NIS – Neuropathy Impairment Score
The Neuropathy Impairment Score (NIS) is the summed scores of standard items of the neuromuscular examination of weakness, reflex loss, and sensation loss, originally named Neurologic Disability Score (NDS).
A standard list of neurologic test items and of both sides of the body are to be scored using standard approaches and taking age, sex, physical fitness and height, and other physical characteristics into account.
It was designed to provide standard, objective, and overall scores of neurologic impairment for the purpose of serial evaluation of patients in epidemiologic studies and in controlled clinical trials of treatment. Also it can be used to as certain worsening or impairment of the neuromuscular condition for medical practice purposes. Unlike functional scales, the degree of neuromuscular impairment was intended to be judged by an independent medical expert.
It was designed to provide:
- a balance between muscle weakness,
- reflex loss,
- sensation loss.
A standard group of 37 neuromuscular items and both sides are graded and scored. These scores are then summed.
Subscores of the NIS may be used (e.g., NIS lower limbs [LL] items 17–24, 28 and 29, and 34–37; NIS legs [including feet] items 21–24, 29, and 37–37; or NIS [thigh] items 17–20, 28, and sensation of thigh [substituted in standard forms]) [1]
[1] Dyck et al. J Peripher Nerv Syst 2005;10:158-173
WEAKNESS
Assessment: Muscle strength in 24 muscle groups
Area of body:
- Cranial (five muscle groups)
- Upper body (eleven muscle groups)
- Lower body (eight muscle groups)
Grading:
- 0: normal
- 1: 25% weak
- 2: 50% weak
- 3: 75% weak
- 3.25: can just move against gravity
- 3.50: can move with gravity just eliminated
- 3.75: muscle contraction can be felt or seen but no visible movement
- 4: paralysis
Scale: 0–192
CRANIAL NERVES |
RIGHT |
LEFT |
| 3rd Nerve | ||
| 6th Nerve | ||
| Facial weakness | ||
| Palate weakness | ||
| Tongue weakness |
MUSCLE WEAKNESS |
RIGHT |
LEFT |
| Respiratory | ||
| Neck flexion | ||
| Shoulder abduction | ||
| Elbow flexion | ||
| Brachioradialis | ||
| Elbow extension | ||
| Wrist flexion | ||
| Wrist extension | ||
| Finger flexion | ||
| Finger spread | ||
| Thumb abduction |
HIP |
RIGHT |
LEFT |
| Hip flexion | ||
| Hip extension | ||
| Knee flexion | ||
| Knee extension | ||
| Ankle dorsiflexors | ||
| Ankle plantar flexors | ||
| Toe extensor | ||
| Toe flexors |
REFLEXES
Assessment: Muscle stretch reflexes in five muscle groups
Area of body:
- Biceps
- Triceps
- Brachioradialis
- Quadriceps
- Ankle
Grading:
- 0: normal
- 1: decreased
- 2: absent
Scale: 0–20
REFLEXES |
RIGHT |
LEFT |
| Biceps brachii | ||
| Triceps brachii | ||
| Brachioradialis | ||
| Quadriceps femoris | ||
| Triceps surae |
SENSATION
Assessment:
- Touch-pressure
- Vibration
- Joint position
- Pinprick
Area of body:
- Index finger
- Great toe
Grading:
- 0: normal
- 1: decreased
- 2: absent
Scale: 0–32
SENSATION – I. FINGER |
RIGHT |
LEFT |
| Touch pressure | ||
| Pin-prick | ||
| Vibration | ||
| Joint position |
SENSATION – G. TOE |
RIGHT |
LEFT |
| Touch pressure | ||
| Pin-prick | ||
| Vibration | ||
| Joint position |
Dyck PJ, Turner DW, Davies JL, O’Brien PC, Dyck PJB, Rask CA, rhNGF Group (2002). Electronic case-report forms of
symptoms and impairments of peripheral neuropathy. Can J Neurol Sci 29:258–266.