Stroke Impact Scale
The Stroke Impact Scale (SIS) was developed to capture the elements outside of physical recovery that help clinicians and researchers understand how stroke affects individuals beyond basic physical impairment.
Summary
- The SIS measures how stroke affects multiple areas of life from strength and mobility to emotion and participation providing a comprehensive view of recovery beyond just physical function.
- Becasue it’s self-reported, clients actively share their recovery experiences, which supports personalized goal-setting and client ownership in rehabilitation.
- The SIS 3.0 evaluates strength, hand function, ADLs/IADLs, mobility, communication, emotion, memory/thinking and participation.
- The SIS can be administered in various formats (in-person, telehealth through an EHR like TheraPlatform, etc.) and is evolving to include digital and adaptive versions for more efficient use in clinical and research settings.
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Emotional well-being, cognitive skills, social participation, and daily life activities all interact together to shape the client’s overall quality of life.
When working with clients recovering from a stroke, occupational therapists use the Stroke Impact Scale (SIS) – a stroke-specific, self-report, health status measure.
Origins and purpose of the Stroke Impact Scale
The Stroke Impact Scale (SIS) was created at the University of Kansas Medical Center, and informed by feedback from patients and their caregivers. “It measures the aspects of stroke recovery found to be important to patients and caregivers as well as stroke experts, according to the KU website.
The Stroke Impact Scale’s main purpose is to measure how stroke has impacted a person’s life from their own perspective. It’s a self-report questionnaire, meaning the client provides the information directly, empowering them to express their feelings about recovery and daily functioning. This makes it particularly valuable in occupational therapy, where client-centered practice is at the heart of intervention.
Impact rating scale
The SIS 3.0 is a self-report measure that has 59 questions that are broken into eight different domains, including the following:
- Strength
- Hand Function
- ADLs and IADLs
- Mobility
- Communication
- Emotion
- Memory and Thinking
- Participation
Each question in the domain is rated on a 5-point Likert scale in terms of the difficulty the patient has experienced in completing each item with summative scores generated for each domain; scores range from 0-100.
An extra question asks that the client rate on a scale from 0-100 how much the client feels that he/she has recovered from his/her stroke.
Scores are averaged and converted to a 0–100 scale, with higher scores indicating better function or less perceived difficulty.
Stroke Impact Scale scores
- A score of 100 means no impairment or difficulty in that domain
- A score of 0 means complete inability to perform the activities in that domain
As far as interpretation, therapists often look for patterns. A client might score high in mobility but low in emotion or participation, meaning that while physical recovery is strong, psychosocial aspects may need greater attention.
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Using the Stroke Impact Scale in stroke rehabilitation
The Stroke Impact Scale offers therapists a comprehensive understanding of how stroke has altered a person’s life. It can be administered in person, via telehealth, over the phone, or via an interview-style approach, typically taking about 15–20 minutes.
In clinical practice, it can:
- Establish a baseline for function and perception.
- Track changes over time during the rehab process.
- Guide goal setting and intervention planning.
- Support insurance or research documentation showing measurable outcomes.
Interview approach and rapport building
While SIS is a structured tool, its success depends on the therapist’s ability to create a comfortable and empathetic environment. Clients may feel discouraged or emotional when reflecting on their limitations. Using open-ended questions, gentle pacing, and affirmations can help build trust.
Collaborative goal setting with the Stroke Impact Scale
Once the Stroke Impact Scale is scored, the results provide a clear road map for client-centered goal setting. OTs can collaborate with clients to identify which areas matter most to them.
This empowers clients to take ownership of their recovery journey by:
- Reviewing each domain score together.
- Asking which area feels most important or frustrating.
- Translating that priority into specific, measurable goals.
Stroke Impact Scale client goal samples by domain
- Strength: Client will increase left upper extremity strength to 4/5 to support independent dressing within 6 weeks.
- Hand function: Client will use the affected hand to stabilize clothing during dressing in 75% of trials.
- ADLs/IADLs: Client will independently prepare a simple 3-step breakfast using adaptive strategies.
- Mobility: Client will safely navigate the home environment with a quad cane with no physical assistance.
- Communication: Client will participate in a 10-minute conversation with clear articulation using communication strategies.
- Emotion: Client will report using at least one coping strategy daily to manage frustration.
- Memory/thinking: Client will use a written checklist to complete the morning routine independently.
- Participation: Client will attend weekly community gatherings with family and report an increased sense of belonging.
Free Resources for Therapists
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Pros and cons of using the Stroke Impact Scale
Pros of the Stroke Impact Scale
- Client-centered
- Holistic in nature
- Quantifiable scores
- Collaborative
Cons of the Stroke Impact Scale
- Subjective
- Language barriers
- Emotional state of the individual
- Time consuming
Future directions of the Stroke Impact Scale
Digital health tools are transforming the way clinicians collect and interpret data. Future versions of the Stroke Impact Scale are expected to integrate with mobile apps, telehealth platforms, and electronic medical records (EMRs), allowing clients to complete self-assessments remotely.
Machine learning may even help predict recovery patterns based on Stroke Impact Scale data, making it a powerful tool for personalized rehabilitation. Some researchers are exploring short-form or adaptive versions of the SIS to reduce administration time while maintaining reliability.
Virtual reality and wearable tech could also pair with SIS outcomes to quantify movement and participation in real-world contexts.
The Stroke Impact Scale (SIS) offers a powerful framework for understanding recovery through the client’s eyes. By encompassing domains that span body function, emotion, cognition, and participation, it ensures that occupational therapy remains true to its holistic and person-centered roots. Using the SIS in everyday practice reinforces the core values of occupational therapy. It transforms assessment from a checklist into a meaningful dialogue about what matters most after stroke: rebuilding not just function, but identity and participation in life.
Documenting SIS
An essential component of the SIS (and indeed nearly all therapeutic work) is accurate, timely documentation.
One common structure is the SOAP format:
- S (Subjective): What the clients report — emotional state, concerns, events since last session.
- O (Objective): What the therapist observes — interaction patterns, tone, nonverbal cues.
- A (Assessment): Therapist’s clinical interpretation — what the subjective and objective data suggest in terms of attachment needs, emotional blocks, and relational dynamics.
- P (Plan): What will be done going forward — interventions, new homework, focus for next session.
Example SOAP note informed by the Stroke Impact Scale
S – Subjective
Client reports feeling more confident walking around the home but is frustrated with limited hand function. Scores hand function domain as 35/100 and mobility as 80/100 on SIS.
O – Objective
Administered SIS 3.0; client completed 59-item self-report. Scores: Strength – 50, Hand Function – 35, Mobility – 80, Emotion – 60, Participation – 40. Required minimal assistance to complete the form due to mild expressive aphasia.
A – Assessment
Client demonstrates significant improvement in mobility but continues to have decreased fine motor control impacting ADLs. SIS results align with clinical observations and support need for targeted intervention in hand function and emotional regulation.
P – Plan
Continue OT 3x/week focusing on fine motor tasks, coping strategies, and community participation. Use SIS monthly to track progress and guide goals.
Watch this video to learn how to save time on therapy notes
Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.
They allow therapists to:
- Use templates (e.g. SOAP, DAP, others) to speed note writing and ensure completeness.
- Link notes to treatment plans, goals, and session history so that therapeutic progress is more easily tracked.
- Securely access and share documents (with clients or other providers, where appropriate) and maintain confidentiality.
Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:
- Automatically transcribing session audio (if permitted) and highlighting key moments (e.g., emotional shifts, major themes).
- Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
- Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.
Together, structured SOAP-type notes plus good EHR platforms and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.
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Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.
More resources
- Therapy resources and worksheets
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- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Mental health credentialing
- Insurance billing 101
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- 9 Admin tasks to automate in your private practice
References
Stroke Impact Scale. https://www.kumc.edu/school-of-medicine/academics/departments/population-health/res earch/stroke-impact-scale.html
Stroke Impact Scale. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/stroke-impact-scale
Zeltzer, L. Stroke Impact Scale (SIS). StrokeEngine. https://strokengine.ca/en/assessments/stroke-impact-scale-sis
FAQs about the Stroke Impact Scale
What is the Stroke Impact Scale used for?
The SIS is a self-report tool used to assess how a stroke has affected an individual’s life, covering areas like emotion, cognition, mobility, and social participation. It helps occupational therapists develop personalized, client-centered treatment plans.
How is the Stroke Impact Scale scored?
Each item is rated on a 5-point scale, with domain scores converted to a 0–100 scale—where 100 indicates no difficulty and 0 indicates severe difficulty. Therapists use these scores to identify strengths and areas needing support.
Can the Stroke Impact Scale be used remotely?
Yes. The SIS can be administered in person, via phone, through telehealth, or in an interview-style format. Future developments aim to integrate it with apps and electronic records for remote and efficient tracking.
