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Vignos Lower Extremity Scale
Availability
Please visit this website for more information about the instrument: Vignos Lower Extremity Scale
Classification
Supplemental - Highly Recommended: Duchenne Muscular Dystrophy (DMD)
 
Supplemental: Congenital Muscular Dystrophy (CMD)
Short Description of Instrument
The Vignos Lower Extremity Scale, also referred to as The Vignos Functional Scale/The Vignos Scale, was developed to assess lower extremity function and also to help document progression. It is an ordinal scale used to describe lower extremity functional ability in boys with DMD with higher values representing lower function. Any changes to a higher score in the Vignos Scale would reflect functional loss.
 
Additional equipment is needed to perform this test.
Comments/Special Instructions
Functional Grades: Hips and Legs (Jung et al., 2012; Vignos & Archibald, 1960)
 
    1. Walks and climbs stairs without assistance
    2. Walks and climbs stairs with the aid of a railing
    3. Walks and climbs stairs slowly (elapsed time of more than 12 seconds for 4 std. stairs) with aid of a railing
    4. Walks unassisted and rises from a chair, but cannot climb stairs
    5. Walks unassisted but cannot rise from a chair or climb stairs
    6. Walks only with assistance or walks independently with long-leg braces
    7. Walks in long-leg braces but requires assistance for balance
    8. Stands in long leg braces, but is unable to walk even with assistance
    9. Is in a wheelchair for all mobility
    10. Is confined to bed
Scoring and Psychometric Properties
Scoring: The Vignos Scale was designed to assess the lower extremity function. The grades of the Vignos scale range from 1 to 10.
 
Grade 1 means that the subject can walk and climb stairs without assistance.
 
Grades 2 and 3 means that the strength is insufficient to walk upstairs without assistance as they need to use a rail for climbing stairs (grade 2: in a normal speed; grade 3: slowly).
 
Grades 4 and 5 refer to subjects still having the ability to walk unassisted but unable to climb stairs (grade 4 also can rise from a chair but grade 5 cannot).
 
Grades 6 to 8 refer to patients using the long leg brace for walking or standing (grade 6: walk without assistance; grade 7 can walk with assistance for balance; grade 8 cannot walk, only for standing).
 
Grade 9 refers to the subject being unable to stand but can sit in a wheelchair.
 
Grade 10 refers to the subject being confined to a bed. (Mapi-trust.org, 2023)
 
Psychometric Properties: See Vignos & Archibald, 1960 and Vignos et al., 1963 for psychometric properties information.
Rationale/Justification
Strengths: The Vignos scale is a clinically meaningful assessment of loss of lower extremity abilities and is appropriate to assess change in boys with DMD. (Duong et al., 2021) It is easy to assess and takes little time to complete. (Lu & Lue, 2012)
 
Weaknesses: Limitations of the Vignos Scale include non-specificity; time required to complete the assessment and poor clinical applicability and relevance (Bakker et al.2000; Skalsky & McDonald, 2012); low cultural sensitivity (Bushby et al., 2010); and poor alignment with interventions that are currently used for the clinical management of patients with DMD. (Kim et al., 2018) The Vignos scale is not as precise and detailed as other scales used to assess upper extremity function. (Bérard et al., 2005)
References
Key Reference:
 
Vignos PJ Jr, Archibald KC. Maintenance of ambulation in childhood muscular dystrophy. J Chronic Dis. 1960 Aug;12:273-90.
 
Vignos PJ Jr, Spencer GE Jr, Archibald KC. Management of progressive muscular dystrophy in childhood. JAMA. 1963 Apr 13;184:89-96.
 
Additional References:
Bakker JP, de Groot IJ, Beckerman H, de Jong BA, Lankhorst GJ. The effects of knee-ankle-foot orthoses in the treatment of Duchenne muscular dystrophy: review of the literature. Clin Rehabil 2000;14:343-59.
 
Bérard C, Payan C, Hodgkinson I, Fermanian J; MFM Collaborative Study Group. A motor function measure for neuromuscular diseases. Construction and validation study. Neuromuscul Disord. 2005 Jul;15(7):463-70.
 
Brooke MG, Griggs RC, Mendell JR, Fenichel, GM, Shumate JB and Peggegrino RJ (1981). Clinical trial in duchenne dystrophy. I The Design of the Protocol. Muscle and Nerve: 4:186-197.
 
Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy. Part 2. Implementation of multidisciplinary care. Lancet Neurol 2010;9:177-89.
 
Duong T, Canbek J, Birkmeier M, Nelson L, Siener C, Fernandez-Fernandez A, Henricson E, McDonald CM, Gordish-Dressman H; CINRG-DNHS Investigators. The Minimal Clinical Important Difference (MCID) in Annual Rate of Change of Timed Function Tests in Boys with DMD. J Neuromuscul Dis. 2021;8(6):939-948.
 
Florence JM, Pandya S, King WM, Robison JD, Signore LC, Wentzell M, Province MA. Clinical trials in Duchenne dystrophy. Standardization and reliability of evaluation procedures. Phys Ther. 1984 Jan;64(1):41-5.
 
Jung IY, Chae JH, Park SK, Kim JH, Kim JY, Kim SJ, Bang MS. The correlation analysis of functional factors and age with duchenne muscular dystrophy. Ann Rehabil Med. 2012 Feb;36(1):22-32.
 
Kim J, Jung IY, Kim SJ, Lee JY, Park SK, Shin HI, Bang MS. A New Functional Scale and Ambulatory Functional Classification of Duchenne Muscular Dystrophy: Scale Development and Preliminary Analyses of Reliability and Validity. Ann Rehabil Med. 2018 Oct;42(5):690-701.
 
Lu Y-H & Lue Y-J. (2012). Strength and Functional Measurement for Patients with Muscular Dystrophy. In: Muscular Dystrophy. (Hedge M & Ankala A, eds.) pp. 321-30. InTech, Available from: https://cdn.intechopen.com/pdfs/36741/InTech-Strength_and_functional_measurement_for_patients_with_muscular_dystrophy.pdf
 
Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am 2012;23:675-87.
 
Mapi-trust.org (2022) Vignos PJ Jr & Archibald KC. (1960) The Vignos Scale. Available at: https://eprovide.mapi-trust.org/instruments/the-vignos-scale Accessed 21 October 2024.
 
 
Document last updated October 2024