;Attempt History
Hernandez, Delmy
01- NIHSS-English Group A-V3 - 1st Certification
Date Result
3/3/2018 4:12:38 AM Passed 89 of 90 (98.89 %) View Responses
Patient 1
Topic Question Answer Grade
Level of
1a. Level of 0 = Alert; keenly responsive Correct
Consciousness
Consciousness: The
investigator must
choose a response,
even if a full evaluation
is prevented by such
obstacles as an
endotracheal tube,
language barrier,
orotracheal
trauma/bandages. A 3
is scored only if the
patient makes no
movement (other than
reflexive posturing) in
response to noxious
stimulation.
LOC Questions 1b. LOC Questions: The 0 = Answers both Correct
patient is asked the questions correctly
month and his/her age.
The answer must be
correct there is no
partial credit for being
close. Aphasic and
stuporous patients who
do not comprehend the
questions will score 2.
Patients unable to
speak because of
endotracheal intubation,
orotracheal trauma,
severe dysarthria from
any cause, language
barrier or any other
problem not secondary
to aphasia are given a
1. It is important that
only the initial answer
be graded and that the
examiner not "help" the
patient with verbal or
nonverbal cues.
LOC Commands 1c. LOC Commands: 0 = Performs both tasks correctly Correct
The patient is asked to
open and close the
eyes and then to grip
and
, release the nonparetic
hand. Substitute
another one step
command if the hands
cannot be used. Credit
is given if an
unequivocal attempt is
made but not
completed due to
weakness. If the
patient does not
respond to command,
the task should be
demonstrated to them
(pantomime) and score
the result (i.e., follows
none, one or two
commands). Patients
with trauma,
amputation, or other
physical impediments
should be given
suitable onestep
commands.
Only the first attempt is
scored. 0 = Normal Correct
Best Gaze 2. Best Gaze: Only
horizontal eye
movements will be
tested.Voluntary or
reflexive (oculocephalic)
eye movements will be
scored but caloric
testing is not done. If
the patient has a
conjugate deviation of
the eyes that can be
overcome by voluntary
or reflexive activity, the
score will be 1. If a
patient has an isolated
peripheral nerve paresis
(CN III, IV or VI) score
a 1. Gaze is testable in
all aphasic patients.
Patients with ocular
trauma, bandages, pre
existing blindness or
other disorder of visual
acuity or fields should
be tested with
reflexive movements
and a choice made by
the investigator.
Establishing eye contact
and then moving about
the patient from side to
side will occasionally
, clarify the presence of
a partial gaze palsy.
Visual 3. Visual: Visual fields 0 = No visual loss Correct
(upper and lower
quadrants) are tested
by confrontation, using
finger counting or visual
threat as appropriate.
Patient must be
encouraged, but if they
look at the side of the
moving fingers
appropriately, this can
be scored as normal. If
there is unilateral
blindness or
enucleation, visual fields
in the remaining eye
are scored. Score 1
only if a clearcut
asymmetry, including
quadrantanopia is
found. If patient is blind
from any cause score 3.
Double simultaneous
stimulation is performed
at this point. If there is
extinction patient
receives a 1, and the
results are used to
answer question 11.
Facial Palsy 4. Facial Palsy: Ask, or 0 = Normal Correct
use pantomime to symmetrical movement
encourage the patient
to show teeth or raise
eyebrows and close
eyes. Score symmetry
of grimace in response
to noxious stimuli in the
poorly responsive or
noncomprehending
patient. If facial
trauma/bandages,
orotracheal tube, tape
or other physical
barriers obscure the
face, these should be
removed to the extent
possible.
Motor Arms 5a. Motor Arm Left: The
0 = No drift, limb holds 90 (or Incorrect
limb is placed in the
45) degrees for full 10
appropriate position:
seconds
extend the arms (palms
down) 90 degrees (if
sitting) or 45 degrees
(if supine). Drift is
scored if
, the arm falls before 10
seconds. 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)
Motor Arms 5b. Motor Arm Right:
0 = No drift, limb holds 90 (or Correct
Limb is placed in the
45) degrees for full 10
appropriate position:
seconds
extend the arms (palms
down) 90 degrees (if
sitting) or 45 degrees
(if supine). Drift is
scored if the arm falls
before 10 seconds. 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
nonparetic arm. Only in
the case of amputation
or joint fusion at the
shoulder, the examiner
should record the score
as untestable (UN)
Motor Legs 6a. Left Leg: The limb
is placed in the Correct
appropriate position: 1 = Drift, leg falls by the end of
hold the leg at 30 the 5 second period, but does
degrees (always tested not hit bed
supine). Drift is scored
if the leg falls before 5
seconds. 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 leg. Only in the
case of amputation or
joint fusion at the hip,
the examiner should
record
Hernandez, Delmy
01- NIHSS-English Group A-V3 - 1st Certification
Date Result
3/3/2018 4:12:38 AM Passed 89 of 90 (98.89 %) View Responses
Patient 1
Topic Question Answer Grade
Level of
1a. Level of 0 = Alert; keenly responsive Correct
Consciousness
Consciousness: The
investigator must
choose a response,
even if a full evaluation
is prevented by such
obstacles as an
endotracheal tube,
language barrier,
orotracheal
trauma/bandages. A 3
is scored only if the
patient makes no
movement (other than
reflexive posturing) in
response to noxious
stimulation.
LOC Questions 1b. LOC Questions: The 0 = Answers both Correct
patient is asked the questions correctly
month and his/her age.
The answer must be
correct there is no
partial credit for being
close. Aphasic and
stuporous patients who
do not comprehend the
questions will score 2.
Patients unable to
speak because of
endotracheal intubation,
orotracheal trauma,
severe dysarthria from
any cause, language
barrier or any other
problem not secondary
to aphasia are given a
1. It is important that
only the initial answer
be graded and that the
examiner not "help" the
patient with verbal or
nonverbal cues.
LOC Commands 1c. LOC Commands: 0 = Performs both tasks correctly Correct
The patient is asked to
open and close the
eyes and then to grip
and
, release the nonparetic
hand. Substitute
another one step
command if the hands
cannot be used. Credit
is given if an
unequivocal attempt is
made but not
completed due to
weakness. If the
patient does not
respond to command,
the task should be
demonstrated to them
(pantomime) and score
the result (i.e., follows
none, one or two
commands). Patients
with trauma,
amputation, or other
physical impediments
should be given
suitable onestep
commands.
Only the first attempt is
scored. 0 = Normal Correct
Best Gaze 2. Best Gaze: Only
horizontal eye
movements will be
tested.Voluntary or
reflexive (oculocephalic)
eye movements will be
scored but caloric
testing is not done. If
the patient has a
conjugate deviation of
the eyes that can be
overcome by voluntary
or reflexive activity, the
score will be 1. If a
patient has an isolated
peripheral nerve paresis
(CN III, IV or VI) score
a 1. Gaze is testable in
all aphasic patients.
Patients with ocular
trauma, bandages, pre
existing blindness or
other disorder of visual
acuity or fields should
be tested with
reflexive movements
and a choice made by
the investigator.
Establishing eye contact
and then moving about
the patient from side to
side will occasionally
, clarify the presence of
a partial gaze palsy.
Visual 3. Visual: Visual fields 0 = No visual loss Correct
(upper and lower
quadrants) are tested
by confrontation, using
finger counting or visual
threat as appropriate.
Patient must be
encouraged, but if they
look at the side of the
moving fingers
appropriately, this can
be scored as normal. If
there is unilateral
blindness or
enucleation, visual fields
in the remaining eye
are scored. Score 1
only if a clearcut
asymmetry, including
quadrantanopia is
found. If patient is blind
from any cause score 3.
Double simultaneous
stimulation is performed
at this point. If there is
extinction patient
receives a 1, and the
results are used to
answer question 11.
Facial Palsy 4. Facial Palsy: Ask, or 0 = Normal Correct
use pantomime to symmetrical movement
encourage the patient
to show teeth or raise
eyebrows and close
eyes. Score symmetry
of grimace in response
to noxious stimuli in the
poorly responsive or
noncomprehending
patient. If facial
trauma/bandages,
orotracheal tube, tape
or other physical
barriers obscure the
face, these should be
removed to the extent
possible.
Motor Arms 5a. Motor Arm Left: The
0 = No drift, limb holds 90 (or Incorrect
limb is placed in the
45) degrees for full 10
appropriate position:
seconds
extend the arms (palms
down) 90 degrees (if
sitting) or 45 degrees
(if supine). Drift is
scored if
, the arm falls before 10
seconds. 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)
Motor Arms 5b. Motor Arm Right:
0 = No drift, limb holds 90 (or Correct
Limb is placed in the
45) degrees for full 10
appropriate position:
seconds
extend the arms (palms
down) 90 degrees (if
sitting) or 45 degrees
(if supine). Drift is
scored if the arm falls
before 10 seconds. 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
nonparetic arm. Only in
the case of amputation
or joint fusion at the
shoulder, the examiner
should record the score
as untestable (UN)
Motor Legs 6a. Left Leg: The limb
is placed in the Correct
appropriate position: 1 = Drift, leg falls by the end of
hold the leg at 30 the 5 second period, but does
degrees (always tested not hit bed
supine). Drift is scored
if the leg falls before 5
seconds. 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 leg. Only in the
case of amputation or
joint fusion at the hip,
the examiner should
record
