Stroke Impact Scale

The Stroke Impact Scale (SIS) was designed at the University of Kansas (KU) Medical Center to evaluate the psychometric impact of a stroke on an individual’s daily life and functioning and measures the aspects of stroke recovery important to patients and caregivers as well as stroke experts.(1)

The Stroke Impact Scale is an outcome measurement tool and intervention planning method for stroke rehabilitation in occupational therapy. It provides valuable insight and quantifiable data regarding specific areas of need for an individual, allowing therapists to tailor client-centered interventions and address their unique goals. 

Therapists can understand the client comprehensively, communicate and collaborate with other healthcare professionals, and improve clients' quality of care.

Watch Your Free On-Demand Webinar: 9 Admin Tasks to Automate In Your Private Practice

Stroke impact

The impact of a stroke may involve a plethora of challenges including physical, emotional, or psychological, social, cognitive, communication, financial, caregiver burden, and rehabilitation. All of these challenges impact an individual’s ability to perform and engage in daily activities. 

Specific challenges areas in each category include:

• Physical challenges: Balance, strength, coordination, and mobility

• Emotional challenges: Depression, anxiety, emotional regulation, motivation, coping

• Social challenges: Social isolation, participation, and engagement in social activities

• Cognitive challenges: Problem-solving, memory, and concentration

• Communication challenges: Language acquisition, speaking, comprehension, reading, and writing

• Financial challenges: Changes in employment, healthcare expenditure, lack of resources

• Rehabilitation challenges: Access to quality care and rehabilitative services

• Caregiver burden: Increase in stress for caregivers and decrease in quality of life of stroke survivors

Overview of Stroke Impact Scale

There are different versions of the SIS including SIS-16 and SIS-3.0 In this article, we will be focusing on Stroke Impact Scale 3.0. 

For reference, the SIS-16 is “a 16-item physical dimension instrument) was developed as a brief, stand-alone tool for measuring the physical aspects of stroke recovery.”(1) 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, mobility, activities of daily living (ADL), emotion, memory, communication, and social participation.

Eight domains of the Stroke Impact Scale

The SIS consists of eight different domains:(2)

1. Strength: Muscle strength and endurance
2. Hand function: Grip strength and functions of the affected arm to perform various day to day activities
3. Activities of Daily Living and Instrumental Activities of Daily Living: Questions about ability to complete ADLs and IADLs such as cutting food with a fork and knife, dressing the top part of your body, and performing household chores
4. Mobility: The ability to be mobile at home and in the community. Questions are regarding balance challenges, stair negotiation, and getting in and out of a car
5. Communication: The ability to communicate with other people and comprehend reading and conversational language
6. Emotion: Changes in mood, about how a client feels, and ability to control emotions post stroke
7. Memory and thinking: Questions regarding concentration, remembering short-term conversations, thinking quickly, and solving problems
8. Participation: Questions are about how stroke has affected the ability to participate in activities that you usually do, things that are meaningful and purposeful in life 

Scoring and interpretation of the Stroke Impact Scale

Scoring is based on a Likert scale, with each item rated using a 5-point Likert scale. 

Overall scores are based out of 100, with 100 representing full recovery and 0 representing no recovery. Reviewing each domain and analyzing higher scores vs lower scores can indicate areas of strength and areas for improvement.

In addition, it can allow for a baseline assessment, and track progress. 

• 1 = Could not do it at all
• 2 = Very difficult
• 3 = Somewhat difficult
• 4 = A little difficult
• 5 = Not difficult at all

Assessment, evaluation, goals and interpretation

The Stroke Impact Scale is a self-report questionnaire that considers the point of view of the client. (3) The therapist asks questions about the impairments and disabilities caused by the stroke. Administration of the assessment may be done as an interview. 

During the interview process, it is important to first establish a therapeutic relationship or rapport and explain the purpose of the SIS. It is important to be flexible, offer comfort, clarify questions, allow time for thinking of responses, and encourage honest answers. 

A vital component of the rehabilitation process is to tailor client specific goals and address the needs of the client. The SIS allows for collaborative goal setting where both the therapist and client can identify strengths, weaknesses, priorities, and decide SMART goals together. 

Download My Free SMART Goals worksheet

Examples of client-centered goals using the SIS assessment focus on the domains of need such as: 

• Improving muscle strength to enhance ability to perform daily activities
• Improving hand function in order to perform dressing tasks
• Developing coping strategies to work on emotional regulation 
• Enhancing cognitive skills to promote greater independence 

Evidence-based intervention methods may include:

• Resistance and endurance training
• Functional and purposeful activities 
• Hand-therapy
• Constraint-induced movement therapy (CIMT) 

Once a baseline and goals are established, regular monitoring, consistent communication with clients and other healthcare members such as physical therapists, speech therapists, and/or counselors are vital aspects to track progress. 

Pros and cons of Stroke Impact Scale

Pros:

• Client-centered
• Holistic in nature
• Quantifiable scores
• Collaborative

Cons:

• Subjective
• Language barriers
• Emotional state of individual
• Time consuming