样本 SIS3.0-- Stroke Impact Scale version 3.0.pdfVIP

Stroke Impact Scale VERSION 3.0 The purpose of this questionnaire is to evaluate how stroke has impacted your health and life. We want to know from YOUR POINT OF VIEW how stroke has affected you. We will ask you questions about impairments and disabilities caused by your stroke, as well as how stroke has affected your quality of life. Finally, we will ask you to rate how much you think you have recovered from your stroke. Stroke Impact Scale These questions are about the physical problems which may have occurred as a result of your stroke. 1. In the past week, how would A lot of Quite a bit Some A little No you rate the strength of your strength of strength strength strength strength at all a. Arm that was most affected by 5 4 3 2 1 your stroke? b. Grip of your hand that was 5 4 3 2 1 most affected by your stroke? c. Leg that was most affected by 5 4 3 2 1 your stroke? d. Foot/ankle that was most 5 4 3 2 1 affected by your stroke? These questions are about your memory and thinking. 2. In the past week, how difficult Not A little Somewhat Very Extremely difficult at difficult difficult difficult difficult was it for you to... a