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Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI)
Availability
For more information about the instrument: Neurological Outcome Scale
Classification
Supplemental: Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), and Traumatic Brain Injury (TBI)
Short Description of Instrument
The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) is a 15-item scale modified after the National Institutes of Health Stroke Scale (NIHSS), but validated in a TBI population and containing items specific to TBI. Items include level of consciousness, vision, extraocular movements, facial paresis, limb strength, sensation, speech and language, olfaction, hearing, pupillary response, and gait (supplemental) and ataxia (supplemental).
 
Sport-Related Concussion Specific: Advantage: The NOS-TBI is a reliable and valid measure of neurological functioning in patients with moderate to severe TBI (McCauley et al., 2010). This scale offers (1) a cost-effective, brief, practicable, standardized, and quantifiable method of communicating and analyzing neurological deficits in a way that traditional neurological assessment alone cannot currently provide, and (2) a measure that non-physicians can administer (Wilde et al., 2010).
 
Limitations: Has to be completed by clinician (physician, therapist, nurse, psychologist, social worker). Also, some training is required as well as videotape. It has to be validated for use in sports populations. It might be difficult to administer the measure to severely-injured patients, also it might be difficult to administer items from the NOS-TBI or the neurological examination to participants who were agitated or uncooperative. (Wilde et al., 2010).
Scoring
Minimum score is 0 (no deficits) and maximum score is 58 (without supplemental items). Each item is scored 0-2, 0-3, or 0-4 and scores for each item are summed for a total score. Two supplemental items can be given to patients that are ambulatory and weight- bearing (measuring gait and limb ataxia) for an additional supplemental score. Higher scores reflect greater impairment.
 
Completed by clinician (physician, therapist, nurse, psychologist, social worker); some training required and videotape, online certification training of the NIHSS is recommended. Administration time is 10-15 minutes.
References
McCauley SR, Wilde EA, Kelly TM, Weyand AM, Yallampalli R, Pedroza C, Schnelle KP, Boake C, Levin HS, Moretti P. The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): II. Reliability and Convergent Validity. J. Neurotrauma. 2010;27:991–997
 
Wilde EA, McCauley SR, Levin HS, Kelly TM, Weyand AM, Boake C, Pedroza C, Clifton GL, Valadka AB, Robertson CS, Shah M Moretti PM. Feasibility of using the Neurophysical Outcome Scale in adults with traumatic brain injury. J. Neurotrauma. 2010;27:975–981.
 
Wilde EA, McCauley SR, Kelly TM, Weyand AM, Pedroza C, Levin HS, Clifton GL, Schnelle KP, Shah MV, Moretti P. The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): I. Construct Validity. J. Neurotrauma. 2010;27:983–989.
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