24
General Supportive Early Management
Table 2. Guidance for Determining Deficits to be Clearly
Disabling at Presentation
Among patients with NIHSS scores 0–5 at presentation, if the observed deficits
persist, would they still be able to do basic activities of daily living and/or return to
work (if applicable)?
• Basic activities of daily living include bathing/dressing, ambulating, toileting,
hygiene, and eating (BATHE mnemonic).
• To fully evaluate the level of deficits, the ability to ambulate and swallow
independently should be assessed.
• The clinician should make this determination in consultation with the patient and
available family.
As a guideline, while always considering individual circumstances:
e following deficits would typically
be considered clearly disabling :
• Complete hemianopsia (≥2 on the
NIHSS "vision" question)
• Severe aphasia (≥2 on the NIHSS
"best language" question)
• Severe hemi-attention or extinction
to >1 modality (≥2 on the NIHSS
"extinction and inattention" question)
• Any weakness limiting sustained
effort against gravity (≥2 on the
NIHSS "motor" questions)
e following deficits may not be clearly
disabling in an individual patient:
• Isolated mild aphasia (but still able to
communicate meaningfully)
• Isolated facial droop
• Mild cortical hand weakness (especially
nondominant, NIHSS score, 0)
• Mild hemimotor loss
• Hemisensory loss
• Mild hemi sensorimotor loss
• Mild hemiataxia (but can still ambulate)
NIHSS indicates National Institutes of Health Stroke Scale.
