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NIH Stroke Scale Instructions 1A Level of Consciousness Administer Stroke Scale Items in the Instructions Scale Definition Order Listed

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NIH Stroke Scale Instructions 1A Level of Consciousness Administer Stroke Scale Items in the Instructions Scale Definition Order Listed NIH Stroke Scale Instructions 1a Level of Consciousness Administer stroke scale items in the Instructions Scale Definition order listed. Record performance in Level of Consciousness: Alert; keenly responsive. each category after each subscale exam. The investigator must choose a response 0 Do not go back and change scores. if a full evaluation is prevented by such Follow directions provided for each obstacles as an endotracheal tube, language Not alert; but arousable by minor exam technique. Scores should reflect barrier, orotracheal trauma/bandages. A 3 is 1 stimulation to obey, answer, what the patient does, not what the scored only if the patient makes no movement or respond. clinician thinks the patient can do. (other than reflexive posturing) in response to The clinician should record answers while noxious stimulation. Not alert; requires repeated administering the exam and work quickly. stimulation to attend, or is Except where indicated, the patient obtunded and requires strong should not be coached (i.e., repeated 2 or painful stimulation to make requests to patient to make a movements (not stereotyped). special effort). Responds only with reflex motor or autonomic effects, or totally 3 unresponsive, flaccid, and areflexic. Score Level of Consciousness 1b 1c Level of Consciousness Instructions Scale Definition Instructions Scale Definition LOC Questions: Answers both questions correctly. LOC Commands: Performs both tasks correctly. The patient is asked the month and his/her 0 The patient is asked to open and close 0 age. The answer must be correct — there is the eyes and then to grip and release no partial credit for being close. Aphasic and the non-paretic hand. Substitute stuporous patients who do not comprehend another one-step command if the hands the questions will score 2. Patients unable cannot be used. Credit is given if an to speak because of endotracheal intubation, Answers one question correctly. unequivocal attempt is made but not Performs one task correctly. orotracheal trauma, severe dysarthria from any 1 completed due to weakness. If the 1 cause, language barrier, or any other problem patient does not respond to command, not secondary to aphasia are given a 1. It the task should be demonstrated to is important that only the initial answer be him or her (pantomime), and the result scored graded and that the examiner not “help” the (i.e., follows none, one, or two commands). patient with verbal or non-verbal cues. Patients with trauma, amputation, or Answers neither question correctly. other physical impediments should be Performs neither task correctly. 2 given suitable one-step commands. 2 Only the first attempt is scored. Score Score Best Gaze 2 3 Visual Instructions Scale Definition Instructions Scale Definition Best Gaze: Normal. Visual: No visual loss. Only horizontal eye movements will be tested. 0 Visual fields (upper and lower quadrants) are 0 Voluntary or reflexive (oculocephalic) eye tested by confrontation, using finger counting movements will be scored, but caloric testing or visual threat, as appropriate. Patients may is not done. If the patient has a conjugate Partial gaze palsy; gaze is abnormal be encouraged, but if they look at the side of Partial hemianopia. deviation of the eyes that can be overcome in one or both eyes, but forced the moving fingers appropriately, this can 1 by voluntary or reflexive activity, the score 1 deviation or total gaze paresis is be scored as normal. If there is unilateral will be 1. If a patient has an isolated not present. blindness or enucleation, visual fields in the peripheral nerve paresis (CN III, IV, or VI), remaining eye are scored. Score 1 only if a score a 1. Gaze is testable in all aphasic clear-cut asymmetry, including quadrantanopia, Complete hemianopia. patients. Patients with ocular trauma, is found. If patient is blind from any cause, 2 bandages, pre-existing blindness, or other Forced deviation, or total score 3. Double simultaneous stimulation is disorder of visual acuity or fields should be gaze paresis is not overcome by the performed at this point. If there is extinction, tested with reflexive movements, and a choice patient receives a 1, and the results 2 oculocephalic maneuver. Bilateral hemianopia (blind including made by the investigator. Establishing eye are used to respond to item 11. 3 cortical blindness). contact and then moving about the patient from side to side will occasionally clarify the presence of a partial gaze palsy. Score Score Facial Palsy 4 5 Motor Arm Instructions Scale Definition Instructions Scale Definition Facial Palsy: Normal symmetrical movements. Motor Arm: No drift; limb holds 90 (or 45) degrees Ask — or use pantomime to encourage — the 0 The limb is placed in the appropriate position: 0 for full 10 seconds. patient to show teeth or raise eyebrows and extend the arms (palms down) 90 degrees Drift; limb holds 90 (or 45) degrees, close eyes. Score symmetry of grimace in (if sitting) or 45 degrees (if supine). Drift is but drifts down before full 10 seconds; response to noxious stimuli in the poorly Minor paralysis (flattened nasolabial scored if the arm falls before 10 seconds. The 1 does not hit bed or other support. responsive or non-comprehending patient. fold, asymmetry on smiling). aphasic patient is encouraged using urgency 1 Some effort against gravity; limb If facial trauma/bandages, orotracheal tube, in the voice and pantomime, but not noxious tape, or other physical barriers obscure stimulation. Each limb is tested in turn, cannot get to or maintain (if cued) 90 the face, these should be removed to the beginning with the non-paretic arm. Only 2 (or 45) degrees, drifts down to bed, but has some effort against gravity. extent possible. Partial paralysis (total or near-total in the case of amputation or joint fusion at paralysis of lower face). the shoulder, the examiner should record the No effort against gravity; limb falls. 2 score as untestable (UN) and clearly write the 3 explanation for this choice. 4 No movement. Complete paralysis of one or both sides (absence of facial movement in a Score Amputation or joint fusion, explain: 3 Left Arm UN the upper and lower face). 5 b Score 5 Right Arm Score Motor Leg 6 7 Limb Ataxia Instructions Scale Definition Instructions Scale Definition Motor Leg: No drift; leg holds 30-degree position Limb Ataxia: Absent. The limb is placed in the appropriate position: 0 for full 5 seconds. This item is aimed at finding evidence of a 0 hold the leg at 30 degrees (always tested unilateral cerebellar lesion. Test with eyes supine). Drift is scored if the leg falls before Drift; leg falls by the end of the 5- open. In case of visual defect, ensure testing 5 seconds. The aphasic patient is encouraged 1 second period but does not hit the bed. is done in intact visual field. The finger- using urgency in the voice and pantomime but Some effort against gravity; leg falls nose-finger and heel-shin tests are performed Present in one limb. not noxious stimulation. Each limb is tested to bed by 5 seconds but has some on both sides, and ataxia is scored only if 1 in turn, beginning with the non-paretic leg. 2 effort against gravity. present out of proportion to weakness. Ataxia Only in the case of amputation or joint fusion is absent in the patient who cannot under- at the hip, the examiner should record the No effort against gravity; leg falls to stand or is paralyzed. Only in the case of score as untestable (UN) and clearly write the 3 bed immediately. amputation or joint fusion, the examiner explanation for this choice. should record the score as untestable (UN) 2 Present in two limbs. and clearly write the explanation for this No movement. choice. In case of blindness, test by having 4 the patient touch nose from extended arm position. Amputation or joint fusion, explain: a Score UN Amputation or joint fusion, explain: 6 Left Leg UN b 6 Right Leg Score Score Sensory 8 9 Best Language Instructions Scale Definition Instructions Scale Definition Sensory: Normal; no sensory loss. Best Language: No aphasia; normal. Sensation or grimace to pinprick when tested, 0 A great deal of information about 0 Mild-to-moderate aphasia; some obvious or withdrawal from noxious stimulus in the comprehension will be obtained during the loss of fluency or facility of comprehension, obtunded or aphasic patient. Only sensory preceding sections of the examination. For without significant limitation on ideas loss attributed to stroke is scored as abnormal Mild-to-moderate sensory loss; this scale item, the patient is asked to expressed or form of expression. Reduction of speech and/or comprehension, however, and the examiner should test as many body patient feels pinprick is less sharp describe what is happening in the attached makes conversation about provided materials areas [arms (not hands), legs, trunk, face] or is dull on the affected side; or picture, to name the items on the attached 1 difficult or impossible. For example, in as needed to accurately check for hemisensory 1 there is a loss of superficial pain naming sheet, and to read from the attached conversation about provided materials, loss. A score of 2, “severe or total sensory with pinprick, but patient is aware list of sentences. Comprehension is judged examiner can identify picture or naming card content from patient’s response. loss,” should only be given when a severe of being touched. from responses here, as well as to all of the or total loss of sensation can be clearly commands in the preceding general neurological Severe aphasia; all communication is demonstrated. Stuporous and aphasic patients exam. If visual loss interferes with the tests, through fragmentary expression; great need will, therefore, probably score 1 or 0.
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