74:443. 124. Nakayama H, J rgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994; 75:394. 125. Fritz SL, Light KE, Patterson TS, et al. Active finger extension predicts outcomes after constraint-induced movement therapy for individuals with hemiparesis after stroke. Stroke 2005; 36:1172. 126. Smania N, Paolucci S, Tinazzi M, et al. Active finger extension: a simple movement predicting recovery of arm function in patients with acute stroke. Stroke 2007; 38:1088. 127. Katrak P, Bowring G, Conroy P, et al. Predicting upper limb recovery after stroke: the place of early shoulder and hand movement. Arch Phys Med Rehabil 1998; 79:758. 128. Beebe JA, Lang CE. Active range of motion predicts upper extremity function 3 months after stroke. Stroke 2009; 40:1772. 129. Nijland RH, van Wegen EE, Harmeling-van der Wel BC, et al. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study. Stroke 2010; 41:745. 130. Veerbeek JM, Van Wegen EE, Harmeling-Van der Wel BC, et al. Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 24/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Neurorehabil Neural Repair 2011; 25:268. 131. Preston E, Ada L, Stanton R, et al. Prediction of Independent Walking in People Who Are Nonambulatory Early After Stroke: A Systematic Review. Stroke 2021; 52:3217. 132. Pedersen PM, J rgensen HS, Nakayama H, et al. Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol 1995; 38:659. 133. Smithard DG, O'Neill PA, England RE, et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12:188. 134. Galovic M, Stauber AJ, Leisi N, et al. Development and Validation of a Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke. JAMA Neurol 2019; 76:561. 135. Dennis MS, Lewis SC, Warlow C, FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365:764. 136. Kumar S, Langmore S, Goddeau RP Jr, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis 2012; 21:114. 137. Okubo PC, F bio SR, Domenis DR, Takayanagui OM. Using the National Institute of Health Stroke Scale to predict dysphagia in acute ischemic stroke. Cerebrovasc Dis 2012; 33:501. 138. Teasell R, Foley N, McRae M, Finestone H. Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients. Arch Phys Med Rehabil 2001; 82:1412. 139. Doyle S, Bennett S, Fasoli SE, McKenna KT. Interventions for sensory impairment in the upper limb after stroke. Cochrane Database Syst Rev 2010; :CD006331. 140. Tyson SF, Hanley M, Chillala J, et al. Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function. Neurorehabil Neural Repair 2008; 22:166. 141. Flaster M, Meresh E, Rao M, Biller J. Central poststroke pain: current diagnosis and treatment. Top Stroke Rehabil 2013; 20:116. 142. Cassidy TP, Lewis S, Gray CS. Recovery from visuospatial neglect in stroke patients. J Neurol Neurosurg Psychiatry 1998; 64:555. 143. Hier DB, Mondlock J, Caplan LR. Recovery of behavioral abnormalities after right hemisphere stroke. Neurology 1983; 33:345. 144. Gray CS, French JM, Bates D, et al. Recovery of visual fields in acute stroke: homonymous hemianopia associated with adverse prognosis. Age Ageing 1989; 18:419. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 25/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate 145. Lai SM, Duncan PW, Keighley J. Prediction of functional outcome after stroke: comparison of the Orpington Prognostic Scale and the NIH Stroke Scale. Stroke 1998; 29:1838. 146. Kalra L, Crome P. The role of prognostic scores in targeting stroke rehabilitation in elderly patients. J Am Geriatr Soc 1993; 41:396. 147. Reding MJ, Potes E. Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach. Stroke 1988; 19:1354. 148. Ntaios G, Faouzi M, Ferrari J, et al. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology 2012; 78:1916. 149. Papavasileiou V, Milionis H, Michel P, et al. ASTRAL score predicts 5-year dependence and mortality in acute ischemic stroke. Stroke 2013; 44:1616. 150. Strbian D, Meretoja A, Ahlhelm FJ, et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score. Neurology 2012; 78:427. 151. Saposnik G, Raptis S, Kapral MK, et al. The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke. Stroke 2011; 42:3421. 152. Saposnik G, Reeves MJ, Johnston SC, et al. Predicting clinical outcomes after thrombolysis using the iScore: results from the Virtual International Stroke Trials Archive. Stroke 2013; 44:2755. 153. De Marchis GM, Dankowski T, K nig IR, et al. A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score. Neurology 2019; 92:e1517. 154. Caplan LR. Scores of scores. JAMA Neurol 2013; 70:252. 155. Belagaje SR. Stroke Rehabilitation. Continuum (Minneap Minn) 2017; 23:238. 156. AVERT Trial Collaboration group, Bernhardt J, Langhorne P, et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 386:46. 157. Dromerick AW, Lang CE, Birkenmeier RL, et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT. Neurology 2009; 73:195. 158. Dromerick AW, Geed S, Barth J, et al. Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Proc Natl Acad Sci U S A 2021; 118. 159. Wolf SL, Winstein CJ, Miller JP, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA 2006; 296:2095. 160. Lo AC, Guarino PD, Richards LG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med 2010; 362:1772. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 26/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate 161. Etoom M, Hawamdeh M, Hawamdeh Z, et al. Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res 2016; 39:197. 162. Dawson J, Liu CY, Francisco GE, et al. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. Lancet 2021; 397:1545. 163. Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98. 164. Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2012; :CD000425. 165. Lang CE, Strube MJ, Bland MD, et al. Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial. Ann Neurol 2016; 80:342. Topic 14086 Version 26.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 27/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate GRAPHICS Modified Rankin Scale Score Description 0 No symptoms at all 1 No significant disability despite symptoms; able to carry out all usual duties and activities 2 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 3 Moderate disability; requiring some help, but able to walk without assistance 4 Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance 5 Severe disability; bedridden, incontinent, and requiring constant nursing care and attention 6 Dead Reproduced with permission from: Van Swieten JC, Koudstaa PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19:604. Copyright 1988 Lippincott Williams & Wilkins. Graphic 75411 Version 13.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 28/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Barthel Index Activity Score Feeding 0 = Unable 5 = Needs help cutting, spreading butter, etc, or requires modified diet 10 = Independent Bathing 0 = Dependent 5 = Independent (or in shower) Grooming 0 = Needs to help with personal care 5 = Independent face/hair/teeth/shaving (implements provided) Dressing 0 = Dependent 5 = Needs help but can do about half unaided 10 = Independent (including buttons, zips, laces, etc) Bowels 0 = Incontinent (or needs to be given enemas) 5 = Occasional accident 10 = Continent Bladder 0 = Incontinent, or catheterized and unable to manage alone 5 = Occasional accident 10 = Continent Toilet use 0 = Dependent 5 = Needs some help, but can do something alone 10 = Independent (on and off, dressing, wiping) Transfers (bed to chair and back) https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 29/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate 0 = Unable, no sitting balance 5 = Major help (one or two people, physical), can sit 10 = Minor help (verbal or physical) 15 = Independent Mobility (on level surfaces) 0 = Immobile or <50 yards 5 = Wheelchair independent, including corners, >50 yards 10 = Walks with help of one person (verbal or physical) >50 yards 15 = Independent (but may use any aid; for example, stick) >50 yards Stairs 0 = Unable 5 = Needs help (verbal, physical, carrying aid) 10 = Independent Total (0-100): The Barthel ADL Index: Guidelines The index should be used as a record of what a patient does, not as a record of what a patient could do The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason The need for supervision renders the patient not independent Patient performance should be established using the best available evidence provided by the patient, family, friends and caregivers; direct observation and common sense are also important, but direct testing is not needed Usually the patient's performance over the preceding 24 to 48 hours is important, but occasionally longer periods will be relevant Middle categories imply that the patient supplies over 50 percent of the effort Use of aids to be independent is allowed ADL: activities of daily living. References: 1. Mahoney FI, Barthel D. Functional evaluation: The Barthel Index. Maryland State Medical Journal 1965; 14:56. Used with permission. 2. Loewen SC, Anderson BA. Predictors of stroke outcome using objective measurement scales. Stroke 1990; 21:78. 3. Gresham GE, Phillips TF, Labi ML. ADL status in stroke: Relative merits of three standard indexes. Arch Phys Med Rehabil 1980; 61:355. 4. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: A reliability study. Int Disability Study 1988; 10:61. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 30/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Graphic 77371 Version 3.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 31/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate National Institutes of Health Stroke Scale (NIHSS) Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the exam and work quickly. Except where indicated, the patient should not be coached (ie, repeated requests to patient to make a special effort). Instructions Scale definition Score 1a. Level of consciousness: The 0 = Alert; keenly responsive. investigator must choose a response if a full evaluation is prevented by such obstacles as 1 = Not alert; but arousable by minor stimulation to obey, answer, or respond. an endotracheal tube, language barrier, 2 = Not alert; requires repeated stimulation orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped). _____ (other than reflexive posturing) in response to noxious stimulation. 3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and areflexic. 1b. Level of consciousness questions: The 0 = Answers both questions correctly. patient is asked the month and his/her age. The answer must be correct - there is no partial credit for being close. Aphasic and stuporous patients who do not comprehend the questions will score 2. Patients unable to speak because of endotracheal intubation, orotracheal trauma, severe dysarthria from 1 = Answers one question correctly. 2 = Answers neither question correctly. _____ any cause, language barrier, or any other problem not secondary to aphasia are given a 1. It is important that only the initial answer be graded and that the examiner not "help" the patient with verbal or non-verbal cues. 1c. Level of consciousness commands: The 0 = Performs both tasks correctly. _____ patient is asked to open and close the eyes and then to grip and release the non-paretic 1 = Performs one task correctly. 2 = Performs neither task correctly. hand. Substitute another one step command if the hands cannot be used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If the patient does not respond to command, the task should be demonstrated to him or her (pantomime), and the result scored (ie, https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 32/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate follows none, one or two commands). Patients with trauma, amputation, or other physical impediments should be given suitable one-step commands. Only the first attempt is scored. 2. Best gaze: Only horizontal eye movements will be tested. Voluntary or 0 = Normal. 1 = Partial gaze palsy; gaze is abnormal in reflexive (oculocephalic) eye movements will one or both eyes, but forced deviation or total gaze paresis is not present. be scored, but caloric testing is not done. If the patient has a conjugate deviation of the 2 = Forced deviation, or total gaze paresis not overcome by the oculocephalic eyes that can be overcome by voluntary or reflexive activity, the score will be 1. If a maneuver. patient has an isolated peripheral nerve paresis (cranial nerves III, IV or VI), score a 1. _____ Gaze is testable in all aphasic patients. Patients with ocular trauma, bandages, pre- existing blindness, or other disorder of visual acuity or fields should be tested with reflexive movements, and a choice made by the investigator. Establishing eye contact and then moving about the patient from side to side will occasionally clarify the presence of a partial gaze palsy. 3. Visual: Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or visual threat, as appropriate. Patients may be encouraged, 0 = No visual loss. 1 = Partial hemianopia. 2 = Complete hemianopia. but if they look at the side of the moving fingers appropriately, this can be scored as normal. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Score 1 only if a clear-cut 3 = Bilateral hemianopia (blind including cortical blindness). _____ asymmetry, including quadrantanopia, is found. If patient is blind from any cause, score 3. Double simultaneous stimulation is performed at this point. If there is extinction, patient receives a 1, and the results are used to respond to item 11. 4. Facial palsy: Ask - or use pantomime to encourage - the patient to show teeth or 0 = Normal symmetrical movements. _____ 1 = Minor paralysis (flattened nasolabial raise eyebrows and close eyes. Score symmetry of grimace in response to noxious fold, asymmetry on smiling). 2 = Partial paralysis (total or near-total paralysis of lower face). stimuli in the poorly responsive or non- comprehending patient. If facial trauma/bandages, orotracheal tube, tape or https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 33/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate other physical barriers obscure the face, 3 = Complete paralysis of one or both sides these should be removed to the extent (absence of facial movement in the upper possible. and lower face). 5. Motor arm: The limb is placed in the appropriate position: extend the arms 0 = No drift; limb holds 90 (or 45) degrees for full 10 seconds. (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm 1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not falls before 10 seconds. The aphasic patient hit bed or other support. is encouraged using urgency in the voice and pantomime, but not noxious 2 = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in _____ effort against gravity. the case of amputation or joint fusion at the shoulder, the examiner should record the 3 = No effort against gravity; limb falls. score as untestable (UN), and clearly write 4 = No movement. the explanation for this choice. UN = Amputation or joint fusion, explain:________________ 5a. Left arm 5b. Right arm 6. Motor leg: The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine). Drift is scored if the leg falls before 5 seconds. The 0 = No drift; leg holds 30-degree position for full 5 seconds. 1 = Drift; leg falls by the end of the 5-second period but does not hit bed. aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic leg. Only in the case of amputation or joint fusion at the hip, the examiner should 2 = Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity. _____ 3 = No effort against gravity; leg falls to bed immediately. record the score as untestable (UN), and clearly write the explanation for this choice. 4 = No movement. UN = Amputation or joint fusion, explain:________________ 6a. Left leg 6b. Right leg 7. Limb ataxia: This item is aimed at finding 0 = Absent. _____ evidence of a unilateral cerebellar lesion. Test with eyes open. In case of visual defect, 1 = Present in one limb. 2 = Present in two limbs. ensure testing is done in intact visual field. The finger-nose-finger and heel-shin tests UN = Amputation or joint fusion, explain:________________ are performed on both sides, and ataxia is scored only if present out of proportion to weakness. Ataxia is absent in the patient https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 34/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate 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. 8. Sensory: Sensation or grimace to pinprick 0 = Normal; no sensory loss. when tested, or withdrawal from noxious stimulus in the obtunded or aphasic patient. 1 = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial Only sensory loss attributed to stroke is scored as abnormal and the examiner pain with pinprick, but patient is aware of being touched. should test as many body areas (arms [not hands], legs, trunk, face) as needed to 2 = Severe to total sensory loss; patient is not aware of being touched in the face, arm, accurately check for hemisensory loss. A score of 2, "severe or total sensory loss," should only be given when a severe or total loss of sensation can be clearly and leg. _____ demonstrated. Stuporous and aphasic patients will, therefore, probably score 1 or 0. The patient with brainstem stroke who has bilateral loss of sensation is scored 2. If the patient does not respond and is quadriplegic, score 2. Patients in a coma (item 1a=3) are automatically given a 2 on this item. 9. Best language: A great deal of 0 = No aphasia; normal. _____ information about comprehension will be obtained during the preceding sections of the examination. For this scale item, the patient is asked to describe what is happening in the attached picture, to name 1 = Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes the items on the attached naming sheet and to read from the attached list of sentences. conversation about provided materials Comprehension is judged from responses here, as well as to all of the commands in difficult or impossible. For example, in conversation about provided materials, the preceding general neurological exam. If examiner can identify picture or naming card content from patient's response. visual loss interferes with the tests, ask the patient to identify objects placed in the 2 = Severe aphasia; all communication is through fragmentary expression; great need hand, repeat, and produce speech. The intubated patient should be asked to write. for inference, questioning, and guessing by the listener. Range of information that can The patient in a coma (item 1a=3) will automatically score 3 on this item. The be exchanged is limited; listener carries burden of communication. Examiner cannot examiner must choose a score for the patient with stupor or limited cooperation, but a score of 3 should be used only if the https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 35/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate patient is mute and follows no one-step identify materials provided from patient commands. response. 3 = Mute, global aphasia; no usable speech or auditory comprehension. 10. Dysarthria: If patient is thought to be normal, an adequate sample of speech must 0 = Normal. 1 = Mild-to-moderate dysarthria; patient be obtained by asking patient to read or slurs at least some words and, at worst, can be understood with some difficulty. repeat words from the attached list. If the patient has severe aphasia, the clarity of 2 = Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence articulation of spontaneous speech can be rated. Only if the patient is intubated or has _____ of or out of proportion to any dysphasia, or is mute/anarthric. other physical barriers to producing speech, the examiner should record the score as untestable (UN), and clearly write an UN = Intubated or other physical barrier, explanation for this choice. Do not tell the patient why he or she is being tested. explain:________________ 11. Extinction and inattention (formerly 0 = No abnormality. neglect): Sufficient information to identify neglect may be obtained during the prior testing. If the patient has a severe visual loss preventing visual double simultaneous stimulation, and the cutaneous stimuli are normal, the score is normal. If the patient has aphasia but does appear to attend to 1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities. 2 = Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space. _____ both sides, the score is normal. The presence of visual spatial neglect or anosognosia may also be taken as evidence of abnormality. Since the abnormality is scored only if present, the item is never untestable. _____ Adapted from: Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non- neurologists in the context of a clinical trial. Stroke 1997; 28:307. Graphic 61698 Version 8.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 36/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Canadian Neurological Scale Patient Name: Rater Name: Date: Time: Mentation Score Level consciousness Alert 3.0 Drowsy 1.5 Orientation Oriented 1.0 Disoriented/NA 0.0 Speech Normal 1.0 Expressive deficit 0.5 Receptive deficit 0.0 TOTAL: Motor functions (no comprehension deficit) Weakness Score Face None 0.5 Present 0.0 Arm: proximal None 1.5 Mild 1.0 Significant 0.5 Total 0 Arm: distal None 1.5 Mild 1.0 Significant 0.5 Total 0 Leg None 1.5 Mild 1.0 Significant 0.5 Total 0 TOTAL: Motor response (comprehension deficit) Score https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 37/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Face Symmetrical .5 Asymmetrical 0 Arms Equal 1.5 Unequal 0 Legs Equal 1.5 Unequal 0 TOTAL: Reproduced with permission from: C t R, Hachinski VC, Shurvell BL, et al. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke 1986; 17:731. Copyright 1986 Lippincott Williams & Wilkins. Graphic 55644 Version 9.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 38/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Time course of neurologic recovery after stroke The time course of recovery in survivors shown as the cumulated rate of patients having reached their best neurological outcome. Rates are given for all patients, ; for patients with initial mild stroke severity, ; for patients with initial moderate stroke severity, ; for patients with initial severe stroke severity, *; for patients with initial very severe stroke severity, . The ANOVA test showed an overall difference in the time course of recovery between the groups, p<0.0001. Further analyses showed that the time course of recovery differed significantly between patients with initially mild strokes versus moderate strokes, p<0.0001, and between patients with moderate strokes versus severe strokes, p<0.03. No difference was found between patients with severe versus very severe strokes, p = 0.19. ANOVA: analysis of variance. Reproduced from: J rgensen HS1, Nakayama H, Raaschou HO, et al. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995; 76:406. Illustration used with the permission of Elsevier Inc. All rights reserved. Graphic 96471 Version 4.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 39/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Orpington Prognostic Scale A. Motor deficit in arm Lying supine, patient flexes shoulder to 90 and is given resistance. 0.0 = MRC grade 5 (normal power) 0.4 = MRC grade 4 (diminished power) 0.8 = MRC grade 3 (movement against gravity) 1.2 = MRC grade 1 to 2 (movement with gravity eliminated or trace) 1.6 = MRC grade 0 (no movement) B. Proprioception (eyes closed) Locates affected thumb: 0.0 = Accurately 0.4 = Slight difficulty 0.8 = Finds thumb via arm 1.2 = Unable to find thumb C. Balance 0.0 = Walks 10 feet without help 0.4 = Maintains standing position (unsupported for one minute) 0.8 = Maintains sitting position 1.2 = No sitting balance D. Cognition Hodkinson's Mental Test: Score one point for each correct answer. _____ 1. Age of patient _____ 2. Time (to the nearest hour) I am going to give you an address, please remember it and I will ask you later: 42 West Street. _____ 3. Name of hospital _____ 4. Year _____ 5. Date of birth of patient _____ 6. Month _____ 7. Years of the Second World War _____ 8. Name of the President https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 40/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate _____ 9. Count backwards (20 to 1) _____ 10. What is the address I asked you to remember: 42 West Street. 0.0 = Mental test score of 10 0.4 = Mental test score of 8 to 9 0.8 = Mental test score of 5 to 7 1.2 = Mental test score of 0 to 4 TOTAL SCORE: 1.6 + Motor + Proprioception + Balance + Cognition. MRC: Medical Research Council. From: Lai SM, Duncan PW, Keighley J. Prediction of functional outcome after stroke: comparison of the Orpington Prognostic Scale and the NIH Stroke Scale. Stroke 1998; 29:1838. Reproduced with permission from Lippincott Williams & Wilkins. Copyright 1998 American Heart Association. Unauthorized reproduction of this material is prohibited. Graphic 98568 Version 5.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 41/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Reding prognostic subgroups for outcome after stroke Life table curves for probability of reaching the goal of walking with assistance and assisted self-care function, defined as a Barthel Index score of 60. From: Reding MJ, Potes E. Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach. Stroke 1988; 19:1354. Reproduced with permission from Lippincott Williams & Wilkins. Copyright 1998 American Heart Association. Unauthorized reproduction of this material is prohibited. Graphic 98557 Version 4.0 https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 42/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Contributor Disclosures Matthew A Edwardson, MD No relevant financial relationship(s) with ineligible companies to disclose. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. John F Dashe, MD, PhD No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 43/43