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Pediatric Modified Rankin Scale (mRS)
Public access.
Click here for Bigi, et al version.
Click here for Cnossen, et al version.
Exploratory: Stroke
Short Description of Instrument
Purpose: To assess global neurological impairment following stroke in children
Overview: This is a modification of the adult Modified Rankin Scale (mRS) which takes into account age-related expectations of neurologic function. There are two published pediatric modifications of the mRS (Bigi, 2011; Cnossen, 2010). Neither version has been subjected to rigorous evaluation of inter-rater reliability or validity. The version published by Bigi is more comparable to the adult version of the mRS, and is the most widely used of the two versions. A comparison of the PSOM and pediatric mRS showed concordance of the two instruments in 88% of subjects when dichotomized into "good" vs "poor" outcomes (Bulger, 2011).
Time: 5 min (scored after completing a standard clinical neurologic examination)
Comments/Special Instructions
Scoring and Psychometric Properties
Pediatric mRS modification of Bigi, et al:
  1. No symptoms at all
  2. No significant disabilities despite symptoms; behavior appropriate to age and normal further development
  3. Slight disability; unable to carry out all previous activities, but same independence as other age- and sex-matched children, according to gross motor function scale (Palisano et al 1997)
  4. Moderate disability; requiring some help, but able to walk without assistance; in younger patients adequate motor development despite mild functional impairment, defined as reduction of 1 level on the gross motor function scale
  5. Moderately severe disability; unable to walk without assistance; in younger patients reduction of at least 2 levels on the gross motor function scale
  6. Severe disability; bedridden, requiring constant nursing care and attention
  7. Dead
Pediatric mRS, modification of Cnossen, et al:
  1. No residual disability; the child attends regular education and does not need remedial teaching
  2. Mild residual disability; the child is able to attend regular education but needs remedial teaching because of mild motor disturbances, mild learning disability, or both
  3. Severe residual disability; the child has a severe motor deficit (needs braces or wheelchair), severe learning disability, or both, attends a school for special education or is confined to a daily care center
  4. Dead
Psychometric Properties: N/A
Bigi S, Fischer U, Wehrli E, Mattle HP, Boltshauser E, Burki S, Jeannet P, Fluss J, Weber P, Nedeltchev K, El-Koussy M, Steinlin M, Arnold M Acute ischemic stroke in children versus young adults. Ann Neurol 2011;70(2): 245-254.
Bulder MM, Hellmann PM, van Nieuwenhuizen O, Kappelle LJ, Klijn CJ, Braun KP Measuring outcome after arterial ischemic stroke in childhood with two different instruments. Cerebrovasc Dis 2011;32(5):463-70.
Cnossen MH, Aarsen FK, Akker SLj, Danen R, Appel IM, Steyerberg EW, Catsman-Berrevoets CE. Paediatric arterial ischaemic stroke: functional outcome and risk factors. Dev Med Child Neurol. 2010;52(4):394-9.
Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39: 214-23.


Document last updated April 2020