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Neuromuscular Recovery Scale
Availability
Copyrighted via publication. Available in Behrman et al., 2012 and Harkema, et al., 2012.
Classification
Exploratory: Spinal Cord Injury (SCI) and SCI-Pediatric (over 12 years old)
Short Description of Instrument
Construct measured: Function, neuromuscular recovery
Generic vs. disease specific: Disease specific
Intended respondent: Participant
Comments/Special Instructions
Scoring: Each task (item) is scored on a scale from the lowest level of capacity or neuromuscular recovery (1A) to the highest level of capacity (4C) with 12 possible scores per item. An overall score is calculated, as well as "lagging" items or the lowest scoring items. Three items were added to the NRS to measure upper extremity function and the scoring was also updated (Harkema et al., 2016).
 
Background: The Neuromuscular Recovery Scale (NRS) is a classification of neuromuscular recovery after adult spinal cord injury based on an individual's capacity to perform functional tasks without compensation (e.g., braces, physical assist, and assistive devices). The scale compares the participant's performance to how the task would have been performed on day prior to injury.
 
Psychometric Properties:
Strong test-retest (r=+>0.92); inter-rater reliability (W=0.82–0.89) and better responsiveness than comparative measures.
 
SCI-Pediatric-specific: The NMR Scale is not indicated for youth 12 years old and younger. Work is under way to develop a pediatric version (see Pediatric Neuromuscular Recovery Scale).
Rationale/Justification
Strengths/Weaknesses: NRS can provide the therapist and patient an effective means to quantify recovery, set goals, and assess progress. No issues with either a floor or ceiling effect have been detected and the NRS met many of the criteria for a Rasch model, which supports its construct validity and measurement scale (Velozo et al, 2015). There is also evidence to suggest it is a responsive measure that detects change in motor function during outpatient neurorehabilitation for SCI Tester et al, 2016). Further evaluation of the psychometric properties in future studies are warranted.
References
Basso DM, Velozo C, Lorenz D, Suter S and Behrman AL. Interrater reliability of the Neuromuscular Recovery Scale for spinal cord injury. Arch Phys Med Rehabil. 2015;96(8):1397-1403.
 
Behrman, AL, Ardolino E, Vanhiel LR, Kern M, Atkinson D, Lorenz DJ and Harkema SJ. Assessment of functional improvement without compensation reduces variability of outcome measures after human spinal cord injury. Arch Phys Med Rehabil. 2012;93(9):1518-1529.
 
Harkema S, Behrman A and Barbeau H. Evidence-based therapy for recovery of function after spinal cord injury. Handb Clin Neurol. 2012;109:259-274.
 
Harkema SJ, Shogren C, Ardolino E, Lorenz DJ. Assessment of Functional Improvement without Compensation for Human Spinal Cord Injury: Extending the Neuromuscular Recovery Scale to the Upper Extremities. J Neurotrauma. 2016;33(24):2181-2190.
 
Tester NJ, Lorenz DJ, Suter SP, Buehner JJ, Falanga D, Watson E, Velozo CA, Behrman AL, Michele Basso D. Responsiveness of the Neuromuscular Recovery Scale During Outpatient Activity-Dependent Rehabilitation for Spinal Cord Injury. Neurorehabil Neural Repair. 2016;30(6):528-538.
 
Velozo C, Moorhouse M, Ardolino E, Lorenz D, Suter S, Basso DM, Behrman AL. Validity of the Neuromuscular Recovery Scale: a measurement model approach. Arch Phys Med Rehabil. 2015 Aug;96(8):1385-96.