How to use it
- Examine the items in order, from 1a to 11, as the scale is designed to be done.
- Pick the answer matching the patient’s first response for each item.
- Read the total and the severity group.
How the scale works
The 15 items have different ranges, and the total is their sum.
| Item | Range |
|---|---|
| 1a Level of consciousness | 0–3 |
| 1b Questions, 1c Commands | 0–2 each |
| 2 Gaze | 0–2 |
| 3 Visual fields | 0–3 |
| 4 Facial palsy | 0–3 |
| 5a, 5b Arms | 0–4 each |
| 6a, 6b Legs | 0–4 each |
| 7 Limb ataxia | 0–2 |
| 8 Sensory | 0–2 |
| 9 Language | 0–3 |
| 10 Dysarthria | 0–2 |
| 11 Extinction and inattention | 0–2 |
Worked example
A patient is alert and answers and obeys correctly (0, 0, 0), has a partial gaze palsy (1), full visual fields (0), partial lower facial paralysis (2), a right arm that cannot resist gravity (3), a right leg with some effort against gravity (2), no ataxia or sensory loss (0, 0), moderate aphasia (1), mild dysarthria (1) and no neglect (0). The total is 1 + 2 + 3 + 2 + 1 + 1 = 10, moderate stroke.
Tips
- Score ataxia only when it is out of proportion to weakness; a limb that cannot move scores 0 for ataxia.
- A patient in coma (1a = 3) gets fixed scores on several items; follow the official instructions.
- Repeat the scale after treatment and at set times so changes are compared on the same scale.
- A suspected stroke is an emergency: call emergency services. This page is for information.