Scales & Tables Reference
Every major PM&R outcome measure and classification system — click any card to expand. Use the search to filter by name or keyword.
Top 10 Board Pearls
1FIM 3 = Mod assist: patient does 50–74% of effort (examiner does 26–49%)
2ASIA D: ≥50% key muscles below NLI are grade ≥3 (useful motor)
3Brunnstrom Stage 4 is where out-of-synergy movement first appears
4Berg <45 = increased fall risk; 0–20 = wheelchair bound
5Modified Ashworth 1+ = catch <50% ROM; distinguishes from "2" (most of ROM)
6GCS ≤8 = severe TBI; intubation threshold; 13–15 = mild
7FIM efficiency = (Dc FIM − Admit FIM) ÷ LOS; >1.5 pts/day = good rehab value
8Rancho IV (confused–agitated) is not a safe discharge level; patient is combative
9Waddell ≥3 signs → non-organic component; does not mean malingering
10MRC grade 3 = moves against gravity but no added resistance (pivotal for ASIA grading)
ASIA Impairment Scale (AIS)
AIS / ASIA ▾| Grade | Classification | Definition |
|---|---|---|
| A | Complete | No motor or sensory function preserved in sacral segments S4–S5 |
| B | Incomplete — Sensory | Sensory but no motor function preserved below the neurological level, including S4–S5 |
| C | Incomplete — Motor (non-functional) | Motor preserved below NLI; >50% of key muscles below NLI have grade <3 |
| D | Incomplete — Motor (functional) | Motor preserved below NLI; ≥50% of key muscles below NLI have grade ≥3 |
| E | Normal | Sensory and motor function are normal; patient may have prior deficits |
Board pearl: ASIA C vs D hinges on 50% of key muscles at grade 3. AIS B → C requires voluntary anal contraction OR motor 3+ more than 3 levels below NLI.
Key Motor Levels
| Level | Key Muscle |
|---|---|
| C5 | Elbow flexors (biceps) |
| C6 | Wrist extensors (ECRL/ECRB) |
| C7 | Elbow extensors (triceps) |
| C8 | Finger flexors (FDP) |
| T1 | Small finger abductors (ADM) |
| Level | Key Muscle |
|---|---|
| L2 | Hip flexors (iliopsoas) |
| L3 | Knee extensors (quadriceps) |
| L4 | Ankle dorsiflexors (tibialis anterior) |
| L5 | Long toe extensors (EHL) |
| S1 | Ankle plantar flexors (gastroc/soleus) |
Scoring: UEMS (C5–T1, bilateral) = max 50. LEMS (L2–S1, bilateral) = max 50. Total Motor Score = max 100. One key sensory point per dermatome C2–S4/5.
Frankel Classification (SCI — historical)
Frankel ▾| Grade | Definition |
|---|---|
| A | Complete motor and sensory loss below injury level |
| B | Incomplete — sensory preserved only |
| C | Incomplete — motor preserved but not useful (grade 1–2) |
| D | Incomplete — motor preserved and useful (grade 3–4) |
| E | Normal motor and sensory function |
Board pearl: AIS has superseded Frankel but still appears on boards. Key distinction: Frankel C/D maps loosely to AIS C/D but lacks the precise 50% threshold. AIS is the modern standard.
Glasgow Coma Scale (GCS)
GCS ▾| Eye Opening (E) | |
|---|---|
| 4 | Spontaneous |
| 3 | To voice |
| 2 | To pain |
| 1 | None |
| Verbal Response (V) | |
|---|---|
| 5 | Oriented |
| 4 | Confused |
| 3 | Inappropriate words |
| 2 | Sounds |
| 1 | None |
| Motor Response (M) | |
|---|---|
| 6 | Obeys commands |
| 5 | Localizes pain |
| 4 | Withdraws |
| 3 | Abnormal flexion (decorticate — cortex lesion) |
| 2 | Extension (decerebrate — brainstem lesion) |
| 1 | None |
| GCS Total | TBI Severity | Clinical Note |
|---|---|---|
| 13–15 | Mild TBI | LOC <30 min; PTA <24h |
| 9–12 | Moderate TBI | LOC 30 min–24h; PTA 1–7 days |
| ≤8 | Severe TBI | LOC >24h; intubation threshold; ICU admission |
Board pearl: Minimum GCS = 3 (not 0). Decorticate (flexion) = lesion above midbrain; decerebrate (extension) = midbrain/pontine lesion — worse prognosis.
Rancho Los Amigos Levels of Cognitive Functioning
RLA / Rancho ▾| Level | Name | Behavior / Clinical Features |
|---|---|---|
| I | No Response | Unresponsive to any stimuli |
| II | Generalized Response | Inconsistent, non-purposeful responses; often to pain only |
| III | Localized Response | Inconsistent but purposeful responses; follows simple commands inconsistently |
| IV | Confused — Agitated | Heightened activity, severely decreased attention; aggressive/combative behavior; verbalizes incoherently |
| V | Confused — Inappropriate, Non-Agitated | Agitation resolved; still severely impaired memory; follows simple commands consistently; no carryover |
| VI | Confused — Appropriate | Goal-directed but dependent on external cues; some carryover of learning |
| VII | Automatic — Appropriate | Follows routine appropriately with minimal confusion; good memory for daily events; poor recall for remote events; lacks insight |
| VIII | Purposeful — Appropriate | Alert, oriented; needs standby assist or supervision for cognitively demanding tasks |
| IX | Purposeful — Appropriate | Independent with standby assist as needed; recognizes and compensates for deficits |
| X | Purposeful — Appropriate | Modified independent; uses assistive memory devices; anticipates problems |
Board pearl: Level IV (Confused–Agitated) is not a safe discharge level. Inpatient rehab admission typically starts at Level IV–V when agitation is manageable. Family training appropriate at Level VII–VIII.
Brunnstrom Stages of Motor Recovery (Stroke)
Brunnstrom ▾| Stage | Name | Motor Characteristics |
|---|---|---|
| 1 | Flaccidity | No voluntary movement; flaccid paralysis immediately post-stroke |
| 2 | Synergy Emerging | Spasticity begins to appear; minimal voluntary movement; limb synergies start to develop |
| 3 | Synergy Peak | Spasticity at peak; voluntary movement only within obligatory flexion/extension synergy patterns |
| 4 | Out-of-Synergy Begins | Spasticity begins to decline; first out-of-synergy movements possible (some combinations outside synergy) |
| 5 | Out-of-Synergy Increasing | Spasticity continues to wane; more complex independent joint movements; combinations outside synergy more reliable |
| 6 | Near-Normal | Isolated joint movements; spasticity nearly absent; coordination close to normal but subtle deficits may remain |
| 7 | Normal | Normal movement (sometimes added); full recovery |
UE Flexion Synergy (typical)
- Scapular retraction/elevation
- Shoulder ER + abduction
- Elbow flexion
- Forearm supination
- Wrist/finger flexion
LE Extension Synergy (typical)
- Hip extension + adduction + IR
- Knee extension
- Ankle plantar flexion + inversion
Board pearl: Stage 4 is the exam pivot — this is where out-of-synergy movement first appears. Stages 1–3 = synergy-dominated. Stages 4–6 = escape from synergy.
Functional Independence Measure (FIM)
FIM ▾| Level | Label | Patient % Effort | Helper % Effort |
|---|---|---|---|
| 7 | Complete Independence | 100% | None |
| 6 | Modified Independence | 100% (uses device/more time/safety concern) | None |
| 5 | Supervision / Set-Up | 100% | Standby only |
| 4 | Minimal Assist | ≥75% | ≤25% |
| 3 | Moderate Assist | 50–74% | 26–49% |
| 2 | Maximal Assist | 25–49% | 51–75% |
| 1 | Total Assist | <25% | >75% |
Motor Subscale (max 91) — 13 items
| Self-Care | |
|---|---|
| 1 | Eating |
| 2 | Grooming |
| 3 | Bathing |
| 4 | Upper extremity dressing |
| 5 | Lower extremity dressing |
| 6 | Toileting (perineal hygiene) |
| Sphincter Control | |
| 7 | Bladder management |
| 8 | Bowel management |
| Transfers | |
| 9 | Bed/chair/wheelchair transfer |
| 10 | Toilet transfer |
| 11 | Tub/shower transfer |
| Locomotion | |
| 12 | Walk/wheelchair locomotion |
| 13 | Stairs |
Cognitive Subscale (max 35) — 5 items
| Communication | |
|---|---|
| 14 | Comprehension |
| 15 | Expression |
| Social Cognition | |
| 16 | Social interaction |
| 17 | Problem solving |
| 18 | Memory |
Score Summary
Total max: 126
Motor max: 91 (13 × 7)
Cognitive max: 35 (5 × 7)
Minimum: 18 (18 × 1)
FIM efficiency =
(Discharge FIM − Admit FIM) ÷ LOS days
Motor max: 91 (13 × 7)
Cognitive max: 35 (5 × 7)
Minimum: 18 (18 × 1)
FIM efficiency =
(Discharge FIM − Admit FIM) ÷ LOS days
Board pearl: FIM does NOT measure how well, only how much help is needed. FIM 3 (Mod Assist) means patient provides 50–74% of the effort — the most tested level. FIM efficiency >1.5 points/day is generally considered good rehab ROI.
Berg Balance Scale
BBS ▾| Score Range | Fall Risk / Function |
|---|---|
| 41–56 | Low fall risk — independent ambulation |
| 21–40 | Medium fall risk — ambulatory with assistance |
| 0–20 | High fall risk — wheelchair dependent |
14 items tested (each scored 0–4):
1. Sitting unsupported
2. Sitting → standing
3. Standing unsupported
4. Standing → sitting
5. Transfers (chair to chair)
6. Standing eyes closed
7. Standing feet together
8. Reaching forward (arms outstretched)
9. Pick up object from floor
10. Turn to look behind
11. Turn 360°
12. Tandem stepping on stool
13. Tandem standing
14. One-leg standing
Board pearl: A 4-point drop in BBS score predicts fall risk more reliably than a single threshold. Tandem standing and one-leg standing are the highest difficulty items (hardest to score 4). A score of <45 triggers fall precautions in most inpatient programs.
Modified Ashworth Scale (Spasticity)
MAS ▾| Grade | Description |
|---|---|
| 0 | No increase in muscle tone |
| 1 | Slight increase — catch and release OR minimal resistance at end range of motion only |
| 1+ | Slight increase — catch followed by minimal resistance throughout less than 50% of ROM |
| 2 | Marked increase in tone through most of ROM, but part can still be moved easily |
| 3 | Considerable increase in tone; passive movement difficult |
| 4 | Limb rigid in flexion or extension |
Board pearl: Grade 1 vs 1+ is the tricky distinction — the key is whether resistance persists beyond the catch point. Grade 1 = catch only at end range; Grade 1+ = catch then resistance through <50% of the arc. Grade 2 = resistance through >50% but part moves easily.
MRC Muscle Strength Grading
MRC ▾| Grade | Description | ASIA Relevance |
|---|---|---|
| 0 | No contraction | AIS motor 0 |
| 1 | Flicker or trace contraction visible/palpable; no movement | AIS motor 1 |
| 2 | Active movement through full ROM with gravity eliminated (horizontal plane) | AIS motor 2 |
| 3 | Active movement against gravity only; no added resistance | AIS motor 3 — pivot for C/D |
| 4 | Active movement against gravity with some resistance (can subdivide 4−, 4, 4+) | AIS motor 4 |
| 5 | Normal power — full resistance | AIS motor 5 |
Board pearl: MRC 3 is the ASIA threshold for C vs D (≥50% of key muscles at grade ≥3 = AIS D). Testing position matters for gravity elimination (grade 2) — hip abductors tested in side-lying, shoulder abduction in supine, etc.
Oswestry Disability Index
ODI ▾| 10 Sections (0–5 each) | |
|---|---|
| 1 | Pain intensity |
| 2 | Personal care / ADLs |
| 3 | Lifting |
| 4 | Walking |
| 5 | Sitting |
| 6 | Standing |
| 7 | Sleeping |
| 8 | Sex life (if applicable) |
| 9 | Social life |
| 10 | Travelling |
| % Score | Disability Category |
|---|---|
| 0–20% | Minimal disability |
| 21–40% | Moderate disability |
| 41–60% | Severe disability |
| 61–80% | Crippling disability |
| 81–100% | Bed-bound or symptom exaggeration |
Scoring: Total raw score ÷ 50 × 100 = %. If a section is skipped (e.g., sex life not applicable), adjust denominator: ÷ 45 × 100. Minimum clinically important difference (MCID) ≈ 10–15% change.
Waddell Signs (Non-Organic Low Back Pain)
Waddell ▾| Sign | Category | Test |
|---|---|---|
| 1 | Tenderness | Superficial: light skin-roll tenderness over lumbar area Non-anatomic: deep tenderness over wide area, non-dermatomal |
| 2 | Simulation | Axial loading: downward pressure on skull causes LBP Rotation: passive shoulder/pelvis rotation together → LBP |
| 3 | Distraction | SLR markedly different supine vs. seated (distracted). Positive = seated SLR normal but supine markedly abnormal |
| 4 | Regional | Give-way weakness: sudden give-way on strength testing Non-dermatomal sensory loss: stocking-glove, global hemisensory |
| 5 | Overreaction | Disproportionate verbalization, facial expression, muscle tension, tremor, or collapse during examination |
Board pearl: ≥3 of 5 Waddell signs = significant non-organic component. This does NOT mean malingering — it identifies psychological overlay that affects outcomes. Used in FCE and disability evaluations but should not end the diagnostic workup.