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Liverpool Outcome Score Teaching Presentation. Brain Infections Group University of Liverpool, United Kingdom. Introduction Using this presentation Background to disability after JE and Liverpool Outcome Score development Liverpool Outcome Score Examples for each question:

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Liverpool outcome score teaching presentation

Liverpool Outcome ScoreTeaching Presentation

Brain Infections GroupUniversity of Liverpool, United Kingdom


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

Contents


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.

Using this presentation


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.

Introduction


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

Japanese encephalitis and disability


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

Outcome after JE


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

Problems with measuring disability


Liverpool outcome score teaching presentation

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.


Liverpool outcome score methodology 1

15 questions in total:

10 questions to the parent or caregiver

5 observations of the child

Liverpool Outcome Score: Methodology (1)


Liverpool outcome score methodology 2

Includes measurement for the following:

Speech

Feeding

Behaviour

Seizures

Sitting and standing

Liverpool Outcome Score: Methodology (2)


Liverpool outcome score methodology 3

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.

Liverpool Outcome Score: Methodology (3)


Liverpool outcome score teaching presentation

Liverpool Outcome Score: Methodology (4)


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

Liverpool Outcome Score: Methodology (5)Outcome score


Liverpool outcome score methodology 6

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

Liverpool Outcome Score: Methodology (6)


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.

Liverpool Outcome Score:


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)

1. Speech or communication


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.

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


1 speech or communication child a

1. Speech or communication: Child “A”

Back to question

Forward to child

“B”

Forward to answer


1 speech or communication child a1

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

1. Speech or communication: Child “A”


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.

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


1 speech or communication child b

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.


1 speech or communication child b1

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)

1. Speech or communication: Child “B”


1 speech or communication child b2

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. Score3

Did you get it right?

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

1. Speech or communication: Child “B”


2 feeding

The child’s feeding is:

The same as other children (5)

Occasionally needs help (3)

Always needs more help (2)

2. Feeding


2 feeding c hild 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.”

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


2 feeding child a

2. Feeding: Child “A”


Liverpool outcome score teaching presentation

2. Feeding: Child “B”


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.

2. Feeding: Child “A” and Child “B”


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)

3. Leaving Alone


3 leaving alone c hild 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.

Score this child.

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


3 leaving alone child a and child b

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)

Child “A,” normal child, scores 5

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

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


Liverpool outcome score teaching presentation

Now look at the picture and try and score:

Child “C,” 7-year-old boy

Child “D,” 10-year-old girl

Child “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)

3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl; Child “E,” 18-month-old babyTry and score:


3 leaving alone child c 7 year old boy child d 10 year old girl child e 18 month old baby

3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl, Child “E,” 18-month-old baby


3 leaving alone child c 7 year old boy child d 10 year old girl child e 18 month old baby1

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)

Child “C” and “D” are old enough to be left alone,

score Yes 5

Child “E” is too young too be left alone, but this is

normal for a child of this age score No 5

3. Leaving Alone: Child “C,” 7-year-old boy; Child “D,” 10-year-old girl, Child “E,” 18-month-old baby


3 leaving alone a few more notes

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

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 5as 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)

3. Leaving Alone: A few more notes


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

4. Behaviour


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.)

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


4 behaviour try and score

4. Behaviour Try and score:

These children are all playing happily together


4 be h aviour 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, score5

All three children are playing together normally.

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

4. Behaviour: Child “A, B, C”


4 behaviour child d try and score

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

4. Behaviour: Child “D”Try and score:


4 behaviour child d

4. Behaviour Child “D”

This child is screaming and irritable


4 behaviour child d1

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” scores4

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

4. Behaviour: Child “D”


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)

5. Recognition


5 recognition child a 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 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.

Score this child.

5. Recognition:Child “A”Try and score


5 recognition child a

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)

Child “A,” normal child, scores 5

5. Recognition: Child “A”


5 recognition child b

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)

Child “B” cannot recognise family or caregivers

so scores 2

5. Recognition: Child “B”


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)

6. School and working


6 school and working try and score

For this question imagine:

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

Score this child.

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.

Score this child.

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.

Score this child.

6. School and workingTry and score


6 school and working child a1 school children playing

6. School and working: Child “A1”School children playing


6 school and working child a2 helping with tasks at home

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


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

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


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

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


6 school and working child b try and score

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


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, score3

6. School and working: Child “B”


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).

6. School and working: A few more notes


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)

7. Epilepsy/Seizures:


7 epilepsy seizures child a 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 is not on any medication and is having subtle partial seizures involving just the left arm once or twice a month.

Score this child.

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


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 score5

7. Epilepsy/Seizures: Child “A”


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

7. Epilepsy/Seizures: Child “B”


7 epilepsy seizures child c try and score

Look at the following picture and try and score:

Child “C”, a 7-year-old girl.

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


7 epilepsy seizures child c

7. Epilepsy/Seizures: Child “C”

This child is having a seizure involving her left arm


7 epilepsy seizures child c1

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, score3

If she has seizures most days, score 2

7. Epilepsy/Seizures: Child “C”


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)

8. Dressing


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.

8. Dressing: Child “A”Try and score


8 dressing child a

8. Dressing: Child “A”

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


8 dressing child a1

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 “A,” normal child, scores5

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.

8. Dressing: Child “A”


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.

8. Dressing: Child “B”Try and score


8 dressing child b

8. Dressing: Child “B”


8 dressing child b1

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 score2

8. Dressing: Child “B”


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

8. Dressing: A few more notes


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)

9. Bladder and Bowel control


9 bladder and bowel control child a b try and score

For this question imagine:

Child “A,” a normal 7-year-old child

Score this 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.

Score this child.

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


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)

Child “A,” normal child, scores 5

9. Bladder and Bowel control: Child “A”


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

9. Bladder and Bowel control: Child “B”


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

9. Bladder and Bowel control: A few more notes


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)

10. Hearing


10 hearing child a try and score

For this question imagine:

Child “A”, a normal 7-year-old child, and try and score.

10. Hearing:Child “A”Try and score


10 hearing child a

Does the parent think this child’s hearing is:

Normal (5)

Reduced in one or both ears (4)

Cannot hear at all (3)

Child “A,” normal child, scores 5

10. Hearing: Child “A”


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.

10. Hearing:Child “B”Try and score


10 hearing child b

Does the parent think this child’s hearing is:

Normal (5)

Reduced in one or both ears (4)

Cannot hear at all (3)

Trick question – don’t guess!

The information was not given!

Check with parent/caregiver.

10. Hearing: Child “B”


10 hearing child c try and score

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

10. Hearing: Child “C”Try and score


10 hearing child c

10. Hearing: Child “C”

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


10 hearing child c1

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.

10. Hearing: Child “C”


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.

Observation of the child’s abilities: Q11-Q15


11 sitting

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)

11. Sitting


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.

11. Sitting: Child “A”Try and score


11 sitting child a

11. Sitting: Child “A”


11 sitting child a1

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 “A,” normal child, scores5

11. Sitting: Child “A”


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.

11. Sitting: Child “B”Try and score


11 sitting child b

11. Sitting: Child “B”


11 sitting child b1

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 “B,” who can’t sit at all, scores 2

11. Sitting: Child “B”


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.

11. Sitting: Child “C”Try and score


11 sitting child c

11. Sitting: Child “C”


11 sitting child c1

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

11. Sitting: Child “C”


12 standing up

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)

12. Standing up


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.

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


12 standing up child a

12. Standing up: Child “A”


12 standing up child a1

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)

Child “A,” normal child, scores5

12. Standing up: Child “A”


12 standing up child b try and score

For this question look at the following picture:

Child “B”, a 10-year-old boy, who can stand only with someone holding him.

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


12 standing up child b

12. Standing Up: Child “B”


12 standing up child b1

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. Score2

12. Standing up: Child “B”


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)

13. Walking


13 walking child a try and score

For this question look at the following picture:

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

13. Walking: Child “A”Try and score


13 walking child a

13. Walking: Child “A”


13 walking child a1

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)

Child “A,” normal child, score5

13. Walking: Child “A”


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.

13. Walking Child “B”Try and score


13 walking child b

13. Walking: Child “B”


13 walking child b1

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)

Child “B,” not able to walk, scores2

13. Walking: Child “B”


13 walking child c try and score

For this question look at the following picture:

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

13. Walking: Child “C”Try and score


13 walking child c

13. Walking: Child “C”


13 walking child c1

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

13. Walking: Child “C”


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)

14. Hands on head


14 hands on head demonstrate putting your hands on your head

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


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.

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


14 hands on head child a

14. Hands on head: Child “A”


14 hands on head child a1

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 score5

14. Hands on head: Child “A”


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.

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


14 hands on head child b

14. Hands on head: Child “B”


14 hands on head child b1

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 score4

Look again if you’re not sure.

14. Hands on head: Child “B”


15 picking up

Ask child to pick up a 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)

15. Picking Up


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

15. Picking Up:Child “A”Try and score


15 picking up child a

15. Picking Up:Child “A”


15 picking up child a1

Ask child to pick up a 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 “A,” normal child, scores5

15. Picking Up: Child “A”


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.

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


15 picking up child b

15. Picking Up: Child “B”

Normal picking up with right hand.

Unable to pick up with left hand

Picking up safety pin with right hand


15 picking up child b1

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

15. Picking Up: Child “B”


15 picking up child c try and score

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

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


15 picking up child c

15. Picking Up: Child “C”


15 picking up child c1

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

Child is:

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

15. Picking Up: Child “C”


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.

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


15 picking up child d

15. Picking Up: Child “D”

Picking up a safety pin, right hand.

Picking up a safety pin, left hand.


15 picking up child d1

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. Score3

15. Picking Up: Child “D”


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.

Determining the final Liverpool Outcome Score


Example what is the final liverpool outcome score for this patient

Example:What is the final Liverpool Outcome Score for this patient?


Answer

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

Answer


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

Interpretation of final Liverpool Outcome Score


Acknowledgments and contacts

Liverpool, UK

Penny Lewthwaite, Tom Solomon,

Rachel Kneen, Janet Lewthwaite

Vijayanagar Institute of Medical Sciences, Bellary, India

Ravikumar 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, Malaysia

Wong 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, USA

Medical Research Council, UK

Wellcome Trust, UK

Further information and contacts:

www.jeproject.org

www.liv.ac.uk/braininfections

Acknowledgments and contacts:


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