Adult Neuromuscular Recovery Scale (NRS)

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Quantifying recovery after spinal cord injury (SCI) in the clinic is a challenge, yet a timely need with advances in therapies targeting enhanced recovery post-SCI. While some measurement instruments specifically designed for SCI rehabilitation typically allow compensation, other measures such as manual muscle testing prohibit use of compensatory strategies during testing. The NRS is innovative and unique in that recovery scores are based on a comparison to pre-injury performance criteria or how a task was performed one day prior to SCI and without use of compensation strategies. For instance, the ability to stand up from sitting is assessed without use of load-bearing on the arms and with usual, pre-injury limb and trunk kinematics for this task as the reference for comparison.

The Neuromuscular Recovery Scale (NRS) was developed by clinicians and scientists in the Reeve Foundation NeuroRecovery Network (NRN) at 7 outpatient clinical sites in the U.S. This instructional course will introduce the instrument and its utility in practice and research. Items that comprise the NRS will be described and viewed in detail, as will standardization procedures for conducting and scoring the NRS. Scientific literature examining the NRS will be reviewed as a foundation for application. Video case examples with hands-on demonstrations for use with patients with neurological injury by skilled clinicians will maximize learning to both conduct the NRS assessment and score patient performance. Interpretation of the scores and discussion of how the NRS can be used to guide rehabilitation as a clinical and/or research outcome will be drawn from widespread use of the NRS in the NRN.


Target Audience: Intermediate level course open to program directors, licensed physical therapists, physical therapy assistants, occupational therapists, exercise physiologist, and rehab technicians.


Upon completion, the learner will be able to:

  1. Identify the specific use of the Neuromuscular Recovery Scale relative to other measurement instruments in rehabilitation and research of persons with spinal cord injury.
  2. Explain the basis for development of the NRS and the scientific literature supporting its use as a measurement tool.
  3. Competently conduct a standardized NRS assessment of adult patients with a spinal cord injury with varied levels of injury and severity.
  4. Competently and reliably score performance on the Neuromuscular Recovery Scale of patients with varied levels of injury and severity.
  5. Understand the use of the NRS to assess patient performance, identify therapeutic goals for progression, and establish directions for therapeutic intervention.

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