liverpool outcome score teaching presentation brain infections group university of liverpool, united...

Liverpool Outcome ScoreTeaching Presentation

Brain Infections Group University of Liverpool, United Kingdom

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Contents

• Introduction

• Using this presentation

• Background to disability after JE and Liverpool Outcome Score development

• Liverpool Outcome Score

• Examples for each question:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15

• Acknowledgments

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Using this presentation

This presentation can be used either by going through each slide consecutively, moving forward and backward by clicking on the arrows on the bottom right and left of each screen, or by clicking on specific questions on the contents slide to find details of examples.

To get back to the start from any slide simply click on the house image.

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Introduction

• This assessment tool, the Liverpool Outcome Score (LOS), has been developed for use in areas where Japanese encephalitis (JE) is endemic

• Two versions of this teaching tool for the LOS exist:

– A smaller file with no video clips

– A larger file with video clips which is available on CD ROM

• The tool is freely available, but when using it, please acknowledge the University of Liverpool, UK and PATH.

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Japanese encephalitis and disability

• The impact of JE is felt not just from acute illness and deaths, but disability.

• Disability affects up to 50% of JE survivors.

• It impacts family, the health system, and the community.

• It is important to document disability to:

– Understand the complete burden of JE disease

– Advocate for funding from governments and other bodies to control the disease

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Outcome after JE

• Studies show a wide variation in outcomes of JE survivors; from 19% to 71% have sequelae after JE.

• Possible reasons for this variation:

– The study population (adults or children)

– The time point when assessment occurs after illness

– Differences in acute care facilities

– Selection bias

– Lack of a standard assessment of outcome and disability

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Problems with measuring disability• There are many components of disability:

– Physical (motor skills): vision, hearing, speech, walking

– Self-care skills: self-feeding, bathing, dressing

– Cognition

– Behaviour

• Ideally, need a multidisciplinary team to assess, but challenges with assessments:

– Time-consuming

– Lack of standard assessment tool

– Results from different assessors not comparable

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Published disability data interesting, but…

• Many take a scientific approach, and do not consider important issues that affect activities of daily life:

– Can the child walk?

– Can they feed themselves?

– Will they be independent?

• There is a clear need for a simple, rapid way to assess outcome of illness which is:

– Consistent when used in different places or by different staff

– Able to be used by any health professional

• The Liverpool Outcome Score (LOS) has been developed to meet this need.

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Liverpool Outcome Score: Methodology (1)

• 15 questions in total:– 10 questions to the parent or caregiver– 5 observations of the child

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• Includes measurement for the following: – Speech– Feeding– Behaviour– Seizures– Sitting and standing

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Notes:

• It is important that the parent or caregiver's answer is used (and not the assessor’s opinion).

• The parents or caregivers are often asked to compare how their child is, compared to other children or siblings of the same age in the community.

12 Liverpool Outcome Score: Methodology (4)

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Liverpool Outcome Score: Methodology (5) Outcome score

• 15 Questions: each scores between 2 and 5• The final Liverpool Outcome Score is the lowest

score for any single question.

What does the score mean?• Score 3 to 5: independent living possible• Score 2: likely to be dependent

• Total score is out of 75

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LOS: Outcome score ranges from 1 - 5

5 = Full recovery

4 = Minor sequelae with mild effects on function, or personality change or on medication

3 = Moderate sequelae mildly affecting function compatible with independent living

2 = Severe sequelae, greatly impairing function, likely to make patient dependent

1 = Death

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Liverpool Outcome Score:

• Instructions for conduct of Part 1 of the assessment:

– Ask the parent or caregiver the questions on the form

– For some of the questions, as directed, ask the parent or caregiver how this child compares with other children of a similar age in their locality.

• In the following slides:

– After each question, examples of a normal child, Child “A,” and then one or more children with some problems are given for you to try and score.

– You may like to have a question sheet to mark your answers on.

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1. Speech or communication

• Compared with other children the same age in the community, the child’s speech or communication is:

– The same as other children of this age (5)

– Changed or reduced (3)

– Not speaking or communicating (2)

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1. Speech or communication: Child “A”Try and score

For this question look at the following picture. She is a normal 7-year old girl who is singing a song.

• Child “A”: what score would she get?

• Then press the button to move forward to the next slide to see the answer.

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1. Speech or communication: Child “A”

Back to question

Forward to answer

Forward to child

“B”

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1. Speech or communication: Child “A”

• Compared with other children the same age in the community, the child’s speech or communication is:

– The same as other children of this age (5)

– Changed or reduced (3)

– Not speaking or communicating (2)

• A normal child scores 5. This includes young children who can only say a few words. 5

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1. Speech or communication: Child “B” Try and score:

For this question look at the following picture and try and score her :

• Child “B”, a 10-year-old girl.

• Then press the button to move forward to the next slide to see the answer.

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1.Speech or communication: Child “B

The child has a facial palsy affecting the left side of her lower face, involving her mouth, so that her speech is distorted.

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1. Speech or communication: Child “B”

• Compared with other children the same age in the community, this child’s speech or communication is: – The same as other children of this age (5)– Changed or reduced (3) – Not speaking or communicating (2)

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1. Speech or communication: Child “B”

Child “B” has weakness of the left side of her mouth. Her speech is changed from before her illness and is abnormal compared to other children in her community. Score 3

Did you get it right?

If not look, at the picture again. Use the button.

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2. Feeding

• The child’s feeding is:

– The same as other children (5)

– Occasionally needs help (3)

– Always needs more help (2)

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2. Feeding: Child “A” and Child “B” Try and score:

• For this question imagine:

– Child “A,” a normal 4-year-old girl.

– Child “B,” a 12-year-old girl who the parents say cannot stand, walk or sit unsupported, or feed herself.

• View the following pictures and then score Child “A” and Child “B.”

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2. Feeding: Child “A”

272. Feeding: Child “B”

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2. Feeding: Child “A” and Child “B”

• The child’s feeding is:

– The same as other children (5)

– Occasionally needs help (3)

– Always needs more help (2)

• Child “A,” normal child, scores 5

• If a child cannot feed themselves (Child “B”) and other children their age can, then they would score 2

Note: An infant of 1 or 2 years of age would be expected to need help feeding and so would score 5, as this would be normal for other children, too.

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3. Leaving Alone

• Could a child of this age be left alone without coming to harm?

– If No, score 5 (5)

– If Yes, can this child be left alone now?

• Yes (5)

• Yes, briefly in familiar environment (3)

• No (2)

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3. Leaving Alone: Child “A” and Child “B”Try and score

• For this question imagine

– Child “A,” a normal 7-year-old child.

• Score this child.

– Child “B,” a 5-year-old child who cannot speak or recognise family members, stand, walk or sit, and who is incontinent and unable to feed or dress themselves and can be aggressive at times. The parents cannot leave them alone at home in case they fall.


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3. Leaving Alone: Child “A” and Child “B”



– If Yes, can this child be left alone now?

• Yes (5)

• Yes, briefly in familiar environment (3)

• No (2)

Child “A,” normal child, scores 5

Child “B,” who cannot be left alone, scores 2

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3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl;

Child “E,” 18-month-old baby Try and score:

Now look at the picture and try and score: Child “C,” 7-year-old boyChild “D,” 10-year-old girlChild “E,” 18-month-old baby

Could a child of this age be left alone without coming to harm?– If No score 5 (5) – If Yes, can this child be left alone?

• Yes (5)• Yes, briefly in familiar environment (3)• No (2)

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3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl, Child “E,”

18-month-old baby

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3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl, Child “E,”

18-month-old babyCould a child of this age be left alone without coming to harm?

– If No score 5 (5) – If Yes, can this child be left alone?

• Yes (5)• Yes, briefly in familiar environment (3)• No (2)

Child “C” and “D” are old enough to be left alone, score Yes 5Child “E” is too young too be left alone, but this is normal for a child of this age score No 5

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3. Leaving Alone: A few more notes


• How long can the child be left for? – This varies with what is acceptable in the community.– For example a baby might be left sleeping, but not completely

alone in the home. (Score 5 as normal )– A 2-year-old might not be left alone at all in case they came to

harm, e.g., fell onto the fire/knocked a cooking pot over. (Score 5 as normal)

– A 12-year-old who had JE and now cannot remember where she lives could not be left alone in case she got lost if she wandered out of the house. (Score 2 as not normal)

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4. Behaviour

• Compared with before the illness, do the caregivers think the child’s behaviour is altered?

– No, same as before illness (5)

– Gets angry easily (4)

– Other behavioural problems (4)

– Severely abnormal (2)

If abnormal, give details

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4. Behaviour: Child “A” “B” “C”Try and score:

For this question look at the picture and try and score:

Child “A,” a 7-year-old child

Child “B,” a 10-year-old girl

Child “C,” an 18-month-old girl

(Hint: You’ve seen this picture before.)

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4. Behaviour Try and score:

These children are all playing happily together

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4. Behaviour: Child “A, B, C”

• Compared to before the illness, do the caregivers think the child’s behaviour is altered ?

– No, same as before illness (5) – Gets angry easily (4) – Other behavioural problems (4) – Severely abnormal (2)

If abnormal, give details____________________________

Child “A”,B”,”C”, normal children, score 5

All three children are playing together normally.

It’s important to check that the child’s behaviour is normal with parents or caregivers, too.

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4. Behaviour: Child “D” Try and score:

Now look at the picture and try and score Child “D:”

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4. Behaviour Child “D”

This child is screaming and irritable

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4. Behaviour: Child “D”

• Compared with before the illness, do the caregivers think the child’s behaviour is altered ?

– No, same as before the illness (5)

– Gets angry easily (4)

– Other behavioural problems (4)

– Severely abnormal (2)

If abnormal give details ________________________

Child “D” scores 4

Note: Clarify further with parents/caregivers. For example, if the child is very disruptive they would score a 2.

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5. Recognition

• Can other children of this age recognise their relatives, other than their main caregiver?– If No, score 5 (5)– If Yes, can this child recognise their relatives, other

than their main caregiver? • Yes (5)• Some (3)• None (2)

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5. Recognition: Child “A”Try and score


– Child “A,” a normal 7-year-old child


– Child “B,” a 5-year-old child who can’t speak or recognise family members or caregiver, stand, walk or sit, and who is incontinent and unable to feed or dress themselves and can be aggressive at times and can no longer do simple tasks around the home.


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5. Recognition: Child “A”




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5. Recognition: Child “B”



Child “B” cannot recognise family or caregivers so scores 2

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6. School and working

• Are other children of the same age at school or working?

– If Yes, is the child: • Now back to normal at school or work (5) • Not doing as well (4) • Dropped a school grade or no longer attending school or work

(3)

– If No, is the child: • Able to do activities at home similar to other children his/her

age (5) • Not able to do as many activities as other children his/her age

(4) • Not able to do any activities at all (3)

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6. School and workingTry and score


– Child “A1,” a normal 7-year-old boy who is back at school and doing well.


– Child “A2,” a normal 7-year-old who does not attend school but is helping with day to day tasks in his community as usual.


– Child “B,” a 5-year-old boy who cannot speak, stand, or walk, who can only sit with support and who is incontinent and unable to feed or dress himself and can no longer do simple tasks around the home.


496. School and working: Child “A1”

School children playing

50 6. School and working: Child “A2” Helping with tasks at home

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6. School and working: Child “A1” at school

• Are other children of the same age at school or working?– If Yes, is the child:

• Now back to normal at school or work (5) • Not doing as well (4) • Dropped a school grade or no longer attending school or work (3)

– If No, is the child: • Still able to do the same tasks at home and follow the same

routine (5) • Not able to do as well as before (4) • not able to do at all (3)

Child “A1”, normal child, scores 5

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6. School and working: Child “A2” helping at home

• Are other children of the same age at school or working?

– If Yes, is the child:

• Now back to normal at school or work (5)

• Not doing as well (4)

• Dropped a school grade or no longer attending school or work

– If No, is the child:

• Able to do activities at home similar to other children his/her age (5)

• Not able to do as many activities as other children his/her age (4)

• Not able to do any activities at all (3)

Child “A2”, normal child (not at school but working) scores 5

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6. School and working: Child “B” Try and score

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6. School and working: Child “B”

• Are other children of the same age at school or working?– If Yes, is the child:

• Now back to normal at school or work (5)

• Not doing as well (4)

• Dropped a school grade or no longer attending school or work

– If No, is the child: • Able to do activities at home similar to other children his/her age (5)

• Not able to do as many activities as other children his/her age (4)

• Not able to do any activities at all (3)

For Child “B”

• If they are unable to attend school when children of the same age do, score 3

• If children of the same age are not going to school or working and if they can no longer do simple tasks around the home, score 3

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6. School and working: A few more notes

• In some places children aged 7 years may be at school, but in other places a child of this age may not go to school but may help at home.

• Some children may be working even though there may be laws against this.

• Children who are too young to be at school may still be able to do simple tasks at home.

• It is important to assess the child by what is acceptable to the community and not to the assessor (e.g., the assessor may feel that all children under 14 should be in school, but in some communities children may be helping at home or working at this age).

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7. Epilepsy/Seizures:

• Has the child had any seizures in the last two months? – No seizures and not on anti-epileptic drugs (5)

– No seizures and on anti-epileptic drugs (4)

– Yes has had seizures (3)

– Yes, seizures most days (2)

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7. Epilepsy/Seizures: Child “A” Try and score


– Child “A,” a normal 7-year-old child.


– Child “B,” a 5-year-old child who is not on any medication and is having subtle partial seizures involving just the left arm once or twice a month.


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7. Epilepsy/Seizures: Child “A”

• Has the child had any seizures in the last two months?

– No seizures and not on anti-epileptic drugs (5)

– No seizures and on anti-epileptic drugs (4)

– Yes has had seizures (3)

– Yes, seizures most days (2)

Child “A,” normal child, no seizures score 5

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7. Epilepsy/Seizures: Child “B”

• Has the child had any seizures in the last two months? – No seizures and not on anti-epileptic drugs (5) – No seizures and on anti-epileptic drugs (4) – Yes has had seizures (3) – Yes, seizures most days (2)

Child “B,” not on anti-epileptic medication, having subtle partial seizures involving left arm once or twice a month, score 3

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7. Epilepsy/Seizures: Child “C”Try and score

Look at the following picture and try and score:

• Child “C”, a 7-year-old girl.

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7. Epilepsy/Seizures: Child “C”

This child is having a seizure involving her left arm

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7. Epilepsy/Seizures: Child “C”

• She is having partial seizures of her left arm and has a reduced conscious level.

• Look again if you’re not sure.

• If she has had a seizure like this in the last two months, score 3

• If she has seizures most days, score 2

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8. Dressing

• Is the child’s ability to dress: – The same as other children the same age(5)– Occasionally needs extra help (3) – Needs more help than other children of the same age

(2)

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8. Dressing: Child “A” Try and score

For this question look at the following picture:

• Child “A”, a 4-year-old girl, and try and score her.

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8. Dressing: Child “A”

This 4-year-old child is trying to dress herself but will need some assistance with buttons

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8. Dressing: Child “A”

• Is the child’s ability to dress: – The same as other children the same age (5)– Occasionally needs extra help (3) – Needs more help than other children of the same age

(2)


The child needs will need some help with the buttons, but this is normal for a 4 year old, so her ability to dress is the same as other children the same age and she scores 5.

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8. Dressing: Child “B” Try and score

For this question look at the next picture:• Child “B”, a 10-year-old boy who can’t, stand, walk or sit

without support and is unable to feed or dress himself.

He can say a few words and is able to read and communicate with his family.

688. Dressing: Child “B”

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8. Dressing: Child “B”

• Is the child’s ability to dress: – The same as other children the same age(5)– Occasionally needs extra help (3) – Needs more help than other children of the same age (2)

Child “B” is unable to dress himself and so needs more help than other 10-year-olds, so score 2

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8. Dressing: A few more notes• It is important to compare the child with other children of the

same age in the community.

• Some general points are given below:

– A 10-year-old would usually be expected to dress themselves completely.

– An infant aged 2 years would need dressing completely by someone else.

– A 5-year-old might need help with some things but could almost dress themselves.

– All of these are normal and would score 5

– A 12-year-old who needs help dressing is not normal and would score 2

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9. Bladder and Bowel control

• Is urinary and faecal continence: – The same as other children the same age (5)– Occasionally needs more help or occasionally is

incontinent (4)– Needs more help or is incontinent of bowel or bladder (2)

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9. Bladder and Bowel Control: Child “A” “B”Try and score


– Child “A,” a normal 7-year-old child


– Child “B,” a 6-year-old child who cannot speak or recognise family members, stand, walk or sit and who is incontinent and unable to feed or dress themselves and can be aggressive at times.


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9. Bladder and Bowel control: Child “A”

• Is urinary and faecal continence: – The same as other children the same age (5) – Occasionally needs more help or occasionally is

incontinent (4) – Needs more help or is incontinent of bowel or bladder (2)


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9. Bladder and Bowel control: Child “B”

• Is urinary and faecal continence: – The same as other children the same age (5) – Occasionally needs more help or occasionally is

incontinent (4) – Needs more help or is incontinent of bowel or bladder (2)

Child “B” is incontinent when other children of the same age are continent, so score 2

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9. Bladder and Bowel control: A few more notes

• Notes on urinary and faecal continence:

– A 10-year-old would be expected to have full bladder and bowel control.

– A 2-year-old may wear diapers/nappies.

– A 5-year-old may have the occasional “accident” (incontinent episode).

• All these are normal for age and would score 5

• A 6-year-old child who is incontinent of bladder and bowel is not normal and so would score 2

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10. Hearing

• Does the parent think this child’s hearing is: – Normal (5) – Reduced in one or both ears (4) – Cannot hear at all (3)

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10. Hearing: Child “A” Try and score

For this question imagine:• Child “A”, a normal 7-year-old child, and try and score.

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10. Hearing: Child “A”



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10. Hearing: Child “B” Try and score

• Imagine – Child “B”, a 5-year-old child who can’t speak

or recognise family members or caregiver, and is unable to stand, walk or sit, who is incontinent and unable to feed or dress themselves and can be aggressive at times.

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10. Hearing: Child “B”


Trick question – don’t guess!

The information was not given!

Check with parent/caregiver.

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10. Hearing: Child “C”Try and score

Child “C”: Now look at this picture and try and score.

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10. Hearing: Child “C”

A loud clap is made behind the child’s head. The child does not notice.

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10. Hearing: Child “C”

Does the parent think this child’s hearing is: – Normal (5)– Reduced in one or both ears (4)– Cannot hear at all (3)

The child doesn’t hear the loud clap and so scores 3

Loss of hearing in one ear is more difficult to find. Always ask the parent or caregiver.

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Observation of the child’s abilities: Q11-Q15

• For these questions you observe what the child can do.

• If you cannot get the child to cooperate, answer these questions based on what the caregiver says the child is able to do.

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11. Sitting • Can other children of the same age sit?


– If Yes, observe, can this child sit?

• Yes independently (5)

• Needs help (3)

• Not at all (2)

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11. Sitting: Child “A” Try and score

For this question look at the next picture:• Child “A”, a normal 8-year-old boy, and try and score

him.

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11. Sitting: Child “A”

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11. Sitting: Child “A”

• Can other children of the same age sit?



• Yes, independently (5)

• Needs help (3)

• Not at all (2)


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11. Sitting: Child “B” Try and score

For this question look at the next picture:• Child “B”, a 6-year-old girl who can’t speak, stand, walk

or sit and who is incontinent and unable to feed or dress herself.

90

11. Sitting: Child “B”

91

11. Sitting: Child “B”

• Can other children of the same age sit?



• Yes independently (5)

• Needs help (3)

• Not at all (2)

Child “B,” who can’t sit at all, scores 2

92

11. Sitting: Child “C” Try and score

For this question look at the picture:

• Child “C”, a 9-year-old girl who can’t stand, and has

limited mobility.

93

11. Sitting: Child “C”

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11. Sitting: Child “C”

Can other children of the same age sit?•If No, score 5 (5) •If Yes, observe, can this child sit?

– Yes independently (5)– Needs help (3) – Not at all (2)

Child “C” can sit independently, although she obviously has some disability. Score 5

95

12. Standing up

• Can other children of this age get from sitting to standing?


– If Yes, observe, can the child get from sitting to standing ?

• Yes, independently (5)

• Needs help (3)

• Not at all (2)

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12. Standing up: Child “A” Try and score

For this question look at the next picture:

• Child “A”, an 8-year-old girl, and try and score her.

97

12. Standing up: Child “A”

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12. Standing up: Child “A”

• Can other children of this age get from sitting to standing?– If No, score 5 (5)– If Yes, observe, can the child get from sitting to

standing?• Yes, independently (5)• Needs help (3) • Not at all (2)


99

12. Standing up: Child “B”Try and score


• Child “B”, a 10-year-old boy, who can stand only with

someone holding him.

10012. Standing Up: Child “B”

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12. Standing up: Child “B”

Can other children of this age get from sitting to standing?• If No, score 5 (5)• If Yes, observe whether the child can get from sitting to

standing:– Yes, independently (5) – Needs help (3) – Not at all (2)

Child “B”, cannot stand up at all. Score 2

102

13. Walking

• Can other children of this age walk? – If No, score 5 (5)– If Yes, observe this child walking 5 metres across

room. The child walks: • Normally (5)• Abnormally, but independently (may use crutches

or stick to assist) (3) • Not able to walk (2)

103

13. Walking: Child “A” Try and score


• Child “A”, an 8-year-old boy, and try and score him.

104

13. Walking: Child “A”

105

13. Walking: Child “A”




Child “A,” normal child, score 5

106

13. Walking Child “B” Try and score

For this question look at the next picture:• Child “B”, an 8-year-old boy, and try and score him.

107

13. Walking: Child “B”

108

13. Walking: Child “B”




Child “B,” not able to walk, scores 2

109

13. Walking: Child “C”Try and score


• Child “C”, a 12-year-old girl, and try and score her.

110

13. Walking: Child “C”

111

13. Walking: Child “C”

Can other children of this age walk? • If No, score 5 (5)• If Yes, observe this child walking 5 metres across room

– Walks: Normally (5) – Abnormally, but independently (may use crutches or

stick to assist) (3) – Not able to walk (2)

Child “C” able to walk, abnormally. Score 3

112

14. Hands on head

• Put both your hands on your head, and ask the child to copy you.

– Child is too young (5)

– Normal both hands (5)

– Abnormal one or both hands (4)

– Unable one or both hands (3)

113 14. Hands on head: Demonstrate putting your hands on your head.

114

14. Hands on head: Child “A” Try and score

For this question look at the following picture:• Child “A”, an 11-year-old girl, and try and score her.

115

14. Hands on head: Child “A”

116

14. Hands on head: Child “A”

• Put both your hands on your head, and ask the child to copy you– Child is too young (5)– Normal both hands (5)– Abnormal one or both hands (4) – Unable one or both hands (3)

Normal child score 5

117

14. Hands on head: Child “B”Try and score

For this question look at the next picture:• Child “B”, a 12-year-old girl and try and score her.

118

14. Hands on head: Child “B”

119

14. Hands on head: Child “B”

Put both your hands on your head, and ask the child to copy you.Child is: – Too young (5)– Normal both hands (5) – Abnormal one or both hands (4)– Unable one or both hands (3) Abnormal, as both hands are in an abnormal position

score 4Look again if you’re not sure.

120

15. Picking Up

• Ask child to pick up a pea-sized ball of paper or a small coin:


– Normal pincer grasp both hands (5)

– Unable one hand (3)

– Abnormal one hand or both hands (3)

– Unable both hands (2)

121

15. Picking Up: Child “A”Try and score

For this question look at the following picture:• Child “A”, a normal 7-year-old child, and try and score

122

15. Picking Up: Child “A”

123

15. Picking Up: Child “A”








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15. Picking Up: Child “B”Try and score

For this question look at the next pictures and try and score:

• Child “B”, a 13-year-old girl who is very shy about her left

hand. Her parents say she is clumsy since the illness.

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15. Picking Up: Child “B”

Picking up safety pin with right hand

Normal picking up with right hand.

Unable to pick up with left hand

126

15. Picking Up: Child “B”







Child “B”: right hand is normal but child is unable to pick up coin with left hand, so score 3

127

15. Picking Up: Child “C” Try and score

Here is another example of abnormal picking up, Child “C.”

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15. Picking Up: Child “C”

129

15. Picking Up: Child “C”

Ask child to pick up pea-sized ball of paper or a small coin: Child is:






– Child “C” has fixed deformities of both hands and so cannot grip. This is abnormal for both hands. Score 2

130

15. Picking Up: Child “D”Try and score

For this question look at the following pictures and try and score:

• Child “D”, a 13-year-old girl who gets angry easily and is only able to help with simple tasks at home. Her parents

say she is clumsy since the illness.

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15. Picking Up: Child “D”

Picking up a safety pin, right hand. Picking up a safety pin, left hand.

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15. Picking Up: Child “D”

Ask child to pick up pea-sized ball of paper or a small coin: Child is:

– Too young (5)– Normal pincer grasp both hands (5)– Unable one hand (3)– Abnormal one hand or both hands (3)– Unable both hands (2)

Child “D” has deformities of both hands and so cannot grip normally. She has learnt to alter her hand position and use her left hand to help her right to pick things up. Both hands are abnormal. Score 3

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Determining the final Liverpool Outcome Score

• There are 15 Questions: each scores between 2 and 5.

• The final Liverpool Outcome Score is the lowest score for any single question.

• Interpretation:

– If the score is “3”, “4” or “5”, independent living is possible.

– If the score is “2”, the patient is likely to be dependent.

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Example:What is the final Liverpool Outcome Score

for this patient?Question Score Question Score Question Score

Question 1 5 Question 6 5 Question 11 5





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Answer

• The lowest score this child got for any question was 3, therefore the final Liverpool Outcome Score is 3.

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Interpretation of final Liverpool Outcome Score

• 5 = Full recovery

• 4 = Minor sequelae with mild effects on function, or personality change or on medication

• 3 = Moderate sequelae mildly affecting function compatible with independent living

• 2 = Severe sequelae, greatly impairing function, likely to make patient dependent

• 1 = Death

137

Acknowledgments and contacts:Liverpool, UKPenny Lewthwaite, Tom Solomon,

Rachel Kneen, Janet Lewthwaite

Vijayanagar Institute of Medical Sciences, Bellary, IndiaRavikumar R,Veerashankar, Ashia, Begum, Sri Hari, Subhashinai, Asma, Prathiba, Kailash, Sangeetha, Gaurav, Abhishek, Indy Sandaradura, Tom Shulz, Hospital Director, Nursing staff

Universiti Malaysia Sarawak Malaysia, Mong How Ooi, Cardosa MJ

Sibu Hospital, Sarwarak, MalaysiaWong See Chang, Lai Boon Foo, Anand, Hospital Director, Nursing staff, Occupational Therapy staff

National Institute of Mental Health and Neurological Sciences, Bangalore, India, Ravi V, Desai A

All the parents and caregivers and children who have helped with the development of this tool.

Funders:PATH, Seattle, USAMedical Research Council, UKWellcome Trust, UK

Further information and contacts:www.jeproject.orgwww.liv.ac.uk/braininfections

liverpool outcome score teaching presentation brain infections group university of liverpool, united...

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