not going to want to get much further than an arm's length away from grandma because you don't want that to happen. With therapy, perhaps grandma gets up to the point where she's only at a 25 risk of having a fall. Providing her with that freedom and that quality of life might be worth the chance of that lower probability of having a fall. So we have many tools that are very useful. Certainly, discuss those with your therapist to see what tools are being utilized and how what they're doing is improving the scores. Everybody likes to hear a score right, so I tell my patients those scores and I cheer for them every time I repeat that they're going to do better on those. 


As for which ones are used more than others, that's kind of an individual thing to a therapist. My favorites for balance are one known as the bird balance assessment. It was developed many years ago to predict falls among the elderly but has been shown to be highly effective in predicting whether somebody will have a fall after a brain injury as well. Another one of my favorite higher-level balance tests is the community balance and mobility scale, which was designed in Canada. It’s tough, I did a study at a university with young healthy college students and they could not get a hundred percent on this balancing test. I'm betting Simone Biles would have no trouble with it but students and individuals, even without challenges to their balance and their brain, struggle with it. As a therapist, I like that because I don't want a test that's too easy. Remember, I always want to challenge people and make sure that I'm giving them difficult but doable challenges. So certainly, I need that in the test as well.


In regard to strength, the gold standard for therapists is what we refer to as manual muscle testing. You've most likely all been through it, where we ask you to hold and we push against your joint for different motions and we grade your strength on a scale from zero to five. As for flexibility, the basic one is goniometry, which is that funny little tool that we use to measure your joint angles to see if you have flexibility problems that may be impacting your ability to move. Everybody loves the coordination tests, which are all of those tests where we ask you to touch your nose and touch a finger or do crazy things like that. These are basic movements to evaluate how coordinated you are. Lastly, from a muscle tone point of view, or what many people might refer to as spasticity, my favorite assessment is the modified Ashworth.

speech language pathologist

As a speech-language pathologist, we have both formal and informal assessments.

Given the nature of teletherapy for the last year I've been using a lot of informal assessments.  Sometimes the internet connection might not be great and my sound may be a little funny, so it doesn’t have the context of a formal proper assessment.  We have many sources of informal assessments where we can understand areas of cognition or speech and language.

There are also a lot of formal assessments that we use.  There's RBANS, SCATBI, SLUMS, MAST, CLQT, BDAE.  These require a proper setting, proper minutes, proper administration.  Many of these are very similar in what they're looking at. They're assessing short-term memory, temporal orientation, visual spatial, problem solving, cause effects, abstract reasoning, generative naming, attention.  Pragmatics, or social skills, are difficult to assess - that is a subjective section based on what the clinician observes.

I like to use both, and can get a comprehensive assessment from both.