National Institutes of Health (NIH) Stroke Scale

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National Institutes of Health stroke scale is a tool used to systematically evaluate the acuity of stroke patients in order to determine apt treatment & outcome.

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National Institutes of Health (NIH) stroke scale is a tool used to systematically evaluate the acuity of stroke patients in order to determine the apt treatment and patient outcome. Although anyone may perform the NIH stroke scale, it is generally recommended for trained professionals to handle it. It is important to strictly administer the stroke scale items in the order listed and to record the performance in each category without changing initial answers. A stroke is when blood supply to the brain is disrupted.

NIH Stroke Scale: Level of Consciousness

• 1a: Level of Consciousness
  • 0: (Alert) keenly responsive
  • 1: (Not alert) can respond, obey or answer by minor stimulation
  • 2: (Not alert) can respond but needs repeated or strong/ painful stimulation
  • 3: makes no movement or completely unresponsive
  • 2a: Level of Consciousness Questions: patient is asked his/ her birthday and age
    • 0: answers both questions correctly
    • 1: answers one question correctly
    • 2: answers neither question correctly
    • *answers are given credit only when answered accurately and close answers are not considered
    • 3a: Levels of Consciousness Commands: asked to (1) open and close eyes and (2) grip and release the non-paretic (paralysed) hand
      • 0: performs both tasks correctly
      • 1:  performs one task correctly
      • 2: performs neither task correctly
      • *weak completed actions are given credit

NIH Stroke Scale: Best Gaze

• Test only the horizontal eye movements
  • 0: normal
  • 1: partial gaze palsy (abnormal gaze in one or both eyes, but no forced deviation)
  • 2: total gaze paresis

NIH Stroke Scale: Visual

• Tested by confrontation, using finger counting or visual threat (by moving fingers)
  • 0: no visual loss
  • 1: partial hemianopia
  • 2: complete hemianopia
  • 3: bilateral hemianopia
  • Hemianopia: decrease vision or blindness

NIH Stroke Scale: Facial Palsy

• Ask patient to show teeth or raise eyebrows and close eyes with symmetry
  • 0: normal symmetrical movements
  • 1: minor paralysis (flattened nasolabial fold, asymmetry on smiling)
  • 2: partial paralysis (total or near-total paralysis of lower face)
  • 3: complete paralysis of both sides (absence of facial movement in the upper and lower face)

NIH Stroke Scale: Motor Arm

• Arm is extended 90 degrees (if sitting) or 45 degrees (if supine) with palms down for ten seconds
  • 0: no drift and holds for full 10 seconds
  • 1: arm holds but drifts down before completing 10 seconds; does not hit bed
  • 2: arm cannot get to or maintain hold and drifts down to bed but has some effort against gravity
  • 3: arm falls
  • 4: no movement
  • UN: amputation
  • *left arm and right arm should be graded separately

NIH Stroke Scale: Motor Leg

• Leg is extended at 30 degrees while supine for five seconds
  • 0: no drift and holds for full five seconds without drifting
  • 1:  leg falls by the end of five seconds but does not hit the bed
  • 2: leg cannot get to or maintain hold and drifts down to bed but has some effort against gravity
  • 3: leg falls to bed immediately
  • 4: no movement
  • UN: amputation

NIH Stroke Scale: Limb Ataxia

• Check for muscle coordination of the limbs by performing finger-nose-finger and heel-shin tests are performed on both sides
  • 0: absent
  • 1: present in one limb
  • 2: present in two limbs
  • UN: amputation

NIH Stroke Scale: Sensory

• Feels sensation when noxious stimulus is tested
  • 0: no sensory los
  • 1: mild-to-moderate sensory less (superficial pain with pinprick or aware of being touched)
  • 2: severe or total sensory loss (completely unaware of stimulus)

NIH Stroke Scale: Best Language

• Test for comprehension by asking the patient to describe what is happening in an attached picture, to name the items in an attached picture and to read from the attached list of sentences
  • 0: no aphasia
  • 1: mild-to-moderate aphasia (some obvious loss of fluency or facility of comprehension without significant limitation on ideas expressed or form of expression; reduction of speech and/ or comprehension)
  • 2: severe aphasia (communicates through fragmented expressions with great need for interference, questioning, and guessing; limited range of information)
  • 3: mute, global aphasia

NIH Stroke Scale: Dysarthria

• If patient is thought to be normal, the patient is to be asked to read or repeat words from an attached list
  • 0: normal
  • 1: mild-to-moderate dysarthria (slurs some words and can be understood but with some difficulty)
  • 2: severe dysarthria (slurred speech)
  • UN: intubated or other physical barrier

NIH Stroke Scale: Extinction and Inattention

• Information from previous tests may be used such as:
  • Severe visual loss preventing visual double simultaneous stimulation, and the cutaneous stimuli are normal, the score is normal
  • Aphasia but does not attend to both sides, the score is normal
  • Only scored if abnormality is present:
    • 0: no abnormality
    • 1: visual, tactile, auditory, spatial or personal inattention
    • 2: profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients only one side of space

First Aid Management based on NIH Stroke Scale:

Chances of developing complications from stroke greatly decrease when an individual receives help immediately. Giving first aid to people suffering stroke is very important:

• Call for emergency medical services immediately.
• Learn to recognize symptoms. Think FAST
  • Face: face drooping of one side while trying to smile
  • Arms: one arm lowering when trying to raise both arms
  • Speech: unable to repeat simple sentences; slurred or strange speech

Learning how to recognize symptoms of stroke can help save a life. Sign up for first aid and CPR courses with credible Canadian and American approved providers to learn how to manage emergency cases. The NIH stroke scale can help determine damages of stroke in an individual.

Sources:

NIH Stroke Scale Booklet. (ND). National Institute of Neurological Disorders and Stroke. Retrieved on October 15, 2013, from http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale_Booklet.pdf