Stroke-Related Measurement Tools

Hemispheric Stroke Scale (HSS)

Authors: R.J. Adams, K.J. Meador, K.D. Sethi, J.C. Grotta, D.S. Thomson (1986)
Administration: 25-item clinical assessment tool that takes less than 30 minutes to complete.
Constructs Measured: The HSS is used by the physician to assess five factors in stroke: Level of conciousness, Language ability, Other cortical function, Motor function, Sensory function.
Reliability and Validity: Interobserver reliability of the five factors ranged from 0.75 to 0.95, with overall reliability of 0.95. Correlation of the overall score with the Barthel Index is high.
Assessment in Minorities and Elderly: Age range of the tested patient population was 35 to 80.
Costs: None.

Authors: T. Brott, H.P. Adams Jr., C/P. Olinger, J.R. Marler, W.G. Barsan, J. Biller, J. Spilker, R. Holleran, R. Eberle, V. Hertzberg, M. Rorick, C.J. Moomaw, M. Walker (1989)
Administration: 15-item clinical examination tool that takes less than 10 minutes to complete.
Constructs Measured: The NIHSS is used to assess the impact of acute cerebral infarction on levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. It is designed to be easy and quick to administer in order to facilitate the assessment of stroke repeatedly over the course of clinical treatment.
Reliability and Validity: With minimal training, test-retest reliability measures showed no significant differences of scores between neurologists, neurology house officers, neurology nurses, or emergency department nurses. Other researchers have also found high interrater reliability in using the NIHSS to assess stroke severity. Validity of the scale was measured by comparing the scale score with infarction volume as measured by CAT scan one week after the stroke. The NIHSS has also been validated in clinical trials of therapeutic treatment. The scale can also be reliably used remotely through a television system
Assessment in Minorities and Elderly: Not applicable.
Costs: Video training tapes are available from the authors.

Authors: P.W. Duncan, D. Wallace, S.M. Lai, D. Johnson, S. Embretson, L.J. Laster (1999)
Administration: 64-item self report measure.
Constructs Measured: Eight domains measured: Strength, Hand Function, Activities of Daily Living / Instrumental Activities of Daily Living, Mobility, Communication, Emotion, Memory and Thinking, and Participation..
Reliability and Validity: Good to excellent reliability. Test-retest reliability also good. Moderate to strong correlations when compared to established outcome measures.
Assessment in Minorities and Elderly: Average age of the participants was 71. The SIS has been translated into 14 other languages.
Costs: None.

Authors: P.W. Duncan, S.M. Lai, R.K. Bode, S. Perera, J. DeRosa (2003)
Reference: Stroke Impact Scale-16. A brief assessment of physical function. Neurology, 60(2), 291 to 296.
Administration: 16-item self report measure.
Constructs Measured: One Physical domain incorporating the first four domains of the SIS: Strength, Hand Function, Activities of Daily Living / Instrumental Activities of Daily Living, and Mobility.
Reliability and Validity: After reduction of the number of items from 28 in the SIS to 16, reliability of the SIS-16 is not significantly reduced. The SIS-16 has less ceiling effects than other scales such as the Barthel Index or the NIHSS, thereby giving it greater differentiation among patients with less severe limitations.
Assessment in Minorities and Elderly: Average age of the participants was 68.
Costs: None. Printed as an appendix to Duncan et al. (2003)