nsaa version 2.0 manual may 2017 - muscular …...1. north star ambulatory assessment (nsaa) –...

1. NorthStarAmbulatoryAssessment(NSAA)–Version2.0

TestDescription

TheNSAAisa17-itemscalethatgradesperformanceofvariousfunctionalskillsonascalefrom0(unable),1(completesindependentlybutwithmodifications),and2(completedwithoutcompensation).

NOTE:Theorderhasbeenmodifiedtoenablemoreefficientconductoftheassessment.

a. ClimbandDescendstairs:climbboxstepisperformedstepupright,stepdownright,stepupleft,stepdownleft.

b. Liftsheadisperformedbefore‘getstositting’and‘risefromfloor’toavoidfatigue.

TestGuidelines

• Performanceofuprightactivitiesmustnotbecompletedifalowerlimbinjuryexists.However,thesubjectmayperformtheheadliftandgets-to-sittingitemsifheisable.Provide‘comments’onthesourceworksheet.

• CompletetheNSAAintheorderprovided(Pleasenotethishasbeenmodifiedfromprevioustrialsforasmootheradministration).

• DoNOTuseamat.

• Pleasenotethetimeinsecondsroundedtothenearesttenthofasecondforalltimedtests(eg,risefromfloorand10m‘run’).

• Generally,activitiesaregradedinthefollowingmanner:

Scoreof2=‘Normal’–noobviousmodificationofactivity

Scoreof1=Modifiedmethodbutachievesgoalwithnophysicalassistance

Scoreof0=Unabletoachievegoalindependently

• Ifyouthinkthesubjectiscapableofabetterperformance,duetonon-complianceorimprovedunderstandingoftask,itisacceptabletoaskthesubjecttorepeattheitemandre-scoreifappropriate.

• Ifunsureiftheperformanceonaparticularitemmeetsthehighercriteria,givethesubjectthelowerscore.

Set-Up

• Markoffa10-metrecourseinalong,quiethallwayorroom.Providea‘finish’lineatapproximately11metrestoensurethesubjectmoves‘through’the10-metreline,ratherthanslowingdownpriortofinishing.

• Ensureaclearfloorspace,measuringapproximately10feetx12feet,isavailableforremainingassessments(i.e.,risefromfloor).

ConductingtheTest

Testitem1:Standing

Startingposition

Feetmustbenofurtherthan10cmapartandheelsonthegroundifpossible.Armsbysides.

Instruction Canyoustanduptallformeforaslongasyoucanandasstillasyoucanforthreesecondswithyourheelsflatontheground?

Scoringdetail Whencountingto3–Use“And1,and2,and3”sothatthreesecondsisachievedonthewordof3.Score2-Minimumcountof3seconds.

Activity 2 1 0

Standing Standsupright,still,symmetrical,withoutcompensation(heelsflatandhipsinneutralrotation)forminimumcountof3seconds

Standsstillbutwithcompensation(e.g.ontoesorwithlegsabductedorwithbottomstuckout/hipflexion,etc)forminimumcountof3seconds

Cannotstandstillorcannotstandindependently,needssupport(evenminimal)

Photographs/

Notes

Score2-Symmetricalheelsflat

Score1–Asymmetricorcompensation

Testitem2:WalkStartingposition Standing.Observewalkforatleast10stepsinbothsagittalandcoronal

planes.

Instruction CanyouwalkfromAtoB(statetoandwherefrom–approximately8-10feet)forme?

Scoringdetail

Score1-Ifthepatientgenerallytoewalksbutoccasionallygetsheelsflat,orcanonrequest,theymustscore1

Activity 2 1 0

Walk Walksconsistentlywithheel-toeorflat-footedgaitpattern

Persistentorhabitualtoewalker,unabletoheel-toeconsistently

Lossofindependentambulation–mayuseknee-ankle-footorthosis(KAFO)orwalkshortdistanceswithassistance

Score1–habitualtoewalker

Testitem3:StandupfromchairStartingposition

Sittinginchair,benchorplinthwitharmsfoldedacrosschestwithhishandupbyhisshouldersandwithfeetabletoreachfloororsupportedonsecurebox.Adjusttheseatheightsothatthehipsandkneesareata90ºanglefromthefloor.Feetnomorethanshoulderwidthapart.

Instruction Canyoustandupfromthechairkeepingyourarmsfolded?

Scoringdetail

Asize-appropriatechair(withoutarm-rests)orheightadjustableplinthmustbeused.Alternatively,aboxstepunderthefeettoachievethecorrectstartingpositionmaybeused.

Score2-Armsmustbekeptcrossedwiththehandsupbytheshouldersthroughouttheactivitytoscore2

Activity 2 1 0

Standupfromchair

Abletostandupkeepingarmsfolded

Withhelpfromthighs/pushonchair/proneturnoraltersstartingpositionbywideningbase

Unable

Photographs/notes

Score2–keepsarmsfoldedandstandsupwithoutwideningbase

Score1-Needstwohandstopushand/or

Widenedbase

Score0-Unabletorisefromstartingposition

Score0-Needstochangebodyposition;and/orhipsextendedtoslideforwardfromchair(not90/90)

Testitem4&5:StandononelegRight&LeftStartingposition

Standing.

Instruction Showmehowlongyoucanstandonyourright/leftlegwithyourarmsatyourside.

Count“And1,and2,and3”

Scoringdetail

Score2–Minimumcountof3secondsrequired

Activity 2 1 0

Standononeleg

Abletostandinarelaxedmanner(nofixation)foracountof3seconds

Standsbuteithermomentarilyorwithtrunkside-flexionorneedsfixatione.g.bythighsadducted

Unable

Photographs/notes

Score2–Relaxedandnofixation

Score1-Hookslegbehindstandingleg

Score1-Posturalcompensation/leaningtoside

Score0-Ifneedstoholdontoatableorpersonforsupport

Testitem6&8:ClimbboxstepRight&LeftStartingposition

Standinginfrontofboxstep,toesnomorethan20cm(~8in)awayfromboxstep.

Instruction Canyoustepontothetopoftheboxusingyourright/leftleg.

Scoringdetail Boxstepmustbe15cmhigh.Score1:Iftheyneedahandforbalanceonly–evaluatorshandshouldbekeptrelativelyhigh.Score1:Iftheyuseahandontheirthigh.Ifindoubtwhetherthisisusedforbalanceorsupportofferthemyourhandandrepeattest.Score0:Iftheyputweightthroughtheevaluatorshand(withoneortwohands)orunabletoclimbstep

Theyshouldnothavetheirhandsintheirpocket.

Activity 2 1 0

Climbsboxstep

Facesstep–nosupportneeded

Goesupsideways/rotatestrunk/circumductshiporneedshandforbalance

Unabletoperformindependently

Photographs/notes

Score1–Needshandforbalanceonly

Score2–Facesstep

Score1-Rotatestrunkoruseshandonthigh

Testitem7&9:DescendboxstepRight&LeftStartingposition

Standingonboxstep

Instruction Canyoustepdownfromtheboxusingyourright(orleft)leg?

Scoringdetail Boxstepmustbe15cmhigh.

Score1:Iftheyneedahandforbalanceonly–evaluatorshandshouldbekeptrelativelyhigh.Iftheyuseahandontheirthigh.Ifindoubtwhetherthisisusedforbalanceorsupportofferthemyourhandandrepeattest.Usesmethodthatavoidsflexingsupportingknee(oneontheboxstep)Score0:Iftheyputweightthroughtheevaluatorshand(withoneortwohands)orunabletodescendstep

Theyshouldnothavetheirhandsintheirpocket.

Activity 2 1 0

Descendsboxstep

Facesforward,stepsdowncontrollingweight-bearingleg.Nosupportneeded

Sideways,skipsdownorneedshandforbalance

Unablewithoutmorethanminimalsupport,orrequireshandsforsupport

Photographs/notes

Score2–facesforward

Score1–Needshandforbalance.Noweighttakenthroughhand.

Score1–Turningtosidetodescend

Testitem10:LiftsheadfromsupineStartingposition

Supineonaplinthorfloor,armsfoldedacrosschestandthehandsupbytheshoulders.Nopillowmustbeused.

Instruction Canyouliftyourheadandtouchyourchintoyourchestkeepingyourarmsfolded?

Scoringdetail

Askpatienttokeeparmscrossedoverchestduringtheactivitytoavoidself-assistance.

Activity 2 1 0

Liftsheadfromsupine

Insupine,fullneckflexion,headmustbeliftedinmid-line.Chinmovestowardschest

Headisliftedthroughsideflexion,partialneckflexion,orwithprotraction.

Unable.Noclearanceofheadfromsurface

Photographs/Notes

Score2–Chinonchest

Score1-Didn’tachievefullrangeofflexion

Testitem11:GetstosittingStartingposition

Startingpositionsupineonthefloor,orlargeplinthwitharmsbyside.Nopillowmustbeusedunderhead.

Instruction Canyougetfromlyingintositting?

Scoringdetail Aimistomoveintolongsittingratherthansittingovertheedgeofaplinth.Useofonehandorarmisacceptabletoachieveascoreof2.

Score1ifpatientturnsintoproneortowardsthefloortoworktheirwayintosittingorifusestwoarms.Alsoscoreaoneifthechilduseslegmomentum/rockingtogettositting.

Activity 2 1 0

Getstositting Startsinsupine–mayuseonehand/armtopushup

Usestwoarms/pullsonlegsorturnstowardsfloororusesmomentum/rocking

Unable

Photographs

/notes

Score2-Onlyneedsonearmtositup

Score1-Pullswithbothhandsonlegs

Testitem12:RisefromfloorStartingposition

Startingpositionsupinewitharmsbysides,legsstraight.Nopillowtobeused.

Instruction • Givethefollowingverbalinstructionstothepatient:• “WhenIsayGOcanyougetupasfastasyoucanandstandupstraight

withyourarmsbyyoursidelikeasoldierusingaslittlesupportaspossible”.Givethecommand“Ready,Set,GO!”andstartthestopwatchwhensaying“GO”.

• Stopthetimerwhenthepatientassumesanuprightpositionwithhisarmsbyhisside.

Scoringdetail/Diagram

Activitymustbeattemptedwithoutuseoffurnitureinthefirstinstance.Score1:Ifthepatientgetstostandingindependentlyofanyfurniturebutdemonstratesanypartofthemaneuverdescribedbelow.ComponentsofGower’smanoeuvre:Turnstowardsthefloor(intoafour-pointkneelingpositionorrollstoprone).Placeshandsonthefloortoassistrisingfromfloorandwalkshandsbackintowardshim.Usesoneorbotharmstopushuponlegstoachieveuprightstanding.Largebaseofsupportbyabductinghipsandextendingknees.

Activity 2 1 0

Risefromfloor NoevidenceofGower’smaneuver.

Exhibitsatleastoneofthecomponentsdescribedabove–inparticularrollstowardsfloor,and/orusehand(s)onlegs

(a)NEEDStouseexternalsupportobjecte.g.chair,wall–stillrecordtimeOR(b)Unable(timemustbeenteredasN/Aifthepatientscores0)

Photographs/Note

Score2-Doesn’troll.Only1handonfloortomoveintositting

Score1–Rollstoprone

Score1-Useshandonthigh

Score0–Useschair

Testitem13:StandsonheelsStartingposition Standingonthefloor.Noshoestobeworn.

Instruction Canyoustandonyourheels?Count‘And1,and2,and3.”

Scoringdetail Score2:Mustclearbothfeetatthesametimeusingcleardorsiflexion

Score1:Ifbothforefeetarelifted-allmetatarsalheadsoffloorevenifinversionisevidentorcleardorsiflexionofonefoot.

Score0:Ifusesinversionwithlateralborder(fifthmetatarsal)offootstillonthegroundorifjustliftstoes.

Activity 2 1 0

Standonheels Bothfeetatthesametime,clearlystandingonheelsonly(acceptabletomoveafewstepstokeepbalance)forcountof3

Raisesforefootonbothfeet–allmetatarsalheadsoffground–orclearlydorsiflexesonefootonly

Unable

Photograph/Notes

Score2–Bothfeetraised

Score1-Bothfeetraisedbutonlyforefeet

Score0–Unabletoraiseevenforefeet

Testitem14:JumpStartingposition

Standingonthefloor,feetcomfortablyclosetogether

Instruction Howhighcanyoujump?

Scoringdetail Wantheight,notforwardmovement.Smallamountofforwardmovementacceptable

Activity 2 1 0

Jump Bothfeetatthesametime,clearthegroundsimultaneously

Onefootaftertheother(skip)ordoesnotfullyclearbothfeetatthesametime

Unable

Photographs/Notes

Score2–Clearsfloor

Score1-Onestepaftertheother(skip)

Score0-Feetdonotleavefloor

Testitem15&16:HopRight&LeftlegStartingposition

Startingpositionstandingonflooronright/leftleg.

Instruction Canyouhoponyourright/leftleg?

Scoringdetail Score2:Needsobviousfloorclearance.Mustlandononefoot.Ifleavesfloorbutlandswithtwofeetthisisnotahop.

Activity 2 1 0

Hop Clearsforefootandheelofffloor

AbletobendkneeANDraiseheel,nofloorclearance

Unableoronlyraisesheel

Photographs/Notes

Score2–Clearsfootofffloor

Score1-Bendskneebutfootdoesnotleavefloor

Testitem17:Run(10metres)Startingposition

Standing

Instruction Givethefollowingverbalinstructionstothepatient:“WhenIsayGO,yougoasfastasyousafelycanallthewaytome.Ifyoucanrun,thenrun.Ifyoucan’tthenwalktomeasfastasyoucan.”(Encouragechildtorunpastthe10-metremark)bystandingatleastonemetrebehindtheline.Givethecommand“Ready,Set–GO”.Continuouslyencouragethepatientuntilhecrossesthefinishline.

Startthetimerwhenyousay“GO”.Stopthetimerwhenthesecondfootclearsthefinishline.

Scoring

detail

Astraight12-mwalkwaymustbeclearlymarkedat10-minaquietdepartmentorcorridor.Astopwatchmustbeusedtotimethewalk.Theymustself-selectspeedafterbeingaskedtogo‘asfastastheycan’.Score1-‘Duchennejog’-notatruerun(Thereisadoublesupportphase),butitisfasterthanawalk.Characterisedbyexcessiveuseofarms,trunkrotation,substantial’waddle’.Noreal‘push-off’.

Activity 2 1 0

Run Bothfeetofftheground(nodoublestancephaseduringrunning)

‘Duchennejog’orfastwalk

Walk(Noacceleration)

Photographs/Notes

Score2-Bothfeetofftheground

Definite‘run’

Score1-Picksupspeedbutwaddlesandhasonefootincontactwithflooratalltimes

NSAABriefTestDetailActivity 2 1 0 Score

1.Stand Standsupright,stillandsymmetrically,withoutcompensation(withheelsflatandlegsinneutral)forminimumcountof3seconds

Standsstillbutwithsomedegreeofcompensation(e.g.ontoesorwithlegsabductedorwithbottomstuckout)forminimumcountof3seconds

Cannotstandstillorindependently,needssupport(evenminimal)

2.Walk Walkswithheel-toeorflat-footedgaitpattern

Persistentorhabitualtoewalker,unabletoheel-toeconsistently

Lossofindependentambulation–mayuseKAFOsorwalkshortdistanceswithassistance

3.Standupfromchair

Keepingarmsfolded.Startingposition90ºhipsandknees,feetonfloor/supportedonaboxstep.

Withhelpfromthighs/pushonchair/proneturnoraltersstartingpositionbywideningbase.

Unable

4.Standononeleg–right

Abletostanduprightinarelaxedmanner(nofixation)forcountof3seconds

Standsbuteithermomentarilyorwithtrunkside-flexionorneedsfixatione.g.bythighsadducted

Unable

5.Standononeleg-left

Abletostanduprightinarelaxedmanner(nofixation)forcountof3seconds

Standsbuteithermomentarilyorwithtrunkside-flexionorneedsfixatione.g.bythighsadducted

Unable

6.Climbboxstep-right

Facesstep–nosupportneeded

Goesupsideways/rotatestrunk/circumductshiporneedshandforbalance

Unable

7.Descendboxstep–right

Facesforward,stepsdowncontrollingweight-bearingleg.Nosupportneeded

Sideways,skipsdownorneedshandforbalance

Unable

8.Climbboxstep-left

Facesstep–nosupportneeded

Goesupsideways/rotatestrunk/circumductshiporneedshandforbalance

Unable

9.Descendboxstep-left

Facesforward,stepsdowncontrollingweight-bearingleg.Nosupportneeded

Sideways,skipsdownorneedshandforbalance

Unable

Activity 2 1 0 Score10.Liftshead

Insupine,headmustbeliftedinmid-line.Chinmovestowardschest

Headisliftedbutthroughsideflexionorwithnoneckflexion(protracts)

Unable

11.Getstositting

Startsinsupine–mayuseonehand/armtopushup

Usestwoarms/pullsonlegsorturnstowardsfloor.

Unable

12.Risefromfloor

NoevidenceofGower’smaneuver.

ExhibitsatleastoneoftheGower’scomponentsdescribed–inparticularrollstowardsfloor,and/orusehand(s)onlegs

(a)NEEDSexternalsupportofobjecte.g.chairOR(b)Unable

Timed

13.Standsonheels

Bothfeetatthesametime,clearlystandingonheelsonly(acceptabletomoveafewstepstokeepbalance)forcountof3

Raisesforefootonbothfeet–allmetatarsalheadsoffground–orclearlydorsiflexesonefootonly

Unable

14.Jump Bothfeetatthesametime,clearthegroundsimultaneously

Onefootaftertheother(skip)ordoesnotfullyclearbothfeetatthesametime.

Unable

15.Hoprightleg

Clearsforefootandheelofffloor

Abletobendkneeandraiseheel,nofloorclearance

Unable

16.Hopleftleg

Clearsforefootandheelofffloor

Abletobendkneeandraiseheel,nofloorclearance

Unable

17.Run(10m)

Bothfeetofftheground(nodoublestancephaseduringrunning)

‘Duchennejog’orfastwalk Walk Timed

TOTAL=/34

2. TimedGradedFunctionalactivities

RiseFromFloor

Placetheparticipantinasupinepositionwithhisarmsbyhissidesandhislegstogether.Noshoesorsocksshouldbeworn.

Givethefollowingverbalinstructionstotheparticipant:“WhenIsayGOyougetupasfastasyoucanandstandupstraightwithyourarmsbyyoursidelikeasoldier”.

Givethecommand“Readysteady–GO”andstartthestopwatchwhensaying“GO”.

Stopthetimerwhentheparticipantassumesanuprightpositionwithhisarmsbyhisside.

Onlyprovideachairaftertheparticipanthasattemptedtostandfromthefloorfor30secondsandfailed.

Recordthefastesttimeandthemethodtheyusedtoachievethisfastesttime.Youcanrepeatifyouthinktheycandoitfasterorthegradewasnotrepresentativeoftheirusualability.

Assignoneofthefollowinggrades:

NSAAequivalent

grade

FunctionalGrade

Description

0 1 Unabletostandfromsupine,evenwithuseofachair DONOTRECORDTIME

0 2 Requiresfurnituretostandupfromsupinetofulluprightposture

DONOTRECORDTIME*

1 3 Rollsover,standsupwithbothhands“climbingup”thelegstoachievefulluprightposture.

TIME

1 4 Rollsover,standsupwith1handsupportonleg TIME

1 5 Rollstothesideandstandsupwithoneorbothhandsonthefloortostarttorisebutdoesnottouchlegs

TIME

2 6 Standsupwithoutrollingoverorusinghandsonlegs TIME

*Usingfurnituretogetupmakesiteasier/fasterandiftheyhavenotusedfurniturebeforeafastertimewithfurniturewouldnotreflectprogressionaccurately

10-MetreRun/Walk

10mrunisgradedduringtheperformanceofthetestfortheNSAA.Youcanrepeatthetesttocheckthetimeorthegrade.

Thistestmeasureshowfastthesubjectcanrun/walk10metres.

• Askthesubjecttostanduprightwithbothfeetbehindthestartinglineandtoestouchingthestartingline.

• Theevaluatorshouldstandata12-metremark.Youstand2metrespastthe“finishline”

• Givethefollowingverbalinstructionstothesubject:WhenIsayGO,yougoasfastasyousafelycanallthewaytome

• Givethecommand“readyset–GO”andstartthestopwatchwhensaying“GO”.

• Continuouslyencouragethesubjectuntilhecrossesthefinishline.

• Stopthetimerwhenthesecondfootclearsthefinishline.

Note:Encouragethechildtokeeprunningacrossthefinishlineandnottoslowdownbeforethe10-metremark.

Scorethefastesttimeandrecordthemethodtheyusedtocompleteitinthefastesttime.

Assignoneofthefollowinggrades:

NSAAequivalentgrade

FunctionalGrade

Description

0 1 Unabletowalkindependently

0 2 Unabletowalkindependentlybutcanwalkwithknee-ankle-footorthosis(KAFO)orsupportfromaperson

0 3 Cannotincreasewalkingspeed,highlyadapted,wide-basedlordoticgait

1 4 Canpickupspeedbutcannotrun,moderatelyadaptedgait

1 5 Nearlyrunning,butrunswithadoublestancephase,i.e.,cannotachievebothfeetofftheground

2 6 Runsandgetsbothfeetofftheground(achievesflight)