Spanish - Post-NIHSSCough and dysphagia should be assessed in patients who are upright, alert, and responsive (NIHSS 1a = 0) and able to follow commands (NIHSS 1c = 0). The patient is asked to cough. An absent or weak voluntary cough is scored as a 9 (5 for abnormal cough and 4 for dysphagia for items 13 and 14 respectively).
E: Cough.
S: Tosa.
The patient is asked to cough. An absent or weak voluntary cough is scored as a 9 (5 for abnormal cough and 4 for dysphagia for item 13 and 14 respectively). Presence of anatomical abnormalities (palatal paralysis or asymmetry, tongue deviation) is then evaluated. If no anatomical abnormalities are present, the indirect swallowing screen is performed by asking the patient to swallow his/her own saliva. If the patient able to swallow his/her own saliva, the direct swallowing screen is performed from a cup of water with sequentially increasing volumes of water (5 mL, 10 mL, 20 mL, and 50 mL). The patient passes the direct swallowing test if there is no cough, throat clearing, or drooling for 1 minute, and is given a rating of 0 for no dysphagia. The indirect swallowing and direct swallowing tests are based on the Gugging Swallowing Screen.
E: Swallow your saliva.
S: Trague su propia saliva.
E: Drink this water.
S: Beba este agua.
This is a modified version of NIHSS item 7 in which 3 points are scored instead of 2. This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with eyes open. In case of visual defect, ensure testing is done within an intact visual field. 1) The finger-nose-finger and heel-shin tests are performed on both sides, and ataxia is scored only if present out of proportion to weakness. Ataxia is absent in the patient who cannot understand or is paralyzed. Only in the case of amputation or joint fusion, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice. In case of blindness, test by having the patient touch nose from extended arm position. 2) The examiner instructs the patient to stand with feet together with eyes open for a few seconds and subsequently to walk naturally. If this test is normal, ask the patient to walk in tandem. In stroke patients who are unable to walk due to limb weakness, truncal ataxia should be evaluated in sitting position by assessing trunk control.
E: Use your left hand. Touch your nose. Touch my finger. Nose. Finger.
S: Use su mano izquierda. Toque su nariz. Toque mi dedo. Nariz. Dedo.
E: Use your right hand. Touch your nose. Touch my finger. Nose. Finger.
S: Use su mano derecha. Toque su nariz. Toque mi dedo. Nariz. Dedo.
E: Use your left heel. Touch your right knee. Slide your foot down. Up. Down.
S: Use su talón izquierdo. Toque su rodilla derecha. Deslize su pie hacia abajo. Arriba. Abajo.
E: Use your right heel. Touch your left knee. Slide your foot down. Up. Down.
S: Use su talón derecho. Toque su rodilla izquierda. Deslize su pie hacia abajo. Arriba. Abajo.
E: Stand up.
S: Levántese.
E: Walk back and forth.
S: Camine de ida y vuelta.
E: Walk in a straight line with one foot in front of the other.
S: Camine en línea recta, con un pie delante del otro.
Your total score is:
