There are two current versions of the Neurological Impairment Scale (NIS):
- NIS v 9.3
- Trauma NIS v 10
UK ROC software & user-guide – please contact LNWH-tr.ukroc@nhs.net
Neurological Impairment Scale v 9.3
The Neurological impairment scale v 9.3 is in use in all specialist Level 1 and 2 neurorehabilitation units. It contains 13 sub-domains:
- Motor
- Tone/Joint range
- Sensation
- Perceptual function
- Speech and language
- Cognitive function
- Behaviour
- Mood
- Seeing/vision
- Hearing
- Pain
- Fatigue
- Other (e.g. seizures/pressure sores)
Each domain is rated from 0-3 based on the level of impairment and impact on function
|
Score
|
Level of impairment
|
Functional impact
|
|
0
|
None
|
Normal function
|
|
1
|
Mild
|
Affecting high level function only
|
|
2
|
Moderate
|
Significant limitation, but some useful function
|
|
3
|
Severe
|
Little or no useful function, effectively limiting rehabilitation
|
|
U
|
Unknown/Untestable
|
Total scores range from 0-50 (Motor impairments have a range from 0-14)
Scores for unknown = 0 and untestable = 3
Each listed impairment is matched onto the International Classification of Functioning (ICF).
Trauma Neurological Impairment Scale v 10 (NIS-T)
The Trauma Neurological Impairment Scale v 10 is an extended version of the NIS that was developed for use in Major Trauma Centres
It comprises the same 13 sub-domains as the NIS, plus an additional 11 sub-domains:
- Seizures
- Bladder dysfunction
- Bowel dysfunction
- Skin integrity
- Nutritional status
- Substance abuse
- Fractures
- Limb loss
- Vascular
- Chest/abdominal injuries
- Co-morbidities
- Other
The scoring criteria are the same as the NIS; the total scores range from 0-113.
Each listed impairment is matched onto the International Classification of Functioning (ICF) where possible.
The Neurological Impairment Scale (NIS) was developed for use across a broad range of disabling conditions. It provides a standardised measure of neurological impairment against which any change in functional independence can be measured.
The original NIS was developed in the 1990’s for use alongside the UK FIM+FAM. It was a simple checklist of neurological impairments that may affect functional gain, but it did not identify level of severity.
Further development of the NIS included a simple ordinal scoring system to capture severity (none, mild, moderate, severe). Items are mapped on to the International Classification of function (ICF).
The NIS has proven reliability and validity.
- Factor analysis identified two principal domains ("Physical" and "Cognitive") together accounting for 35% of the variance: their Cronbach's alpha values were 0.76 and 0.67, respectively.
- Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95) and acceptable between the medical and multidisciplinary team (ICC = 0.92).
- Change in NIS-physical score predicted 29% of the variance in functional gain.
Reference
- Turner-Stokes L, Aung T, Williams H, Casey R, Rose H, Siegert RJ. The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation. Disability and Rehabilitation 2014; 36 (1): 25-31 doi: 10.3109/09638288.2013.775360
The Neurological Impairment Scale - Trauma (NIS-T)
Further development of the NIS was completed in 2015 prior to commencement of the National Clinical Audit of Specialist Rehabilitation for patients with complex need following major trauma (NCASRI) Audit. Additional domains were included to reflect the additional impairments that may be experienced following major Ttauma. The additional items follow the same ordinal scoring system and where possible, mapping onto the ICF. Additional information is also captured for some items e.g., stability and management of fractures, healing of amputation. The additional items in the NIS-T provide an additional range of 0-63. The total NIS-T score range is 0-113.
Completion of the NIS/NIS-T
The NIS/NIS-T is completed at the same time as the UK FIM+FAM scores.
Each domain is scored from 0-3 or if the impairment cannot be assessed -untestable/unknown can be indicated. (Untestable = score 3, unknown = score 0). The total score is the sum of all the individual domain scores (excluding the overall impairment score for motor items on the NIS tool). Where a score greater than 0 is selected, the impairment type should be indicated.
Guidelines
The NIS score sheet is single sided for the NIS and double-sided for the NIS-T.
The score descriptions are presented at the top of the score sheet for reference and impairment types are listed for selection.
If teams would like further clarification on the scoring, please email LNWH-tr.ukroc@nhs.net
Training
For those who want further training in the use of the NIS, sessions are provided annually as part of the UK FIM+FAM Training Course
For further information on the date of the next course, please contact the UK ROC team – LNWH-tr.ukroc@nhs.net
Additional References
Find out more additional FIM+FAM/NIS references on PURE.
Use of Neurological Impairment Scale-Trauma (NIS-T)
The NIS-T was used by Major Trauma Centres that participated in the National Clinical Audit of Specialist Rehabilitation for Patients with Complex needs following Major Injury (NCASRI) review. Trauma Audit and Rehabilitation Network (TARN) and the United Kingdom Rehabilitation Outcomes Collaborative (UK ROC) worked in partnership on the audit from 2015-2018
Find out more about NCASRI.
The NIS was developed in conjunction with the UK FIM+FAM and is therefore used by all UK Specialist in-patient Neurorehabilitation Settings.
As the NIS is part of the UK FIM+FAM outcome measure, it is distributed to all services requesting the UK FIM+FAM.
Translation of the Neurological Impairment Scale
Other countries have enquired about translation of the NIS and FAM items, but it is unknown if this has been completed.