Group B Patient Examination Flashcards

A patient in the NIHSS Group B category is BEST described as someone who:

Answer: Has a known communication barrier, altered consciousness, intubation, or significant aphasia that limits the standard exam

Group B patients are those whose neurological deficits or medical status (e.g., intubation, profound aphasia, altered consciousness) create barriers to the standard NIHSS examination format. Group A patients are cooperative and able to follow standard instructions.

When administering the NIHSS to an intubated patient, how should the examiner score the Dysarthria item?

Answer: Mark the item as UN (untestable) and do not penalize the patient

Dysarthria cannot be evaluated in an intubated patient. The NIHSS protocol requires marking the item as UN (untestable) in this case. UN items are not counted against the patient's score.

For a Group B patient who has a pre-existing language barrier (speaks no English and no interpreter is available), how should the examiner approach the Language/Aphasia item?

Answer: Mark as UN (untestable) and note the language barrier

When the patient has a language barrier and no interpreter is available, the item is marked UN. The NIHSS is designed to measure neurological deficits, not language differences, so a pure language barrier without neurological cause renders the item untestable.

A Group B patient is deeply stuporous and does not respond to voice but does withdraw to painful stimuli. How should Level of Consciousness (item 1a) be scored?

Answer: 2 — Not alert and requires repeated stimulation or painful stimuli to make purposeful movements

A score of 2 is assigned when the patient is not alert and requires repeated or painful stimulation to make non-reflex (purposeful) movements. Withdrawal to pain is considered a purposeful response, distinguishing this from a score of 3.

When scoring the Best Gaze item on a Group B patient who cannot follow verbal commands, which approach is correct?

Answer: Use oculocephalic (doll's-eye) maneuver to assess eye movement and score based on observed range of motion

The NIHSS explicitly allows the use of oculocephalic (doll's-eye) testing when a patient cannot voluntarily follow gaze commands. The examiner scores based on the range and conjugacy of eye movement observed, making the item testable even in unresponsive patients.

A Group B patient with global aphasia cannot name or read aloud. How should the examiner assess the Language item for this patient?

Answer: Observe comprehension responses to written commands, pictures, and gestures to determine the best possible score

For Group B patients who cannot speak, the examiner assesses all components available — comprehension of written commands, picture identification, and gesture responses — to assign the most accurate score rather than defaulting to the maximum. The score should reflect the best performance observed.