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National Institutes of Health Stroke Scale

1. Level of Consciousness (LOC)
1a: LOC-Response If unable to fully assess due to intubation or other treatment, a selection must still be made; a score of 3 should only be recorded if no activity (other than reflexive positioning) is elicited by painful stimuli.
LOC-Response
Please select
LOC-Response
Alert and responsive
Not alert, arousable with minimal stimulation
Not alert, requires repeated stimulation to focus
Not alert/slow response, requires painful stimulation to elicit activity
Vegetative state or unresponsive to pain
1b: LOC-Questions Ask the patient the current month and age.
LOC-Questions
Please select
LOC-Questions
Both questions answered correctly
One question answered correctly
Both questions answered incorrectly
Dysarthria, intubation, oral-tracheal injury, speech impairment
Patient has aphasia
1c: LOC-Commands Have the patient open and close their eyes, then make a fist tightly (use alternative commands/gestures for those with speech impairments/confusion).
LOC-Commands
Please select
LOC-Commands
Both commands followed correctly
One command followed correctly
Both commands not followed correctly
2. Horizontal Eye Movements
Test horizontal eye movements
Please select
Horizontal Eye Movements
Normal eye movements
Partial gaze paralysis: can be overcome
Partial gaze paralysis: can be overcome by eye-brain reflex
Partial gaze paralysis: cannot be overcome
3. Visual Field
Test visual field
Please select
Visual Field
No visual field deficit
Partial hemianopia
Complete hemianopia
Patient is completely blind
Bilateral hemianopia
4. Facial Paralysis
If the response is slow, ask the patient to show teeth, raise eyebrows, and close eyes.
Test facial paralysis
Please select
Facial Paralysis
Normal symmetric movement
Mild paralysis (nasolabial fold flattened, asymmetrical when smiling)
Partial paralysis (complete or nearly complete paralysis of lower face)
Complete paralysis on one side (loss of movement in both upper and lower face)
Complete paralysis bilaterally (loss of movement in both upper and lower face)
5. Upper Limb Movement
5a: Left Arm Movement
Left Arm Movement
Please select
Left Arm Movement
Sustained for 10 seconds without drift
Drifting, not touching the bed or other support
Drifting, touching the bed or other support
Partially resists gravity
Cannot resist gravity
No movement
Amputation/Joint fusion
5b: Right Arm Movement
Right Arm Movement
Please select
Right Arm Movement
Sustained for 10 seconds without drift
Drifting, not touching the bed or other support
Drifting, touching the bed or other support
Partially resists gravity
Cannot resist gravity
No movement
Amputation/Joint fusion
6. Lower Limb Movement
6a: Left Leg Movement
Left Leg Movement
Please select
Left Leg Movement
Sustained for 5 seconds without drift
Drifting, not touching the bed
Drifting, touching the bed or other support
Partially resists gravity
Cannot resist gravity
No movement
Amputation/Joint fusion
6b: Right Leg Movement
Right Leg Movement
Please select
Right Leg Movement
Sustained for 5 seconds without drift
Drifting, not touching the bed
Drifting, touching the bed or other support
Partially resists gravity
Cannot resist gravity
No movement
Amputation/Joint fusion
7. Ataxia
Ataxia
Please select
Ataxia
No ataxia
One limb affected
Two limbs affected
Does not understand
Paralysis
Amputation/No joint fusion
8. Sensation
Sensation
Please select
Sensation
Normal, no sensation loss
Mild to moderate sensation loss: not sharp/dull
Mild to moderate sensation loss: can feel touch
Complete sensation loss: cannot feel touch at all
No response and limb paralysis
Coma/no response
9. Best Language/Aphasia
Ask the patient to look at pictures, speak, read words, and read sentences.
Language
Please select
Language
No aphasia, normal
Mild to moderate aphasia: some noticeable changes, no significant limitations
Severe aphasia: fragmented speech, listener needs to infer, unable to read materials
Cannot speak or complete aphasia: no speech or comprehension
Coma/no response
10. Articulation Disorder
Read words
Articulation Disorder
Please select
Articulation Disorder
Normal
Mild to moderate: the patient can at least mumble some words, though with some difficulty
Severe articulation disorder: speech is unclear to the point of being unintelligible, but no aphasia or disproportionate to aphasia
Cannot speak or articulation is incomplete
Tracheal intubation or other physical obstacles
11. Neglect and Inattention
Neglect and Inattention
Please select
Neglect and Inattention
No abnormalities
Visual/tactile/auditory/spatial neglect or inattention to self
One form of neglect when stimulating both sides simultaneously
Severe unilateral neglect (e.g., not recognizing one’s own hand)
Neglect in more than one sensory modality
NIH Stroke Scale:

Results Interpretation

Note: A score of 0 on the NIH Stroke Scale does not necessarily mean the patient has no stroke disease! (Beware of the risk of posterior circulation stroke)

Note: The National Institutes of Health Stroke Scale requires you to understand neurological examination and the rules it entails; if your patient has any previously diagnosed neurological deficits (weakness, hemiplegia or quadriplegia, blindness, etc.), this situation can become quite complex. You should consult the NIH Stroke Scale website. The software strives to clarify your confusion but cannot replace official treatment protocols.

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