What the MPAI-4 is
The MPAI-4 was developed in the United States to assess people after an acquired brain injury, such as a traumatic brain injury, stroke, hypoxic injury or brain infection. It is designed for the period after hospital, when the focus moves to rebuilding everyday life.
It is used in brain injury rehabilitation services around the world, including in Australia, to plan rehabilitation and to measure change over time.
What it measures
The inventory has 35 items. The first 29 are scored and grouped into three subscales. The other 6 record related issues, such as conditions that were present before the injury, and are not counted in the score.
- Ability: physical, thinking and communication skills, such as mobility, hand use, memory, attention, problem solving and speech
- Adjustment: emotional and behavioural changes, such as anxiety, low mood, irritability, fatigue and self awareness
- Participation: involvement in daily and community life, such as initiative, social contact, leisure, self care, transport, work or study, and managing money
How it is completed and scored
Each item is rated on a five point scale, from no problem to a severe problem. There are versions for the rehabilitation team, the person with the brain injury, and a family member or other significant person. Comparing the views can be useful, because people with brain injury sometimes see their difficulties differently from those around them.
Raw scores are converted to standard scores, so a person's result can be compared with others who have had a brain injury, and repeated later to show progress.
How it fits with NDIS evidence
For acquired brain injury, the NDIA lists its preferred evidence of functional impact as the Care and Needs Scale (CANS) for people 17 and over, then the WHODAS 2.0 for people 17 and over or PEDI-CAT for children 16 and under. The MPAI-4 is not on that list.
That does not make it unhelpful. A rehabilitation report that includes MPAI-4 results can give a detailed picture of how the injury affects behaviour, mood and community participation, which are often what drive support needs after brain injury. If you are applying, ask your team to include one of the NDIA's preferred tools as well, and to explain both in plain words.
Who completes it and the cost
Brain injury rehabilitation teams, including occupational therapists, neuropsychologists, psychologists, speech pathologists and rehabilitation physicians, commonly use the MPAI-4. If you are still linked to a public rehabilitation service, ask whether it has already been done.
For NDIS participants, assessments that help plan or review supports are usually paid from the Capacity Building budget. Occupational therapy has a 2026/27 price limit of $193.99 an hour and psychology $252.99 an hour in most of Australia. Ask for a quote that includes scoring and the report.
Tips for an accurate result
- Ask a family member or close supporter to complete their version as well
- Describe your hardest days, including fatigue and behaviour changes, not just good days
- Tell the assessor about prompting and supervision you get that others may not notice
- Keep copies to compare at your next plan reassessment