Nih Stroke Scale Group C Answers
NIH Stroke Scale Group C Answers: A Detailed Guide to Scoring Language, Dysarthria, and Extinction/Inattention
The National Institutes of Health Stroke Scale (NIHSS) is a standardized tool used by clinicians to quantify the neurological deficit caused by acute stroke. That said, while the scale consists of 11 items grouped into three sections—A (level of consciousness), B (visual fields and motor function), and C (language, dysarthria, and extinction/inattention)—the Group C items are often the most challenging for newcomers because they require careful observation of speech and higher‑order cortical functions. This article provides a clear, step‑by‑step explanation of the NIH Stroke Scale Group C answers, including what each item assesses, how to score it correctly, common pitfalls, and practical tips for reliable use in clinical settings.
Understanding the NIH Stroke Scale Structure
Before diving into Group C, it helps to recall the overall layout of the NIHSS:
| Section | Items | Primary Focus |
|---|---|---|
| A | 1a, 1b, 1c | Level of consciousness (LOC) and responsiveness |
| B | 2‑6 | Visual fields, facial palsy, motor arm/leg strength, limb ataxia, sensory loss |
| C | 7‑11 | Language (aphasia), dysarthria, extinction and inattention (neglect) |
Group C therefore comprises items 7 through 11. So each item is scored on a 0‑ to 2‑ or 0‑ to 3‑point scale, where higher numbers indicate greater impairment. The total NIHSS score ranges from 0 (no deficit) to 42 (maximal deficit), with Group C contributing up to 11 points.
Item‑by‑Item Breakdown of Group C Answers
Item 7: Level of Consciousness – Commands (Already covered in Section A, but often reviewed)
Note: Some versions of the NIHSS list Item 7 as “Best Gaze” (already in Section B). For clarity, we follow the most common 11‑item version where Items 7‑11 are the language‑focused section.
Item 7: Best Gaze (if using the 11‑item version) – Not part of Group C in the classic NIHSS.
(If your institution uses the 15‑item extended NIHSS, treat this as a visual‑field item and skip to the language items below.)
Item 8: Visual Fields – Also part of Section B.
(Again, for the purpose of Group C we start at Item 9.)
Item 9: Best Language – Aphasia Assessment
What it assesses:
- Ability to comprehend spoken language
- Ability to produce spoken language (naming, repetition, fluency) - Presence of global aphasia, Broca’s aphasia, Wernicke’s aphasia, or mild dysphasia
How to test:
- Ask the patient to describe what is happening in the picture (the standard NIHSS picture shows a cookie‑theft scene).
- Ask the patient to name the items listed on the NIHSS card (e.g., “cup”, “watch”, “key”).
- Ask the patient to repeat a simple sentence (e.g., “You are cute”).
Scoring (0‑2‑3 scale):
| Score | Description | Typical Answer Pattern |
|---|---|---|
| 0 | No aphasia; normal fluency, comprehension, and repetition. | |
| 3 | Not used in the original NIHSS; some versions reserve 3 for “global aphasia with no response”. Also, | |
| 2 | Severe aphasia; patient is mute or produces only unintelligible sounds, or follows only one‑step commands. So | |
| 1 | Mild to moderate aphasia; some loss of fluency or comprehension, but patient can still convey ideas. | Patient may hesitate, use circumlocution, miss one or two names, or make minor repetition errors but overall message is understandable. Still, |
Common Pitfalls:
- Confusing dysarthria (slurred speech) with aphasia. If the patient’s words are slurred but understandable and they can name objects, score aphasia as 0 and note dysarthria separately.
- Over‑scoring when a patient is fatigued; give them a second chance if they appear to be trying but are simply tired.
- Ignoring bilingual patients; test in the language they are most comfortable with, using an interpreter if needed.
Item 10: Dysarthria
What it assesses:
- Motor speech production: clarity, articulation, and intelligibility of spoken words due to cranial nerve or motor pathway involvement.
How to test:
- Ask the patient to read or repeat a list of words (the NIHSS provides a standard phrase: “Mama, papa, baby”).
- Listen for slurring, imprecise consonants, abnormal rhythm, or nasal quality.
Scoring (0‑2 scale):
| Score | Description | Typical Answer Pattern |
|---|---|---|
| 0 | Normal articulation; speech is clear and intelligible. | Patient repeats the phrase crisply, each consonant distinct. |
| 1 | Mild to moderate dysarthria; speech is slurred but still understandable. | Listener can understand the sentence after a moment’s effort; some consonants are blurred. Worth adding: |
| 2 | Severe dysarthria; speech is unintelligible or patient cannot produce speech. | Listener cannot decipher any words; patient may only produce vowel sounds or be mute. |
Common Pitfalls:
- Mistaking aphasia for dysarthria. If the patient can name objects correctly but the words sound garbled, the deficit is motor (dysarthria), not linguistic.
- Overlooking mild dysarthria in patients with severe weakness; even a slight slur warrants a score of 1 if it affects intelligibility.
- Failing to consider environmental noise; ensure a quiet setting for accurate listening.
Item 11: Extinction and Inattention (Neglect)
What it assesses:
If you found this helpful, you might also enjoy words with the sound er or wie heißt du in english.
- Sensory inattention to one side of space (visual, tactile, or auditory) that is not explained by primary sensory loss.
- Often reflects parietal lobe damage and predicts functional outcome.
How to test:
- Visual extinction: Simultaneously present finger wiggling in each visual field; ask the patient to report where they see movement.
- Tactile extinction: Simultaneously touch both hands (or both cheeks) and ask the patient to report where they felt touch.
- Auditory extinction (optional): Present snapping sounds near each ear and
Item 11: Extinction and Inattention (Neglect) (Continued)
- Auditory extinction (optional): Present snapping sounds near each ear and ask the patient to report the location of the sound.
Scoring (0-2 scale):
| Score | Description | Typical Answer Pattern |
|---|---|---|
| 0 | No extinction; reports stimuli correctly in both single and double stimulation. | Patient correctly identifies unilateral stimuli and reports both when presented simultaneously. In real terms, |
| 1 | Mild extinction; misses contralateral stimulus only during double stimulation. | Patient reports ipsilateral stimulus correctly but misses contralateral stimulus during simultaneous testing. |
| 2 | Severe extinction; misses contralateral stimulus even with single stimulation. | Patient fails to perceive stimuli on one side regardless of presentation method. |
Common Pitfalls:
- Missing unilateral neglect in right hemisphere strokes; always test extinction even if weakness is absent.
- Misinterpreting extinction as primary sensory loss; confirm sensation is intact before scoring extinction.
- Overlooking tactile extinction in comatose patients; test only if patient can respond to unilateral stimuli.
Item 12: Limb Ataxia
What it assesses:
- Integrity of the cerebellum or its pathways, manifested by incoordination, dysmetria, or tremor during voluntary movement.
How to test:
- Finger-to-nose: Ask the patient to touch their nose and then your finger repeatedly.
- Heel-to-shin: Ask the patient to run their heel down the opposite shin.
- Observe for dysmetria (overshooting/undershooting), intention tremor, or decomposition of movement.
Scoring (0-2 scale):
| Score | Description | Typical Answer Pattern |
|---|---|---|
| 0 | No ataxia; movements are smooth and accurate. | |
| 2 | Severe ataxia; present in two limbs. | Patient performs tasks precisely without tremor or overshoot. |
| 1 | Mild ataxia; present in one limb. | Marked dysmetria/tremor in both limbs; movements are grossly incoordinated. |
Common Pitfalls:
- Confusing ataxia with weakness; test strength separately if motor weakness is present.
- Overlooking mild ataxia in the non-paretic limb; always assess both sides.
- Misattributing ataxia to sedation; ensure recent medication history is considered.
Item 13: Sensory
What it assesses:
- Primary somatosensory function (light touch and proprioception) in the face, arms, and legs.
How to test:
- Light touch: Use a cotton wisp to touch limbs and face bilaterally; ask the patient to report where they feel it.
- Proprioception: Move the patient’s large toe up/down (eyes closed); ask them to identify the direction.
Scoring (0-2 scale):
| Score | Description | Typical Answer Pattern |
|---|---|---|
| 0 | Normal sensation; reports touch/direction correctly. Even so, | Patient accurately identifies touch location and toe movement direction. Because of that, |
| 2 | Severe sensory loss; unable to perceive stimuli. | Patient may delay or misidentify stimuli but recognizes presence of sensation. |
| 1 | Mild sensory loss; partial impairment. | Patient reports no sensation in tested limb/face despite repeated testing. |
Common Pitfalls:
- Overlooking sensory neglect; test both sides simultaneously if extinction is suspected.
- Misinterpreting aphasia as sensory loss; ensure verbal responses are not language-limited.
- Ignoring bilateral sensory deficits; compare affected vs. unaffected side.
Latest Posts
Related Posts
More from This Corner
-
Which Statement Is Always True
Aug 08, 2026
-
Which Statement Is Always True According To Vsepr Theory
Aug 08, 2026
-
Which Statement Is Always True When Describing Sex Linked Inheritance
Aug 08, 2026
-
Which Statement Is An Accurate Description Of Genes
Aug 08, 2026
-
Which Statement Is An Example Of A Central Idea
Aug 08, 2026
