1. Keystone Heart Reflect Neurology
Dr. Daryl Gress

2. NIHSS (National Institute of Health Stroke Scale)
The NIHSS is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke.
The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4.
For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.
The individual scores from each item are summed in order to calculate a patient's total NIHSS score.
The maximum possible score is 42, with the minimum score being a 0.
SCORE
1-4
5-15
16-20
21-42
STROKE SEVERITY
No stroke symptoms
Minor stroke
Moderate stroke
Moderate to severe stroke
Severe stroke

3. NIHSS-Assessment 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).

7. SUMMARY AND KEY POINTS:
NIHSS is a standard outcome measure in clinical stroke trials
Validated across various trial designs, including multicenter and international
Careful neurologic examination adds to study credibility
Any increase in score from baseline triggers an AE, and consideration by the adjudication committee
Examiner training is available online, multiple sites
Documentation of current certification needed for all study examiners
If certified in the last two years, no need to repeat for this trial
SUMMARY
AND
KEY POINTS:

8. MRS (modified Ranking Scale)t
The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke  or other causes of neurological disability.
It has become the most widely used  clinical outcome measure for stroke  clinical trials.

10. MRS – Summary and Key Points
The MRS is a standard function outcome measure in clinical stroke trials
The exam is scored based on current overall function, not just what is attributed to stroke deficits
Any increase in score from baseline triggers an AE, and consideration by the adjudication committee
Examiner training is important to assure reliability of the measure
Documentation of current certification needed
If certified within last two years, no need for repeat training.