NIH STROKE SCALE UPDATED SCRIPT 2026
PRACTICE SOLUTIONS GRADED A+
● 1B - Ask month and age. Answer: 0 - Both questions right
1 - One question right
1 - Dysarthric, intubated, trauma, or language barrier
2 - Aphasic
● 1C - "Blink eyes" and "Squeeze hands". Answer: 0 - Performs both
tasks
1 - Performs one task
2 - Performs neither task
● 2 - Test horizontal extraocular muscles. Answer: 0 - Normal
1 - Partial gaze palsy: can be overcome
1 - Partial gaze palsy: corrects with oculocephalic reflex
2 - Forced gaze palsy: can not be overcome
● 3 - Test visual fields. Answer: 0 - No visual loss
1 - Partial hemianopia
2 - Complete hemianopia
3 - Patient is bilaterally blind
, 3 - Bilateral hemianopia
● 4 - Test facial palsy (use grimace if obtunded). Answer: 0 - Normal
symmetry
1 - Minor paralysis (flat nasolabial fold, asymmetric smile)
2 - Partial paralysis (lower face)
3 - Unilateral complete paralysis (upper/lower face)
3 - Bilateral complete paralysis
● 5A - Test left arm motor drift. Answer: 0 - No drift for 10 seconds
1 - Drift, but doesn't hit bed
2 - Driift, hits bed
2 - Some effort against gravity
3 - No effort against gravity
4 - No movement
0 - Amputation/joint fusion
● 5B - Test right arm motor drift. Answer: 0 - No drift for 10 seconds
1 - Drift, but doesn't hit bed
2 - Driift, hits bed
2 - Some effort against gravity
3 - No effort against gravity
PRACTICE SOLUTIONS GRADED A+
● 1B - Ask month and age. Answer: 0 - Both questions right
1 - One question right
1 - Dysarthric, intubated, trauma, or language barrier
2 - Aphasic
● 1C - "Blink eyes" and "Squeeze hands". Answer: 0 - Performs both
tasks
1 - Performs one task
2 - Performs neither task
● 2 - Test horizontal extraocular muscles. Answer: 0 - Normal
1 - Partial gaze palsy: can be overcome
1 - Partial gaze palsy: corrects with oculocephalic reflex
2 - Forced gaze palsy: can not be overcome
● 3 - Test visual fields. Answer: 0 - No visual loss
1 - Partial hemianopia
2 - Complete hemianopia
3 - Patient is bilaterally blind
, 3 - Bilateral hemianopia
● 4 - Test facial palsy (use grimace if obtunded). Answer: 0 - Normal
symmetry
1 - Minor paralysis (flat nasolabial fold, asymmetric smile)
2 - Partial paralysis (lower face)
3 - Unilateral complete paralysis (upper/lower face)
3 - Bilateral complete paralysis
● 5A - Test left arm motor drift. Answer: 0 - No drift for 10 seconds
1 - Drift, but doesn't hit bed
2 - Driift, hits bed
2 - Some effort against gravity
3 - No effort against gravity
4 - No movement
0 - Amputation/joint fusion
● 5B - Test right arm motor drift. Answer: 0 - No drift for 10 seconds
1 - Drift, but doesn't hit bed
2 - Driift, hits bed
2 - Some effort against gravity
3 - No effort against gravity
