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NIH Stroke Scale: Application and Effectiveness

NIH Stroke Scale is a tool that is primarily used internationally to assess the cognitive effects of stroke. It can scientifically be described as the quantitative measure of stroke-associated neurologic deficit. Before this scale, other scales were in use, but with the help of videos available on how to efficiently use the scale, it has led to it being adopted internationally. The tool was developed as clinical equipment to research stroke patients, but lately, it has been incorporated into the health care sector by specialists to determine stroke severity. The scale is vital as it creates a common language among all the practitioners responsible for treating stroke patients. In the treatment procedure, the scale has three main functions: predicting the patients’ outcomes, determining the appropriate treatment, and evaluating the severity of stroke.

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The scale comprises several elements that are vital in evaluating a specific ability. The scores for every ability are given a number between 0 and 4, with zero being a normal functioning and four as total impairment (Purrucker et al., 2017). The highest score possible is 42, and the scores are derived by adding the numbers of every score on the scale. When the score is high, so is the severity of the impairment the stroke patient. Although the scale has proven to be helpful over the past, it has developed complications in determining stroke index in the cortex area of the brain by giving a less accurate prediction. With a score higher than 16, there is a high possibility of death, and with a score of 6 or lower, the probability of recovery is high.

The NIH Score is essential to patients as it determines the course of treatment and action to be taken once a stroke has been identified. The scale is applied at the onset of stroke-like symptoms, which is basically in the emergency department. When patients’ conditions change significantly, the scale is then applied at regular intervals as described by the physician. Additionally, it is essential to keep the patient’s records in order, monitor the progress, make amendments to the treatment where necessary, and quantify the improvement or decline with time.

As mentioned above, the scale contains several elements containing a specific action used when reading the scale. According to Purrucker et al. (2017), these elements are grouped according to their importance, and the first one is the level of consciousness. This element evaluates responsiveness and alertness through asking simple questions and following simple commands. Best gaze analyses the ability to move one’s eyes normally. Visual element tests the ability to see things that are not directly in front of the patient. Facial palsy is the ability to move facial muscles with actions like raising the eyebrows. Motor arm and motor leg test the capability to hold arms up for a given time and rotate the legs at a certain angle. Limb ataxia examines any damage in the cerebellum, the motor center of the brain. Sensory scale determines the sensory abilities, while best language evaluates the amount of damage the stroke has caused on language abilities. Dysarthria examines the level of overlapping in one’s speech. Lastly, extinction and inattention evaluate the attention levels the patient gives to their surroundings.

Stroke location affects the stroke severity as people with the condition on the left hemisphere have high scores than those with it on the right hemisphere. The NIH Stroke scale is most preferred for predicting outcomes for patients with the disorder located on the left hemisphere. With this knowledge, both the physician and the patient are better suited to learning about this scale and can comfortably use it without fear of misleading results or technical complications.


Purrucker, J.C., Härtig, F., Richter, H., Engelbrecht, A., Hartmann, J., Auer, J., Hametner, C., Popp, E., Ringleb, P.A., Nagel, S. and Poli, S. (2017). Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: The shortened NIH Stroke Scale for emergency medical services. BMJ Open, 7(9), e016893. Web.

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