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AFTER STROKE:
CANDIDATE
SUMMATIVE
ASSESSMENT PACK
You will be informed of your final course assessment mark within one month of Day 6. This will
be in the form of a Candidate Assessment Record, Coursework Case Study Feedback, a Practical
Observation Checklist and Assessors Feedback Sheets (examples given later). In order to receive
your Qualification Certificate you must hold a valid CPR Certificate. Refer also to page 24.
This 20-credit course has been validated through Queen Margaret University (QMU) at Level 8 of the
Scottish Credit and Qualifications Framework. This is equivalent to a BSc(Hons) module at Level 2.
The assessment consists of two components:
2. The Practice
The EfS practice assessment comprises 60% of the overall course module mark. It comprises two
parts:
2.1 ONE Group 30 minute Practical Examination, combined with:
2.2 ONE Strength exercise delivered to, and ONE outcome measure conducted with, an
individual participant.
Further information on each component of the assessment can be found later in this Summative
Assessment Manual.
In order to pass this assessment, candidates will have to demonstrate that they have achieved the
following learning outcomes (Skills Active Stroke Standards) associated with this module:
In cases where a student refers on any part of the EfS Course Assessment, the student shall
normally be reassessed in the failed component only. If you have any questions about assessment
and cannot find the answer in this document, please contact the LLT Office or speak to your
course tutor.
Specifications
The written exam will have a duration of 2 hours, preceded by 5 minutes reading time. The exam
will consist of 20 questions, 15 of which are short answer questions and 5 are multiple choice
questions on medication. The exam is designed to test your knowledge and understanding of all
the theory discussed during the course, i.e.:
• Stroke
• Treatment after stroke
• Physical fitness after stroke: theory and evidence
• Physical fitness after stroke: guidelines for practice including health and safety, referral,
ethics and professional standards.
A useful source for exam questions are the directed learning questions in your “Tutorial, Self
Assessment and Distance Learning Pack”.
Sample questions
1. What is the difference between the two main types of stroke? (5 marks)
2. A 84 year old lady who had had a lacunar ischaemic stroke was referred for exercise. She
had a past history of asthma. She mentioned that she was dizzy when she stood up. Which
of her drugs are most likely to be the cause? (2 marks)
a) Salbutamol inhaler
b) digoxin
c) lisinopril (an angiotensin converting enzyme inhibitor)
d) aspirin
e) simvastatin
3. The multidisciplinary team involved in stroke rehabilitation often involves a speech and
language therapist (SLT). List five important aspects that characterise the role of the SLT in
this context. (5 marks)
4. With respect to the STARTER trial: what is the rationale for including the “Sit to stand”
exercise? (5 marks)
5. Exercise instructors need to undertake a specific risk assessment for people exercising after
stroke. Describe two stroke-specific impairments and explain, in detail, what action you
would undertake to reduce the risk associated with each of these impairments. (20 marks)
1. Answer: Ischaemic strokes are due to a blockage of the blood supply to part of the brain
whereas haemorrhagic strokes are due to bleeding in the brain
2. Correct answer is c)
3. The answer should include any five of the following (1 mark per point):
• Assessment and diagnosis
• Provision of information and support
• Individualised SLT therapy programme to maximise function
• Strategies to compensate for the communication impairment
• Facilitate access to information
• Advice and training (of others) to facilitate interaction
• Assessment for and provision of alternative and augmentative methods of
communication
• Referral to support groups / other professional support
• Liaison with others
5. The answer should include two of the risks listed in the syllabus with the indicated action
explained, e.g.:
• Symptom: Abnormal Tone (1 mark)
• Description: Altered tone is an “ Abnormal response to stimuli resulting in alteration in
muscle function” i.e. the muscles affected by the stroke may behave differently from
1. From the information provided about Mr. R, identify the impairments and activity
limitations. Select one impairment and one activity limitation and explain, in detail, how
each of these might impact on Mr. R’s ability to exercise.
2. Before Mr. R. is allowed to commence his exercise programme, indicate which other
information you require from Mr. R’s GP, who referred him for exercise.
3. Having obtained the required information from his GP, Mr. R has now been enrolled in your
exercise programme. Explain the possible impact of Mr. R’s co-morbidities and medications
on his abilities to exercise. Which symptoms will you need to monitor especially?
4. Mr. R experiences a degree of executive dysfunction. This first manifests itself in your initial
session, where he expresses some goals that are clearly unrealistic (i.e. “I want to be able to
walk to the gym instead of taking the bus” - he lives 1 mile away from the gym). Detail
which measures you will put in place to help Mr. R achieve his personal goals through his
exercise programme and explain your rationale.
5. In relation to the impairment and activity limitation identified in question 1, explain how you
will reduce the risks associated with each of these two problems in your exercise
programme.
6. In order to be able to evaluate the effectiveness of the exercise programme for Mr. R, Select
two different assessment tools that you might use for his outcome measures, and provide a
clear rationale for selecting each of your tools.
7. Based on the specific case information, as well as the relevant evidence and national
guidelines on exercise after stroke, complete a ONE HOUR session plan for week 7-8,
following the STARTER plan (issued in class). Design appropriately adapted exercises with
tailoring strategies/approaches to meet Mr R’s needs and specific impairments, based on
Please bring your completed case study coursework to Day 6 of the course. You should also bring
your completed session plan to your practical assessment, as you will be expected to teach
elements of this. Your handed in coursework will not be returned to you so please keep a copy.
Your session plan has no word count but must be an appropriate length. A session plan template
can be found on page 19, for you to photocopy and use. Alternatively an electronic session plan
(word document) can be downloaded from the EfS Student Webpage on the LLT website. Your
plans can be completed with neat hand-writing (but must be in INK) or word-processed and each
page of the plan needs to be signed and dated.
20.1 A piece of written work which exceeds the specified word limit by 10% or more will receive a
maximum mark of 40% for undergraduate or 50% for postgraduate programmes.
20.2 In each piece of written work where a word limit is identified, students are required to include and
clearly state the total number of words used. The number of words counted should include all the
text, references and quotations used in the text, but should exclude abstracts, supplements to the
text, diagrams, appendices, reference lists and bibliographies.
In addition, extracts from the LLT EfS terms and conditions state that:
13. Deferral during the course – if candidates wish to defer the course assessments (Theory Paper, Case Study
and Practical Assessment) there will be an administration charge of £50. Once candidates have signed the
assessment sign-up form on DAY 3 of the course, failure to attend the assessments (‘late deferral’) will
result in a maximum re-assessment fee of £140. Late deferred assessment costs are £35 for the Theory
Paper, £35 for the Case Study, £25 for the Session Plan (where the Practical teaching was passed) and £70
for the Practical Assessment. Late deferrals of all assessments with a Med 3 Certificate received by LLT and
related to the assessment date, will incur an administration charge of £50 only and the place will be
transferred to a future course. No refunds will be given if course assessments are not taken. An invoice for
late deferral costs will be sent to the Individual or Host/Funder, as appropriate, as soon as transfer course
and dates are agreed, and must be paid before the assessment dates.
14. Assessment referrals – a referral of any part of the assessments will result in a re-assessment. The re-
assessment costs are £35 for the Theory Paper, £35 for the Case Study, £25 for the Session Plan (where the
Practical teaching was passed) and £70 for the Practical Assessment. A maximum of three referrals on an
assessment is permitted before having to re-take the full course at full course cost. An invoice for referral
costs will be sent to the Individual or Host/Funder, as appropriate, as soon as transfer course and dates are
agreed and must be paid before the assessment dates. Non attendance at the arranged re-assessment of
the referred Assessments will not generate the refund of re-assessment costs and will be subject to the
same Med 3 Certificates requirements as covered in items 14 above.
24.1.1 This institution’s degrees and other academic awards are given in recognition of the candidate’s
achievement. Plagiarism is therefore, together with other forms of academic dishonesty such as
personation, falsification of data, computer and calculation fraud, examination room cheating and
bribery, considered an act of academic fraud and is an offence against University discipline.
24.1.2 Plagiarism is defined as follows:
The presentation by an individual of another person’s ideas or work (in any medium, published or
unpublished) as though they were his or her own.
24.1.3 In the following circumstances academic collusion represents a form of plagiarism:
Academic collusion is deemed to be unacceptable where it involves the unauthorised and
unattributed collaboration of students or others work resulting in plagiarism, which is against
University discipline.
24.1.5 QMU has a policy to use the TurnItIn UK plagiarism detection system, or other equivalent systems, to
help students avoid plagiarism and improve improve their scholarship skills.
Personal details:
Name: Mr. R
Address: provided (but omitted from case study for data protection reasons)
DOB: provided (but omitted from case study for data protection reasons). Age: 55 years.
Telephone number: provided (but omitted from case study for data protection reasons)
GP Details: all details provided (but omitted from case study for data protection reasons)
Prior to the stroke, Mr. R was a heavy smoker. Mr. R still occasionally smokes and has a generally
low alcohol intake per week (i.e. 1 pint of beer on Friday-Sunday).
Current medication :
o Tramadol 150 mg qds
o Perindopril 4mg od
o Simvastatin 80mg od
o Aspirin 75 mg od
o Bendroflumethiazide 2.5 mg od
o Fluoxetine 20mg od
o Diazepam 2mg prn
o Dipyridamole SR 200mg bd
Gait
• hip and pelvis on the affected side are externally rotated
• full knee extension is limited at the end of the swing phase of gait, prior to heel strike.
• during mid to end stance phase, the affected leg is still externally rotated but the knee has
the tendency to hyperextend.
Pain control
• increased tone in general is an issue which is associated with chronic pain affecting his L hip,
thigh and shoulder regions as well as restricting range of movement at these joints.
Social History
Mr R was previously self-employed in a variety of jobs, ranging from garage foreman to supermarket
agent, but has been unable to return to work after his stroke. He admitted having a generally poor
diet with little regular exercise prior to his stroke, mainly because of irregular hours and the
frequently changing locations of his job. Since his stroke, Mr. R has moved with his wife from a two-
storey house to a bungalow. This has an extensive garden, which he loves tending. However, this
has a variety of surface areas, including a few steps which he currently has difficulty negotiating.
Mr. R is planning to grow a range of fruit and vegetables this summer which he hopes to harvest by
himself. Mr. R manages to get himself up, showered and dressed each morning, but requires approx
1 hour to achieve this. He has a Modified Barthel Index score of 94/100. Mr. R is now regularly
Further information
In his referral letter to you, the GP provides the following additional information: Mr. R is highly
motivated to exercise, but admits experiencing frustration at times - especially concerning the lack
of return of function in his upper limb; prior to the stroke, Mr. R was left hand dominant. The GP
feels that exercise may be of benefit to Mr. R to increase his general level of fitness, lower his level
of cholesterol and blood pressure and enable him to reduce his medication for these conditions.
According to the GP, Mr. R specifically wants to improve his arm function to make it easier to engage
in the gardening activities that he enjoys. He would also like to improve his balance and leg strength
so he can manage getting on/ off the ground easier when kneeling to manage his flower beds. The
GP emphasises the need for adequate supervision, especially given the degree of Mr. R’s executive
dysfunction.
Video footage of this case study will be available on the EfS Student webpage. You will be
able to watch these clips as often as you like.
You will need to bring along the 1 hour Session Plan you have created for your Case Study 2, based
on week 7-8 of the STARTER programme (see Section 1.2)
The practical assessment consists of a demonstration of your exercise and teaching technique and
approaches. This, includes the need to demonstrate your ability to adapt and tailor your proposed
session plan for the range of designated impairments modelled by your peers (ie. the individual
participants in the session). These competencies and will be marked against the Summative Practical
Observation Checklist (pages 30-31) –against strict criteria (pages 32-36). Your assessor will provide
you with written feedback based on these criteria (page 40).
On Day 6 of the course, you will be asked to draw tickets from a hat to indicate the specific
exercises you will be required to teach and which outcome measure you are required to
apply/administer. You will then be given 10 minutes to prepare and set up any equipment for the
whole of the practical assessment, including the outcome measure. Further details on pages 25-26.
Following your session you will be expected to complete a Self Evaluation based your own thoughts
about your performance as a specialist instructor on this occasion and how this correlates with the
feedback gained from the group (see pages 41-42).
You will be teaching a group (your peers on the course). Your peers will have badges with specified
impairments clearly visible. You must tailor and adapt the exercises to meet their needs.
2.2 ONE Strength exercise delivered and tailored to, and ONE outcome
measure conducted with, an individual participant.
Following straight on from your group practical assessment, you will then be asked to teach the
second strength exercise you have been allocated, this time to an individual participant. Then you
will be asked to demonstrate and conduct ONE outcome measure (pages 43-45) with that individual
participant.
You will need to complete a Health & Safety/Risk Assessment for the session. Guidance and advice
on completing this is provided (see pages 27-29).
Identifying Hazards can help determine the level of risk by asking ‘What If…?’ scenario questions
surrounding the environment/ activity
- Personal Observation - Workforce Consultation
- Previous Experience - External Advice
If the Risk Rating is between 1-4 = Low Risk = Existing control measure must be maintained
If the risk Rating is between 5-10 = Medium Risk = Action required soon to control. Interim
measure may be necessary in short term
If the risk rating is between 12-25 = High Risk = Action required urgently to control. Further
resources may be required.
You should complete the Health and Safety Venue Assessment Checklist (page 27), the
Environmental / Exercise/ Client Based Risk Assessment (page 28) and, if your risk rating is either
medium or high risk please complete the Medium / High Risk Continuation Assessment (Page 29).
1. WARM UP
You will be required to teach only TWO elements from the warm up component (ie ONE Circulation
exercise and ONE Mobility exercises) but the other warn up exercises should be included in your
session plan
1a WARM UP: circulation exercise: gentle 'pulse raiser' i.e. low level marching on the spot/ side
stepping
1b1 WARM UP: mobility: shoulders (standing with 1 person seated)
1b2 WARM UP: mobility: lateral spinal flexion (trunk side bend)(standing with 1 seated)
1b3 WARM UP: mobility: spinal rotation (trunk twist)(standing with 1 person seated)
1b4 WARM UP: mobility: ankle flexion and extension(standing with 1 person seated)
1c1 WARM UP: stretches: calf (standing with 1 person seated)
1c2 WARM UP: stretches: hamstrings (all seated)
1c3 WARM UP: stretches: pectorals (all seated)
1c4 WARM UP: stretches: triceps (all seated)
1c5 WARM UP: stretches: latissimus (standing with 1 person seated)
4. COOL DOWN
You will be required to teach ONE flexibility stretch from the cool down component but all elements
of the cool down should be included in your session plan.
4a COOL DOWN: circulation exercise: gentle 'pulse lowerer' i.e. low level marching on the spot.
4b1 COOL DOWN: stretches: calf (standing)
4b2 COOL DOWN: stretches: pectorals (seated)
4c3 COOL DOWN: stretches: hamstrings(seated)
4b4 COOL DOWN: stretches: triceps (seated)
4b5 COOL DOWN: stretches: latissimus (seated OR standing)
OUTCOME MEASURES
You will be required to demonstrate and conduct ONE of the following outcome measures.
Address of Venue
Client Information
Maximum number within class Any known special requirements of client group i.e. NO YES
Are support Staff required Medical/Overall Risk Stratification /Behavioural (if yes please indicate action below)
First Aid and Fire
Location of First Aid Kit Fire Exits
Venue specific procedure for 1st Aid Venue Specific procedure for Fire
Site Information
Location / Distance of toilets Wheelchair access
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
Floor L S =R H/M/L
Obstacles L S =R H/M/L
Equipment L S =R H/M/L
Lighting/Distractions L S =R H/M/L
Other L S =R H/M/L
Name of Risk Original Risk Rating Further Action taken to reduce risk rating Revised Risk Rating
Likelihood (L) x Severity (S) = Risk (R) Level
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
L S =R H/M/L
Source: St John Ambulance Issue 3 (2007). Level 2 Certificate in Risk Assessment Booklet. BSC Awards.
4) ENDING THE SESSION AND GAINING FEEDBACK - The candidate: (5) EVALUATING – The candidate evaluated correctly in terms of:
F1. Gained constructive feedback about strengths and gaps in meeting the assessment E1. Their application of the standard outcome measure
criteria from participants at the end of the session E2. Their own teaching skills
E3. Their delivery of contents of the session (safety and effectiveness)
E4.The feedback received from participants
KEY: P / √ = PASS = PASS WITH COMMENT Q = QUESTION R = REFER (3) TEACHING is overleaf
MOBILITY
Warm Up
Aerobic 1
Circuit
Aerobic 2
Circuit
(group)
Strength
stretch
Cool down
(1:1)
Strength
Measure
Outcome
Result
Overall
Practical Assessment. Success in 7 out of 8 sections is required to pass
(3) TEACHING – The candidate:
T1. Appropriately arranged the group, individuals and resources to allow for safe and effective exercise taking into account the needs of stroke
participants and individual functional ability/comprehension/communication etc
T2 Delivered safe and effective exercises appropriate to the component and in accordance with the evidence-based exercise programme and
rationale for fitness training after stroke
T3. Demonstrated and performed adapted exercises (with alternatives and tailored therapy led approaches for individuals) with correct
technique (posture, stable base, positioning, alignment, grip, movement quality /control) using appropriate visual and verbal cues and
information to account for the needs of stroke survivors and individual functional ability/comprehension/communication
T4. Gave effective and appropriate visual and verbal cues and instructions eg. adjusting pace of speech, language, volume and clarity of
instructions appropriate for a diverse range of communication challenges experienced by stroke survivors
T5. Explained the purpose of the exercises, relating them to activities of daily living & benefits for fitness after stroke and tailoring information in
an appropriate way for individuals with specific stroke related needs
T6. Provided specific teaching points and demonstrated use of therapy led approaches to stroke specific adaptations for all exercises to enhance
technique, safety and effectiveness (especially with relevance to inattention, memory loss and fatigue)
T7. Selected the appropriate intensity for the exercises (speed/level of effort) whilst monitoring and adjusting intensity for each individual,
tailoring to meet the needs of participants with stroke specific limitations
T8. Engaged participants in order to encourage, motivate and promote confidence and adapted communication skills (visual and verbal cues) to
meet the needs of each individual with relation to their specific physical and sensory impairments
T9. Offered alternatives to allow for different levels of ability and tailored exercises for individuals by responding to feedback from participants
and offer appropriate alternatives as well as offering stroke specific adaptations and progressions to the group as a whole
T10. Reinforced relevant teaching points at regular intervals recognising the need to adapt language and approaches for stroke survivors to
enhance performance (especially with relevance to inattention, memory loss and fatigue)
T11. Changed teaching position to improve observation and enhance communication to accommodate the stroke specific needs of each
participant
T12. Demonstrated the use of observation and effective correction which was appropriate and sensitive, respecting individuals dignity and
ability, to ensure the most effective performance considering the stroke specific needs of each participant
T13.Provided safe transitions and took measures to reduce the risk of falls through excellent group management skills between exercises and
session components (including use of equipment) and between exercises ensuring instructions are tailored to stroke specific conditions
T14. Asked questions and encouraged interactive communication, to check or clarify understanding in a way to engage and receive quality
feedback to ascertain that understanding has taken place (with respect to disarthia, dysphasia, cognition and sensory impairments)
T15. Spoke clearly, audibly and at an appropriate pace by adapting pitch/tone/timing and language with respect to disarthia, dysphasia,
cognition and sensory impairments
T16. Adapted exercises to meet the specific needs of stroke survivors. Delivered stroke specific adaptations to the group and offered tailoring
and alternatives to individuals (i.e. promoting external rotation at shoulder, stance positioning with AFO, unaffected side focus on shuttle
walk, bilateral assistive support on upper limbs with altered tone, postural stability strategies during knee raises)
T17. Demonstrated best practice to guide participants in preventing/managing adverse effects of exercise by observing and individual correction
to ensure movement patterns remain in optimum ranges without adverse affects (i.e. triggers that exercises may be too intense leading to
adverse tonal changes in affected limbs/posture)
(1) PLANNING –
The candidate produced a plan that:
P1. Included a health and safety • Clearly showed they had considered all aspects of health and safety to reduce risk by providing a written health
information sheet relevant to the and safety information sheet which included a risk assessment for the venue and participants. Covering issues
needs of participants and exercise concerning equipment, environment and the needs of the group. Identifying they had considered emergency
after stroke identifying specific procedures and first aid issues with particular attention to the needs of stroke survivors.
environmental and equipment
factors to ensure safety during the
session
P2. Produced a plan that was • Provided a plan using exercises from the stroke after exercise programme (STARTER) with particular attention to
appropriate to the needs of the evidence base and the specific adaptations for stroke survivors.
participants after stroke • Provided a plan selecting exercises from the STARTER programme, and demonstrated mastery of the therapy
led approaches to individual tailoring
P3. Selected safe and effective • Ensuring that each component is effective and appropriate for the needs of stroke survivors (eg appropriate
exercises appropriate to the content and intensity for fitness gains in EfS including appropriate number of reps/sets and timings tailoring for
component and fitness after stroke individual needs where appropriate)
(including warm-up and cool-down)
P4. Provided specific, relevant • Provided teaching points for all exercises with particular attention to stroke specific adaptations (eg outward
teaching points for each exercise in rotation with shoulder extension to reduce/prevent increased tone) ensuring that teaching points are specific to
order to provide a safe and effective the exercise.
session of exercise after stroke • Teaching points given where prioritized and specific to the exercise.
P5.Included alternative exercises • Provided alternatives to allow for individual fitness levels and ability to ensure the exercise is safe and effective
and tailoring of each component for all participants with consideration for issued concerning hemi-inattention, AFO splints and acemetrical
which enable stroke survivors to movement patterns
participate safely and effectively in
all exercises and components
P6. Contained exercises that reflect • Provided a plan that included components and exercises that reflect current guidelines/good practice (ie
current good practice and current included an appropriate warm up and cool down) with appropriate timings/intensity/reps for stroke survivors.
guidelines for exercise after stroke
T12. Demonstrated the use of observation and effective • Demonstrated effective observation and appropriate individual corrected technique in a sensitive way, respecting individuals dignity and
correction which was appropriate and sensitive, ability to ensure the best/most effective performance of each exercise by all participants (taking into account stroke specific conditions eg.
respecting individuals dignity and ability, to ensure visual impairments, those with altered body schema AFO’s, wrist splints and use of FES)
the most effective performance considering the
stroke specific needs of each participant
Summary of Assessment Date of Evidence & Summary of Candidates Action Plan for L4 Exercise and Assessors signature
Assessment Outcome (Delete Assessment Assessment Fitness Training after Stroke Qualification
as appropriate) Method
TRAINING PROVIDER:
APA WRITTEN
CERTIFICATE NUMBER:
CPR
DEFER Awarding date: Renewal date:
Criterion
No.
PEER FEEDBACK
After teaching my session, I received the following feedback from the
Participants (ie. my peers):
SELF EVALUATION ~
Comments on your thoughts of how your teaching met the Specialist EfS Instructor assessment
criteria
Assessor comments on how the candidate’s evaluation correlated with their teaching and
with participant feedback/Action plan
In the assessment, students will be asked to undertake one of the following THREE outcome measures in
a one-to-one setting:
- 10 meter walk test or
- Visual Analogue Scale or
- Timed Up and Go.
Protocol:
Set up a 10 m walkway, e.g. two lines, perpendicular to the direction of travel, and at a distance of 10m
apart. The participant is asked to walk at their preferred speed, using any aid needed (including personal
support, Wade, 1992). The participant starts 2m before the starting line and finishes 2 m over the
finishing line. Time is started as the leading foot first crosses the starting line and ends as the leading
foot first crosses the finishing line, respectively. If possible, the average of 3 tests should be taken, after
a practice trial.
References
SCHEFFER TM, HACKER TA, MOLLINGER L (2002). Age- and Gender-Related Test Performance in Community-
Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds.
Physical Therapy 82 (2): 128-137.
WADE DT (1992) Measurement in Neurological Rehabilitation, Oxford, Oxford University Press.
WILLENHEIMER R, ERHARDT L (2000) Value of 6-min-walk test for assessment of severity and prognosis of heart
failure The Lancet 355 (9203): 515 -516.
Introduction:
Visual Analogue Scales are used widely in health care settings to obtain a measure of a patient’s
perception of a health issue. There is a considerable body of research on the properties of the VAS.
“Pain” is probably the most widely assessed issue, but other examples include overall well-being and
function. Students may assess any issue, provided this is relevant to the participant in an exercise after
stroke setting. Examples discussed in class included: fatigue, confidence in a particular exercise, pain,
mood. The student must be specific in their statement, and the anchors must reflect extreme ends of
the spectrum pertaining to the construct being measured (e.g. no confidence at all/ extremely
confident). Students should check that the participant understands the statement, and how the VAS
works, since people with stroke may have difficulty understanding the tool (Price et al., 1999).
A VAS can be horizontal or vertical. For working with people with stroke, vertical VAS is less prone to
error than horizontal VAS (Price et al., 1999).
Protocol
The participant should be seated at a table.
Students are given a blank sheet of A4 paper, a pen and a ruler and are asked to construct a VAS at the
assessment.
The VAS comprises a line of 10 cm long without any numbers or subdivisions.
Each end of the line is anchored with an extreme statement reflecting the issue being measured, e.g.
“zero represents no pain whatsoever and 10 represents the worst possible pain”.
The assessor explains the VAS to the participant and clearly explains what the anchors stand for.
The VAS should then be offered to the participant, with the participant’s midline aligned with the
midline of the paper. The vertical VAS should be drawn in the middle of the paper (this is to avoid any
boas due to hemi-inattention, neglect or visual impairment).
The participant is then asked to mark the line at a position that indicates their current perception of the
issue being measured.
The location of this mark is then measured in millimetres from the lower end.
References
PRICE CIM, CURLESS RH, RODGERS H (1999) Can Stroke Patients Use Visual Analogue Scales? Stroke 30: 1357-
1361.
Introduction:
The Timed Up & Go was designed to assess basic mobility skills in frail elderly people, living in the
community. It is based on the Get-Up and Go test by Mathias et al. (1986), which was originally scored
on an observational scale. Time taken to perform the test is simple to measure and improves the
robustness of the results.
Protocol:
“The timed "Up & Go" measures, in seconds, the time taken by an individual to stand up from a standard
arm chair (approximate seat height of 46 cm), walk a distance of 3 meters, turn, walk back to the chair,
and sit down again. The subject wears his regular footwear and uses his customary walking aid (none,
cane, or walker). No physical assistance is given. He starts with his back against the chair, his arms
resting on the chair's arms, and his walking aid at hand. He is instructed that, on the word "go," he is to
get up and walk at a comfortable and safe pace to a line on the
floor 3 meters away, turn, return to the chair, and sit down again. The subject walks through the test
once before being timed in order to become familiar with the test. Either a wrist-watch with a second
hand or a stop-watch can be used to time the performance..” (Podsiadlo & Richardson, 1991, p. 142).
References
PODSIADLO D & RICHARDSON S (1991). The Timed "Up & Go": A Test of Basic Functional Mobility for Frail Elderly
Persons. Journal of the American Geriatric Society 39: 142-148.
SHUMWAY-COOK, A., BRAUER, S., & WOOLLACOTT, M. (2000). Predicting the probability for falls in community-
dwelling older adults using the timed up & go test. Physical Therapy, 80(9): 896-903.