ACUTE BRAIN INJURY PHYSIOTHERAPY ASSESSMENT (ABIPA)

Date: Time: E V M

GCS:

Medications: (Dose, time, frequency)

Comments:

SUPINE Alignment

Head

Trunk

Upper Limb R L General Tone Movement

Lower Limb R L

ALIGNMENT SCALE 4. Aligned in all planes 3. Not aligned in one plane 2. Not aligned in two planes 1. Not aligned in three planes 0. Fixed position or unable to assess GENERAL TONE SCALE 4. Normal muscle tone. 3. Slight increase, catch or minimal resistance 2. Marked increase in muscle tone, full PROM available 1. Difficulty moving through ROM, PROM reduced 0. Rigid in flexion or extension, or flaccid MOVEMENT SCALE 4. Normal movement, but may be weak or agitated 3. Active movement through 1/4 ROM 2. Some movement or flickers 1. Moves in mass patterns or reflexive movement 0. No active movement

SITTING Control Alignment

Head

Trunk

POSTURE BILATERAL HEMIPARESIS +/SPASTICITY HEMIPLEGIA HEMIPARESIS MONOPLEGIA MONOPARESIS

0 1 2 3 4 CONTROL SCALE 4. Holds in midline for 10 secs 3. Holds for in any position 10 sec 2. Hold for 5 sec 1. Hold for 1 sec 0. Unable to Hold

Total Score:

/ 60

ABIPA GUIDELINES
The ABIPA is designed for patients in the acute phase after a severe brain injury or subarachnoid haemorrhage. It is a global assessment based on observation, which considers overall patterns. The scale can be used with patients who are unable to follow commands or have cognitive deficits. 1. ALIGNMENT IN SUPINE The resting alignment of the patients head and trunk is observed from the bedside. The patient is then placed in a midline position with a single pillow and allowed to settle before assessing alignment which is graded for obvious deviations from midline. Trunk alignment observations are confirmed by palpation. 4. 3. 2. 1. 0. Aligned in all three planes, midline position Alignment is lost in one plane, either sagittal, coronal or transverse Alignment is lost in any two planes Alignment is lost in all three planes Patient is fixed in a position, or alignment is unable to be assessed (for example due to medical equipment, positioning, and orthopaedic injuries)

2.

GENERAL TONE

This subscale is based on the Modified Ashworth scale and considers only the presence or absence of tone and not its source. Joints are moved through passive range of motion three times then graded on the worst score (for repetition of PROM, or joint). 4. 3. 2. 1. 0. Normal muscle tone Slight increase, catches or minimal resistance, including patient resisting More marked increase in muscle tone through ROM, full PROM available Difficulty with passive movement due to tone, PROM reduced Rigid in flexion or extension, or limb is flaccid.

3. MOVEMENT SCALE This subscale looks for active movement, whether normal and selective or pathologic. All four limbs are assessed individually by: Patient is observed for any spontaneous movement including reflexive, patterned or selective movement. Asking: Patient is asked to move the limb in any way possible. Positioning: Place the patients limb in a mid range position and note any muscle activity or holding ability. Feeling: Move the limb through range noting any active involvement. Looking: Complete all components of the assessment and grade on completion, unless the patient scores 4 in which case assessment of that limb is concluded.

4. 3. 2. 1. 0.

Movement appears normal, but may be weak or agitated. Some active movement felt, anywhere in ROM for >= ROM Some active movement evident or flickers at any point in range Movement in mass patterns of flexion or extension, or reflexive movement No active movement

4. CONTROL SCALE The control subscale requires the patient to be sitting on a firm surface with feet supported. The ability to hold or maintain this position with normal or abnormal muscle activity is assessed and timed using a stopwatch. For head control, the trunk should be fully supported midline. 4. 3. 2. 1. 0. Able to hold in midline 10 seconds Able to hold in any position 10 seconds Able to hold any position for 5 seconds Able to hold any position for 1 seconds Unable to hold position, no active involvement, patient completely dependent and falls unless supported

Note: Score head and trunk = 0: if for any reason the patient is unable to achieve sitting, for example medical limitations, safety, or concomitant injuries 5. ALIGNMENT IN SITTING Alignment in sitting is rated using the same scale as alignment in supine. The patient should be sitting on a firm surface with feet supported. For head alignment have the trunk fully supported in midline, take the head to midline and release as able. For patients constantly moving, repeat three times and rate on the worst alignment. Note: Score head and trunk = 0: if for any reason the patient is unable to achieve sitting, for example medical limitations, safety, or concomitant injuries Score head = 0: if patient does not have any head control (as per control scale) Score trunk =0: if patient requires maximum assistance to maintain sitting 6. POSTURE Overall posture is rated based on the completed assessment of tone, movement, alignment and control. 4. 3. 2. 1. 0. Monoparesis - weakness in one limb Monoplegia - no or abnormal movement in one limb, may be spastic or flaccid Hemiparesis - weakness of one side of body Hemiplegia - one side of body affected, no movement present in one side, may have spastic or flaccid limbs Bilateral hemiparesis +/ spasticity - all four limbs involved