"2 = profound hemi-inattention or extinction to more than one modality; does not recognise own hand or orientates to only one side of space"
"Posterior National Institutes of Health Stroke Scale (POST-NIHSS)"
"The POST-NIHSS includes assessment of gait/truncal ataxia and bulbar dysfunction, in order to better represent disability from posterior circulation strokes 4. The POST-NIHSS is calculated by adding 3 points for gait/truncal ataxia, 4 points for dysphagia, and 5 points for abnormal cough, to the baseline NIHSS 4. It may have a higher prognostic accuracy than the NIHSS in patients with posterior circulation strokes 4."
"The POST-NIHSS includes assessment of gait/truncal ataxia and bulbar dysfunction, in order to better represent disability from posterior circulation strokes 4. The POST-NIHSS is calculated by adding 3 points for gait/truncal ataxia, 4 points for dysphagia, and 5 points for abnormal cough, to the baseline NIHSS 4. It may have a higher prognostic accuracy than the NIHSS in patients with posterior circulation strokes 4."
"1a. Level of consciousness"
"Modified National Institutes of Health Stroke Scale (mNIHSS)"
"Shortened National Institutes of Health Stroke Scale (sNIHSS)"
"Posterior National Institutes of Health Stroke Scale (POST-NIHSS)"
"Expanded National Institutes of Health Stroke Scale (e-NIHSS)"
"Paediatric National Institutes of Health Stroke Scale (PedNIHSS)"
"The first iteration of the NIHSS was developed in 1989 8 for use in a National Institutes of Health-funded trial of naloxone in ischaemic stroke 9. This early form included pupillary responses, plantar reflex, included only one item for each of the best upper and lower limbs, and had items for change from previous examination and change from baseline 8,9. This initial scale was eventually modified for use in the NINDS r-tPA for Acute Stroke Trial, and has since been a standard rating scale for stroke clinical trials 9."
"National Institutes of Health Stroke Scale"
Expected headings
"Items and scoring"
"1a. Level of consciousness"
"1b. Level of consciousness questions"
"1c. Level of consciousness commands"
"2. Best gaze"
"3. Visual fields"
"4. Facial palsy"
"5. Motor: arm"
"6. Motor: leg"
"7. Limb ataxia"
"8. Sensory"
"9. Best language"
"10. Dysarthria"
"11. Extinction and inattention (formerly neglect)"
"Modifications"
"Modified National Institutes of Health Stroke Scale (mNIHSS)"
"Shortened National Institutes of Health Stroke Scale (sNIHSS)"
"Posterior National Institutes of Health Stroke Scale (POST-NIHSS)"
"Expanded National Institutes of Health Stroke Scale (e-NIHSS)"
"Paediatric National Institutes of Health Stroke Scale (PedNIHSS)"
"External links"
"0 = alert; keenly responsive"
"1 = not alert; but arousable by minor stimulation to obey, answer, or respond"
"2 = not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped)"
"1 = partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present"
"0 = no drift; limb holds 90° (or 45°) for full 10 seconds"
"1 = drift; limb holds 90° (or 45°), but drifts down before full 10 seconds; does not hit bed or other support"
"1 = drift; limb holds 90° (or 45°), but drifts down before full 10 seconds; does not hit bed or other support"
"2 = some effort against gravity; limb cannot get to or maintain (if cued) 90° (or 45°), drifts down to bed, but has some effort against gravity"
"3 = no effort against gravity; limb falls"
"0 = no drift; leg holds 30° position for full 5 seconds"
"1 = drift; leg falls by the end of the 5-second period but does not hit bed"
"2 = some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity"
"3 = no effort against gravity; leg falls to bed immediately"
"0 = normal; no sensory loss"
"1 = mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched"
"1 = mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched"
"2 = severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg"
"0 = no aphasia; normal"
"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, however, makes conversation about provided materials difficult or impossible; for example, in conversation about provided materials, examiner can identify picture or naming card content from patient’s response"
"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, however, makes conversation about provided materials difficult or impossible; for example, in conversation about provided materials, examiner can identify picture or naming card content from patient’s response"
"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, however, makes conversation about provided materials difficult or impossible; for example, in conversation about provided materials, examiner can identify picture or naming card content from patient’s response"
"2 = severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener; range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response"
"2 = severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener; range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response"
"2 = severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener; range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response"
"2 = severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener; range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response"
"2 = severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener; range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response"
"3 = mute, global aphasia; no usable speech or auditory comprehension"
"1 = mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty"
"2 = severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric. UN = Intubated or other physical barrier, explain:_____________________________"
"2 = profound hemi-inattention or extinction to more than one modality; does not recognise own hand or orientates to only one side of space"
"item 9: for children aged 2-6 years (or older children with premorbid language skills at"
"The limb is placed in the appropriate position: extend the arms (palms down) 90° (if sitting) or 45° (if supine). Drift is scored if the arm falls before 10 seconds (count out loud and use your fingers to show the patient your count 9). The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as untestable (UN), and clearly write the explanation for this choice."
"item 9: for children aged 2-6 years (or older children with premorbid language skills at"
"**the naming items (glove, cactus, key, chair, feather, hammock) were also updated in 2024 (bucket, bicycle, clouds, traffic lights, leaf, mouse, bridge) due to concerns regarding cultural acceptability 2"
"sNIHSS-8: eliminates items 1b, 1c, 5a, 5b, 7, 8, and 11 (i.e. keeps items 1a, 2, 3, 4, 6a, 6b, 9, and 10)"
"sNIHSS-5: eliminates items 1a, 1b, 1c, 4, 5a, 5b, 7, 8, 10, and 11 (i.e. keeps items 2, 3, 6a, 6b, and 9)"
"if there are no anatomical bulbar abnormalities, then ask the patient to swallow their own saliva, if they are unable to (e.g. stops to cough, voice changes, drooling), then the patient scores 4 points for dysphagia, and stop assessment for dysphagia"
"if the patient scan swallow their own saliva, then ask them to attempt to swallow water (Gugging Swallow Screen), sequentially 5 mL, 10 mL, 20 mL, and then 50 mL, if they are unable to (e.g. stops to cough, voice changes, drooling), then the patient scores 4 points for dysphagia"
"item 9: for children aged 2-6 years (or older children with premorbid language skills at"