Assessment of motor limb strength by neuroscience nurses: variations in practice and associated challenges
Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches.
To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice.
This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160).
Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the ‘normal power’ to ‘no movement’ scale found on the neurological observation chart. Most respondents used the same tool across all conditions.
This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used.
Neurological assessment is the cornerstone of practice in neuroscience nursing, being the core method of evaluating the function of the nervous system for people with neurological disorders (Agrawal, 2019). However, the evidence base around neurological assessment is an emerging one, and aspects of practice could be considered legacy based, rather than evidence informed. A common error seen across the literature is that of confusion between the Glasgow Coma Scale (GCS) and neurological assessment (Jain and Iverson, 2022). The GCS is just one component of the overall assessment used to assess the level of consciousness (arousability and awareness). However, there remain four other components: pupillary response, sensory assessment (not normally included on a standard neurological observation chart), vital signs, and motor limb assessment. The latter, for most nurses working in neuroscience, traditionally focuses on limb strength or motor limb strength.
Muscle/limb weakness may result from injury or disorders of the central nervous system or the peripheral nerves or muscle. Furthermore, a person's active muscles determine that individual's ability to carry out daily activities and any change in strength measurements is a critical indicator of improvement or deterioration in the underlying disease. Thus, an evaluation of muscle strength is an important component of a neurological assessment. Currently the evidence informing practice is limited, despite such assessment being central to monitoring neurological status, determining the presence of deficits, and informing decisions around interventions, treatment and care. Moreover, the need for nurses to be able to undertake a full neurological assessment that is accurate and cohesive within an interprofessional arena is paramount for patient care to be effective and safe.
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