NIH Stroke Scale
NIH Stroke Scale
Adapted from Lyden et al. Copyright © 1994, American Heart Association, Inc.
Download the complete stroke scale from the NIH, here: https://stroke.nih.gov/documents/NIH_Stroke_Scale.pdf
Modalities
- Level of consciousness
- Orientation
- Response to commands
- Gaze
- Visual fields
- Facial movement
- Motor function
- Arms
- Legs
- Limb ataxia
- Sensory
- Language
- Articulation
- Extinction or inattention
Scoring
Level of consciousness
0—Alert
1—Drowsy
2—Obtunded
3—Coma/unresponsive
Orientation questions (2)
0—Answers both correctly
1—Answers 1 correctly
2—Answers neither correctly
Response to commands (2)
0—Performs both tasks correctly
1—Performs 1 task correctly
2—Performs neither
Gaze
0—Normal horizontal movements
1—Partial gaze palsy
2—Complete gaze palsy
Visual fields
0—No visual field defect
1—Partial hemianopia
2—Complete hemianopia
3—Bilateral hemianopia
Facial movement
0—Normal
1—Minor facial weakness
2—Partial facial weakness
3—Complete unilateral palsy
Motor function (arm): a. Left, b. Right
0—No drift
1—Drift before 10 s
2—Falls before 10 s
3—No effort against gravity
4—No movement
Motor function (leg): a. Left, b. Right
0—No drift
1—Drift before 5 s
2—Falls before 5 s
3—No effort against gravity
4—No movement
Limb ataxia
0—No ataxia
1—Ataxia in 1 limb
2—Ataxia in 2 limbs
Sensory
0—No sensory loss
1—Mild sensory loss
2—Severe sensory loss
Language
0—Normal
1—Mild aphasia
2—Severe aphasia
3—Mute or global aphasia
Articulation
0—Normal
1—Mild dysarthria
2—Severe dysarthria
Extinction or inattention
0—Absent
1—Mild loss (1 sensory modality lost)
2—Severe loss (2 modalities lost)