NIH STROKE SCALE Q & A CORRECTLY ANSWERED.

NIH STROKE SCALE Q & A CORRECTLY ANSWERED. How many items on the NIH stroke scale? - CORRECT ANSWER-11 NIH Stroke scale is - CORRECT ANSWER-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 cerebral ischemia on levels of ... (7 items) - CORRECT ANSWER-levels of: 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 and to assess the outcome after - CORRECT ANSWER-treatment Should the patient be coached? Should you go back and rethink a particular assessment? - CORRECT ANSWER-NO Having what when using NIH scale is important? - CORRECT ANSWER-reference materials DO NOT RATE what you think the patient wants to do or what you think they can do, RATE ONLY - CORRECT ANSWER-rate only what they actually do use patient"s first response? - CORRECT ANSWER-YES - DO NOT USE SUMMARY OF RESPONSES re ataxia score 1-if real weak, assume ataxia score is... 2-if they can hold leg or arm up w/ minimal drift but are all over place when trying finger to nose test, that's 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... - CORRECT ANSWER-1) 0 2) ataxia 3) 1 or 2 4) 0 You should only score loss of sensation if you can really demonstrate... - CORRECT ANSWER-that they have loss of sensation if patient has sensory loss from neuropathy, do you count thatt? - CORRECT ANSWER-no, but you do if there's loss on top of the neuropathy aphasia is difficult because it can take a while to go through the battery and it can be subjective as to whether it is one of which classification? - CORRECT ANSWER-mild, mod, severe start to recognise aphasia when you meet them and start talking and you don't get a history of... - CORRECT ANSWER-what happened dysarthria is interesting because there are many cultural things about slurred ________? - CORRECT ANSWER-speech. Score is associated with prognosis? - CORRECT ANSWER-YES Is NIH scale a measure of disability? - CORRECT ANSWER-NO. The NIH scale is a measure of impairments. The NIH scale creates a common currency so that everybody understands the patient's level of... - CORRECT ANSWER-deficit, by giving a number that communicates to other professionals how sick the patient is how much time to budget to perorm NIH scale - CORRECT ANSWER-7-10 mins What effort should be recorded? Do not do what? - CORRECT ANSWER-The patient's first effort. Don't go back and change scores. IMPORTANT CONVENTIONS IN ADMINISTRATION: Administer scale items in their exact ______ -Avoid ______ing patient -Accept patient's _______ effort -Score only what the patient _______ -Be consistent -Include all _________s into scoring, including those that may be from _________s ______s - CORRECT ANSWER--order -coaching -first -does -Be consistent -previous strokes ITEM 1a and how to get it - CORRECT ANSWER--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: 0 1 2 3 - CORRECT ANSWER--Alert -Not alert, aroused w/ minor verbal stim -Not alert, requires strong or painful stim -Only reflexive movements or totally unresponsive ITEM 1a - patient w/ 3 on this item is generally considered to be in... 3 is scored ONLY if patient makes no movement other than.... - CORRECT ANSWER-a coma reflexive posturing in response to noxious stimulation If difficult to determine 1 vs 2 in item 1a, continue with... - CORRECT ANSWER-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 BARRIERS, YOU MUST CHOOSE A - CORRECT ANSWER-SCORE NIH Item 1B based on responses to two items: When? -What about patient - CORRECT ANSWER--month of year -patient's age ITEM 1B SCORING 0 1 2 - CORRECT ANSWER--answers both qs correctly -answers 1 q correctly OR patients unable to communicate d/t intubation, oral-tracheal trauma, severe dysarthria from any cause, language barrier, or any 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 communicate can be allowed to convey the answer how? - CORRECT ANSWER-writing If the patient answers incorrectly first and then corrects self, how is the answer scored? - CORRECT ANSWER-it is still scored as incorrect What if patient gives DOB as answer to question asking for their age? How is this scored? Is there credit for partial answers that are close like being off a month when answering what month it is? - CORRECT ANSWER-This is scored as a WRONG answer. NO NIH 1C is what? Make sure to position what in testable position - CORRECT ANSWER-Commands Eyes and Hands NIH 1C ask patient to do how many actions and what are they? - CORRECT ANSWER-3 commands "close your eyes for me" "now open them" "now make a fist with your hand" NIH 1C - may I repeat the commands? May I encourage? May I pantomime command? May I hold up arm for hand to make fist? - CORRECT ANSWER-Yes, you can repeat command ONCE. No, no encouragement or coaching. Yes, you should try and pantomime command so that patient receives verbal and visual input. Yes, can hold up arm for hand command NIH scale 1C scoring: 0 1 2 - CORRECT ANSWER-0 - both tasks performed correctly 1 - one task performed correctly 2 - neither task if performed correctly Can a friend/family member translate w/ NIH commands? - CORRECT ANSWER-Yes NIH scale 1C -for patient who has comprehension deficit and perform incorreclty, what is scored? - CORRECT ANSWER-2 NIH scale 1C -for patient who gives a real attempt but not completed due to weakness, is credit given? - CORRECT ANSWER-yes, give credit but ONLY score the first attempt NIH scale Number 2 item is... - CORRECT ANSWER-Best Gaze what does the best gaze item test? - CORRECT ANSWER-voluntary horizontal eye movements does NIH scale #2 measure distortions in vertical gaze, nystagmus or schew deviation - CORRECT ANSWER-NO, NIH scale #2 does not measure these visual issues NIH scale #2 -first test, noting what? -second test - CORRECT ANSWER--look at position of eyes at rest, noting spontaneous eye movements to left or right -then move finger or other target from side to side and ask patient to track MOVING EYES ONLY, being sure to keep asking patient to follow the target If patient does not accurately follow finger, a stronger test is needed USE what other tests? - CORRECT ANSWER-oculocephalic maneuver, eye fixation or tracking of the examiner's face Item 2 - if patient has ocular rotary problems, such as strabismus, but leaves mid-line in attempt to look both left and right, what should the response be considered? - CORRECT ANSWER-normal Item 2 Best Gaze Scoring 0 1 2 - CORRECT ANSWER-0 - normal 1 - partial gaze palsy 2- forced deviation If there is a conjugate deviation of eyes that can be overcome with voluntary or reflexive activity, score a - CORRECT ANSWER-1 If patient has isolated cranial nerve paralysis such as ocular motor or abducens palsy, score a - CORRECT ANSWER-1