8/18/2021 Activity History
AA01.1 - NIHSS-English Group A-V5 - 1st Certification
DATE
Patient 1
TOPIC ANSWER
Level of 1a. Level of Consciousness: The investigator must choose a response, even if a full evaluation is preve
Consciousness such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages. A 3 is scored
the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.
1b. LOC Questions: The patient is asked the month and his/her age. The answer must be correct - there
partial credit for being close. Aphasic and stuporous patients who do not comprehend the questions wi
LOC Questions 2. Patients unable to speak because of endotracheal intubation, orotracheal trauma, severe dysarthria
any cause, language barrier or any other problem not secondary to aphasia are given a 1. It is importan
only the initial answer be graded and that the examiner not "help" the patient with verbal or non-verbal
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip and release the
paretic hand. Substitute another one step command if the hands cannot be used. Credit is given if an
LOC unequivocal attempt is made but not completed due to weakness. If the patient does not respond to
Commands command, the task should be demonstrated to them (pantomime) and score the result (i.e., follows no
or two commands). Patients with trauma, amputation, or other physical impediments should be give
suitable one-step commands. Only the first attempt is scored.
2. Best Gaze: Only horizontal eye movements will be tested.Voluntary or reflexive (oculocephalic) eye
movements will be scored but caloric testing is not done. If the patient has a conjugate deviation of the e
that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated
Best Gaze peripheral nerve paresis (CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients with o
trauma, bandages, pre-existing blindness or other disorder of visual acuity or fields should be tested wit
reflexive movements and a choice made by the investigator. Establishing eye contact and then moving
the patient from side to side will occasionally clarify the presence of a partial gaze palsy.
3. Visual: Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or v
threat as appropriate. Patient must be encouraged, but if they look at the side of the moving fingers
appropriately, this can be scored as normal. If there is unilateral blindness or enucleation, visual fields in
Visual
remaining eye are scored. Score 1 only if a clear-cut asymmetry, including quadrantanopia is found. If
is blind from any cause score 3. Double simultaneous stimulation is performed at this point. If there is
extinction patient receives a 1, and the results are used to answer question 11.
4. Facial Palsy: Ask, or use pantomime to encourage the patient to show teeth or raise eyebrows and
Facial Palsy eyes. Score symmetry of grimace in response to noxious stimuli in the poorly responsive or non-
, 8/18/2021 Activity History
s. The should record the score as untestable (UN)
aphasic
patient is
encourage
d using
urgency in
the voice
and
pantomim
e but not
noxious
stimulatio
n. Each
limb is
tested in
turn,
beginning
with the
non-
paretic
leg. Only
in the
case of
amputatio
n or joint
fusion at
the hip,
the
examiner
should
record the
score as
untestable
(UN)
6b. Right
Leg: The
limb is
placed in
the
appropriat
e position:
hold the
leg at 30
degrees
(always
tested
supine).
Drift is
scored if
the leg
falls
before 5
seconds.
The
aphasic
patient is
encourage
d using
urgency in
AA01.1 - NIHSS-English Group A-V5 - 1st Certification
DATE
Patient 1
TOPIC ANSWER
Level of 1a. Level of Consciousness: The investigator must choose a response, even if a full evaluation is preve
Consciousness such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages. A 3 is scored
the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.
1b. LOC Questions: The patient is asked the month and his/her age. The answer must be correct - there
partial credit for being close. Aphasic and stuporous patients who do not comprehend the questions wi
LOC Questions 2. Patients unable to speak because of endotracheal intubation, orotracheal trauma, severe dysarthria
any cause, language barrier or any other problem not secondary to aphasia are given a 1. It is importan
only the initial answer be graded and that the examiner not "help" the patient with verbal or non-verbal
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip and release the
paretic hand. Substitute another one step command if the hands cannot be used. Credit is given if an
LOC unequivocal attempt is made but not completed due to weakness. If the patient does not respond to
Commands command, the task should be demonstrated to them (pantomime) and score the result (i.e., follows no
or two commands). Patients with trauma, amputation, or other physical impediments should be give
suitable one-step commands. Only the first attempt is scored.
2. Best Gaze: Only horizontal eye movements will be tested.Voluntary or reflexive (oculocephalic) eye
movements will be scored but caloric testing is not done. If the patient has a conjugate deviation of the e
that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated
Best Gaze peripheral nerve paresis (CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients with o
trauma, bandages, pre-existing blindness or other disorder of visual acuity or fields should be tested wit
reflexive movements and a choice made by the investigator. Establishing eye contact and then moving
the patient from side to side will occasionally clarify the presence of a partial gaze palsy.
3. Visual: Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or v
threat as appropriate. Patient must be encouraged, but if they look at the side of the moving fingers
appropriately, this can be scored as normal. If there is unilateral blindness or enucleation, visual fields in
Visual
remaining eye are scored. Score 1 only if a clear-cut asymmetry, including quadrantanopia is found. If
is blind from any cause score 3. Double simultaneous stimulation is performed at this point. If there is
extinction patient receives a 1, and the results are used to answer question 11.
4. Facial Palsy: Ask, or use pantomime to encourage the patient to show teeth or raise eyebrows and
Facial Palsy eyes. Score symmetry of grimace in response to noxious stimuli in the poorly responsive or non-
, 8/18/2021 Activity History
s. The should record the score as untestable (UN)
aphasic
patient is
encourage
d using
urgency in
the voice
and
pantomim
e but not
noxious
stimulatio
n. Each
limb is
tested in
turn,
beginning
with the
non-
paretic
leg. Only
in the
case of
amputatio
n or joint
fusion at
the hip,
the
examiner
should
record the
score as
untestable
(UN)
6b. Right
Leg: The
limb is
placed in
the
appropriat
e position:
hold the
leg at 30
degrees
(always
tested
supine).
Drift is
scored if
the leg
falls
before 5
seconds.
The
aphasic
patient is
encourage
d using
urgency in
