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Pediatric Stroke Outcome Measure Short Neuro Exam (PSOM-SNE) - Child Version (Children Aged 2 Year and Older)
*The Pediatric Stroke Outcome Measure Short Neuro Exam (PSOM-SNE) Child and Infant Versions are copyrighted by The Hospital for Sick Children Sickkids®. Permission must be obtained directly from The Hospital for Sick Children Sickkids® before use of the Pediatric Stroke Outcome Measure Short Neuro Exam (PSOM-SNE) Child and Infant Versions. Please consult the link below to obtain necessary permissions.*
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Supplemental - Highly Recommended: Stroke
Short Description of Instrument
Purpose: This scale assesses neurologic deficit severity following pediatric ischemic stroke.
Overview: The PSOM is a composite scoring system for findings on a standard clinical neurological examination. It assumes knowledge of normal age-related findings by the examiner, thus is designed to be performed by individuals with extensive training and experience in pediatric neurology.. The measure was published in 2000.
Time: Examination time in keeping with a standard detailed neurologic exam by a qualified child neurologist, depending on age of child and extent and nature of any abnormalities present (typically 10-15 minutes), plus time to enter findings and assign scoring in recording form and final Summary of Impressions (typically 5 minutes).
Comments/Special Instructions
Scoring and Psychometric Properties
Scoring: The PSOM is a system of scoring findings on a standard detailed neurologic examination by an individual with extensive experience and training in clinical child neurology. Exam findings are recorded on a form with 115 test items ordered developmentally in the areas of behavior, mental status, cranial nerves, motor functions, sensory function, cerebellar function, and gait function. At the completion of the examination, the examiner completes a final Summary of Impressions which summarizes examination findings in the form of a Likert-type rating from 0 (no abnormality) to 2 (severe abnormality with absent function) in each of five domains. The five domains are: right sensorimotor (including motor, visual, hearing, and somatosensory function), left sensorimotor, language production, language comprehension, and cognitive and behavioral performance. The domain scores are summed for a total POSM score ranging from 0 (normal exam) to a maximum of 10 (severe abnormalities and loss of function in all five domains).
Interpretation and Analysis
The original and simplest interpretation strategy assigns a subject to global outcome strata, as follows:
Scoring for Pediatric Stroke Outcome Measure (PSOM)
Adapted from (deVeber et al., 2000)
Good, Normal: Score = 0 in all five domains?
Good, Mild deficit: Total Score = 0.5, by definition involves mild abnormalities without functional loss in one domain only
Poor, Moderate deficit: Total Score = 1.0-1.5, and involves scores of 0.5 in two, three, or four domains; or a Score = 1 in one domain and 0.5 in one other domain; or a Score = 1 in one domain only
Poor, Severe deficit: Total Score is  = 2.0 and involves scores of  0.5 in all five domains; or Score = 1 in one domain plus 0.5 in two other doamins; or Score = 1 in at least two domains; or Score = 2 in at least one domain
Other strategies have been used by other authors to stratify total PSOM scores into four groups of increasing severity (Jordan et al 2018; Fullerton et al 2018):
0 -1.0   = no/mild impairment
1.5-3.0 = moderate impairment
3.5-6.0 = severe impairment
6.5-10.0 = profound impairment
0 = No impairment, normal function; 0.5 = minimal to mild impairment, normal function; 1 = moderate impairment, decreased function; 2 = severe impairment, loss of function.
?Right sensorimotor, left sensorimotor, language expressive, language comprehensive, and cognitive and behavior.
Psychometric Properties: The PSOM has demonstrated reliability and validity. It has been used in several neonatal/ childhood stroke studies to assess neurological deficit severity.
deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000;15(5):316-324.
Fullerton HJ, Stence N, Hills NK, Jiang B, Amlie-Lefond C, Bernard TJ, Friedman NR, Ichord R, Mackay MT, Rafay MF, Chabrier S, Steinlin M, Elkind MSV, deVeber GA, Wintermark M; VIPS Investigators. Focal Cerebral Arteriopathy of Childhood: Novel Severity Score and Natural History. Stroke. 2018 Nov;49(11):2590-2596.
H?rtel C, Schilling S, Sperner J, Thyen U. The clinical outcomes of neonatal and childhood stroke: review of the literature and implications for future research. Eur J Neurol. 2004;11(7):431-438.
Jordan LC, Hills NK, Fox CK, Ichord RN, Pergami P, deVeber GA, Fullerton HJ, Lo W; VIPS Investigators. Socioeconomic determinants of outcome after childhood arterial ischemic stroke. Neurology. 2018;91(6):e509-e516.
Kitchen L, Westmacott R, Friefeld S, MacGregor D, Curtis R, Allen A, Yau I, Askalan R, Moharir M, Domi T, deVeber G. The pediatric stroke outcome measure: a validation and reliability study. Stroke. 2012;43(6):1602-1608.
Stacey A, Toolis C, Ganesan V. Rates and Risk Factors for Arterial Ischemic Stroke Recurrence in Children. Stroke. 2018 Apr;49(4):842-847.