MPAI Resources For TBI


General Scoring Questions

Yes, the use of an assistive device is automatically a score of 1 or more, whereas wearing glasses (pre-diagnosis) is a 0. 

If a client wears glasses they are not penalized because they do not have an appreciable effect on the patient’s abilities (and thus their rehabilitation), unless the patient is wearing glasses as a result of the injury or diagnosis in which case the score is 1 or more. In contrast, assistive devices are always considered to have an effect on a patient’s ability as it relates to their rehabilitation, meriting a score of 1 or more.

Difficulty with writing would be considered in both of these scores. Difficulty writing informs the use of hands score as an indicator of fine motor skill and coordination, but writing is not assessed directly here. It is directly scored in verbal communication, as one form of communication along with speaking and understanding language. 

No item on the MPAI-4 should be left blank. Use your best judgment to score the item and making a note stating any issues you had providing an accurate score. The discussion with the interdisciplinary team will hopefully address this gap in understanding of the client, or obtaining an accurate understanding of the individual’s memory and knowledge may become part of the treatment plan.

Both questions 24 and 26 ask if the client needs support to do certain activities that may be meaningful or enriching. Question 28B differs from these questions because it is primarily asking how many hours the patient spends doing social activities, as opposed to the level of support that they need to do these activities.

Yes, people should be assessed for would be expected for their age-group.

Item Specific Questions

Rate the current level (i.e., the current level of mobility), not the projected or previous level.

Although there is a risk of a slight regression in rating when a user is functional in a wheelchair and leaves walking rehabilitation with difficulty or assistance, the spirit of the Manual should be maintained as much as possible. In any case, if the user uses a wheelchair, he/she is rated at least at level 2.

If the client can only use one hand but have adapted to require no external assistance, they would receive a score of 1. If they require assistance, they would receive a score of 2.

Visual difficulties and symptoms (double or blurred vision, at rest or with physical or mental exertion, sensitivity to light, etc.) are rated under item 3 (vision), while other related elements (e.g., pain behind the eyes with exertion) are rated under the respective item as appropriate (e.g., item 16 pain and headaches). On the other hand, low mental effort/rapid reading fatigue is rated under item 17 (fatigue). Item 12 (visuospatial abilities) specifically reflects problems with visual perception and visuospatial orientation/attention.

Hearing difficulties and symptoms such as hyperacusis and hypersensitivity to noise are rated under item 4 (hearing).

If working memory weaknesses are reported by the user or are documented and have a mild impact on functioning, they should be rated at Level 1 on this item (memory) of the A) ABILITIES scale, as the Manual indicates that memory problems at this level may be associated with other factors such as concentration difficulties or others.

The functional impact of greater working memory weaknesses will also be considered in the rating of scale C) PARTICIPATION.

In this question, family functioning refers to any stress with close family and friends (not only blood-relatives) that is affecting household tasks being accomplished or the provision of mutual support. The premise of this item is that family functioning is affected by the level of stress on the family. So, these two concepts are intertwined in this item. Higher stress = poorer family functioning = higher score.

The intent is to assess the impact of stress on family functioning, not the family’s ability to compensate for the consumer’s difficulties in performing tasks and responsibilities. When in doubt, refer to the more general % hindrance of activities rather than the specific examples described in the Manual, which are not exhaustive.

Referring to the description of item 21, the term “family” generally means relatives who live together or nearby, but more broadly this item includes any type of significant relationship that can provide concrete support to the person, even if that relationship is at a distance.  

Anyone without meaningful supportive relationships would be rated 3 or 4 in the Handbook: “no family cohesion” or “dysfunctional family life” (rated 3), or “no cohesion at all” (rated 4).  

Taking the client’s social life pre-injury (during and pre-COVID) and their satisfaction with their current level of social contact may be the most appropriate scoring method. If the person is satisfied with their current level of social contact, then it being reduced due to the pandemic isn’t necessarily an issue. If they are not satisfied, then there are obstacles to be overcome and that should be reflected in the score they receive.

Score according to what is observed by the team rather than solely on the basis of the problem reported or not by the user.  

Score on current need for assistance to complete tasks with a socially acceptable outcome, regardless of the type of assistance required (i.e., physical assistance, stimulation, reminders), even if this is not significantly different from the premorbid picture.  

Consider the supervision required to do the tasks (not to remain alone). Assess what the person is doing in terms of socio-residential and associated responsibilities, not their ability to stay on their own.  

Score according to the user’s ability to perform domestic activities as in the assessment during in-house scenarios.

If the user does not require assistance with these tasks, but does not do them for cultural reasons, for example, score 0 (as if he/she were capable). However, if he/she does not do them (or did not do them before) because he/she requires encouragement/reminders/stimulation (i.e., any form of assistance), then score at the severity level corresponding to functioning. 

If the person lives in an area where public transportation is available such that they do not need assistance to get around, then a score of 0 is appropriate. If they live in an area where they do not have access to public transit, then they are dependent on someone else to drive them and should receive a score of 1 or more. This score would depend on how often they require someone to drive them as opposed to walking or biking to get where they need to go, for example.

This is a good example of a score of 1 or 2 for someone who can’t drive but is fairly independent. If they are restricted to using specialized adaptive transit and cannot take standard public transit options, a score of 2 may be more appropriate.

Stick to the functional level. Even if they have the ability to drive, because it’s only for a short time, it restricts them significantly in doing that activity. So this issue needs to be reflected in the rating.  

These persons should be considered as not having a working status. Therefore, item 28B (not 28A) should be marked with a check mark in the box “Person at home, without children or dependants”.  

If the person was unemployed prior to the most recent brain injury, rate item 28B, not 28A, as they are not considered to be gainfully employed at that time.  

Do as for all the other items and rate the status at the time the MPAI-4 is completed, even if the user is likely to change in this respect later on.  

The data will have to be interpreted according to the organization of services in place in each of the settings. A comment could be included in the section of the questionnaire to this effect in order to identify this type of situation in the database.  

Question 28B gives several options to select for primary social role, including childrearing/care-giving, homemaker without childrearing or caregiving, student, volunteer and retired. The primary role of the patient should be selected; however you can take all their activities that fit under this question into account when scoring it.

Detach from the term diagnosis (it is an example to show that it is clinically significant) and try to focus on the clinical and functional impact. Although it may be helpful, it is not essential to have the diagnosis from the professional who can make it.

In the case of premature termination (the user stops his rehabilitation), it is agreed to check the box “Premature termination of rehabilitation” and to indicate a comment on the reason in the section at the end of the questionnaire. Completion of the MPAI-4 will be optional and will depend on where the user is in his or her progress (e.g.: if close to discharge, the final MPAI-4 could be completed). 

At the beginning of inpatient or outpatient rehabilitation, score items 30-35 at the pre-and post-brain injury level (to reflect pre- morbid and associated conditions at the beginning of rehabilitation, i.e., at the initial IIP). At the end of rehabilitation, score these items at the post-brain injury level (to reflect the presence of these conditions at the end of rehabilitation, i.e., final IIP).