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How to Measure Strokes

There are many assessment tools for measuring strokes, but none are as well known as the National Institute of Health Stroke Scale. It is a quick way of measuring the deficits that a stroke has created in a patient and summing it up in a convenient score. A neurologist does not need to perform the Stroke Scale, and you can learn the process from healthcare practitioners for free over the Internet. It is a universal way to measure stroke severity.

Things You'll Need

  • NIH Stroke Scale Sheet
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Instructions

  1. Level of Consciousness

    • 1

      Determine if the patient is alert and responsive, arousable to minor stimulation, arousable only to painful stimulation, or if he responds with reflexes or is unresponsive. Assign the patient a score and record it in the box.

    • 2

      Ask the patient his month and age. There is no partial credit for being close. Take only the first answer given. Record the score in the given box.

    • 3

      Ask the patient to blink his eyes and open and close a hand that is not affected by paralysis. Substitute some other command if neither hand is capable of movement. Give credit if the patient makes an attempt, but the tester must be sure that the patient made an attempt. It is acceptable to show the patient how to do the command in order to get him to comply. Record the score.

    Vision, Symmetry and Drift

    • 4

      Ask the patient to follow a finger from side to side with eyes. If both eyes follow, then gaze is normal. If one eye is unable to follow but not totally paralyzed, then it is a score of 1. If the gaze is totally paralyzed, it is a score of 2. Record the score.

    • 5

      Ask the patient to look directly at the tester. Hold fingers to the side in peripheral vision and ask him to say when he sees them. Do this for all four quadrants of each eye field. If unable to speak, confront the eye with fingers in all four quadrants to see if the eye reflexively closes. Score appropriately.

    • 6

      Ask the patient to smile, raise his eyebrows or show his teeth. Score the amount of paralysis noted to the patient's face. Administer a noxious stimulus to produce a grimace, if necessary, for an unresponsive patient. Record the score.

    • 7

      Extend the patient's arm at a 45 degree angle if the patient is lying down or at a 90 degree angle if he is sitting with palm down. If the patient is unable to hold the position for 10 seconds, then record the drift. Test each arm and score appropriately.

    • 8

      Lay patient flat and extend his leg at a 30 degree angle. If the patient cannot maintain the leg's position for 5 seconds, then note the drift. Record the score as appropriate for each leg.

    Sensory and Language

    • 9

      Ask the patient to run the heel of his right foot down the shin of his left leg. Then, ask the patient to run the heel of his left foot down the shin of his right leg. If patient is unable to do this, then ataxia is present. If the patient cannot understand your instructions or if there is paralysis, score this as absent. Score accordingl to how the patient responds.

    • 10

      Touch the patient on both sides of the face, both arms and both legs. Ask the patient if he is able to feel the touch. Use a pin to pinprick lightly the same areas and ask if he is able to feel these touches as well. If patient is unable to respond, measure withdrawal to painful stimuli for this test; score according to how the patient is able to respond.

    • 11

      Show the patient a picture attached to the stroke scale and ask him to describe what is happening. Ask him to name the items and say the words on the attached sheets. If the patient has some loss of comprehension, then give him a score of 1. If there is just fragmentary comprehension, then give him a score of 2. Reserve a score of 3 for a patient who could not respond at all.

    • 12

      Ask the patient to repeat the words from the attached list. If the words are somewhat slurred, but can be understood, then give him a score of 1. If the patient is unintelligible, then give him a score of 2. If the patient cannot speak due to the insertion of an endotracheal tube for breathing, then indicate "unable to test."

    • 13

      Observe whether the patient ignores one side of the body in the visual, auditory, tactile, or personal fields. This should be evident from the testing that has come before. If the patient seems to have some neglect to one side, give him a score of 1. If there is profound neglect or the patient does not recognize his own hand, then assign a score of 2.

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