PASS Assessment

What is a PASS Assessment?

The Postural Assessment Scale for Stroke Patients (PASS) is a specialized tool designed to assess and measure postural control among stroke patients. This performance assessment is designed to identify the specific postural control impairments that may be affecting a patient's functional abilities, such as their ability to sit, stand, or walk.

Developed by Benaim and colleagues (1999), the PASS was specifically created to evaluate patients post-stroke. Its independence and safety scales allow therapists and clinicians to identify specific postural deficits that may be affecting their progress toward rehabilitation goals. Importantly, PASS has been validated through rigorous testing, demonstrating both high reliability and good content validity. This means the assessments accurately reflect the construct of postural control it aims to measure.

In addition to its use in clinical settings, the PASS assessment has also been used in research settings to investigate the effects of various interventions on postural control in stroke patients. For example, studies have used the PASS assessment to evaluate the effectiveness of balance training programs, gait training programs, and robotic-assisted therapy in improving postural control in stroke patients (Wu et al., 2021).

What can you expect from this test?

In practice, the PASS can be a valuable component of a patient’s rehabilitation evaluation and ongoing monitoring. It enables practitioners to:

• Quantify levels of functional independence that impact self-care skills
• Formulate targeted rehabilitation strategies
• Determine the amount of assistance needed in daily life tasks
• Monitor patient progression over time
• Enhance communication between health professionals through a shared metric
• Inform patients and their families about current abilities in a concrete manner

The administration of the PASS assessment is straightforward and can be completed in approximately 15-20 minutes. It is a valuable tool for monitoring a patient's progress over time, as it can be used to track changes in postural control and balance throughout the rehabilitation process.

One of the PASS's key strengths is the physical emphasis on posture, a crucial aspect of mobility and function often affected by stroke. The PASS produces quantifiable data, which allows practitioners to have a detailed picture of a patient's occupational performance.

However, like all assessments, the PASS must be used as part of a comprehensive evaluation. While highly effective for evaluating postural control and task independence, it does not replace assessments for other impairments that might accompany stroke, such as tests with cognitive emphasis or those that address sensory deficits.

How are results interpreted?

The PASS consists of a total of 12 items, each evaluated on a scale from 0 to 3. The scoring is detailed as follows:

• 0 points indicate the patient is unable to perform the task.
• 1 point shows the patient can perform the task with major assistance.
• 2 points are given when the patient can perform the task with minimal assistance.
• 3 points reflect complete independence in performing the task, with no assistance required.

The cumulative score can range from 0, indicative of total dependence, to 36, which suggests full independence in postural tasks.

• 0-12 points: Typically indicates severe impairment in postural control. Patients with scores in this range may require substantial assistance for basic postural adjustments and are likely to be highly dependent.
• 13-24 points: Suggests moderate impairment. Patients within this score range have some ability to control posture but still need assistance to maintain or change positions safely.
• 25-36 points: Reflects mild impairment or near independence. Patients scoring in this range can perform most postural tasks and physical self-maintenance with little to no assistance, although some minor difficulties might persist.

When interpreting the PASS results, healthcare practitioners should also consider the following:

• Total PASS score: The total PASS score provides an overall measure of the patient's postural control and balance. A higher score indicates better performance, while a lower score suggests more significant deficits that may require more intensive rehabilitation interventions.
• Individual item scores: Examining the scores for each individual item can help identify specific areas of strength and weakness among only those tasks. This information can guide the development of targeted interventions to address deficits in tasks deemed relevant to their functioning.
• Changes over time: Regularly administering the PASS assessment throughout the rehabilitation process can help track the patient's progress. Observing changes in the total PASS score and individual item scores over time can provide valuable insights into the effectiveness of the rehabilitation interventions and guide adjustments as needed.
• Comparison to normative data: Healthcare practitioners can compare the patient's PASS scores to normative data, which can provide a frame of reference for interpreting the patient's performance and identifying areas that require more intensive rehabilitation efforts.

It is also important to note that the PASS assessment is just one tool in the evaluation of postural control and balance abilities in stroke patients. Healthcare practitioners should use a comprehensive approach that includes a thorough physical examination and medical history. They can also use PASS alongside other assessments, such as an instrumental self-maintenance scale, a functional assessment questionnaire, and a performance assessment of self for a self-report of the patient's needs, capacity, and goals.

How does our PASS Assessment template work?

The PASS assessment provides a standardized and comprehensive evaluation of a stroke patient's postural control and balance, which is essential for guiding rehabilitation efforts. To ensure a consistent and effective administration of the PASS assessment, here's a step-by-step guide on how to use our PASS Assessment template:

Step 1: Preparation

Before beginning the assessment, ensure that the environment is safe and that all necessary materials, including a chair with armrests and a treatment table, are available. Patients should wear their regular footwear and aids they normally use. Review the patient’s medical history to anticipate any special considerations needed during the assessment.

Step 2: Introduction to the patient

Explain the purpose and process of the PASS to the patient to provide reassurance and obtain informed consent. It's essential to communicate what will happen during the assessment, emphasizing that their safety is the primary concern.

Step 3: Performing the assessment

Proceed with the assessment by guiding the patient through each of the 12 items in the PASS template. Follow the standardized instructions for each of the 12 PASS assessment items, ensuring consistent administration across all patients. Observe the patient's performance and score each item according to the 0-4 scale. Then, record the scores for each item in the designated sections of the PASS assessment template.

Step 4: Totaling the scores

After completing all the items, sum the scores for each to obtain a total score. The maximum score possible is 36, indicating full independence in postural control, while lower scores indicate varying levels of dependency.

Step 5: Post-assessment review

Review the scores of each item to identify areas of strength and areas that need work. This allows for a focused intervention on specific postural control aspects requiring attention.

Step 6: Plan the next steps

Use the findings from the PASS assessment to collaborate with the clinical rehabilitation team to plan occupation-based interventions or treatment tailored to the patient’s needs. Documenting the scores and your observations provides a benchmark for measuring progress in subsequent assessments.

Benefits of conducting this assessment

The Postural Assessment Scale for Stroke Patients (PASS) is a beneficial tool for those working with stroke patients and the patients themselves. The following are the key benefits of conducting this assessment:

Simplicity and efficiency

The PASS is a quick and straightforward assessment, easily integrated into routine patient evaluations. It doesn't require extensive equipment or set-up time, making it practical for busy clinical settings.

Standardized scoring

The PASS uses a clear scoring system, ensuring consistency in assessment across different therapists. This allows for reliable comparisons over time and between patients.

Targeted treatment planning

The PASS helps guide the development of a targeted rehabilitation program by pinpointing specific postural weaknesses. A low score in unsupported standing, for instance, highlights the need for balance exercises to improve stability.

Monitoring progress

Serial assessments using the PASS allow you to track a patient's progress over time. Improvements in scores provide objective evidence of the effectiveness of rehabilitation interventions.

How are posture and mobility in stroke patients rehabilitated?

Stroke can significantly impact a patient's posture and mobility, making daily activities challenging. Fortunately, rehabilitation offers a variety of strategies to help patients regain control and independence. Here's a look at some key approaches:

• Positioning techniques: Therapists use specific positioning techniques to improve body alignment and prevent complications like muscle contractures. This might involve using pillows or supports while sitting or lying down.
• Strengthening exercises: Exercises targeting core muscles, those in the trunk and pelvis, are crucial for maintaining good posture and stability. These exercises can be progressively more challenging as the patient improves.
• Balance training: Balance exercises help patients retrain their nervous system to control their body position. Activities like standing on a wobbleboard or practicing weight shifting can be incorporated into therapy sessions.
• Gait training: Physical therapists work with patients to relearn safe and efficient walking patterns. This might involve practicing stepping techniques, using walking aids, or incorporating treadmill training.
• Assistive devices: In some cases, assistive devices like canes, walkers, or wheelchairs can help patients improve mobility and maintain independence.

References

Benaim, C., Pérennou, D. A., Villy, J., Rousseaux, M., & Pelissier, J. Y. (1999). Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke, 30(9), 1862–1868. https://doi.org/10.1161/01.str.30.9.1862

Wu, J., Cheng, H., Zhang, J., Yang, S., & Cai, S. (2021). Robot-assisted therapy for upper extremity motor impairment after stroke: A systematic review and meta-analysis. Physical Therapy, 101(4). https://doi.org/10.1093/ptj/pzab010