NIH Stroke Scale Exam
How many items on the NIH stroke scale? 11
NIH Stroke scale is an 11-item clinical evaluation instrument widely used in clinical trials and practice
to assess neurologic outcome and degree of recovery from stroke.
NIH Stroke Scale is used to quantify the effects of acute levels of:
cerebral ischemia on levels of ... (7 items) consciousness
vision
motor function (facial and extremities)
cerebellar function
sensation
language
extinction or inattention
NIH SS is used to measure patient's status after a stroke treatment
and to assess the outcome after
Should the patient be coached? Should you go back and NO
rethink a particular assessment?
Having what when using NIH scale is important? reference materials
DO NOT RATE what you think the patient wants to do or rate only what they actually do
what you think they can do, RATE ONLY
use patient"s first response? YES - DO NOT USE SUMMARY OF RESPONSES
re ataxia score 1) 0
1-if real weak, assume ataxia score is... 2) ataxia
2-if they can hold leg or arm up w/ minimal drift but are 3) 1 or 2
all over place when trying finger to nose test, that's 4) 0
probably...
3) Important to know if ataxia is present or not and if
present in _____ or _______ limbs
4) if patient very weak or paralyzed, the ataxia score is...
You should only score loss of sensation if you can really that they have loss of sensation
demonstrate...
if patient has sensory loss from neuropathy, do you count no, but you do if there's loss on top of the neuropathy
thatt?
aphasia is difficult because it can take a while to go mild, mod, severe
through the battery and it can be subjective as to
whether it is one of which classification?
start to recognise aphasia when you meet them and start what happened
talking and you don't get a history of...
dysarthria is interesting because there are many cultural speech.
things about slurred ________?
, NIH Stroke Scale Exam
Score is associated with prognosis? YES
Is NIH scale a measure of disability? NO. The NIH scale is a measure of impairments.
The NIH scale creates a common currency so that deficit, by giving a number that communicates to other professionals how sick the
everybody understands the patient's level of... patient is
how much time to budget to perorm NIH scale 7-10 mins
What effort should be recorded? Do not do what? The patient's first effort. Don't go back and change scores.
IMPORTANT CONVENTIONS IN ADMINISTRATION: -order
Administer scale items in their exact ______ -coaching
-Avoid ______ing patient -first
-Accept patient's _______ effort -does
-Score only what the patient _______ -Be consistent
-Be consistent -previous strokes
-Include all _________s into scoring, including those that
may be from _________s ______s
ITEM 1a and how to get it -examiner's overall impression of patient alertness
-ask 2-3 questions about circumstances of admission, stimuate patient by patting
or tapping, occasionally pinching
NIH Item 1a Scoring: -Alert
0 -Not alert, aroused w/ minor verbal stim
1 -Not alert, requires strong or painful stim
2 -Only reflexive movements or totally unresponsive
3
ITEM 1a - patient w/ 3 on this item is generally a coma
considered to be in... reflexive posturing in response to noxious stimulation
3 is scored ONLY if patient makes no movement other
than....
If difficult to determine 1 vs 2 in item 1a, continue with... medical hx qs until confident in assigning a score - THIS IS ONLY TIME IN NIH
scale where you can go back
EVEN IF PRESENTED WITH OBSTACLES OR SCORE
BARRIERS, YOU MUST CHOOSE A
NIH Item 1B -month of year
based on responses to two items: -patient's age
When?
-What about patient
ITEM 1B SCORING -answers both qs correctly
0 -answers 1 q correctly OR patients unable to communicate d/t intubation, oral-
1 tracheal trauma, severe dysarthria from any cause, language barrier, or any
2 issue not secondary to aphasia
-answers neither question correctly --> a 3 on 1a must be a 2 on 1b
A patient that cannot speak but is otherwise able to writing
communicate can be allowed to convey the answer how?
How many items on the NIH stroke scale? 11
NIH Stroke scale is an 11-item clinical evaluation instrument widely used in clinical trials and practice
to assess neurologic outcome and degree of recovery from stroke.
NIH Stroke Scale is used to quantify the effects of acute levels of:
cerebral ischemia on levels of ... (7 items) consciousness
vision
motor function (facial and extremities)
cerebellar function
sensation
language
extinction or inattention
NIH SS is used to measure patient's status after a stroke treatment
and to assess the outcome after
Should the patient be coached? Should you go back and NO
rethink a particular assessment?
Having what when using NIH scale is important? reference materials
DO NOT RATE what you think the patient wants to do or rate only what they actually do
what you think they can do, RATE ONLY
use patient"s first response? YES - DO NOT USE SUMMARY OF RESPONSES
re ataxia score 1) 0
1-if real weak, assume ataxia score is... 2) ataxia
2-if they can hold leg or arm up w/ minimal drift but are 3) 1 or 2
all over place when trying finger to nose test, that's 4) 0
probably...
3) Important to know if ataxia is present or not and if
present in _____ or _______ limbs
4) if patient very weak or paralyzed, the ataxia score is...
You should only score loss of sensation if you can really that they have loss of sensation
demonstrate...
if patient has sensory loss from neuropathy, do you count no, but you do if there's loss on top of the neuropathy
thatt?
aphasia is difficult because it can take a while to go mild, mod, severe
through the battery and it can be subjective as to
whether it is one of which classification?
start to recognise aphasia when you meet them and start what happened
talking and you don't get a history of...
dysarthria is interesting because there are many cultural speech.
things about slurred ________?
, NIH Stroke Scale Exam
Score is associated with prognosis? YES
Is NIH scale a measure of disability? NO. The NIH scale is a measure of impairments.
The NIH scale creates a common currency so that deficit, by giving a number that communicates to other professionals how sick the
everybody understands the patient's level of... patient is
how much time to budget to perorm NIH scale 7-10 mins
What effort should be recorded? Do not do what? The patient's first effort. Don't go back and change scores.
IMPORTANT CONVENTIONS IN ADMINISTRATION: -order
Administer scale items in their exact ______ -coaching
-Avoid ______ing patient -first
-Accept patient's _______ effort -does
-Score only what the patient _______ -Be consistent
-Be consistent -previous strokes
-Include all _________s into scoring, including those that
may be from _________s ______s
ITEM 1a and how to get it -examiner's overall impression of patient alertness
-ask 2-3 questions about circumstances of admission, stimuate patient by patting
or tapping, occasionally pinching
NIH Item 1a Scoring: -Alert
0 -Not alert, aroused w/ minor verbal stim
1 -Not alert, requires strong or painful stim
2 -Only reflexive movements or totally unresponsive
3
ITEM 1a - patient w/ 3 on this item is generally a coma
considered to be in... reflexive posturing in response to noxious stimulation
3 is scored ONLY if patient makes no movement other
than....
If difficult to determine 1 vs 2 in item 1a, continue with... medical hx qs until confident in assigning a score - THIS IS ONLY TIME IN NIH
scale where you can go back
EVEN IF PRESENTED WITH OBSTACLES OR SCORE
BARRIERS, YOU MUST CHOOSE A
NIH Item 1B -month of year
based on responses to two items: -patient's age
When?
-What about patient
ITEM 1B SCORING -answers both qs correctly
0 -answers 1 q correctly OR patients unable to communicate d/t intubation, oral-
1 tracheal trauma, severe dysarthria from any cause, language barrier, or any
2 issue not secondary to aphasia
-answers neither question correctly --> a 3 on 1a must be a 2 on 1b
A patient that cannot speak but is otherwise able to writing
communicate can be allowed to convey the answer how?
