NIH Stroke Scale Demonstration

Overview

• The NIH Stroke Scale is the preferred stroke severity rating scale by the American Heart Association and American Stroke Association.
• Consists of 15 items to quantify neurological deficits.
• Facilitates communication and helps identify patients for emergent treatment.
• Scale ranges from 0 (no deficits) to 42 (severe deficits).
• Originally designed with the concept that a lower score is better.

Key Considerations Before Assessment

• Check for factors that may affect scoring:
  • Sedating medications
  • Alcohol or drug intoxication
  • Previous physical disabilities or stroke
• Document and communicate these factors.

NIH Stroke Scale Items

1. Level of Consciousness

• Assess alertness:
  • 0: Alert
  • 1: Drowsy but arousable
  • 2: Falling asleep during exam
  • 3: Unable to wake up
• Ask two questions:
  • What month is it?
  • What is your age?
  • 0 if both correct, 1 if one correct, 2 if none correct.
• Follow two commands:
  • Close eyes, open fist
  • 0 if both commands followed, 1 if one followed, 2 if none.

2. Lateral Gaze

• Eye movement to the left and right:
  • 0: Full range
  • 1: Partial deviation
  • 2: Forced deviation

3. Visual Field Test

• Test upper/lower quadrants of each eye:
  • 0: No loss
  • 1: Loss in one quadrant
  • 2: Loss in two quadrants
  • 3: Loss in all quadrants

4. Facial Weakness

• Ask for facial expressions:
  • 0: Symmetrical
  • 1: Mild droop
  • 2: Obvious droop
  • 3: Upper and lower weakness

5. Arm Weakness

• Arms at 90° or 45°:
  • 0: Steady
  • 1: Drift
  • 2: Touches surface
  • 3: Partial movement
  • 4: No movement

6. Leg Weakness

• Legs at 30°:
  • 0: Steady
  • 1: Drift
  • 2: Touches bed
  • 3: Partial movement
  • 4: No movement

7. Limb Coordination

• Finger-nose-finger and heel-shin tests:
  • 0: No clumsiness
  • 1: Clumsiness in one limb
  • 2: Clumsiness in two limbs

8. Sensation

• Compare sides with cotton-tipped applicator:
  • 0: Same sensation
  • 1: Dull on one side
  • 2: No sensation on one side

9. Language

• Assess speech comprehension (Aphasia):
  • 0: Full sentences
  • 1: Partial, correct meaning
  • 2: Incomprehensible
  • 3: No communication

10. Dysarthria

• Speech slurring test:
  • 0: No slurring
  • 1: Understandable slurring
  • 2: Unintelligible or no speech

11. Visual/Sensory Neglect

• Test both sides of visual field and sensation:
  • 0: No neglect
  • 1: Partial neglect
  • 2: Complete neglect

Final Thoughts

• Do not coach patients; accept first response.
• Low scores may still indicate significant disability.
• Consider patient’s career impact.
• Use NIH Stroke Scale insights for better patient care.

---

On behalf of the organizations involved, thank you for your commitment to quality stroke care.