Table 2.

Trunk Impairment Scale Items and Scoring Criteria.

Item	Method	Scoring
Perception of trunk verticality	•While the patient is sitting on the edge of a bed or on a chair without a backrest, with the feet off the ground, the examiner holds both sides of the patient's shoulders and makes the patient's trunk deviate to the right and left. •The examiner asks the patient to indicate when he or she feels the trunk is in a vertical position. •The examiner then records the degree of trunk angle deviation from the vertical line drawn from the midpoint of the Jacoby line.	•0: The angle is ≥30°. •1: The angle is <30° and ≥20°. •2: The angle is <20° and ≥10°. •3: The angle is <10°.
Trunk rotation muscle strength on the affected side	•The patient is asked to roll the body from the supine position to the unaffected side. •The arms should be crossed in front of the chest and legs kept extended. •The patient is asked to roll his or her body without pushing the floor with his or her limbs or pulling on bed clothes. •Isometric contractions for stabilization and other muscles than external oblique (e.g., pectoralis major) activation during rolling are allowed.	•0: No contraction is noted in external oblique muscles on the affected side. •1: External oblique muscle contraction is visible on the affected side, but the patient cannot roll his or her body. •2: The patient can lift the affected side scapula but cannot fully rotate the body. •3: The patient can fully rotate the body.
Trunk rotation muscle strength on the unaffected side	•The patient is asked to roll the body from the supine position to the affected side.	•Scoring is the same as for the trunk rotation muscle strength on the affected side.
Righting reflex on the affected side	•The patient sits on the edge of a bed or a chair without a backrest. •The examiner pushes the patient's shoulder laterally (about 30 degrees) to the unaffected side and scores according to the degree of the reflex elicited on the affected side of the patient's trunk.	•0: No reflex is elicited •1: The reflex is poorly elicited, and the patient cannot bring his or her body back to the erect position as before. •2: The reflex is not strong, but the patient can bring his or her body back to the erect position almost as before. •3: The reflex is strong enough, and the patient can immediately bring his or her body back to the erect position as before.
Righting reflex on the unaffected side	•The examiner pushes the patient's shoulder laterally (about 30 degrees) to the affected side.	•Scoring is the same as for the righting reflex on the affected side.
Stroke impairment assessment set verticality	•Instruct the patient to remain in the sitting position.	•0: The patient cannot maintain the sitting position. •1: A sitting position can only be maintained while tilting to one side, and the patient is unable to correct the posture to an erect position. •2: The patient can sit vertically when reminded to do so. •3: The patient can sit vertically in a normal manner.
Stroke impairment assessment set abdominal muscle strength	•Stroke Impairment Assessment Set abdominal muscle strength is evaluated with the patient resting in a 45° semireclining position in either a wheelchair or a high-back chair. •The patient is asked to raise the shoulders off the back of the chair and assume the sitting position.	•0: Unable to sit up. •1: The patient can sit up provided there is no resistance to the movement. •2: The patient can come to the sitting position despite pressure on the sternum by the examiner. •3: The patient has good strength in the abdominal muscles and is able to sit up against considerable resistance.

Source: Am J Phys Med Rehabil (Fujiwara T, et al., 2004, 83:681-8).

Created by citing the development of a new scale for assessing trunk impairment after stroke (Trunk Impairment Scale). Its psychometric properties (2004) (3).

Reprinted with permission of the original author Dr. Toshiyuki Fujiwara, Senior Professor.