APPENDIX D
Standard Instruments for Post-Stroke Assessment
Preferred Standard Instruments for Patient Assessment in Stroke 1
Type
Level-ofconsciousness
scale
Stroke deficit
scales
Global disability
scale
Name and Source
Approximate
Time to
Administer
Weaknesses
Glasgow Coma
Scale]2, 3
2 min
Simple, valid, reliable
None observed
NIH Stroke Scale4
2 min
Brief, reliable; Can be
administered by nonneurologists
Low sensitivity
Canadian
Neurological
Scale5
5 min
Brief, valid, reliable
Some useful
measures omitted
5 min
Walking is the only
Good for overall
explicit assessment
assessment of disability criterion; Low
sensitivity
Rankin
Scale6-8
5-10 min
Widely used for stroke;
Excellent validity and
reliability
Low sensitivity for
high-level functioning
40 min
Widely used for stroke;
Measures mobility,
ADLs, cognition,
functional
communication
"Ceiling" and "floor"
effects
10 min
Widely used for
screening
Several functions
with summed
score—May
misclassify patients
with aphasia
10 min
Does not distinguish
right from left
hemisphere; No
Predicts gain in Barthel
reliability studies in
Index scores; Unrelated
stroke; No studies of
to age
factorial structure;
Correlates with
education
30-40 min
Extensively evaluated
measure; Good validity Considered too
and reliability for
complex and timeassessing sensorimotor consuming by many.
function and balance
Motor Assessment
Scale17, 18
15 min
Reliability assessed
Good, brief assessment
only in stable
of movement and
patients; Sensitivity
physical mobility
not tested
Motricity Index19, 20
5 min
Brief assessment of
motor function of arm,
Sensitivity not tested
le.g.,e.g.,e.g., and trunk
Barthel Index9, 10
Measures of
disability/
activities of daily Functional
Independence
living (ADLs)
Measure (FIM™)
[g]11-13
Folstein MiniMental State
Examination14
Mental status
screening
Neurobehavioral
Cognition Status
Exam (NCSE)15
Fugl-Meyer16
Assessment of
motor function
Strengths
Balance
assessment
Berg Balance
Assessment21, 22
10 min
Simple, well established
with stroke patients;
None observed
sensitive to change
Mobility
assessment
Rivermead Mobility
Index23, 24
5 min
Valid, brief, reliable test
Sensitivity not tested
of physical mobility
1-4 h
Widely used;
Comprehensive, good
standardization data;
Sound theoretical
rationale
Boston Diagnostic
Aphasia
Examination25, 26
Assessment of
speech and
language
functions
Porch Index of
Communicative
Ability (PICA)27
Western Aphasia
Battery28
Beck Depression
Inventory (BDI)29,
1/2-2 h
Depression
scales
Geriatric
Depression Scale
(GDS)32
Hamilton
Depression
Scale33, 34
Measures of
instrumental
ADLs
PGC Instrumental
Activities of Daily
Living35
Time to administer
long; Special training
Widely used;
required to
Comprehensive, careful administer;
test development and
Inadequate sampling
standardization
of language other
than 1 word and
single sentences
Widely used.
Comprehensive
Time to administer
long; "Aphasia
quotients" and
"taxonomy" of
aphasia not well
validated
Widely used; Easily
administered; Norms
available; Good with
somatic symptoms
Less useful in elderly
and in patients with
aphasia or neglect;
High rate of false
positives; Somatic
items may not be
due to depression
< 15 min
Brief, easily
administered, useful in
elderly; Effective for
screening in stroke
population
Not appropriate for
aphasic patients
10 min
Brief, easy to use with
elderly, cognitively
impaired, and those
with visual or physical
problems or low
motivation
High false-negative
rates in minor
depression
< 30 min
Observer rated;
Frequently used in
stroke patients
Multiple differing
versions compromise
interobserver
reliability
5-10 min
Measures broad base
of information
necessary for
independent living
Has not been tested
in stroke patients
Developed specifically
for stroke patients;
Assesses broad array
of activities
Sensitivity and
interobserver
reliability not tested;
sensitivity probably
limited
1-4 h
10 min
30
Center for
Epidemiologic
Studies
Depression (CESD)31
Time to administer
long; Half of patients
cannot be classified
Frenchay Activities
10-15 min
Index36
Family
assessment
Family
Assessment
Device (FAD)37
30 min
Medical Outcomes
Study (MOS) 3610-15 min
Item Short-Form
38
Health Survey
Health
status/quality of
life measures
Sickness Impact
Profile (SIP)39*
20-30 min
Widely used in stroke;
Computer scoring
available; Excellent
validity and reliability;
Available in multiple
languages
Assessment
subjective; sensitivity
not tested; "ceiling"
and "floor" effects
Generic health status
scale SF36 is improved
version of SF20; Brief,
can be selfadministered or
administered by phone
or interview; Widely
used in the United
States
Possible "floor" effect
in seriously ill
patients (especially
for physical
functioning),
suggests it should be
supplemented by an
ADL scale in stroke
patients
Comprehensive and
well-evaluated; Broad
range of items reduces
"floor" or "ceiling"
effects
Time to administer
somewhat long;
Evaluates behavior
rather than
subjective health;
needs questions on
well-being,
happiness, and
satisfaction
[
ADLs indicates activities of daily living. IADLs, instrumental activities of daily living.
* Instrument is available from the Health Services Research and Development Center, The Johns Hopkins
School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205.
Disability/ADL Assessment
Katz Index of ADL40
Kenny Self-Care Evaluation41
LORS/LAD42
PECS43
Mental Status Assessment44
The Stroke Center at http://www.strokecenter.org/trials/scales/index.htm
Depression Assessment
The Zung Scale45
IADL Assessment
OARS: Instrumental ADL46
Functional Health Status47
Stroke Impact Assessment48-50
The Stroke Impact Scale (SIS) - Web site: www2.kumc.edu/coa/Pepper/pepper.htm.
Assessment of Communication:
Websites:
American Speech-Language-Hearing Association: http://www.asha.org
National Aphasia Association: http://www.aphasia.org
Academy of Neurological Communication Disorders and Sciences: http://www.ancds.duq.edu/
University of Minnesota Duluth: http://www.d.umn.edu/~mmizuko/3411/may11.htm
Neuropsychology Central: http://www.neuropsychologycentral.com/interface/content/resources/page_
material/resources_general_materials_pages/resources_document_pages/aphasia_assessment.pdf
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