Review of the Neurobehavioral Symptom Inventory.
Abstract
Purpose/Objective: To describe the psychometrics and utility of the Neurobehavioral Symptom Inventory (NSI) and provide suggestions for clinical usage and future research. Research Method/Design: Thirty studies examining aspects of the NSI, published between 1995 and 2020, were reviewed. Results: The NSI is a 22-item self-report questionnaire of neurobehavioral symptoms. The NSI was first published in 1995 and has since been adopted by the Department of Defense and Department of Veterans affairs for traumatic brain injury (TBI) research and clinical evaluation. Most research on the NSI has been conducted in veteran and military samples with predominantly mild TBI. Cronbach's alpha ranged from .81 to .96 for the total score and exceeded .80 for most scales. Test-retest values ranged from .78 to .94 for the total score and ranged from .52 to .91 for subscales. Item content overlaps with psychiatric disorders and is expectedly correlated with psychiatric measures and emotional distress. Although consensus about its factor structure is lacking, the 3- and 4-factor solutions have been replicated and have the strongest support. Subsequent researchers have published reliable change indices, embedded validity indices, and normative data using civilian and military samples. Conclusions/Implications: The NSI has acceptable reliability and some evidence supporting its validity in measuring neurobehavioral symptoms. Although not intended to diagnose TBI, the NSI has value for clinicians…
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The Neurobehavioral Symptom Inventory has Cronbach alpha=0.81-0.96 (very high).
“Cronbach α=0.81-0.96 (very high) [98]”
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Mureșanu, I. A., Grad, D. A., Muresanu, D. F., Dobran, Ş.-A., Hapca, E., Strilciuc, Ș., Benedek, I., Capriș, D., Popescu, B. O., Perju‐Dumbravă, L., et al. (2022) · Journal of Medicine and Life · doi:10.25122/jml-2022-0120 · Cited by 46 · see citing works
Sass, D., Guedes, V. A., Smith, E. G., Vorn, R., Devoto, C., Edwards, K. A., Mithani, S., Hentig, J., Lai, C., Wagner, C., et al. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.746491 · Cited by 40 · see citing works
Kinney, A. R., Yan, X.-D., Schneider, A. L., King, S., Forster, J. E., Bahraini, N. H., & Brenner, L. A. (2022) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2022.964420 · Cited by 16 · see citing works
Patel, R. S., Krause‐Hauch, M., Kenney, K., Miles, S. R., Nakase‐Richardson, R., & Patel, N. A. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25031473 · Cited by 14 · see citing works
Klyce, D. W., West, S. J., Perrin, P. B., Agtarap, S., Finn, J. A., Juengst, S. B., Dams-O’Connor, K., Eagye, C. B., Vargas, T. A., Joyce, S. C., et al. (2021) · Journal of Neurotrauma · doi:10.1089/neu.2021.0200 · Cited by 14 · see citing works
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Weaver, L. K., Ziemnik, R. E., Deru, K., & Russo, A. A. (2025) · Scientific Reports · doi:10.1038/s41598-025-86631-6 · Cited by 13 · see citing works
Campbell, K. R., Antonellis, P., Peterka, R. J., Wilhelm, J. L., Scanlan, K. T., Pettigrew, N. C., Chen, S., Parrington, L., Fino, P. C., Chesnutt, J. C., et al. (2024) · Physical Therapy · doi:10.1093/ptj/pzae180 · Cited by 12 · see citing works
Karr, J. E., White, A. E., Leong, S. E., & Logan, T. (2024) · Assessment · doi:10.1177/10731911241236687 · Cited by 11 · see citing works
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Rasdall, M. A., Cho, C. Y., Stahl, A. N., Tovar, D. A., Lavin, P., Kerley, C. I., Chen, Q., Ji, X., Colyer, M. H., Groves, L. L., et al. (2024) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2024.5076 · Cited by 11 · see citing works
Diociasi, A., Iaccarino, M. A., Sorg, S. F., Lubin, E. J., Wisialowski, C., Dua, A., Tan, C. O., & Gupta, R. (2025) · Radiology · doi:10.1148/radiol.233264 · Cited by 11 · see citing works
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Assonov, D. O. (2022) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2022.120600 · Cited by 9 · see citing works
Turkstra, L. S., Ray, M. R., LeBlanc, M., Lu, L. H., Curtiss, G., Bowles, A. O., Eapen, B. C., & Cooper, D. B. (2025) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-24-00306 · Cited by 8 · see citing works
Mulvaney, S. W., Lynch, J. H., Olmsted, K. R., Mahadevan, S., & Dineen, K. J. (2024) · Military Medicine · doi:10.1093/milmed/usae193 · Cited by 8 · see citing works
Smith, E. G., Hentig, J., Martin, C. A., Wagner, C., Guedes, V. A., Edwards, K. A., Devoto, C., Dunbar, K. E., Roy, M. J., & Gill, J. (2022) · Biomedicines · doi:10.3390/biomedicines10123289 · Cited by 7 · see citing works
Randomized, controlled clinical trial of acoustic stimulation to reduce postconcussive symptoms
Cole, W. R., Tegeler, C. L., Choi, Y. S., Harris, T. E., Rachels, N., Bellini, P. G., Haight, T. J., Gerdes, L., Tegeler, C., & Roy, M. J. (2023) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51937 · Cited by 4 · see citing works
Rehabilitation Outcomes of Service Members and Veterans With Mild-to-Moderate Traumatic Brain Injury
Haun, J. N., McDaniel, J. T., Nakase‐Richardson, R., Schneider, T., McMahon-Grenz, J., Benzinger, R. C., Barton, S., Sandoval, R., Skop, K. M., Dismuke‐Greer, C. E., et al. (2025) · Medical Care · doi:10.1097/mlr.0000000000002228 · Cited by 6 · see citing works
Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores for Concussion
Weightman, M. M., King, L. A., Fino, P. C., Dibble, L. E., Pelo, R. M., Michielutti, P. G., Richard, H., Parrington, L., Lester, M., & Hoppes, C. W. (2023) · Military Medicine · doi:10.1093/milmed/usad394 · Cited by 6 · see citing works
Nussbaum, S. H., Ales, F., Giromini, L., Watson, M., & Erdődi, L. A. (2023) · Psychological Injury and Law · doi:10.1007/s12207-023-09487-z · Cited by 8 · see citing works
Silva, M. A., Finn, J. A., Dillahunt-Aspillaga, C. J., Cotner, B. A., Stevens, L. F., & Nakase‐Richardson, R. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1900930 · Cited by 5 · see citing works
Self-citationPerrin, P. B., Ramos‐Usuga, D., West, S. J., Merced, K., Klyce, D. W., Lequerica, A. H., Olabarrieta‐Landa, L., Alzueta, E., Baker, F. C., Iacovides, S., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010183 · Cited by 6 · see citing works
Laskowitz, S., Baird, C. L., Huggins, A. A., Nadareishvili, N., Bride, J., Wagner, H. R., Briggs, M., Morey, R. A., & Turner, R. (2024) · Brain Injury · doi:10.1080/02699052.2024.2347552 · Cited by 5 · see citing works
Silva, M. A., Gonzalez, A. V., Tang, X., Carnahan, N. D., Klyce, D. W., Liou‐Johnson, V., Martin, A. M., Moberg, J., & Dreer, L. E. (2023) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000856 · Cited by 5 · see citing works
Self-citationReger, G. M., Smolenski, D. J., Williams, R. M., Norr, A. M., Foa, E. B., Kuhn, E. R., Schnurr, P. P., Weathers, F. W., & Zoellner, L. A. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107115 · Cited by 5 · see citing works
Mulvaney, S. W., Lynch, J. H., Mahadevan, S., Dineen, K. J., & Olmsted, K. R. (2024) · Brain Sciences · doi:10.3390/brainsci14121193 · Cited by 5 · see citing works
Ryan, J., Venkatachalam, H. H., Klyce, D. W., Finn, J. A., Gilmore, N. M., Martin, A. M., Munger, E. J., Picon, L. M., Nakase‐Richardson, R., Swan, A. A., et al. (2025) · Military Medicine · doi:10.1093/milmed/usaf159 · Cited by 4 · see citing works
Self-citationKeller, A. V., Muller-Cohn, C. M., Austin, T., Jak, A., & Twamley, E. (2023) · Clinical Neuropsychologist · doi:10.1080/13854046.2023.2176364 · Cited by 4 · see citing works
Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans
Akin, F. W., Swan, A. A., Kalvesmaki, A., Hall, C. D., Riska, K. M., Stressman, K. D., Nguyen, H. L. T., Amuan, M. E., & Pugh, M. J. (2023) · American Journal of Audiology · doi:10.1044/2023_aja-22-00150 · Cited by 4 · see citing works
Wyrwa, J. M., Brenner, L. A., Yan, X.-D., Schneider, A. L., Burke, L., King, S. E., Forster, J. E., & Kinney, A. R. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001012 · Cited by 4 · see citing works
Crocker, L. D., Sullan, M. J., Jurick, S. M., Thomas, K. R., Davey, D. K., Hoffman, S. N., Twamley, E. W., & Jak, A. J. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22883 · Cited by 4 · see citing works
Skop, K. M., Bajor, L., Sevigny, M., Swank, C., Tallavajhula, S. S., Nakase‐Richardson, R., & Miles, S. R. (2023) · PM&R · doi:10.1002/pmrj.13044 · Cited by 4 · see citing works
Esterov, D., Persaud, T., Higano, J. D., Kassmeyer, B. A., & Lennon, R. J. (2024) · Neurotrauma Reports · doi:10.1089/neur.2024.0014 · Cited by 3 · see citing works
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Scarlett, E., Lu, L. H., Cummings, L. D., & Bowles, A. O. (2022) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000850 · Cited by 3 · see citing works
Kinney, A. R., Bahraini, N. H., Schneider, A. L., Yan, X.-D., Forster, J. E., Holliday, R. P., & Brenner, L. A. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001016 · Cited by 3 · see citing works
Smith, E. R., Houtchens, K., Pearson, M., Dolbeer, J. A., Kneller, S., Fitzgerald, S. M., Lambert, K. H., & Hoppes, C. W. (2023) · Military Medicine · doi:10.1093/milmed/usad399 · Cited by 3 · see citing works
McCulloch, K. L., Oh, A. S., Cecchini, A., Zhang, W., Harrison, C. E., & Favorov, O. V. (2023) · Physical Therapy · doi:10.1093/ptj/pzad100 · Cited by 3 · see citing works
Bernanke, A., Hasley, R., Sabetfakhri, N., de Wit, H., Smith, B. M., Wang, L., Brenner, L. A., Hanlon, C., Philip, N. S., Ajilore, O., et al. (2024) · JMIR Research Protocols · doi:10.2196/58206 · Cited by 2 · see citing works
Mulvaney, S. W., Mahadevan, S., Desronvilles, R. J., Dineen, K. J., & Olmsted, K. R. (2025) · Biomedicines · doi:10.3390/biomedicines13071526 · Cited by 2 · see citing works
Boulais, B. M., Finley, J. A., Cichocki, A. C., Gonzalez, C., Dykins, M. M., Sedgwick, T. A., Pliskin, N. H., Jennette, K. J., Tsai, P., Maniar, N., et al. (2025) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2025.2566649 · Cited by 2 · see citing works
Neumann, D. M., Kumar, A., van Loveren, H., USF HBOT for Veterans with TBI Collaborative Group, Bowling, F. Y., Dituri, J., Dombrowski, K. E., Karlnoski, R., Kessack, K., Mendoza, J., et al. (2026) · Trials · doi:10.1186/s13063-026-09645-z · Cited by 2 · see citing works
Ivins, B. J., Risling, M., Wisén, N., Schwab, K. A., & Rostami, E. (2023) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000919 · Cited by 2 · see citing works
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Nowak, M. K., Fortenbaugh, F. C., & Salat, D. H. (2024) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2024.5121 · Cited by 2 · see citing works
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Tegeler, C. L., Haight, T. J., Cole, W. R., Shaltout, H. A., Choi, Y. S., Harris, T. E., Rachels, N., Bellini, P. G., Roy, M. J., & Tegeler, C. H. (2025) · Brain Injury · doi:10.1080/02699052.2024.2445709 · Cited by 2 · see citing works
Farr, E. M., Esterov, D., Kassmeyer, B. A., Lennon, R. J., & Bergquist, T. F. (2024) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2024.100409 · Cited by 1 · see citing works
Eagle, S. R., Puccio, A. M., Svirsky, S. E., Mountz, J. M., Laymon, C. M., Borrasso, A. J., Henry, L. C., & Okonkwo, D. O. (2025) · Neurotrauma Reports · doi:10.1089/neur.2025.0052 · Cited by 1 · see citing works
Impact of Mild Traumatic Brain Injury on the Subjective Perception of Hearing and Balance
Civantos, A. M., Johnson, K., Azzawi, S. A., Tarapore, P. E., Cheung, S. W., Sabes, J. H., Chang, J. L., & Durr, M. L. (2025) · OTO Open · doi:10.1002/oto2.70152 · Cited by 1 · see citing works
Cota, M. R., & Nathan, D. E. (2025) · Military Medicine · doi:10.1093/milmed/usaf194 · Cited by 1 · see citing works
Boutzoukas, E. M., Skop, K. M., & Silva, M. A. (2025) · The Clinical Neuropsychologist · doi:10.1080/13854046.2025.2598370 · Cited by 1 · see citing works
Self-citationKinney, A. R., Penzenik, M. E., Forster, J. E., O’Donnell, F., Juengst, S. B., & Bahraini, N. H. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001145 · Cited by 1 · see citing works
Clark, J. M. R., Ozturk, E. D., Coffinier, C., Merritt, V. C., & Program, T. V. M. V. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03518-7 · Cited by 1 · see citing works
Lopez, F. V., Hu, R., Krishnan, T., Dell, K. C., Walker, W. C., Merritt, V. C., & Jak, A. J. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001095 · Cited by 1 · see citing works
Klyce, D. W., West, S. J., Perrin, P. B., Agtarap, S., Finn, J. A., Juengst, S. B., Dams-O’Connor, K., Eagye, C. B., Vargas, T. A., Chung, J. S., et al. (2021) · doi:10.31234/osf.io/xqubf
Gilmore, N. M., McKinney, I. R., Tseng, C.-E. J., Greve, D. N., Maffei, C., Healy, B. C., Zürcher, N. R., Hooker, J. M., Tromly, S. L., Perl, D. P., et al. (2025) · Brain Imaging and Behavior · doi:10.1007/s11682-025-00980-4
Psychological Measurement of Special Children Based on Artificial Intelligence
Zhu, Z., Zhang, S., Xie, D., Meng, X., Zhen, W., & Zhou, Y. (2025) · EAI/Springer Innovations in Communication and Computing · doi:10.1007/978-3-031-90903-0_3
McDaniel, M. R., Wallace, J. P., Partridge, J. A., Weshinskey, N., Redner, R. N., & McDaniel, J. T. (2026) · The Psychological Record · doi:10.1007/s40732-026-00685-0
Oliveira, N. D., Horsey, J., Fitch, S., Osama, T. A., Williams, K. L., Zuckerman, S. L., & Terry, D. P. (2026) · Brain Injury · doi:10.1080/02699052.2026.2675398
Haun, J. N., McDaniel, J. T., Nakase‐Richardson, R., Schneider, T., McMahon-Grenz, J., Barton, S. J., Sandoval, R., Skop, K. M., Dismuke‐Greer, C. E., Sabangan, J., et al. (2026) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2026.100638
Cheever, K., Kalvesmaki, A., Swan, A. A., Wright, A. H., Nguyen, H., George, R. T., Hall, C. D., Riska, K. M., Akin, F. W., Umucu, E., et al. (2026) · Brain Injury · doi:10.1080/02699052.2026.2673984
Millar, J. L., Migliaccio, A. A., Grove, C. R., Mukunda, A., Perin, J., Coulibaly, H., Ervin, A., Nogi, A. L., Thorman, I. B., & Schubert, M. C. (2026) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2026.100622
Neurotrauma in Naval Special Warfare Combat Crewmen and Fast Boat Operators
Maroon, J. C., Wakelin, S. H., Agarwal, N., Friedlander, R. M., & Smith, M. A. (2026) · Neurosurgery · doi:10.1227/neu.0000000000004104
Schilling, K. M., Talbert, L. D., Valocchi, E., Lopez, F. V., & Merritt, V. C. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001187
Villalon, A., Li, R., Currao, A., Lebas, A., Fonda, J. R., Fortier, C. B., Milberg, W., & Jorge, R. E. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001212
- Authors
- Silva, M. A.
- Affiliations
- James A. Haley Veterans' Hospital (US)
- Corresponding author
- Silva, Marc A.
- ORCID
- Silva, Marc A.
- Venue
- Rehabilitation Psychology
- Published
- 2021-05
- Volume
- 66
- Issue
- 2
- Pages
- 170-182
- ISSN
- 0090-5550 (ISSN-L)
- 1939-1544
- OpenAlex
- W3096943643
- Cited by
- 61
- References
- 0
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 11 · 2023: 12 · 2022: 7 · 2021: 4
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Rehabilitation Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- Neurobehavioral Symptom Inventory, traumatic brain injury, neurobehavioral symptoms, symptom severity assessment, reliability statistics, validity, symptom monitoring
- MeSH terms
- Brain Concussion, Humans, Military Personnel, Neuropsychological Tests, Veterans, Reproducibility of Results
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