Stroke Impact Scale – SIS 3.0

Rate the strength of the arm that was most affected by your stroke in the past week.

Rate the strength of the grip of your hand that was most affected by your stroke in the past week.

Rate the strength of the leg that was most affected by your stroke in the past week.

Rate the strength of the foot/ankle that was most affected by your stroke in the past week.

In the past week, how difficult was it for you to remember things that people just told you?

In the past week, how difficult was it for you to remember things that happened the day before?

In the past week, how difficult was it for you to remember to do things (e.g., keep scheduled appointments or take medication)?

In the past week, how difficult was it for you to remember the day of the week?

In the past week, how difficult was it for you to concentrate?

In the past week, how difficult was it for you to think quickly?

In the past week, how difficult was it for you to solve everyday problems?

In the past week, how often did you feel sad?

In the past week, how often did you feel that there is nobody you are close to?

In the past week, how often did you feel that you are a burden to others?

In the past week, how often did you feel that you have nothing to look forward to?

In the past week, how often did you blame yourself for mistakes that you made?

In the past week, how often did you enjoy things as much as ever?

In the past week, how often did you feel quite nervous?

In the past week, how often did you feel that life is worth living?

In the past week, how often did you smile and laugh at least once a day?

In the past week, how difficult was it to say the name of someone who was in front of you?

In the past week, how difficult was it to understand what was being said to you in a conversation?

In the past week, how difficult was it to reply to questions?

In the past week, how difficult was it to correctly name objects?

In the past week, how difficult was it to participate in a conversation with a group of people?

In the past week, how difficult was it to have a conversation on the telephone?

In the past week, how difficult was it to call another person on the telephone, including selecting the correct phone number and dialing?

In the past 2 weeks, how difficult was it to cut your food with a knife and fork?

In the past 2 weeks, how difficult was it to dress the top part of your body?

In the past 2 weeks, how difficult was it to bathe yourself?

In the past 2 weeks, how difficult was it to clip your toenails?

In the past 2 weeks, how difficult was it to get to the toilet on time?

In the past 2 weeks, how difficult was it to control your bladder (not have an accident)?

In the past 2 weeks, how difficult was it to control your bowels (not have an accident)?

In the past 2 weeks, how difficult was it to do light household tasks/chores (e.g., dust, make a bed, take out garbage, do the dishes)?

In the past 2 weeks, how difficult was it to go shopping?

In the past 2 weeks, how difficult was it to do heavy household chores (e.g., vacuum, laundry or yard work)?

In the past 2 weeks, how difficult was it to stay sitting without losing your balance?

In the past 2 weeks, how difficult was it to stay standing without losing your balance?

In the past 2 weeks, how difficult was it to walk without losing your balance?

In the past 2 weeks, how difficult was it to move from a bed to a chair?

In the past 2 weeks, how difficult was it to walk one block?

In the past 2 weeks, how difficult was it to walk fast?

In the past 2 weeks, how difficult was it to climb one flight of stairs?

In the past 2 weeks, how difficult was it to climb several flights of stairs?

In the past 2 weeks, how difficult was it to get in and out of a car?

In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to carry heavy objects (e.g., bag of groceries)?

In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to turn a doorknob?

In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to open a can or jar?

In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to tie a shoe lace?

In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to pick up a dime?

During the past 4 weeks, how much of the time have you been limited in your work (paid, voluntary or other)?

During the past 4 weeks, how much of the time have you been limited in your social activities?

During the past 4 weeks, how much of the time have you been limited in quiet recreation (crafts, reading)?

During the past 4 weeks, how much of the time have you been limited in active recreation (sports, outings, travel)?

During the past 4 weeks, how much of the time have you been limited in your role as a family member and/or friend?

During the past 4 weeks, how much of the time have you been limited in your participation in spiritual or religious activities?

During the past 4 weeks, how much of the time have you been limited in your ability to control your life as you wish?

During the past 4 weeks, how much of the time have you been limited in your ability to help others?

On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?