NIHSS Motor Function Assessment 3 — Questions and Answers
Question 1: A patient demonstrates movement of the arm but cannot overcome gravity to lift it off the bed. What is the NIHSS motor score?
- 1
- 2 (Correct answer)
- 3
- 4
Correct answer: 2
A score of 2 indicates some effort against gravity but the limb cannot achieve or maintain the required position.
Question 2: Which position is used for NIHSS arm motor testing in a patient who cannot sit upright?
- 90° in supine
- 45° in supine (Correct answer)
- 30° in supine
- 60° in sitting
Correct answer: 45° in supine
When the patient cannot sit, the arm is held at 45° in the supine position for Item 5 testing.
Question 3: On the NIHSS, a score of 4 on motor arm (Item 5) indicates what finding?
- Mild drift without hitting bed
- Limb sinks to bed within 10 seconds
- No anti-gravity movement, limb falls immediately
- No movement at all (complete paralysis) (Correct answer)
Correct answer: No movement at all (complete paralysis)
A score of 4 represents no movement whatsoever — complete paralysis of the limb.
Question 4: Why is motor function assessed separately for right and left limbs on the NIHSS?
- To calculate a laterality index
- Because stroke often causes asymmetric deficits (Correct answer)
- To average both sides for a composite score
- To comply with Joint Commission requirements
Correct answer: Because stroke often causes asymmetric deficits
Strokes typically affect one side of the body, so lateralized scoring captures the asymmetry of the deficit.
Question 5: A patient holds the right leg at 30° for 3 seconds, then it drifts down and hits the bed at second 4. What is the NIHSS Item 6a score?
- 1
- 2 (Correct answer)
- 3
- 4
Correct answer: 2
A score of 2 is given when the leg drifts down to the bed within the 5-second window.
Question 6: The NIHSS motor items (5 and 6) are graded on a scale from 0 to what maximum value?
- 3
- 4 (Correct answer)
- 5
- 6
Correct answer: 4
Motor arm and leg items each have a maximum score of 4, representing complete paralysis.
Question 7: A patient with known severe arthritis cannot extend the arm due to contracture. How should this be documented on NIHSS?
- Score of 4
- Score of 3
- UN with explanation (Correct answer)
- Score of 2
Correct answer: UN with explanation
Pre-existing joint deformities that prevent testing are marked UN (untestable) with a written explanation.
NIHSS Motor Function Assessment 3
A patient demonstrates movement of the arm but cannot overcome gravity to lift it off the bed.
What is the NIHSS motor score?