NIH Stroke Scale

What is an NIH Stroke Scale (NIHSS)?

The NIH Stroke Scale (NIHSS) is a comprehensive assessment tool that quantitatively measures the neurological function and associated deficits of stroke patients, particularly those experiencing acute stroke or showing early stroke symptoms. This tool plays a crucial role in acute stroke treatment, offering healthcare providers insights into the lesion location, degree of recovery, and both the short-term and long-term outcomes related to acute cerebral infarction. It is an essential component of the acute stroke assessment and helps determine stroke severity.

The NIHSS is divided into 11 key components, which include:

1. Level of consciousness (LOC), including LOC questions and LOC commands
2. Best gaze
3. Visual fields
4. Facial palsy
5. Motor arm
6. Motor leg
7. Limb ataxia
8. Sensory loss
9. Best language
10. Dysarthria
11. Extinction and inattention

Each component has clear instructions and a corresponding scoring guide, which ranges from 0 to 4, with the inclusion of an “untestable" (UN) option, known as the scale definition. The NIHSS score is determined by observing the patient's response to verbal instructions or painful stimuli like minor stimulation or strong, painful stimulation to assess motor ability and other key functions.

A critical aspect of administering the NIH Stroke Scale is that only trained and certified professionals should perform the test to ensure reliability and accuracy of results. Certification is essential to maintain consistency in clinical practice and is available through the National Institutes of Health (NIH). For more information on training and certification, refer to the American Heart Association website.

For stroke survivors, early and accurate assessment using the NIHSS can help identify the severity of ischemic strokeand provide valuable data for making informed decisions about stroke care. It is also crucial for predicting outcomes related to stroke recovery and tailoring the treatment plan based on the quantitative measure of neurological function.

How does our NIH Stroke Scale template work?

Follow these steps to use our free NIH Stroke Scale:

Step 1: Training and certification

It is essential that before you begin, you take the necessary steps to ensure that you are certified to administer the test. If you haven't been certified, head to the American Heart Association's website to undergo training and receive and certificate. Otherwise, double-check if you're due for recertification, generally 6 months to a year after your last certification.

Step 2: access and download the template

Click the "Use template" button to access the template via the Carepatron app. For a PDF copy, click "Download.:

Step 3: Review instructions

Before beginning the test, review the NIH Stroke Scale instructions included in the template. This will help you understand how to assess each of the 11 components accurately and ensure consistent scoring.

Step 4: Conduct the test

Use the template to guide you in assessing the patient’s response to instructions or stimuli for each of the 11 components. Assign scores based on the descriptions provided for each item.

Step 5: Compute the final score

Once you've acquired the scores for the scales, add them to produce a total score which will be used in interpretation and intervention.

Scoring and interpretation

The NIH Stroke Scale uses a scoring system ranging from 0 to 4 for each of its 11 components, with 0 indicating normal neurological function and higher scores (2, 3, or 4) reflecting increasingly severe impairment. Scoring is straightforward and involves observing the patient’s response to instructions or stimuli and selecting the description that best matches their movement or lack thereof.

Each component assesses specific neurological functions, such as consciousness, language, motor abilities, and sensory responses. For every component, you’ll observe the patient’s reaction to given instructions or stimuli and assign a score based on the following scale:

• 0: Normal function
• 1 to 3: Varying degrees of impairment (e.g., mild to severe)
• 4: Severe impairment or complete lack of function

It’s important to review the instructions carefully for each component to ensure accurate scoring based on the patient’s response.

After scoring all 11 components, sum the individual scores to arrive at a total score. This score is essential for interpreting the stroke’s severity and guiding further intervention:

• 0-4: Normal to mild impairment
• 5-15: Moderate impairment
• 16-25: Severe impairment
• 26-42: Very severe impairment

A higher total score indicates greater neurological impairment and more severe effects of the stroke. Scores over 25 are a significant cause for concern, often requiring immediate medical intervention.

Benefits of a free NIH stroke assessment

Here are the benefits of using our NIH stroke evaluation template:

Streamlined processes

Having a ready-made template on hand can streamline the process of completing and administering the acute stroke assessment, including the NIH Stroke Scale.

Standardization

With a standardized test such as the NIH Stroke Scale, involved practitioners will most likely be on the same page when determining the patient's severity. Moreover, testing across patients will be more consistent and accurate, and practitioners in charge of the treatment plan moving forward can formulate an effective plan at the top of their heads.

Establish a baseline for comparison

The NIH Stroke Scale is crucial for establishing a baseline at the initial stroke onset. By recording the patient's scoreduring the first assessment, healthcare providers can track changes over time and assess stroke survivors' recovery. This baseline helps monitor ischemic stroke, hemispheric strokes and acute cerebral infarction, providing insight into the infarction size and progression of symptoms.

Tracks progress

In addition to the baseline, the template allows for repeated stimulation of motor functions and sensory loss, providing continuous tracking of stroke patients' recovery. By comparing NIHSS scores over time, healthcare providers can assess the progress and determine the need for strong or painful stimulation or further acute stroke treatment. It also helps in evaluating the patient's motor leg and motor arm functionality, aiding in stroke rehabilitation.