Page 36 - วารสารกรมการแพทย์แผนไทยฯ ปีที่ 3 ฉบับที่ 3

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3

Rt.side Lt.side

Arm, motor power* Raises arm with normal strength (gr5) 6 6
Raises arm with reduced strength (gr4) 5 5
Raises arm with flexion in elbow (gr3) 4 4
Can move but not against gravity (gr2) 2 2
Paralysis 0 0
Hand, motor power* Normal strength 6 6
Reduced strength in full range 4 4
Some movement, fingertip do not reach palm 2 2
Paralysis 0 0
Leg, motor power* Normal strength (gr5) 6 6
Raises straight leg with reduced strength (gr4) 5 5
Raises leg with flexion of knee(gr3) 4 4
Can move but not against gravity (gr2) 2 2
Paralysis 0 0
Gait Walk 5 m without aids 12 12
Walk with aids 9 9
Walk with help of another person 6 6
Sit without support 3 3
Bed ridden / Wheelchair 0 0
Maximum score58 Sum Score________

Severity :0____________15____________30_____________45_____________58
(Very severe) (severe) (moderate) (mild)
Cause of stroke : 4
1.Cerebrovacular disease (CVD/CVA) Pathology : 1 Thrombotic , 2Hemorrhagic, 3 Embolic
Regional involvement : 1 MCA,2 ACA,3 PCA (main branch ,small branch ,lacuna )
2.Traumatic Brain Injury (TBI) Path physiology : Post traumatic amnesia (10 yes / 20 no)
3.AVM/Aneurysm(310) Brain Tumor (320) Brain Abscess(330) Others(390)
Underlying diseases/conditions&Risk factors(years) modificagleRF, Partially modifiable
1 HT_( ) 2 HD/AF ( ) 3 Prior stroke /TIA ( ) 4 DM ( )
5 Carotid stenosis ( ) 6 Dyslipidemia ( ) 7 smoker ( ) 8 ex-smoker( )
Exercise : 1 no exercise 2 Occasional 3 Regular
Sleep Apnea
Blood Group : 1 A 2 B 3 AB 4 O
Religion : 1 Buddhism 2 Islam 3 Chirstian 4 Hindu