Clinical Prediction Rules

• The EPOS study predicts who would recover independent ambulation at 6 months. Testing should be performed within 72 hours post-stroke.
• EPOS Study

  A) 98%

  B) 27%

  C) 96%

  D) 10%

  
• In the EPOS study, trunk control and lower extremity strength is tested.
• The 2012 Bland study applies to standard PT, not high intensity gait training.
• Per the 2012 Bland study, patients who scored less than or equal to 20 on the BERG and a FIM score less than or equal to 2 at admission were less likely to achieve community ambulation status at discharge.
• The hornby and henderson studies were specific to HIGT.
• The Hornby studies identified that the BERG score taken at week one is better at indicating walking prognosis than scores taken at admission.
• HIGT was proven to help patients with lower levels of abilities achieve independence in the Hornby study.
• In the Hornby study, patients who received HIGT instead of typical PT were more likely to become independent no matter where they started.
• The Henderson study chose patients who were non-ambulatory or low ambulation patients on admission.
• On admission, the Henderson study takes the admit BERG and adds it to the average of all of the MMTs taken of the legs multiplied by 3. It is then plotted on a graph to find the probability that the patient will be able to walk independently (with a contact guard assist).
• The Henderson study also takes the BERG score after one week of HIGT at inpatient rehabilitation to continue to predict ambulation probability.
• Common themes across stroke studies included trunk control, sitting independently, BERG scores, and lower extremity strength.
• The van Middendorp study from 2011 examined prognosis after traumatic spinal cord injuries.
• The van Middendorp study utilized weighted coefficients.
• In the van Middendorp study, independent ambulation was defined by 20 ft.
• In order to use the predictor created by the van Middendorp study, you need to know the patient's age, their best motor scores at L3 and S1, and their best light touch score at L3 and S1.
• The common themes identified across SCI studies that indicated better walking prognosis were younger age, better antigravity strength, and presentation of pinprick below NLI.