What is the National Institutes of Health (NIH) stroke scale score for a lamb that falls completely to the ground on item 5?

NIH Stroke Scale Score for Item 5 - Motor Arm Test

For a limb that falls completely to the bed on item 5 (Motor Arm) of the NIH Stroke Scale, the correct score is 4, indicating "no movement at all." 1

Understanding the NIH Stroke Scale Motor Arm Assessment

• The NIH Stroke Scale (NIHSS) is a standardized, validated instrument that assesses the severity of neurological impairment after stroke with scores ranging from 0 to 42, where higher scores indicate more severe strokes 1
• Item 5 of the NIHSS specifically evaluates motor function in the arms using the following scoring criteria:
  • 0 = No drift (arm holds 90 degrees for full 10 seconds)
  • 1 = Drift (arm holds 90 degrees but drifts down before full 10 seconds)
  • 2 = Some effort against gravity (arm cannot get to or maintain 90 degrees but has some effort against gravity)
  • 3 = No effort against gravity (arm falls)
  • 4 = No movement at all
  • X = Unable to assess due to amputation, fusion, fracture, etc. 1

Clinical Assessment Technique

• The proper technique for assessing motor arm function involves having the patient extend the arm palm down at 90 degrees (if sitting) or 45 degrees (if supine) and hold for 10 seconds 1
• When a limb falls completely to the bed without any resistance to gravity or any movement whatsoever, the appropriate score is 4 1
• This is distinguished from a score of 3, which would be given if the arm falls but shows some movement without being able to overcome gravity 1

Clinical Significance and Implications

• Motor deficits are among the most common manifestations of stroke and are important contributors to the overall NIHSS score 1
• Higher NIHSS scores correlate with poorer outcomes, with scores >20 indicating large strokes with poor prognosis 1
• Complete paralysis of a limb (score of 4) indicates severe motor pathway damage and contributes significantly to functional disability 1

Common Pitfalls in Assessment

• Do not confuse a score of 3 (no effort against gravity but some movement) with a score of 4 (no movement at all) 1
• Ensure that the patient understands the instructions; if they cannot follow commands due to aphasia, demonstrate the movement 2
• If the limb is amputed, has a joint fusion, or fracture, score as "X" rather than attempting to assess 1

Reliability Considerations

• The motor items of the NIHSS have shown good inter-rater reliability compared to some other scale items 3
• The modified NIHSS (mNIHSS) retains the motor arm assessment as it is a reliable and clinically significant component of stroke assessment 4, 5
• Studies have shown that motor function assessment can be reliably estimated from medical records with high validity 4

Remember that accurate scoring of the NIHSS is critical for determining stroke severity, guiding treatment decisions, and predicting outcomes in stroke patients 6.