Stroke Impact Scale

Stroke Impact ScaleThese questions are about the physical problems which may have occurred asa result of your stroke.1. In the past week, how wouldyou rate the strength of your....a. Arm that was most affected byyour stroke?b. Grip of your hand that wasmost affected by your stroke?c. Leg that was most affected byyour stroke?d. Foot/ankle that was mostaffected by your stroke?A lot ofstrengthQuite a bitof strengthSomestrengthA littlestrengthNostrength atall5 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 1These questions are about your memory and thinking.2. In the past week, how difficultwas it for you to...a. Remember things that people justtold you?b. Remember things that happened theday before?c. Remember to do things (e.g. keepscheduled appointments or takemedication)?Notdifficult atallA littledifficultSomewhatdifficultVerydifficultExtremelydifficult5 4 3 2 15 4 3 2 15 4 3 2 1d. Remember the day of the week? 5 4 3 2 1e. Concentrate? 5 4 3 2 1f. Think quickly? 5 4 3 2 1g. Solve everyday problems? 5 4 3 2 1

These questions are about how you feel, about changes in your mood andabout your ability to control your emotions since your stroke.3. In the past week, how often did None of A little of Some of Most of All of theyou...the time the time the time the time timea. Feel sad? 5 4 3 2 1b. Feel that there is nobody you are 5 4 3 2 1close to?c. Feel that you are a burden to others? 5 4 3 2 1d. Feel that you have nothing to look 5 4 3 2 1forward to?e. Blame yourself for mistakes that 5 4 3 2 1you made?f. Enjoy things as much as ever? 5 4 3 2 1g. Feel quite nervous? 5 4 3 2 1h. Feel that life is worth living? 5 4 3 2 1i. Smile and laugh at least once a day? 5 4 3 2 1The following questions are about your ability to communicate with otherpeople, as well as your ability to understand what you readand what you hear in a conversation.4. In the past week, how difficultwas it to...a. Say the name of someone who wasin front of you?b. Understand what was being said toyou in a conversation?Notdifficult atallA littledifficultSomewhatdifficultVerydifficultExtremelydifficult5 4 3 2 15 4 3 2 1c. Reply to questions? 5 4 3 2 1d. Correctly name objects? 5 4 3 2 1e. Participate in a conversation with agroup of people?f. Have a conversation on thetelephone?g. Call another person on thetelephone, including selecting thecorrect phone number and dialing?5 4 3 2 15 4 3 2 15 4 3 2 1

The following questions are about your ability to use your hand that wasMOST AFFECTED by your stroke.7. In the past 2 weeks, how difficultwas it to use your hand that was mostaffected by your stroke to...a. Carry heavy objects (e.g. bag ofgroceries)?Notdifficultat allA littledifficultSomewhatdifficultVerydifficultCould notdo at all5 4 3 2 1b. Turn a doorknob? 5 4 3 2 1c. Open a can or jar? 5 4 3 2 1d. Tie a shoe lace? 5 4 3 2 1e. Pick up a dime? 5 4 3 2 1The following questions are about how stroke has affected your ability toparticipate in the activities that you usually do, things that are meaningful toyou and help you to find purpose in life.8. During the past 4 weeks, howmuch of the time have you beenlimited in...None ofthe timeA little ofthe timeSome ofthe timeMost ofthe timea. Your work (paid, voluntary or other) 5 4 3 2 1b. Your social activities? 5 4 3 2 1c. Quiet recreation (crafts, reading)? 5 4 3 2 1All of thetimed. Active recreation (sports, outings, 5 4 3 2 1travel)?e. Your role as a family member5 4 3 2 1and/or friend?f. Your participation in spiritual or 5 4 3 2 1religious activities?g. Your ability to control your life as 5 4 3 2 1you wish?h. Your ability to help others? 5 4 3 2 1