NIH Stroke Scale Training and Certification Rated A+

NIH Stroke Scale Training and Certification Rated A+ rate what they actually do tips for scoring use patient's first response - ataxia lack of muscle coordination, reflects the affected coordination of one who has experienced a stroke Significance of NIH stroke scale necessary prognostic tool for discerning deficits within different parts of body. provides in common language to understand nature of stroke and severity amongst interdisciplinary team. is the NIH stroke scale a measure of disability? no, it is a measuring tool of impairments. Relevance to medical specialties emergency physicians, neurologists - administer scale items in their - exact order - avoid coaching patient - accept patient's 1st effort - score only what patient does - be consistent NIH level of consciousness item 1a 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* NIH level of consciousness item 1B based on 2 questions 1) patient's age 2) month 0 = answers both questions correctly 1 = answers one question correctly 2 = answers neither questions correctly NIH level of consciousness item 1C ask patient to perform 2 tasks 1) close your eyes, now open them 2) make a fist (independent limbs) NIH Best Gaze tests voluntary horizontal eye movements. - notice position of the eyes at rest, - move finger/object horizontally and ask patient to follow moving target 0 = score if acts performed correctly 1 = partial gaze palsy 2 = forced deviation *consider if eye movements are normal* NIH Visual field test eyes are tested independently patient must be looking directly at your eyes for peripheral tests. 1) cover opposing eye - test peripheral field 0 = no visual loss 1 = partial hemianopia 2 = complete hemianopia 3 = bilateral hemianopia NIH Visual palsy test 1) ask patient to show teeth 2) ask patient to show grimace (discern for symmetry) 3) ask patient to squeeze eyes shut, open them, then raise eye brows 0 = for normal symmetrical movements 1 = minor paralysis or asymmetry when grinning/smiling 3 = complete paralysis NIH Motor ARM ask for patient to extend limb and maintain limb for 10 sec 0 = no drift 1 = drift 2 = some effort against gravity 3 = no effort against gravity, and arm falls 4 = no movement noted NIH Motor LEG always test leg in supine position 0 = no drift 1 = drift 2 = some effort against gravity 3 = no effort against gravity 4 = no movement noted NIH Limb Ataxia ask patient to touch your finger with index finger then back to his nose. with legs, ask patient to place heel of one limb on opposing knee then slide it down and back up to knee 0 = if ataxia present 1 = present in one limb 2 = present in 2 limbs NIH Sensory 0 = normal, no evidence of sensory loss 1 = mild to moderate sensory loss 2 = severe or total sensory loss NIH Best Language scored based on language skills 0 = no aphasia 1 = no significant limitation, mild to moderate aphasia 2 = NIH Dysarthria articulation and clarity of speech is tested via verbal expression of words on a note card 0 = normal 1 = mild to moderate slurring 2 = severe slurring NIH extinction / inattention ask patient to close eyes, ask patient to close eyes, alternatively touch patient's left or right side. ask patient to state which side touched. 0 = 1 = 2 = calculating the scores total the sum