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Stroke Research and Treatment
Volume 2014, Article ID 462681, 6 pages
http://dx.doi.org/10.1155/2014/462681
Clinical Study

Stroke Survivors Scoring Zero on the NIH Stroke Scale Score Still Exhibit Significant Motor Impairment and Functional Limitation

1Occupational Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, 453 West Tenth Avenue, Suite 406, Columbus, OH 43210, USA
2School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, 453 West Tenth Avenue, Suite 406, Columbus, OH 43210, USA

Received 3 December 2013; Accepted 5 February 2014; Published 17 March 2014

Academic Editor: Steve Kautz

Copyright © 2014 Brittany Hand et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To determine the National Institutes of Health Stroke Scale’s (NIHSS’s) association with upper extremity (UE) impairment and functional outcomes. Design. Secondary, retrospective analysis of randomized controlled trial data. Setting. Not applicable. Participants. 146 subjects with stable, chronic stroke-induced hemiparesis. Intervention. The NIHSS, the UE Fugl-Meyer (FM), and the Arm Motor Ability Test (AMAT) were administered prior to their participation in a multicenter randomized controlled trial. Main Outcome Measures. The NIHSS, FM, and AMAT. Results. The association between the NIHSS and UE impairment was statistically significant but explained less than 4% of the variance among UE FM scores. The association between NIHSS total score and function as measured by the AMAT was not statistically significant . Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UE FM and AMAT. Conclusion. While being used in stroke trials, the NIHSS may have limited ability to discriminate between treatment responses, even when only a relatively narrow array of impairment levels exists among patients. Given these findings, NIHSS use should be restricted to acute stroke studies and clinical settings with the goal of reporting stroke severity.