Care And Needs Scale (CANS)

The Care and Needs Scale (CANS; Tate, 2004) is an 8-level categorical scale that has two sections: a Needs Checklist and Support Levels. It is designed to measure the level of support needs of a person with traumatic brain injury and is intended to be administered by health professionals with experience working in a rehabilitation setting with people with brain injury. The checklist of items (Needs Checklist) that underpins the Support Levels, sample the types of activities that research studies and clinical experience have shown are most frequently disrupted after a traumatic brain injury (Kendall & Terry, 1996; Ponsford, Sloan & Snow, 1995; Sohlberg & Mateer, 2001; Tate, Lulham, Broe, Strettles & Pfaff, 1989).

Development of the CANS and its conceptual framework has been described elsewhere (Tate, 2004; 2010). In brief, the impetus to develop the CANS arose because there were no suitable scales that adequately measured the variety and extent of support needs experienced by people with traumatic brain injury. It was constructed in accordance with current conceptualisation underlying International Classification of Functioning, Disability and Health (ICF; WHO, 2001). Items from the Needs Checklist map to eight of the nine domains from the Activities/ Participation component of the ICF (all domains except d1: learning and applying knowledge). The Support Levels map to three of the five Environmental Factors: e1: products and technology, e3: supports and relationships, and e5: services, systems and policies. The Needs Checklist and Support Levels were derived from the author’s clinical and research experience, along with the literature on published scales of disability and outcome. Various configurations of Support Levels were trialled with a group of 67 people with TBI, the final version of eight levels being the most clinically informative.

Research findings on the psychometric properties of the CANS are summarised in Tate (2010). It has now been extensively examined and shows excellent levels of inter-rater and test-retest reliability, along with substantial evidence supporting its criterion and construct validity (see Tate, 2004; Soo, Tate, Hopman, Forman, Secheny, Aird, Browne & Coulston, 2007; Soo Tate, Aird, Allaous, Browne, Carr, Coulston, Diffley, Gurka & Hummell, 2010). Results of these studies are summarised on pages 18-21 of this manual. A paediatric version of the CANS (PCANS) is also currently under development (Soo, Tate, Williams, Waddingham, Waugh, 2008; Soo, Tate, Anderson, Waugh, 2010).

Sydney Psychosocial Reintegration Scale 2 (SPRS 2)

The Sydney Psychosocial Reintegration Scale (SPRS) is a 12-item rating scale that measures participation in the community; specifically, the extent to which a person’s lifestyle may have changed as a result of acquired brain impairment. It adopts an exteriorised frame of reference in measuring participation (i.e., an objective perspective as opposed to a subjective/client-centred perspective) and takes into account both quantitative and qualitative featurs of functioning. Items are grouped into three domains: occupational activity for work and leisure, interpersonal relationships and independent living skills. Each domain contains four items.

The SPRS was designed to be administered by health professionals working in a rehabilitation setting (clinician version), but it can also be completed by an informant who knows the person well (informant version). Additionally, it can be completed as a self-rating scale (self version), although this is not advised if the person experiences significant cognitive impairments (particularly those involving memory, insight and judgement) which may affect the validity of responses.

In addition to the clinician, informant and self-rating versions, the SPRS contains two forms which reflect different comparison standards: Form A measures ‘change since injury’ and Form B measures ‘current status’. Each form uses the same 12 items, with appropriate variants in phrasing.

Items are rated on a 5-point scale (revised from the original 7-point scale), ranging from ‘no change’ to ‘extreme change’ for Form A, and ‘very good’ to ‘extremely poor’ for Form B. Scores range from 0 to 48 for the total score (and 0 to 16 for each of the domains), with higher scores reflecting better levels of functioning.