NIHSS Motor Function Assessment 4 — Questions and Answers
Question 1: A patient holds the arm at 90° for the full 10 seconds with no drift. What is the NIHSS Item 5 score?
- 0 (Correct answer)
- 1
- 2
- 3
Correct answer: 0
A score of 0 indicates no drift — the limb holds position for the full 10 seconds.
Question 2: When scoring NIHSS motor items in an unresponsive patient, what instruction should be given before scoring?
- Score automatically as 4 without instruction
- Use painful stimuli to elicit best response
- Attempt verbal instruction, then physical positioning (Correct answer)
- Skip the item and mark as untestable
Correct answer: Attempt verbal instruction, then physical positioning
The examiner should give verbal instructions and physically place the limb in position to assess best motor response.
Question 3: Which total NIHSS score range would be expected if a patient scores 3 on both motor arm items and 3 on both motor leg items?
- 6 from motor items alone
- 12 from motor items alone (Correct answer)
- 8 from motor items alone
- 4 from motor items alone
Correct answer: 12 from motor items alone
Four motor items at score 3 each (3×4=12) contribute 12 points to the total NIHSS from motor alone.
Question 4: A patient drags the right leg slightly when walking but can hold it at 30° for the full 5 seconds. What is the NIHSS Item 6a score?
- 0 (Correct answer)
- 1
- 2
- 3
Correct answer: 0
If the leg maintains the required position for 5 seconds without drift, the score is 0 regardless of gait findings.
Question 5: For NIHSS leg motor testing, what duration must the leg hold at 30° to receive a score of 0?
- 3 seconds
- 5 seconds (Correct answer)
- 10 seconds
- 15 seconds
Correct answer: 5 seconds
The leg must hold at 30° for 5 seconds without drift to achieve a score of 0 on Items 6a/6b.
Question 6: A patient with left hemiplegia holds the left arm at 45° (supine) and it slowly drifts to the bed at 8 seconds. What is Item 5b?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
The arm drifted but did not quite reach the bed within 10 seconds, which corresponds to a score of 1.
Question 7: Which clinical scenario would result in an NIHSS motor score of 4 for the left arm?
- Arm drifts but doesn't hit bed
- Arm held for 8 seconds then falls
- No voluntary movement of the arm (Correct answer)
- Arm held with mild tremor but steady
Correct answer: No voluntary movement of the arm
Complete absence of voluntary movement in the limb earns the maximum motor score of 4.
NIHSS Motor Function Assessment 4
A patient holds the arm at 90° for the full 10 seconds with no drift.
What is the NIHSS Item 5 score?