[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-572224-105":53,"doc-detail-572224-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","nihss-scoring-tips-tips-and-tricks","NIHSS Scoring Tips - Tips and Tricks","","NIHSS scoring tips for assessing neurologic function, with practical guidance for different patient presentations. The content covers how to evaluate level of consciousness through voice, touch, and stimulus response, how to handle LOC questions and commands without providing cues, and how to score attention-related behaviors. It also provides instructions for assessing best gaze, visual fields, facial palsy, limb weakness and ataxia, sensory testing, language, dysarthria, and extinction, including special considerations for comatose, aphasic, and intubated patients.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/nihss-scoring-tips-tips-and-tricks/572224/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/nihss-scoring-tips-tips-and-tricks/572224.png","ImageObject",442,249,{"name":88,"@type":89},"eBook King","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-10-13",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"How should level of consciousness (LOC) be assessed and scored in the NIHSS?","Question",{"text":109,"@type":110},"Use voice then touch to wake a sleeping patient and apply noxious stimulation when needed. Score a 3 only if no movement occurs (except reflexive posturing) in response to noxious stimulation. For LOC questions, avoid giving partial credit and do not help with verbal or non-verbal cues.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What guidance is given for scoring best gaze and responding to closed eyes or poor attention?",{"text":114,"@type":110},"Ensure the eyes/face are midline and looking at you, and do not allow head movement. If eyes are closed, gently hold lids open. In poor attention or aphasia, establish eye contact, move around the patient, and judge horizontal gaze by whether both eyes follow side-to-side or only one eye follows.",{"name":116,"@type":107,"acceptedAnswer":117},"How should visual fields and extinction be tested and scored, including special cases like blindness or ocular trauma?",{"text":118,"@type":110},"For visual fields, cover the non-examined eye and use finger counting or finger wiggling for aphasic patients. Score 0 if the patient can look or point to correct (moving) fingers. For extinction, have the patient point to the side being touched and score 0 if they attend to both sides; when ocular trauma, bandages, or pre-existing blindness are present, use reflexive movements and investigator choice.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},572224,1792091641,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":101,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","NIHSS Scoring Tips  \n1a. Level of consciousness  \n􀁸 Not UNtestable  \n􀁸 Use voice then touch to wake sleeping patient. May require vigorous stimulation.  \n􀁸 A 3 is scored only if the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.  \n1b. LOC questions  \n􀁸 The answer must be correct. There is no partial credit for being close. The examiner should not\"help\" the patient with verbal or non-verbal cues.  \n􀁸 If their first answer is wrong and the next reply is correct, score the first answer.  \n􀁸 Patients will often give their date of birth in answer to the question of their age; this is wrong and needs to be scored as such.  \n􀁸 If the patient is non-English speaking, get a translator.  \n􀁸 If the patient can’t speak, but is awake, ask him/her to write out the answers or point to a calendar.  \n􀁸 Patients unable to speak because of endotrachealintubation, orotracheal trauma, severe dysarthria from any cause, language barrier, or any other problem not secondary to aphasia are given a 1.  \n􀁸 Aphasic and stuporous patients who do not comprehend the questions will score 2.  \n1c. LOC commands  \n􀁸 The patient does not need to make a fist on both sides. Let the patient select which side to make a fist.  \n􀁸 Substitute another one step command if the hands cannot be used.  \n􀁸 Credit is given if an unequivocal attempt is made but not completed due to weakness.  \n􀁸 If the patient does not respond to command, the task should be demonstrated to him or her (pantomime), and the result scored.  \n􀁸 Only the first attempt is scored.  \nAdapted from: NIHSS Helpful Hints by Tina Dennis, MSN, RN Revised: 11/2017 by Cindy Taylor, MT, BSN, RN, CCRN & Tonya Disorbo, BSN, RN, CNRN, SCRN  \n2. Best Gaze  \n􀁸 Make sure the patient’s eyes/face are midline and looking at you.  \n􀁸 Do not allow the patient to move his/her head.  \n􀁸 If patients have their eyes closed, hold their lids open.  \n􀁸 You are not testing nystagmus or vertical gaze.  \n􀁸 Gaze is testable in all aphasic patients.  \n􀁸 In patients with poor attention or who are aphasic, establish eye contact, walk around them, while trying to keep eye contact, to see if they follow you. If they follow you side to side with both eyes, their horizontal gaze is intact. Only follow with one eye = 1, gaze fixed with both eyes = 2. Trick – use a dollar bill,“snap it” and see if they will follow that side to side!  \n􀀅-Cut out this square & use as a quick reference card.  \nNIHSS for the Aphasic Patient  \n1b: LOC Questions  \n• Can write responses  \n• Can be given yes/no options  \n• Score 2 for those who do not comprehend  \n2. Best Gaze  \n• Establish eye contact and move around bed for tracking  \n• Can check by oculo-cephalic maneuver  \n3. Visual  \n• Testing visual quadrants “Point to hand when fingers move”  \n• Score 0 if they are able to look or point at the correct (moving) fingers  \n4. Facial Palsy , 5 & 6 Limb Weakness, 7 Ataxia  \n• Can pantomime directions 7. Limb Ataxia  \n• Score 0 if cannot understand the task 8. Sensory  \n• Can have them nod yes/no, ask if it feels the same on both sides  \n• Often score =0 as it is difficult to demonstrate severe/total sensory loss  \n9. Language  \n• Can write responses 10. Dysarthria  \n• Can have them repeat listed words after you read them  \n• Score of 2 if no intelligible speech or is mute  \n11. Extinction  \n• Have patient point to side being touched (right, left, or both)  \n• Have pt. point to side that finger moves for visual (right, left, or both)  \n• Score = 0 if they attend to both sides  \n􀁸 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.  \n􀁸 You can also do the oculocephalic test in the comatose patient; this is never un-testable.  \n􀁸 Only horizontal eye movements will be tested. Voluntary or reflexive (oculocephalic) eye movements will be scored, but caloric testing is not done.  \n􀁸 If the ","cbCaioeP33ZSzcvy","https://ap.wps.com/l/cbCaioeP33ZSzcvy","pdf",556110,"English","# NIHSS Scoring Tips\n## Level of Consciousness (1a-1c)\n## Best Gaze (2)\n## Visual (3)\n## Facial Palsy (4)\n## Limb Weakness and Ataxia (5-7)\n## Sensory (8)\n## Language (9) and Dysarthria (10)\n## Extinction (11)\n## Special Patient States (Aphasic, Comatose, Intubated)","[{\"question\":\"How should level of consciousness (LOC) be assessed and scored in the NIHSS?\",\"answer\":\"Use voice then touch to wake a sleeping patient and apply noxious stimulation when needed. Score a 3 only if no movement occurs (except reflexive posturing) in response to noxious stimulation. For LOC questions, avoid giving partial credit and do not help with verbal or non-verbal cues.\"},{\"question\":\"What guidance is given for scoring best gaze and responding to closed eyes or poor attention?\",\"answer\":\"Ensure the eyes/face are midline and looking at you, and do not allow head movement. If eyes are closed, gently hold lids open. In poor attention or aphasia, establish eye contact, move around the patient, and judge horizontal gaze by whether both eyes follow side-to-side or only one eye follows.\"},{\"question\":\"How should visual fields and extinction be tested and scored, including special cases like blindness or ocular trauma?\",\"answer\":\"For visual fields, cover the non-examined eye and use finger counting or finger wiggling for aphasic patients. Score 0 if the patient can look or point to correct (moving) fingers. For extinction, have the patient point to the side being touched and score 0 if they attend to both sides; when ocular trauma, bandages, or pre-existing blindness are present, use reflexive movements and investigator choice.\"}]","NIHSS Scoring Tips - Tips and Tricks | PDF",1791926234]