Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, June 13, 2016

The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status

Anything that uses the National Institutes of Health Stroke Scale for measurement is worthless because of subjectivity. You should have written up a protocol on when it is useful instead of just this lazy research paper.

 

The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status


  1. Elisabeth B. Marsh, MD1
  2. Erin Lawrence, RN, MSN1
  3. Rebecca F. Gottesman, MD, PhD1
  4. Rafael H. Llinas, MD1
  1. 1Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
  1. Elisabeth B. Marsh, Department of Neurology, The Johns Hopkins School of Medicine, 600 North Wolfe St, Phipps 446C, Baltimore, MD 21287, USA. Email: ebmarsh@jhmi.edu

Abstract

Background and Purpose: The National Institute of Health Stroke Scale (NIHSS) is rapid and reproducible, a seemingly attractive metric for the documentation of clinical progress in patients presenting with ischemic stroke. Many institutions have adopted it into daily clinical practice. Unfortunately, the scale may not adequately capture all forms of functional change. We evaluate its utility as a measure of recovery in patients treated with intravenous tissue plasminogen activator (IV tPA) for ischemic stroke.
Methods: We prospectively evaluated the difference in the rate of improvement based on NIHSS (a ≥4 point change based on previous trials) versus physician-documented subjective and objective measures in 41 patients’ status post IV tPA treatment. The NIHSS 24 hours posttreatment, on discharge, and at follow-up were compared to NIHSS on admission using tests of proportions and McNemar tests of paired data. Secondary analyses were performed defining significant improvement as NIHSS changes of 1 to 3 points.
Results: The mean NIHSS improved from 9 to 6, 24 hours post-tPA. Of the 41 patients, 29 improved by physician documentation, although only 11 of the 29 met the NIHSS criteria (P < .001; McNemar P < .001). On discharge, 20 of the 41 patients met the NIHSS criteria; however, the proportion “better” by physician documentation (71%) remained significantly higher (P = .04; McNemar P = .004). The mean postdischarge follow-up NIHSS was 2. Twenty of the 21 patients improved by documentation versus 16 of the 21 by NIHSS (P = .08, McNemar P = .125). Using NIHSS changes of 1 to 3 increased sensitivity for detecting improvement but remained lower than physician documentation.
Conclusion: The NIHSS has many advantages; however, it may miss functional changes when used in place of a comprehensive neurological examination to measure improvement poststroke.

1 comment:

  1. Only 2 of the 11 NIHSS test items look at motor skills. These 2 items ask stroke survivors to lift their affected arm and then leg to see if the limb remains still, drifts, or falls. This is a really crude assessment.

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