When assessed by NIHSS scale it is necessary to strictly follow the sections of the scale, registering points in each of the subsections in turn. You can not go back and change the previously set ratings. Follow the instructions for each of the subsections. The score should reflect what the patient is actually doing, not what the investigator thinks the patient can do. Record the answers and assessments of the test subject during the study, work quickly. Unless indicated in the instructions for the appropriate subsection, the patient should not be coached and/or made to perform better on the command.

wakefulness level

If a full examination is not possible (for example, due to an endotracheal tube, a language barrier, or damage to the orotracheal area), the overall level of responses and reactions is assessed.
Grade 3 is given only in cases where the patient is in a coma and does not respond to painful stimuli or his reactions are reflex in nature (extension of the limbs).

Clear mind, responsive

Stunning and/or somnolence; responses and instructions can be achieved with minimal stimulation.

Deep stupor or stupor, reacts only to strong and painful stimuli, but the movements are not stereotyped.

Atony, areflexia and unresponsiveness or responses to stimuli consist of reflex non-purposeful movements and/or autonomic reactions.

Level of wakefulness: answers to questions

The patient is asked to name the current month and their age. Answers must be exact, you can not count the answer, which is close to the correct one. If the patient does not perceive the question (aphasia, a significant decrease in the level of wakefulness), a score of 2 is given. If the patient cannot speak due to mechanical obstructions (endotracheal tube, damage to maxillofacial region), severe dysarthria, or other problems not related to aphasia, a score of 1 is given. It is important that only the first response is scored and that the investigator does not assist the patient in any way.

Correct answers to both questions.

Correct answer to one question.

Didn't answer both questions.

Wakefulness level: executing commands

The patient is asked to open and then close the eyes, clench and unclench the fist of the non-paralyzed hand. If there are obstacles (for example, it is impossible to use the hand), replace this command with another command that provides a one-step action. If an explicit attempt is made, but the action is not completed due to weakness, the result is read. If the patient does not respond to the utterance of the command, he should demonstrate what is required of him, and then evaluate the result (repeated both, one or none). Only the first attempt is scored.

Run both commands.

Run one command.

Didn't follow any of the commands.

Eyeball movements

Norm.

Partial paresis of the gaze; impaired movement of one or both eyes, but no tonic deviation eyeballs and complete paralysis of the eye.

Tonic deviation of the eyeballs or complete paralysis of the gaze, which persists when checking oculocephalic reflexes.

Fields of view

Visual fields (upper and lower quadrants) are examined by confrontation, by counting the number of fingers or frightening sudden movements from the periphery to the center of the eye. It is possible to give appropriate prompts to patients, but if they look in the direction of moving fingers, this can be regarded as the norm. If one eye does not see or is missing, the second is examined. A score of 1 is given only if there is a clear asymmetry (including quadrantanopsia). If the patient is blind (for any reason), a 3 is given. Simultaneous stimulation on both sides is also examined here, and if there is hemiignorance, a 1 is put and the result is used in the "Hemiignorance (neglect)" section.

Fields of vision are not broken.

Partial hemianopia.

Complete hemianopia.

Blindness (including cortical).

Dysfunction of the facial nerve

Normal symmetrical movements of facial muscles.

Slight paresis of mimic muscles (smoothed nasolabial fold, asymmetrical smile).

Moderate prosoparesis (complete or pronounced paresis of the lower group of facial muscles).

Paralysis of one or both halves of the face (lack of movement in the upper and lower parts of the face).

Strength of the muscles of the left arm

There are no movements in the hand.

impossible to explore.

Right hand muscle strength

The extended arm is set at an angle of 90° (if the patient is sitting) or 45° (if the patient is lying) to the body with palms down and the patient is asked to hold it in this position for 10 s. First evaluate the non-paralyzed hand, then the other. With aphasia, you can help to take the starting position and use pantomime, but not painful stimuli. If it is impossible to examine the strength (the limb is missing, ankylosis in the shoulder joint, fracture), an appropriate mark is made.

The arm does not go down for 10 s.

The hand begins to descend before the 10 s elapses, but does not touch the bed or other surface.

The hand is held for some time, but within 10 seconds it touches a horizontal surface.

The hand immediately falls, but there are movements in it.

There are no movements in the hand.

impossible to explore.

Strength of the muscles of the left leg

There is no movement in the leg.

impossible to explore.

Strength of the muscles of the right leg

Always examined in the supine position. The patient is asked to raise the leg at an angle of 30° to the horizontal surface and hold in this position for 5 seconds. With aphasia, you can help to take the starting position and use pantomime, but not painful stimuli. The non-paralyzed leg is evaluated first, then the other. If it is impossible to examine the strength (the limb is missing, ankylosis in the shoulder joint, fracture), an appropriate mark is made.

The leg is not lowered for 5 s.

The leg begins to descend before 5 s elapses, but does not touch the bed.

The leg is held for some time, but within 5 seconds it touches the bed.

The leg immediately falls, but there are movements in it.

There is no movement in the leg.

impossible to explore.

Ataxia in the limbs

This section provides for the identification of signs of damage to the cerebellum on the one hand. The study is carried out with open eyes. If there is a limitation of the visual fields, the study is carried out in the area where there are no violations. Finger-nose-finger and knee-heel tests are performed on both sides. Points are awarded only when the severity of ataxia exceeds the severity of paresis. If the patient is not available for contact or is paralyzed, there is no ataxia. If the patient cannot see, a finger-nose test is performed. If it is impossible to examine the strength (the limb is missing, ankylosis in the shoulder joint, fracture), an appropriate mark is made.

There is no ataxia.

Ataxia in one limb.

Ataxia in two limbs.

impossible to explore.

Sensitivity

It is examined with the help of pricks with a pin (toothpick) and touches. In case of impaired consciousness or aphasia, grimaces, withdrawal of a limb are evaluated. Only hypoesthesia caused by a stroke (by hemitype) is evaluated, therefore, for verification, it is necessary to compare the reaction to injections in different parts of the body (forearms and shoulders, hips, torso, face). A score of 2 is given only in cases where a gross decrease in sensation in one half of the body is not in doubt, so patients with aphasia or impaired consciousness at the level of stupor will receive a 0 or 1. With bilateral hemihypesthesia caused by a stem stroke, a 2 is given. Patients in a coma automatically get 2.

Norm.

Mild or moderate hemihypesthesia; on the affected side, the patient feels the injections as less sharp or as touches.

Severe hemihypesthesia or hemianesthesia; the patient does not feel any injections or touches.

Speech

Information regarding the understanding of addressed speech has already been obtained in the course of the study of the previous sections. To study speech production, the patient is asked to describe the events in the picture, name objects and read a passage of text (see Appendix). If vision problems interfere with the study of speech, ask the patient to name the objects placed in his hand, repeat the phrase and tell about some event from his life. If an endotracheal tube is placed, the patient should be asked to complete the tasks in writing. Patients in a coma automatically receive 3. In case of impaired consciousness, the assessment is determined by the researcher, but 3 is set only for mutism and complete disregard for simple commands.

Norm.

mild or moderate aphasia; speech is distorted or comprehension is disturbed, but the patient can express his thought and understand the researcher.

severe aphasia; only fragmentary communication is possible, understanding the patient's speech is very difficult, according to the patient, the researcher cannot understand what is shown in the pictures.

Mutism, total aphasia; the patient does not utter any sounds and does not understand the addressed speech at all.

dysarthria

You do not need to tell the patient what exactly you are going to evaluate. With normal articulation, the patient speaks clearly, he does not have difficulty pronouncing complex combinations of sounds, tongue twisters. In severe aphasia, the pronunciation of individual sounds and fragments of words is evaluated, with mutism, 2 is put. If it is impossible to examine the force (intubation, facial trauma), an appropriate mark is made.

Norm.

mild or moderate dysarthria; some sounds are "blurred", the understanding of words causes some difficulties.

Rough dysarthria; the words are so distorted that they are very difficult to understand (the reason is not aphasia), or anartria / mutism is noted.

research impossible

Hemiignorance (neglekt)

Sensory hemiignorance is understood as a violation of perception on one half of the body (usually the left) when stimuli are applied simultaneously on both sides in the absence of hemihypesthesia. Visual hemiignorance is understood as a violation of the perception of objects in the left half of the visual field in the absence of left-sided hemianopia. As a rule, the data from the previous sections is sufficient. If it is not possible to examine visual hemiignorance due to visual impairment, and the perception of pain stimuli is not impaired, the score is 0. Anosognosia indicates hemiignorance. The assessment in this section is given only in the presence of hemishoring, so the conclusion "it is impossible to investigate" does not apply to it.

Norm.

Signs of hemiignorance of one type of stimuli (visual, sensory, auditory) were revealed.

Signs of hemiignorance of more than one type of stimuli were revealed; does not recognize his hand or perceives only half of the space.

In contact with

(NIHSS, NATIONAL INSTITUTES OF HEALTH STROKE SCALE BROTT T., ADAMS H.P., 1989)

It is performed to determine the level of neurological deficit after a stroke. A high score corresponds to a more severe stroke, even if it is not detectable on early neuroimaging. This scale is used in most clinical research, it is also necessary to assess the condition of patients after thrombolysis or anticoagulant therapy. This scale should be assessed for all stroke patients. Follow-up evaluation will help assess the change in the patient's condition.

Level of consciousness	Grade
Conscious, clearly answers questions
Drowsy, but reacts even to the smallest stimulus - a command, question
Reaction only in the form of motor or autonomic reflexes or complete areflexia
Level of consciousness: answers to questions. The patient is asked to name the month of the year and their age.
	0
	1
	2
Level of consciousness: execution of commands. the patient is asked to close their eyes and clench their fist
Correct answers to both questions or the presence of a language barrier	0
Correct answer to one question	1
Wrong answers to both questions or cannot answer	2
Eyeball movements
Full range of motion	0
Partial gaze paralysis or isolated paralysis	1
Fixed deviation of the eyeballs or complete paralysis of the gaze, irresistible with the help of the “doll eyes” technique.	2
Visual fields: explored in each field with the help of finger movements that the researcher performs simultaneously on both sides.
Normal or old blindness	0
Asymmetry or partial hemianopsia	1
Complete hemianopia	2
Bilateral hemianopsia or coma	3
Paralysis of the facial muscles
No or sedation	0
Minimal (only smoothness of the nasolabial fold)	1
Partial (lower half of the face)	2
Complete (full half of the face involved) or coma	3
D movements in the left hand: the patient holds the outstretched arm at an angle of 90 °
	0
	1
	2
	3
No movement	4
D movements in the right hand: the patient holds the outstretched arm at an angle of 90 °
Patient holds arm at 90° for 10 seconds, swelling or amputation	0
The patient first holds the arm in a predetermined position, the arm begins to lower before the expiration of 10 seconds	1
The patient does not hold the hand in a given position for 10 seconds, but still holds it somewhat against gravity	2
The arm falls immediately, the patient cannot overcome gravity	3
No movement	4
Movement in the left leg: the patient lifts the leg 30° for 5 seconds
	0
	1
	2
	3
No movement	4
Movement in the right leg: the patient lifts the leg 30° for 5 seconds
Patient holds leg in position for 5 seconds, swelling or amputation	0
Leg descends to intermediate position by the end of 5 seconds	1
The leg falls within 5 seconds, but the patient still holds it somewhat against gravity.	2
Leg falls immediately, patient cannot overcome gravity	3
No movement	4
TOTAL:
Speech: rated when naming standard pictures score
Normal	0
Light or medium degree severity of error in naming, word choice, or paraphasia	1
Severe: Broca's complete aphasia (motor) or Wernicke's (sensory)	2
Mutism, or total aphasia, or coma	3
dysarthria
	0
Mild to moderate slurring of speech, the patient can be understood	1
Severe dysarthria (slurred, unintelligible speech)	2
BUT taxia in the extremities: finger-nose and heel-to-knee tests
No (no movement in limbs), cannot be assessed	0
Ataxia present in one limb	1
Ataxia in two limbs	2
Sensitivity: Tested with a pin. if the level of consciousness is reduced, it is evaluated only if there is a grimace or asymmetric withdrawal
Normal, sedation or amputation	0
Light and moderate. The patient feels the prick less acutely, but is aware of the touch.	1
Significant or complete loss of sensation, not aware of touch	2
Syndrome of "denial" (ignoring)
No or sedation	0
Visual, tactile or auditory ignoring half of the space	1
Deep disregard for half of the space in two or more modalities	2
TOTAL:

"SCALES FOR ASSESSING THE SEVERITY OF ISCHEMIC STROKE IN THE ACUTE PERIOD NIHSS scale The severity of neurological symptoms in the acute period of ischemic stroke..."

SCALE IN GENERAL

NEUROLOGY

SCALES FOR ASSESSING THE DEGREE OF SEVERITY

ISCHEMIC STROKE IN THE ACUTE PERIOD

NIHSS scale

The severity of neurological symptoms in the acute period

ischemic stroke, it is advisable to evaluate in dynamics using specially designed scales. Widespread

of Health Stroke Scale). The NIHSS score is also important for planning thrombolytic therapy (TLT) and monitoring its effectiveness. The indication for thrombolytic therapy is the presence of a neurological deficit (from 3 points on the NIHSS scale), suggesting the development of disability. Severe neurological deficit (more than 25 points on this scale) is a relative contraindication to thrombolysis and does not significantly affect the outcome of the disease.

National Institutes of Health Stroke Severity Scale (NIHSS)

1. Level of consciousness (assessed in points):

0 - conscious, actively reacting;

1 - doubt, but can be awakened with minimal irritation, executes commands, answers questions;

2 - sopor - repeated stimulation is required to maintain activity, or inhibited - strong and painful stimulation is required to produce non-stereotypical movements;

3 - coma, reacts only with reflex actions or does not respond to stimuli.

2. Level of consciousness - answers to questions.

Ask the patient what month it is and his age. Write down the first answer. If aphasia or stupor - score 2.

If endotracheal tube, severe dysarthria, language barrier - 1.

0 - the correct answer to both questions;

1 - the correct answer to one question;

2 - no correct answers given.

3. Level of consciousness - execution of commands.

The patient is asked to open and close his eyes, to squeeze and unclench his non-paralyzed hand. Only the first attempt counts.

0 - both commands are executed correctly;

1 - one command is executed correctly;

2 - none of the commands were executed correctly.

4. Movement of the eyeballs.

Only horizontal eye movements are taken into account.

1 - partial gaze paralysis;

2 - tonic abduction of the eyes or complete gaze paralysis, not overcome by the induction of oculocephalic reflexes.

5. Examination of visual fields:

1 - partial hemianopsia;

2 - complete hemianopsia.

6. Paresis of the facial muscles:

1 - minimal paralysis (asymmetry);

2 - partial paralysis - complete or almost complete paralysis of the lower muscle group;

3 - complete paralysis (lack of movement in the upper and lower muscle groups).

7. Movements in the upper limbs.

The arms are raised at a 45° angle in the supine position, at an angle of 90° in the sitting position. If the patient does not understand the task, the doctor must place his hands in the required position himself. Scores are recorded separately for the right and left limbs.

0 - limbs are held for 10 s;

1 - limbs are held for less than 10 s;

13 2 - limbs do not rise or do not maintain a given position, but produce some resistance to gravity;

4 - no active movements;

8. Movements in the lower extremities.

In the prone position, raise the paretic limb for 5 seconds at an angle of 30°. Scores are recorded separately for the right and left limbs.

0 - limbs are held for 5 s;

1 - limbs are held for less than 5 s;

2 - limbs do not rise or do not maintain an elevated position, but produce some resistance to gravity;

3 - limbs fall without resistance to gravity;

4 - no active movements;

5 - impossible to check (limb amputated, artificial joint).

9. Ataxia of the limbs.

Finger-nose and heel-to-knee tests are performed on both sides, ataxia is counted if it is not caused by paresis.

0 - absent;

1 - in one limb;

2 - in two limbs.

10. Sensitivity.

Only hemitetype disorder is taken into account.

1 - mild or moderate violations;

2 - significant or complete violation of sensitivity.

11. Aphasia.

The patient is asked to describe the picture, name the object, read the sentence.

0 - no aphasia;

1 - mild aphasia;

2 - severe aphasia;

3 - complete aphasia.

12. Dysarthria:

0 - normal articulation;

15 1 - mild or moderate dysarthria. Does not pronounce some words;

2 - severe dysarthria;

3 - intubated or other physical barrier.

13. Agnosia (ignorance):

0 - no agnosia;

1 - ignoring to bilateral sequential stimulation of one sensory modality;

2 - severe hemiagnosia or hemiagnosia in more than one modality.

The data obtained correspond to the following severity of neurological deficit:

0 - satisfactory condition;

3–8 - mild neurological disorders;

9–12 - moderate neurological disorders;

13–15 - severe neurological disorders;

16–34 - neurological disorders of extreme severity;

The use of the NIHSS scale will allow an objective approach to the condition of a patient with a stroke and assess the neurological status during the patient's stay in the hospital. The total score determines the severity and prognosis of the disease. With a score of less than 10 points, the probability of a favorable outcome after 1 year is 60-70%, and with a score of more than 20 points - 4-16%. This assessment is also important for planning thrombolytic therapy and monitoring its effectiveness. Thus, an indication for thrombolytic therapy is the presence of a neurological deficit (no more than 3–5 points). Severe neurological deficit (more than 25 points on this scale) is a contraindication to thrombolysis, since this manipulation may not have a significant effect on the outcome of the disease.

Systemic thrombolytic therapy is currently used in many cities of Ukraine. The NIHSS scale introduced into practical neurology has shown its effectiveness.

On the first day in patients after thrombolytic therapy, changes in the dynamics of the neurological status are assessed according to the NIHSS scale.

Clinical example. Patient K., aged 50, was admitted to the neurological department of the thrombolytic therapy center of GB No.

Mariupol with complaints of weakness and numbness of the left limbs.

When examining the neurological status - left-sided prosoparesis, pronounced left-sided hemiparesis, left-sided hemihypesthesia (according to the NIHSS scale - 10 points). CT, ECG, duplex scanning of the main vessels, express blood and urine tests were performed.

Thrombolytic therapy started:

Bolus administration - the patient retains moderate left-sided prosoparesis, left-sided hemiparesis: expressed in the arm, moderately expressed in the leg; left-sided hemihypesthesia (NIHSS - 6 points);

At the end of TLT, the patient retains mild left-sided prosoparesis, left-sided moderate hemiparesis, left-sided hemihypesthesia (NIHSS - 4 points);

After 24 hours, the patient retains mild left-sided prosoparesis and mild paresis of the left hand (NIHSS - 2 points).

Scandinavian Stroke Scale For a combined assessment of the severity of patients in the acute period of ischemic stroke and the effectiveness of the treatment, the European Stroke Initiative also recommends using the Scandinavian Stroke Scale, according to which a significant improvement is noted if regression of neurological symptoms is observed on this scale (scores of 10 or more) and at the same time, there is a positive dynamics of laboratory and functional research methods. A moderate improvement can be judged if the regression of the neurological deficit is less than 10 points. At the same time, it is possible to improve some indicators of paraclinical research methods. A slight improvement - with minimal regression of neurological symptoms (1-2 points) and the absence of positive dynamics of laboratory and functional research methods.

19 Table 1. Scandinavian Stroke Study Group (SSS; Scandinavian Stroke Study Group, 1985)

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It is used to assess the neurological status, localization of a stroke (in the carotid or vertebrobasilar basin), differential diagnosis and treatment results. It is based on a number of parameters that reflect the levels of impairment of the main disorders due to acute cerebrovascular disease. The NIHSS score is essential for planning thrombolytic therapy and monitoring its effectiveness. Thus, an indication for thrombolytic therapy is the presence of a neurological deficit (more than 3 points on the NIHSS scale), suggesting the development of disability. Severe neurological deficit (more than 25 points on this scale) is a relative contraindication to thrombolysis and does not significantly affect the outcome of the disease. Also, the results of the assessment of the state on the NIHSS scale make it possible to roughly determine the prognosis of the disease. So, with a score of less than 10 points, the probability of a favorable outcome after 1 year is 60 - 70%, and with a score of more than 20 points, 4 - 16%.

Patient Evaluation Criteria	Number of points on the NIHSS scale
The study of the level of consciousness - the level of wakefulness (if the study is not possible due to intubation, language barrier - the level of reactions is assessed)	0 - conscious, actively responding. 1 - doubt, but can be awakened with minimal irritation, executes commands, answers questions. 2 - stupor, repeated stimulation is required to maintain activity or is inhibited and strong and painful stimulation is required to produce non-stereotypical movements. 3 - coma, reacts only with reflex actions or does not respond to stimuli.
Wakefulness test - answers to questions The patient is asked to answer the questions: "What month is it now?", "How old are you?" (if the study is not possible due to intubation, etc. - put 1 point)	0 - Correct answers to both questions. 1 - The correct answer to one question. 2 - Didn't answer both questions.
Examination of the level of wakefulness - execution of commands The patient is asked to perform two actions - close and open the eyelids, squeeze a non-paralyzed hand, or move the foot	0 - both commands are executed correctly. 1 - one command executed correctly. 2 - none of the commands were executed correctly.
Eyeball movements The patient is asked to follow the horizontal movement of the neurological malleus.	0 is the norm. 1 - partial paralysis of the gaze. 2 - tonic abduction of the eyes or complete gaze paralysis, not overcome by the induction of oculocephalic reflexes.
Study of visual fields We ask the patient to say how many fingers he sees, while the patient must follow the movement of the fingers	0 is the norm. 1 - partial hemianopsia. 2 - complete hemianopsia.
Determination of the functional state of the facial nerve we ask the patient to show his teeth, make movements with his eyebrows, close his eyes	0 is the norm. 1 - minimal paralysis (asymmetry). 2 - partial paralysis - complete or almost complete paralysis of the lower muscle group. 3 - complete paralysis (lack of movement in the upper and lower muscle groups).
Assessment of the motor function of the upper limbs The patient is asked to raise and lower their arms 45 degrees in the supine position or 90 degrees in the sitting position. If the patient does not understand the commands, the doctor independently places his hand in the desired position. This test measures muscle strength. Points are fixed for each hand separately	0 - limbs are held for 10 seconds. 1 - limbs are held for less than 10 seconds. 2 - limbs do not rise or do not maintain a given position, but produce some resistance to gravity. 4 - no active movements. 5 - impossible to check (limb amputated, artificial joint)
Assessment of motor function of the lower extremities Raise the parathecal leg in the prone position by 30 degrees for a duration of 5 seconds. Points are fixed for each leg separately	0 - legs are held for 5 seconds. 1 - limbs are held for less than 5 seconds. 2 - Limbs do not rise or do not maintain an elevated position, but offer some resistance to gravity. 3 - limbs fall without resistance to gravity. 4 - no active movements. 5 - impossible to check (limb amputated, artificial joint).
Assessment of motor coordination This test detects ataxia by evaluating cerebellar function. A finger-nose test and a heel-knee test are performed. Assessment of violation of coordination is made from two sides.	0 - No ataxia. 1 - Ataxia in one limbs. 2 - Ataxia in two limbs. UN - it is impossible to investigate (the reason is indicated)
Sensitivity test examining the patient with a needle, roller to test sensitivity	0 is the norm. 1 - mild or moderate sensory disturbances. 2 - significant or complete impairment of sensitivity
Identification of a speech disorder	0 - Norm. 1 - Mild or moderate dysarthria; some sounds are blurred, understanding of words causes difficulties. 2 - Severe dysarthria; the patient's speech is difficult, or mutism is determined. UN - it is impossible to investigate (specify the reason).
Identification of perceptual disturbances - hemiignoring or negligence	0 - Norm. 1 - Signs of hemiignorance of one type of stimulus (visual, sensory, auditory) are revealed. 2 - Signs of hemiignorance of more than one type of stimuli were revealed; does not recognize his hand or perceives only half of the space.

Sign Number of points

1. Eye opening:

2. Motor reaction 12 :

^ 3. Verbal response 13

The sum of points in three sections and its correspondence to the level of consciousness

^

Motor Deficits Rating Scale (Zacharia)

Range of motion	Number of points
Absence of all movements	0
Contraction of a part of the muscles without a motor effect in the corresponding joint	1
Muscle contraction with a motor effect in the joint without the possibility of elevating the limb	2
Muscle contraction with limb elevation without the possibility of overcoming the additional load applied by the examiner's hand	3
Active movement of the limb with the ability to overcome the additional load applied by the examiner's hand	4
Normal strength. The examiner cannot overcome the resistance of the examinee when extending the arm	5

^

Glasgow Immediate Outcome Scale

1 point	Death in the first 24 hours.
2 points	Death in more than 24 hours.
3 points	Persistent vegetative state: vital functions are stable; neuromuscular and communicative functions are deeply disturbed; the phases of sleep and wakefulness are preserved; the patient may be in the conditions of special care of the intensive care unit.
4 points	Neuromuscular failure: the mental status is within the normal range, however, a profound motor deficit (tetraplegia) and bulbar disorders force the patient to remain in a specialized intensive care unit.
5 points	Severe disability: A severe physical, cognitive and/or emotional disability that precludes self-care. The patient can sit, eat independently. Immobile and in need of nursing care.
6 points	Moderate lack of independence: mental status within the normal range. Some daily functions can be performed by itself. Communication problems. Can move with assistance or with special devices. Needs outpatient care.
7 points	Slight lack of independence: mental status within the normal range. The patient serves himself, can walk on his own or with outside support. Needs special employment.
8 points	Good recovery: the patient returns to the previous stereotype of life, although not everything is still working out. Complete autonomy, although residual neurological impairment may occur. Walks independently without assistance.
9 points	Complete recovery: complete recovery to the premorbid level without residual effects in the somatic and neurological status.

^

National Institutes of Health Stroke Scale

Developed by the American National Institutes of Health

(National Institutes of Health Stroke Scale - NIH Stroke Scale)

T. Brott et al, 1989, J. Biller et al, 1990.

Used to objectify the patient's condition with ischemic stroke at admission, in the dynamics of the process and outcome of stroke by 21 days of hospitalization.

The scale contains 15 points that characterize the main functions that are most often impaired due to cerebral stroke. Functions are evaluated in points. The scale is notable for its obvious simplicity, filling it out takes no more than 5-10 minutes, disciplines the doctor in terms of the need for a comprehensive study of the neurological status, and allows you to record the dynamics of the patient's condition in the acute period of the disease. The internal consistency and retest reliability of the scale has been confirmed by a number of studies (Goldstein J.C. et al 1989). The absence of changes in the neurological status is provided as 0 points, the death of the patient - 31 points.

sign	score	Description
Consciousness: the level of wakefulness	0	clear Stunning (inhibited, drowsy, but responds even to a slight stimulus - a command, a question) Stupor (requires repeated, strong, or painful stimulation in order to move or become temporarily available to contact) Coma (not available for speech contact, responds to stimuli only with reflex motor or autonomic reactions)
Consciousness: answers to questions. Ask the patient to name the month of the year and their age.	0	Correct answers to both questions Correct answer to one question Wrong answers to both questions
Consciousness: following instructions They ask the patient to open and close his eyes, clench his fingers into a fist and unclench them.	0	Executes both commands correctly Executes one command correctly Both commands execute incorrectly
Eyeball movements	0	Norm Partial gaze paralysis (but no fixed gaze deviation) Fixed deviation of the eyeballs
Fields of view (explored using finger movements that the researcher performs simultaneously on both sides)	0	No violations Partial hemianopsia Complete hemianopia Bilateral hemianopia
Paralysis of the facial muscles	0	Not Moderately pronounced Full
Movements in the hand on the side of the paresis The hand is asked to be held for 10 seconds in a 90 ° flexion position at the shoulder joint if the patient is sitting; and at 45° flexion if the patient is lying down	0	The hand doesn't go down No active movements
Movements in the opposite hand (stem stroke)	0	The hand doesn't go down The patient first holds his hand in a given position, then the hand begins to fall The hand begins to fall immediately, but the patient still somewhat holds it against gravity. The hand immediately falls, the patient cannot overcome gravity at all No active movements
Movements in the leg on the side of the paresis The patient lying on his back is asked to hold the leg raised (bent in hip joint) at an angle of 30°	0	No active movements
Movements in the opposite leg (stem stroke)	0	The leg does not go down for 5 seconds The patient first holds the leg in a given position, then the leg begins to lower The leg begins to fall immediately, but the patient still somewhat holds it against gravity. The leg immediately falls, the patient cannot overcome gravity at all No active movements
Ataxia in the limbs Finger-nose and heel-knee tests (ataxia is scored in the case when it is disproportionate to the degree of paresis; with complete paralysis it is coded with the letter “H”) 14	0	Not Available either at the top or at lower limb Present in both upper and lower extremities
Sensitivity Examined with a pin, only violations by hemitype are taken into account	0	Norm Slight decrease Significantly reduced
Syndrome of "denial"	0	Not Partial Full
dysarthria	0	Normal articulation Mild or moderate dysarthria Slurred speech
Aphasia Assessed by the patient's speech responses during his examination	0	Not Mild or moderate aphasia Severe aphasia Mutism

^

Classification of the severity of the condition in subarachnoid hemorrhage according to Hunt-Hess

(Henry J.M. Barnett, Stroke: Pathophysiology, Diagnosis and Management, 1986)

This scale is additionally used to assess the severity of the patient's condition with intracranial hemorrhage or cerebellar infarction (0-V degree); patients whose condition corresponds to grade 0-III have no contraindications on this scale for hospitalization in the neurosurgical department.

Degree	Characteristic
0	Unruptured aneurysm
I	Asymptomatic or minimal headache and mild neck stiffness
IA	Absence of meningeal or cerebral symptoms, but persistent neurological deficit
II	moderate or severe headache, stiff neck; no neurological deficit other than cranial nerve palsy
III	Stunning-stupor, confusion (disorientation in time and space) or mild local deficit
IV	Sopor, moderate or deep hemiparesis, possible early decerebrate rigidity, and autonomic disturbances
V	Deep coma, decerebrate rigidity and signs of agony

^

Barthel ADL index of daily life activity

(F.Mahoney, D.Barthel, 1965; C.Granger et al, 1979; D.Wade, 1992)

Instruction

1. 
   The index should reflect the real actions of the patient, and not the intended ones (not how the patient could perform certain functions).
2. 
   The main purpose of testing is to establish the degree of independence from any help, physical or verbal, no matter how insignificant this help is and no matter what the reasons are.
3. 
   The need for supervision means that the patient does not belong to the category of those who do not need help (the patient is not independent).
4. 
   The level of functioning should be determined in the best possible way for a particular situation among those possible: most often by questioning the patient, his friends/relatives or caregivers, but direct observation and common sense are also important. Direct testing is not required.
5. 
   Usually, the patient's functioning is assessed in the period preceding 24-48 hours, but sometimes a longer assessment period is justified.
6. 
   Medium categories mean that the patient performs more than 50% of the effort required to perform a particular function.
7. 
   The category "independent" allows the use of aids.

^ Defecation control

0 - incontinence (or needs to use an enema, which is put by the caregiver);

5 - random incidents (not more than once a week) or assistance is required when using an enema, suppositories;

10 - complete control of defecation, if necessary, can use an enema or suppositories, does not need help;

^ Urination control

0 - incontinence or a catheter is used, which the patient cannot manage independently;

5 - random incidents (maximum once per 24 hours);

10 - complete control of urination (including those cases of catheterization Bladder when the patient is self-managed with the catheter).

^ Personal hygiene (brushing teeth, handling dentures, combing, shaving, washing face)

0 - needs help with personal hygiene procedures;

5 - independent when washing the face, combing, brushing teeth, shaving (tools for this are provided)

^ Going to the toilet (moving around the toilet, undressing, cleaning skin dressing, leaving the toilet)

5 - needs some help, but some of the actions, incl. hygiene procedures, can perform independently;

10 - does not need help (when moving, taking off and putting on clothes, performing hygiene procedures);

^ Eating

0 - completely dependent on the help of others (feeding with assistance is necessary);

5 - partially needs help, for example, when cutting food, spreading butter on bread, etc., while eating independently;

10 - does not need help (able to eat any normal food, not only soft; independently uses all the necessary cutlery; food is prepared and served by others, but not cut);

^ Transfer (from bed to chair and back)

0 - movement is impossible, unable to sit (balance), two people are required to get out of bed;

5 - when getting out of bed, significant physical assistance is required (one strong / trained person or two ordinary persons), can sit up on his own in bed;

10 - when getting out of bed, little help is required (physical, one person), or supervision, verbal help is required;

15 - does not need help.

^ Mobility (movements within the home/room and outside the home; assistive devices may be used)

0 - unable to move;

5 - can move around with the help of a wheelchair, incl. go around corners and use doors;

10 - can walk with the help of one person (physical support or supervision and moral support);

15 - does not need help (but can use assistive devices, such as a cane).

Dressing

0 - completely dependent on the help of others;

5 - partially needs help (for example, when fastening buttons, buttons, etc.), but performs more than half of the actions independently, can put on some types of clothing completely independently, spending a reasonable amount of time on this;

10 - does not need help, incl. when fastening buttons, buttons, tying shoelaces, etc., can choose and wear any clothing.

^ Climbing stairs

0 - unable to climb stairs, even with support;

5 - needs supervision or physical support;

10 - does not need help (can use aids).

^ Taking a bath

0 - takes a bath (enters and leaves it, washes) without assistance and supervision or washes in the shower without requiring supervision and assistance;

5 - needs help.