Moss Attention Rating Scale

Original Editor - Rucha Gadgil

Top Contributors - Rucha Gadgil, Claire Knott and Aminat Abolade  

Objective[edit | edit source]

The Moss Attention Rating Scale (MARS) is an observational rating scale of attention-related behaviors, useful in assessing people with moderate to severe TBI, particularly those undergoing acute inpatient rehabilitation. It was developed by Whyte and Hart at Moss Rehabilitation Research Institute[1].

Intended Population[edit | edit source]

Patients with brain injury at Rancho level IV or higher[2].

Rancho TBI Index.png

Method of Use[edit | edit source]

The scale is a 22 item measure to be administered manually by clinicians, Each item is a behavioral descriptor rated on a five-point Likert-type scale according to how well that behavior describes the patient, ranging from “definitely true” to “definitely false.”

The Scale is free of cost and requires no special training.

Scoring ranges from 22-110, higher scores showing better attention.

Instrument[edit | edit source]

The questionnaire consists of 22 items which the clinician has to score on observation[1]:

1. Is restless or fidgety when unoccupied

2. Sustains conversation without interjecting irrelevant or off-topic comments

3. Persists at a task or conversation for several minutes without stopping or “drifting off”

4. Stops performing a task when given something else to do or to think about

5. Misses materials needed for tasks even though they are within sight and reach

6. Performance is best early in the day or after a rest

7.Initiates communication with others

8. Fails to return to a task after an interruption unless prompted to do so

9. Looks toward people approaching

10. Persists with an activity or response after being told to stop

11. Has no difficulty stopping one task or step in order to begin the next one

12. Attends to nearby conversations rather than the current task or conversation

13. Tends not to initiate tasks which are within his/her capabilities

14. Speed or accuracy deteriorates over several minutes on a task, but improves after a break

15.Performance of comparable activities is inconsistent from one day to the next

16. Fails to notice situations affecting current performance, e.g., wheelchair hitting against table

17. Perseverates on previous topics of conversation or previous actions

18. Detects errors in his/ her own performance

19. Initiates activity (whether appropriate or not) without cuing

20. Reacts to objects being directed toward him /her

21. Performs better on tasks when directions are given slowly

22. Begins to touch or manipulate nearby objects not related to task


1 = Definitely false

2 = False, for the most part

3 = Sometimes true, sometimes false

4 = True, for the most part

5 = Definitely true

Evidence[edit | edit source]

Reliability[edit | edit source]

  • Excellent inter-rater and intra-rater reliability(r=0.64)[3]

Validity[edit | edit source]

  • strongly correlated to concurrent measures thought to assess attention (e.g., (Digit Span)
  • were more strongly correlated to Cognitive than Motor FIM scores
  • predicted 1-year outcomes of TBI (Disability Rating Scale scores) better than a battery of psychometric measures of attention administered concurrently with the MARS[4].

Responsiveness[edit | edit source]

  • Studies have showed MARS score increases during rehabilitation showing good responsiveness[1].

Miscellaneous[edit | edit source]

  • Excellent Consistency (a=0.95)[2]

Resources[edit | edit source]

Get additional information and the scale: here

References[edit | edit source]

  1. 1.0 1.1 1.2 Whyte J, Hart T, Ellis CA, Chervoneva I. The Moss Attention Rating Scale for traumatic brain injury: Further explorations of reliability and sensitivity to change. Archives of physical medicine and rehabilitation. 2008 May 1;89(5):966-73.
  2. 2.0 2.1 Hart T, Whyte J, Millis S, Bode R, Malec J, Richardson RN, Hammond F. Dimensions of disordered attention in traumatic brain injury: further validation of the Moss Attention Rating Scale. Archives of physical medicine and rehabilitation. 2006 May 1;87(5):647-55.
  3. Hart T, Whyte J, Ellis C, Chervoneva I. Construct validity of an attention rating scale for traumatic brain injury. Neuropsychology. 2009 Nov;23(6):729.
  4. Whyte J, Hart T, Bode RK, Malec JF. The Moss Attention Rating Scale for traumatic brain injury: initial psychometric assessment. Archives of physical medicine and rehabilitation. 2003 Feb 1;84(2):268-76.