---
Understanding the NIH Stroke Scale (NIHSS)
The NIHSS is a standardized assessment tool developed to evaluate neurological function in stroke patients. It covers multiple domains such as consciousness, language, sensation, motor skills, and visual fields. The full assessment typically takes 5 to 10 minutes and results in a score ranging from 0 (no stroke symptoms) to 42 (most severe stroke).
Purpose of the NIH Stroke Scale
- Assess stroke severity
- Guide treatment decisions (e.g., thrombolysis eligibility)
- Predict patient outcomes
- Monitor neurological changes over time
Components of the NIHSS
The NIHSS includes 15 items, each evaluating a specific neurological function:
- Level of consciousness (LOC)
- LOC Questions
- LOC Commands
- Best gaze
- Visual fields
- Facial palsy
- Motor arm
- Motor leg
- Limb ataxia
- Sensory
- Language
- Speech (dysarthria)
- Extinction and inattention (neglect)
---
How to Use NIH Stroke Scale Answers Effectively
Accurate NIH stroke scale answers require a structured approach, clear communication, and clinical judgment. Below are guidelines to optimize assessment accuracy.
Preparation and Environment
- Ensure a quiet, well-lit environment
- Explain the procedure to the patient
- Gather necessary tools (e.g., pen, paper, visual aids)
Assessment Technique
- Follow the sequence of items systematically
- Observe patient responses carefully
- Use standardized questions and commands as per NIHSS protocol
- Document answers precisely, referring to scoring guidelines
---
Sample NIH Stroke Scale Answers and Scoring Guide
Providing correct answers and understanding scoring criteria are vital. Below are common assessment items with typical responses and scoring explanations.
Level of Consciousness (LOC)
The LOC assesses alertness and responsiveness.
- Score 0: Patient is fully alert and responsive.
- Score 1: Patient is arousable with minor stimulation.
- Score 2: Patient is arousable only with repeated stimulation.
- Score 3: Unresponsive, no response to stimulation.
Questions (orientation to time and place)
Sample question: "What is the month?" / "Where are you right now?"
- Answer for score 0: Correct response, e.g., "April," "Hospital."
- Answer for score 1: Incorrect response or answers that are incomprehensible but arouse some response.
Commands (following simple commands)
Sample command: "Open and close your eyes."
- Score 0: Patient performs the command correctly.
- Score 1: Performs the task partially or with difficulty.
- Score 2: Unable to perform the command despite cues.
Gaze
Assessing eye movements and gaze deviation.
- Score 0: Normal gaze, no deviation.
- Score 1: Partial gaze paresis.
- Score 2: Forced deviation or gaze paralysis.
Visual Fields
Testing for visual field deficits.
- Score 0: No visual field loss.
- Score 1: Partial hemianopia.
- Score 2: Complete hemianopia or bilateral hemianopia.
Facial Palsy
Assessing facial muscle strength.
- Score 0: Normal face movement.
- Score 1: Minor facial weakness.
- Score 2: Partial paralysis.
- Score 3: Complete paralysis of facial muscles.
Motor Arm and Leg
Evaluating limb strength and movement.
- Score 0: No drift, movement against gravity.
- Score 1: Drifts but does not reach the limb's vertical position.
- Score 2: Some effort, but limb cannot sustain movement.
- Score 3: No movement
Limb Ataxia
Testing coordination.
- Score 0: No ataxia.
- Score 1: Ataxia present in one limb.
- Score 2: Ataxia in more than one limb.
Sensory
Assessing sensation in limbs.
- Score 0: Normal sensation.
- Score 1: Mild or inconsistent sensory loss.
- Score 2: Severe or complete sensory loss.
Language and Speech
Evaluating speech clarity and comprehension.
- Score 0: Normal language function.
- Score 1: Mild to moderate aphasia or dysarthria.
- Score 2: Severe aphasia or mute.
Extinction and Inattention (Neglect)
Testing for neglect or inattention.
- Score 0: No neglect.
- Score 1: Mild inattention.
- Score 2: Severe neglect or inattention.
---
Common Challenges and Tips for Accurate NIHSS Answers
Achieving precise answers requires practice and awareness of common pitfalls. Here are some tips for healthcare providers and examiners.
Recognizing Patient Limitations
- Consider language barriers or hearing impairments
- Account for patient fatigue or confusion
- Repeat instructions if necessary, documenting responses accurately
Standardization of Response
- Use the NIHSS standardized questions and commands
- Avoid leading or ambiguous prompts
- Document partial or inconsistent responses clearly
Interpreting Responses
- Differentiate between true deficits and language or comprehension issues unrelated to stroke
- Correlate findings with clinical presentation
- Consult with neurology specialists if uncertain
---
Conclusion
Mastering the nih stroke scale answers is a critical skill that enhances stroke assessment accuracy and patient outcomes. By understanding each component, utilizing standardized responses, and practicing assessment techniques, healthcare providers can ensure reliable scoring and timely intervention. Remember, the NIHSS is not just a number—it's a vital tool that guides lifesaving decisions and helps predict recovery trajectories. Continuous education and practice are key to becoming
Frequently Asked Questions
What is the NIH Stroke Scale and why is it important?
The NIH Stroke Scale (NIHSS) is a standardized tool used to assess the severity of a stroke by evaluating neurological function. It helps clinicians determine the extent of neurological deficits, guide treatment decisions, and monitor patient progress.
What are some common questions or items included in the NIH Stroke Scale?
The NIHSS includes questions assessing consciousness, gaze, visual fields, motor strength, sensation, language, speech, and coordination. Examples include asking the patient to describe their symptoms, follow commands, and perform specific movements.
How are NIH Stroke Scale answers scored?
Each item on the NIHSS is scored on a scale from 0 to 4 or 0 to 2, with higher scores indicating greater neurological impairment. The total score helps categorize stroke severity from minor to severe.
Are there common pitfalls or mistakes when answering NIH Stroke Scale questions?
Yes, common pitfalls include misinterpreting the patient's responses, rushing through assessments, or overlooking subtle deficits. Accurate scoring requires careful observation and clear communication with the patient.
Can the NIH Stroke Scale be used by non-neurologists or in pre-hospital settings?
Yes, the NIHSS is designed to be performed by trained healthcare providers, including emergency physicians, paramedics, and nurses, making it useful in pre-hospital and emergency settings to quickly assess stroke severity.
