Question

Discuss how to use the NIH Stroke Scale in assessing the patient's severity of stroke. Research current hospital protocols to support your response.

Answer 1

NIH Stroke Scale: It is a patient diagnostic tool to measure the cognitive effects of a stroke, related to neurological deficit. stroke affects the cognitive domain like memory, language, attention, and orientation.

This scale helps all the people to treat the patient in a better way.

NIH Stroke Scale Purposes:

a. Evaluation: Severity of stroke.

b. Help to determine the authentic treatment.

c.To predicts patient outcomes.

Different evaluation points in NIH Stroke scales are

1 (a).level of consciousness, based on history

Alert, Keenly responsive	0
arouse after minor stimulation	+1
arouse but after repeated stimulation	+2
pain during movement	+2
No response	+3

1 (b). Ask month, date, age

All questions right 0 One question right +1 no answers to any questions +2 Dysarthric/trauma/language problem +3 Aphasic +4

1(c) Blink eyes and hand movement like squeezing

Performs both tasks	0
Performs only one task	+1
No response	+2

2. Horizontal extraocular movements

Normal	0
Partial gaze palsy: It can be overcome	+1
Partial gaze palsy: corrects with oculocephalic reflex	+1
forced gaze palsy: cannot be overcome	+2

3. Visual fields

Appropriate visual, no loss	0
Partial Hemianopia	+1
complete hemianopia	+2
the patient is bilaterally blind	+3
bilateral hemianopia	+3

4. Facial palsy (Use grimace if obtunded) Grimace: the ugly expression on the face

normal symmetry	0
minor paralysis	+1
partial paralysis ( lower face)	+2
Unilateral complete paralysis (Full face)	+3
Bilateral or complete paralysis	+3

5(a): Left-arm motor drift

No drift (for 10 seconds)	0
Drift but doesn't hit the bed	+1
Drift hits the bed	+2
efforts against gravity	+2
no efforts against gravity	+3
no movement	+4
amputation/ joint fusion	0

5(b) Right arm motor drift: same drift and point mentioned in the above table 5(a).

6(a) left leg motor drift: the same table as mentioned in table 5 (a).

6(b) right leg motor drift: Same as table 5(a)

7.Limb ataxia

No ataxia	0
ataxia in 1 limb	+1
ataxia in limb 2	+2
does not understand	0
paralyzed	0
amputation/ joint fusion	0

8. Sensation

normal, no sensory loss	0
mild-moderate loss: less sharp and more dull	+1
mild-moderate loss: touching creates the sensation	+1
complete loss: cannot sense being touched at all	+2
no response	+2
coma or it may be unresponsive	+2

9. language/ aphasia: inability to understand and produce speech

Normal	0
mild-moderate aphasia	+1
severe aphasia	+2
mute /global aphasia	+3
coma/ unresponsive	+3

10.dysarthria/ motor speech disorder

normal	0
mild-moderate	+1
severe dysarthria	+2
mute	+2
unable to test	0

11. Extinction/ Inattention

no abnormality	0
visual/tectile/spatial/personal inattention	+1
extinction to bilateral simultaneous stimulation	+1
profound hemi-inattention	+2
extinction	+2

Research current hospital protocols

It is a research tool.

It helps us to grade the severity of stroke.

it gives a standardized way to monitor and assess the patients over time.

The different examiners give a score that is graded the same way.

It is not a diagnostic tool it is mostly used to grade the severity of the stroke.

It is good to detect the anterior circulation stroke but not more subtle posterior circulation strokes.

Nih scales are standardized and mentioned in the above table, the examiners use this to guide the diagnosis of a severe stroke.

Thanks and God bless you