The problem with doing this scale is when the patient has deficits, the grading of the deficits, and the many associated caveats. Unfortunately, this video glosses over the difficulties this can pose in doing the assessment and the amount of time that may be required to do the assessment. There are also many areas of this assessment that have very poor inter-rater reliability which are not pointed out in the video. I really wish all patients who are being evaluated for an acute stroke were as easy as the patient in the video.
What we might miss with this assessment are those that are already cognitively disabled, non English speaking will not score low, those with visual disabilities are unable to complete a MAJOR portion of the exam. With diabetes we have peripheral neuropathy that damages sensory perception. Someone that’s had bells palsy will have some asymmetric facial features that are not really indicative for a stoke but would score high on this test. NIH is a good test, but we need to use clinical judgment to determine if our patients would benefit from our standard neurological, cognitive, neuromuscular, etc better. Also there are better videos if you really want to get NIH certified, they are just old and long!
@@jljordan1 Exactly. I asked my educator about prior deficits and she said that in order to keep everything consistent, they will just have to have a higher stroke score and we are to rely on the trends, not so much the score itself. So basically, like you said, assess the patients and monitor progress.
Preexisting deficits from previous stroke or Bell’s palsy might make a patient score high, but a new stroke in the same area as a previous stroke might be masked by patient’s preexisting deficits from the old stroke, hence the need to score what we observe regardless of old deficits. Assuming that what we’re observing is from a preexisting deficits and not new symptoms superimposed on old deficits could be detrimental.
Thank you for including the rationale, why its done, what to look out for and what the abnormal finding means, or possible cause of the abnormal finding.
Hi there! Thank you for your wonderful educational video. I was wondering, If the patient has sensory impairment, how would you test for extinction? Also, what is the underlying neurophysiology of extinction? Why is it the NIHSS not use pronator drift instead of this, which I have no idea what is the method of examination called? 😄 I know its a lot of questions. Apologies for the lengthy post. Many thanks
He doesnt have stroke at all!
He's just there for the free delish hospital food!
The problem with doing this scale is when the patient has deficits, the grading of the deficits, and the many associated caveats. Unfortunately, this video glosses over the difficulties this can pose in doing the assessment and the amount of time that may be required to do the assessment. There are also many areas of this assessment that have very poor inter-rater reliability which are not pointed out in the video. I really wish all patients who are being evaluated for an acute stroke were as easy as the patient in the video.
💯
What we might miss with this assessment are those that are already cognitively disabled, non English speaking will not score low, those with visual disabilities are unable to complete a MAJOR portion of the exam. With diabetes we have peripheral neuropathy that damages sensory perception. Someone that’s had bells palsy will have some asymmetric facial features that are not really indicative for a stoke but would score high on this test.
NIH is a good test, but we need to use clinical judgment to determine if our patients would benefit from our standard neurological, cognitive, neuromuscular, etc better.
Also there are better videos if you really want to get NIH certified, they are just old and long!
@@jljordan1 Exactly. I asked my educator about prior deficits and she said that in order to keep everything consistent, they will just have to have a higher stroke score and we are to rely on the trends, not so much the score itself.
So basically, like you said, assess the patients and monitor progress.
Preexisting deficits from previous stroke or Bell’s palsy might make a patient score high, but a new stroke in the same area as a previous stroke might be masked by patient’s preexisting deficits from the old stroke, hence the need to score what we observe regardless of old deficits. Assuming that what we’re observing is from a preexisting deficits and not new symptoms superimposed on old deficits could be detrimental.
This video is literally just try a teach the nihss. It doesnt claim for it to be superior. Thanks for your comment.
I'm going to ask my manager to only make me do NIHSS on alert/oriented patients without stroke.😉
Thank you for including the rationale, why its done, what to look out for and what the abnormal finding means, or possible cause of the abnormal finding.
Thanku for this wonderful video
Its very helpful to us ...
Yeah so you just showed how to perform a stroke assessment on someone not having a stroke.
How do you remember all the points?
Lopez Larry Williams Laura Garcia Shirley
Hi there! Thank you for your wonderful educational video.
I was wondering, If the patient has sensory impairment, how would you test for extinction?
Also, what is the underlying neurophysiology of extinction?
Why is it the NIHSS not use pronator drift instead of this, which I have no idea what is the method of examination called? 😄
I know its a lot of questions. Apologies for the lengthy post.
Many thanks
2 years and no reply.
Savage.
Thank you so much , I write my research project
He was snapping... thats called a compliment
Beautiful presentation and gorgeous doctor.
Great video , great explanations
The look on this dude's face tells me he doesn't believe in what he's teaching.
From where can we get that booklet ?
thanks
NIH score scale is calculated only in ischemic stroke???
Thank you!