Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy
Core concepts
Candidates must select and interpret tests for impairment, activity, and participation, and understand their psychometric properties (reliability, validity, responsiveness, minimal detectable change, minimal clinically important difference). Know common measures: Berg Balance Scale, Dynamic Gait Index, Functional Gait Assessment, Timed Up and Go, 10-Meter Walk Test, 6-Minute Walk Test, Five-Times Sit-to-Stand, Trunk Impairment Scale, Fugl-Meyer Assessment, and the NIH Stroke Scale as a medical tool. Understand tone assessment (Modified Ashworth), reflex testing, cranial nerve screening, coordination testing, and sensory examination. Evaluation integrates examination data with history and systems review to form a diagnosis and prognosis.
Traps
Questions test whether you know when a measure is inappropriate (e.g., Berg in a patient who cannot stand unsafely). Distinguish screening from diagnostic tests and impairment from activity measures. Watch for confusion between MDC (change beyond measurement error) and MCID (change meaningful to the patient). Do not confuse the NIH Stroke Scale (severity, medical) with functional outcome measures.
Rule of thumb
Match the measure to the construct and the patient's ability: choose tools that are valid for the population, feasible in the setting, and responsive to the change you expect. Report scores with their interpretation, not just the number.
Worked example
A patient with chronic stroke walks 0.6 m/s. The 10-Meter Walk Test is appropriate and responsive; a change exceeding the MDC suggests real change, while exceeding the MCID suggests clinically meaningful improvement.