NIHSS Certification
11 components of NIHSS
1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC
0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
---
1a. Level of Consciousness: The investigator must choose a response, even if a full
evaluation is prevented by such obstacles as an endotracheal tube, language barrier,
orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement
(other than reflexive posturing) in response to noxious stimulation.*
1B - LOC Questions (2)
Month of year
Patient age
-----
0 = Answers both questions correctly
, 1 = Answers one question correctly
2 = Answers neither question correctly
---
1b. LOC Questions: The patient is asked the month and his/her age. The answer
must be correct - there is no partial credit for being close. Aphasic and stuporous
patients who do not comprehend the questions will score 2. Patients unable to speak
because of endotracheal intubation, orotracheal trauma, severe dysarthria from any
cause, language barrier or any other problem not secondary to aphasia are given a
1. It is important that only the initial answer be graded and that the examiner not
"help" the patient with verbal or non-verbal cues.*
1C - LOC Commands
Two tasks
- Close your eye for me and now open
- Make a fist with your hand
--------
LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to
grip and release the non-paretic hand. Substitute another one step command if the
hands cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. If the patient does not respond to command, the task
should be demonstrated to them (pantomime) and score the result (i.e., follows
none, one or two commands). Patients with trauma, amputation, or other physical
impediments should be given suitable one-step commands. Only the first attempt is
scored.*
11 components of NIHSS
1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC
0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
---
1a. Level of Consciousness: The investigator must choose a response, even if a full
evaluation is prevented by such obstacles as an endotracheal tube, language barrier,
orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement
(other than reflexive posturing) in response to noxious stimulation.*
1B - LOC Questions (2)
Month of year
Patient age
-----
0 = Answers both questions correctly
, 1 = Answers one question correctly
2 = Answers neither question correctly
---
1b. LOC Questions: The patient is asked the month and his/her age. The answer
must be correct - there is no partial credit for being close. Aphasic and stuporous
patients who do not comprehend the questions will score 2. Patients unable to speak
because of endotracheal intubation, orotracheal trauma, severe dysarthria from any
cause, language barrier or any other problem not secondary to aphasia are given a
1. It is important that only the initial answer be graded and that the examiner not
"help" the patient with verbal or non-verbal cues.*
1C - LOC Commands
Two tasks
- Close your eye for me and now open
- Make a fist with your hand
--------
LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to
grip and release the non-paretic hand. Substitute another one step command if the
hands cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. If the patient does not respond to command, the task
should be demonstrated to them (pantomime) and score the result (i.e., follows
none, one or two commands). Patients with trauma, amputation, or other physical
impediments should be given suitable one-step commands. Only the first attempt is
scored.*
