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  2. Neurobehavioral Symptom Inventory

Neurobehavioral Symptom Inventory

Last Updated

Purpose

The NSI is intended to measure postconcussion symptoms following traumatic brain injury (TBI).

Link to Instrument

Acronym NSI

Area of Assessment

Behavior
Negative Affect
Cognition

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$0.00

CDE Status

NINDS CDE Notice of Copyright
Neurobehavioral Symptom Inventory (NSI)
Availability
The instrument is freely available here: .
Classification
Supplemental: Stroke, Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH) and Traumatic Brain Injury (TBI)

Populations

Brain Injury

Key Descriptions

  • Respondents rate the degree to which they are bothered by each of the 22 symptoms, on a range from 0 (None – Rarely if ever present. Not a problem at all) to 4 (Very Severe - Almost always present and I have been unable to perform at work, school or home due to this problem. I probably cannot function without help).
  • The NSI total score is a sum of the 22 items (range 0 to 88).
  • There are three versions of the NSI that measure symptoms according to three timeframes: (1) since time of injury, (2) in the past month, and (3) in the last two weeks.
  • The NSI contains three embedded symptom validity scales to screen for symptom over-reporting.
  • Can be self-administered (paper/pencil) or administered via interview (in person, telephone).

Number of Items

22

Equipment Required

  • Pencil/Pen

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Marc A. Silva, PhD, Neuropsychologist, James A. Haley Veterans’ Hospital; Assistant Professor, Internal Medicine, University of South Florida; Assistant Professor, Psychiatry and Behavioral Neurosciences, University of South Florida.

Body Part

Head

ICF Domain

Body Function

Measurement Domain

Cognition
Emotion
Sensory

Considerations

The NSI was primarily used and validated for persons with mild TBI. The majority of studies involve veteran and military samples, but not exclusively so.

Brain Injury

back to Populations

Standard Error of Measurement (SEM)

Mild TBI: (Silva et al., 2013; n = 42; no demographic data)

  • SEM = 5.70

 

Mixed sample (mild TBI and no TBI): (Belanger et al., 2016; n = 2016;  Mean Age = 34 (range 19-59); > 6 months post mild TBI)

  • SEM =3.24

Minimal Detectable Change (MDC)

Mild TBI: (Silva et al., 2013)

  • SEM = 5.70

 

Mixed sample (mild TBI and no TBI): (Belanger et al., 2016)

  • SEM =3.24

Normative Data

Mixed sample (mild TBI and no TBI): (Soble et al., 2014; no data on age or time since injury)

Nondeployed, nonclinical sample (mild TBI and no TBI); n = 1,453

  • M=3.0; SD=5.7
  • Quartiles: 0/0/4
  • Range: 0-50

Deployed, nonclinical sample (mild TBI and no TBI); n = 1,064

  • M=6.8; SD=8.2
  • Quartiles: 0/3/10
  • Range: 0-45

Test/Retest Reliability

Mild TBI: (Silva et al., 2013)

  • Excellent: r = 0.94 (7-day test-retest period)

 

Mixed sample (mild TBI and no TBI): (Belanger et al., 2016)

  • Adequate: r = 0.78 (30-day test-retest period)

Internal Consistency

Mild TBI: (Menatti et al., 2019; n = 161; Mean Age = 33.5 (SD=9.2); no data on time since injury)

  • Excellent: Cronbach alpha was 0.94

 

Mild TBI: (Silva et al., 2013)

  • Excellent: Cronbach alpha was 0.94

 

Mixed sample (mild TBI and no TBI): (Soble et al., 2014)

  • Excellent: Cronbach alpha was 0.91 for deployed military service members and 0.90 for those with no history of military deployment.

 

Mixed sample (with TBI mixed severity and no TBI: (King et al., 2012, n = 500; Mean age = 32.2 (SD=8.9); Mean time since injury (months) = 41.5 (range 0-96))

  • Excellent: Cronbach alpha was 0.95

 

TBI mixed severity: (Vos et al., 2019; n = 497; Mean Age = 38.2 (SD=13.3); Mean time since injur (years) = 6.2 (SD=6.8))

  • Excellent: Cronbach alpha was 0.94

Criterion Validity (Predictive/Concurrent)

Predictive Validity

TBI mixed severity: (Belanger et al., 2017; n = 159; Mean Age = 34.0; SD=15.2), 1-year post-TBI)

  • Poor: NSI during inpatient rehabilitation was predictive of satisfaction with life (Satisfaction with Life Scale) at 1-year post-TBI (semi-partial r = -0.16).
  • Poor: NSI during inpatient rehabilitation was predictive of global disability level (Glasgow Outcome Scale-Extended) at 1-year post-TBI (semi-partial r = -0.17).
  • Excellent: Change in NSI score from inpatient rehabilitation to 1-year post-TBI predicted change in posttraumatic stress disorder symptom severity (PTSD Checklist-civilian) from inpatient rehabilitation to 1-year post-TBI (r = 0.62).

 

Concurrent Validity

Mixed sample (with TBI mixed severity and no TBI: (King et al., 2012)

  • Excellent: NSI was correlated with posttraumatic stress disorder symptom severity (PTSD Checklist-Military version), r = 0.67
  • Excellent: NSI was correlated with depression symptom severity (Beck Depression Inventory 2nd Edition), r = 0.64
  • Excellent: NSI was correlated with depression symptom severity (Beck Anxiety Inventory), r = 0.65
  • Adequate: NSI was correlated with self-reported TBI diagnosis, r = 0.41

Construct Validity

TBI mixed severity: (Vos et al., 2019)

  • Excellent: The NSI was correlated with the Rivermead Postconcussive Symptoms Questionnaire, r = .90

Content Validity

Per Cicerone & Kalmar, (1995), NSI items were adapted from a structured interview created for use with hospitalized patients with mild TBI,  to include the most common symptoms reported after “minor head injury.” Many NSI items map onto the symptom criteria listed for Postconcussional Syndrome (International Classification of Diseases [ICD-10]; Word Health Organization, 2019) and Postconcussional Disorder (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR]; American Psychiatric Association, 2000).  

Responsiveness

Mild TBI: (Dretsch et al., 2015; n = 314; Mean Age = 34.7 (SD=8.0); Time since injury (months) 1.6% < 3 months, 8.5% 3-6 months, 17.6% months, 72.3% > 12 months)
  • Medium-to-large: Cohen’s d = 0.70 (after 4-week interdisciplinary outpatient rehabilitation, variable time since injury)

Bibliography

Belanger, H. G., Lange, R. T., Baille, J., Iverson, G. L., Arrieux, J. P., Ivins, B. J., & Cole, W. R. (2016). Interpreting change on the Neurobehavioral Symptom Inventory and the PTSD Checklist in military personnel. The Clinical Neuropsychologist, 30(7), 1063-1073. doi: 10.1080/13854046.2016.1193632

 

Belanger, H. G., Silva, M. A., Donnell, A. J., McKenzie-Hartman, T., Lamberty, G. J., & Vanderploeg, R.D. (2017). Utility of the Neurobehavioral Symptom Inventory (NSI) as an outcome measure: A VA TBI Model Systems study. Journal of Heath Trauma Rehabilitation, 32, 46-54. doi: 10.1097/HTR.0000000000000208

 

Cicerone, K. D., & Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10, 1-17. doi:10.1097/00001199-199510030-00002

 

Dretsch, M., Bleiberg, J., Williams, K., Caban J., Kelly, J., Grammer, G., & DeGraba, T. (2015). Three scoring approaches to the Neurobehavioral Symptom Inventory for measuring clinical change in service members receiving intensive treatment for combat-related mTBI. Journal of Head Trauma Rehabilitation, 31(1):23-29.

doi: 10.1097/HTR.0000000000000109

 

King, P. R., Donnelly, K. T., Donnelly, J. P., Dunnam, M., Warner, G., Kittleson, C. J., Bradshaw, C. B., Alt, M., & Meier, S. T.  (2012).  Psychometric study of the Neurobehavioral Symptom Inventory. Journal of Rehabilitation Research & Development, 49, 879-888. doi:10.1682/JRRD.2011.03.0051

 

Menatti, A. R. R., Melinder, M. R. D., & Warren, S. L. (2019). Limited prediction of performance validity using embedded validity scales of the Neurobehavioral Symptom Inventory in an mTBI veteran sample. Journal of Head Trauma Rehabiliation, 35(1), E36-E42.

doi: 10.1097/HTR.0000000000000467

 

Meterko, M., Baker, E., Stolzmann, K. L., Hendricks, A. M., Cicerone, K. D., & Lew, H. L.  (2012).  Psychometric assessment of the Neurobehavioral Symptom Inventory-22: The structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans. Journal of Head Trauma Rehabilitation, 27, 55-62. doi:10.1097/HTR.0b013e318230fb17

 

Silva, M. A., Barwick, F. H., Kretzmer, T. S., Vanderploeg, R. D., & Belanger, H. G. (2013). Reliable change indices for the Neurobehavioral Symptom Inventory and Brief Symptom Inventory-18 in a mild traumatic brain injury sample [Abstract]. The Clinical Neuropsychologist, 27, 601. doi: 10.1080/13854046.2013.800269.

 

Soble, J. S., Silva, M. A., Vanderploeg, R. D., Curtiss, G., Belanger, H. G., Donnell, A. J., & Scott, S. G. (2014). Normative data for the Neurobehavioral Symptom Inventory (NSI) and postconcussion symptom profiles among TBI, PTSD, and nonclinical samples. The Clinical Neuropsychologist, 28, 614-632. doi: 10.1080/13854046.2014.894576

 

Sullivan, K. A., & Lurie, J. K. (2017). Principle components analysis of the Neurobehavioral Symptom Inventory in a nonclinical sample. Applied Neuropsychology: Adult, 24(6), 522-531. doi: 10.1080/23279095.2016.1216433

Vos, L., Whiteneck, G. G., Ngan, E., Leon-Novelo, L., Harik, L. M., & Sherer, M. (2019). Comparison of the Neurobehavioral Symptom Inventory and the Rivermead Postconcussion Symptoms Questionnaire. Brain Injury, 33, 1165-1172. doi: 10.1080/02699052.2019.1637024

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