1A: Level of Consciousness (LOC) i Assess how alert the patient is. Choose the lowest level of consciousness that best describes their state. 0 - Alert; keenly responsive 1 - Arousable by minor stimulation 2 - Requires repeated stimulation to arouse 3 - Unresponsive or responds only with reflex/autonomic effect
1B: LOC Questions - Month and Age i Ask the patient the current month and their age. Score only the initial answer. Do not help. Dysarthric but otherwise correct answers count as correct. 0 - Answers both correctly 1 - Answers one correctly (or dysarthric/intubated) 2 - Answers neither (or aphasic/stuporous)
1C: LOC Commands - Blink Eyes & Squeeze Hands i Ask the patient to open and close their eyes, then to grip and release the non-paretic hand. Pantomime commands if language is a barrier. 0 - Performs both tasks correctly 1 - Performs one task correctly 2 - Performs neither task correctly
2: Best Gaze (Horizontal Eye Movements) i Test horizontal eye movements only. If patient cannot follow commands, test by oculocephalic (doll's eye) reflex. 0 - Normal 1 - Partial gaze palsy (can be overcome) 2 - Forced deviation or total gaze paresis (cannot be overcome)
3: Visual Fields i Test visual fields by confrontation using finger counting or visual threat in all four quadrants. Score symmetrical findings. 0 - No visual loss 1 - Partial hemianopia or quadrantanopia 2 - Complete hemianopia 3 - Bilateral hemianopia or blindness
4: Facial Palsy i Ask the patient to show teeth or raise eyebrows and close eyes. Score the symmetry of the grimace. Use grimace if the patient is obtunded. 0 - Normal symmetrical movements 1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling) 2 - Partial paralysis (lower face) 3 - Complete paralysis of one or both sides (upper and lower face)
5A: Motor Arm - Left i Extend the arm (palm down) 90 degrees if sitting, 45 degrees if supine. Count aloud and hold up fingers. Score the drift over 10 seconds. Use 0 for amputation or joint fusion. 0 - No drift; arm holds position for full 10 seconds 1 - Drift, but arm does not hit the bed 2 - Arm falls to the bed within 10 seconds; some effort against gravity 3 - No effort against gravity; arm falls immediately 4 - No movement
5B: Motor Arm - Right i Same as 5A but for the right arm. Extend the arm (palm down) 90 degrees if sitting, 45 degrees if supine. Score over 10 seconds. 0 - No drift; arm holds position for full 10 seconds 1 - Drift, but arm does not hit the bed 2 - Arm falls to the bed within 10 seconds; some effort against gravity 3 - No effort against gravity; arm falls immediately 4 - No movement
6A: Motor Leg - Left i Ask the supine patient to raise the left leg to 30 degrees and hold for 5 seconds. Count aloud and hold up fingers. Use 0 for amputation or joint fusion. 0 - No drift; leg holds position for full 5 seconds 1 - Drift, but leg does not hit the bed 2 - Leg falls to the bed within 5 seconds; some effort against gravity 3 - No effort against gravity; leg falls immediately 4 - No movement
6B: Motor Leg - Right i Same as 6A but for the right leg. Ask the supine patient to raise the right leg to 30 degrees and hold for 5 seconds. 0 - No drift; leg holds position for full 5 seconds 1 - Drift, but leg does not hit the bed 2 - Leg falls to the bed within 5 seconds; some effort against gravity 3 - No effort against gravity; leg falls immediately 4 - No movement
7: Limb Ataxia i Perform finger-nose-finger and heel-shin tests bilaterally. Score only if present out of proportion to weakness. Score 0 if paralyzed or if patient does not understand. 0 - Absent (or paralyzed, or unable to understand) 1 - Present in one limb 2 - Present in two limbs
8: Sensation (to Pinprick) i Test with pinprick on face, arm, trunk and leg. Score only loss attributed to stroke. Score 2 only for a clearly abnormal loss to pinprick or withdrawal from touch in coma. 0 - Normal; no sensory loss 1 - Mild to moderate loss (feels pinprick as less sharp or dull) 2 - Severe or total loss (cannot sense being touched)
9: Best Language (Aphasia) i Score language based on responses to all tests. For this item, score the best response. Ask the patient to name objects on a standard form, read sentences, and describe a picture. 0 - No aphasia; normal 1 - Mild to moderate aphasia; loses information but can communicate 2 - Severe aphasia; fragmentary communication 3 - Mute, global aphasia, or coma
10: Dysarthria (Speech Clarity) i Ask the patient to read or repeat several words. An intubated patient or one with a physical barrier scores 0. Do not tell the patient why they are being tested. 0 - Normal articulation (or intubated/physical barrier) 1 - Mild to moderate; slurred but understandable 2 - Severe; unintelligible or mute/anarthric
11: Extinction and Inattention (Neglect) i Test tactile/visual/auditory attention with bilateral simultaneous stimulation. Also assess personal neglect by having patient attend to the paretic side. 0 - No abnormality 1 - Inattention or extinction in one modality 2 - Profound hemi-inattention or extinction in more than one modality