Measuring stroke recovery properly is harder than it sounds. Most single outcome measures capture one dimension of what stroke does to a person and miss everything else… which is why Dr Tom Balchin at ARNI Stroke Rehab UK has built a set of four complementary assessments into every ARNI specialist’s training and into the Training Logbooks that survivors and instructors use together, repeated every 12 weeks so that genuine progress – and any regression – can be tracked with rigour over time.
The Stroke Impact Scale (SIS) is introduced from day one of the ARNI Functional Rehabilitation after Stroke Accreditation; it covers strength, memory, emotion, communication, activities of daily living, mobility and quality of life, giving both trainer and survivor a rounded picture of how stroke is affecting daily living across every domain. Alongside it, also from the outset, comes the Chedoke Arm and Hand Activity Inventory (CAHAI); it assesses the functional use of the affected arm and hand across nine real-life bilateral tasks — opening a jar, doing up buttons, pouring a glass of water and more – producing a score out of 63 that reflects what the upper limb can actually do in practice rather than just what it looks like in a clinical setting. Together the SIS and CAHAI form a strong and complementary pairing; the SIS capturing the broad whole-life picture and the CAHAI drilling down into the upper limb detail that sits at the heart of so much of ARNI’s rehabilitation work.
Once students are established in the course, the Rivermead Mobility Scale (RMS) is introduced; it measures mobility across 15 tasks from turning over in bed through to running, making it an ideal tool for tracking lower limb and whole body functional progress over time. And most recently Dr Tom has begun introducing instructors to the Fatigue Severity Scale (FSS), developed by Krupp et al… which was advised to him by his kind contact Dr Anna Kuppuswamy (formerly of Queen Square, UCL and now at Leeds), because post-stroke fatigue is one of the most debilitating and underassessed sequelae of stroke, recognised by survivors themselves as something that can affect them every day.
What seems to make this quad quite effective is that together they cover the full landscape of stroke recovery without much overlap – upper limb function, mobility, whole-life impact and fatigue – and no single measure could do that alone. They are the evidence base that shows survivors, families and commissioners what ARNI training is actually achieving, session by session and month by month. Every ARNI instructor is trained by Dr Tom and his team to use them with care and consistency.
