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NIH Stroke Scale (NIHSS)
This measurement tool is freely accessible at: NIH Stroke Scale  
 See here for NIH Stroke Scale Training and Certification: American Heart Association Lifelong Learning
NeuroRehab Stroke Core
Supplemental - Highly Recommended:  Stroke (based on study type, disease stage and disease type; recommended as Core for Ischemic Stroke only)
Supplemental: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
The NIHSS is a 11-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.
The NIHSS is a tool used to rapidly assess the effects of stroke. The NIHSS is currently being validated for pediatric stroke.
The examination requires less than 10 minutes to complete.
Comments/Special Instructions
Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the exam and work quickly. Except where indicated, the patient should not be coached (i.e., repeated requests to patient to make a special effort).
It is preferable for the individual item scores to be recorded in addition to the total score.
Scoring and Psychometric Properties
Ratings for each stroke scale item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for un-testable items. A trained observer rates the patient's ability to answer questions and perform activities.
Psychometric Properties:
The NIHSS was designed and validated for ischemic stroke. However, further research is needed to determine its advantages and its advantages over simpler scales to assess disability after hemorrhagic strokes. Reliability was found to be excellent overall and moderate to excellent for most individual scales. The survey can also reliably be used to assess patients through a remote television link, although it requires slightly more time to complete. The NIHSS has been modified from its initial configuration by the elimination of some aspects which showed poor reliability, and the expansion of other aspects.
Brott T, Harold P, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870.
Brott TG, Haley EC Jr., Levy DE, Barsan W, Broderick J, Sheppard GL, Spilker J, Dongable GL, Massey S, and Reed R. Urgent therapy for stroke, I: Pilot study of tissue plasminogen activator administered within 90 minutes. Stroke. 1992;23:632-640.
Goldstein L, Bertels C, Davis J. Interrater reliability of the NIH Stroke Scale. Arch. Neurol. 1989;46:660-662.
Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, Saposnik G, Winstein C, van Wegen EE, Wolf SL, Krakauer JW, Bernhardt J. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2017;12(5):451-461.
Document last updated January 2022