{"id":6689,"date":"2023-11-20T07:58:26","date_gmt":"2023-11-20T07:58:26","guid":{"rendered":"https:\/\/neuropediatoolkit.org\/?p=6689"},"modified":"2023-11-26T08:04:01","modified_gmt":"2023-11-26T08:04:01","slug":"pednihss","status":"publish","type":"post","link":"https:\/\/neuropediatoolkit.org\/en\/pednihss\/","title":{"rendered":"PedNIHSS"},"content":{"rendered":"<div class=\"formbox-wrapper\"><form action=\"https:\/\/neuropediatoolkit.org\/en\/pednihss\/\" name=\"formbox\" class=\"formbox formbox-2\" id=\"calculator_2\" data-trp-original-action=\"https:\/\/neuropediatoolkit.org\/en\/pednihss\/\">\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size: 18px;font-weight: bold;box-shadow: none\">1. Level of consciousness. <\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">1a. Global.<\/div><div class=\"formbox__body\"><div class=\"formbox__field\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-1\" id=\"formbox-field-1_1\"><label for=\"formbox-field-1_1\">Alert<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-1\" id=\"formbox-field-1_2\"><label for=\"formbox-field-1_2\">Drowsy, not alert but awakens with minor stimuli, being able to obey and respond<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-1\" id=\"formbox-field-1_3\"><label for=\"formbox-field-1_3\">Not alert, requires repeated stimulation to maintain attention, or fully conscious and requires strong or painful stimulation to perform movements (non-stereotyped)<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-1\" id=\"formbox-field-1_4\"><label for=\"formbox-field-1_4\">It only responds with a reflex or totally indifferent, flaccid, areflexic motor or autonomic response. Coma.<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">It should always be scored, even if there are obstacles to the examination such as endotracheal tube, language barriers or others. The score \u201c3\u201d is only considered if the patient does not make movements (other than reflex responses) in response to painful stimuli.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">1b. Oral questions. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-2\" id=\"formbox-field-2_1\"><label for=\"formbox-field-2_1\">Both answers are correct<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-2\" id=\"formbox-field-2_2\"><label for=\"formbox-field-2_2\">1 wrong answer<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-2\" id=\"formbox-field-2_3\"><label for=\"formbox-field-2_3\">2 wrong answers<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">Children under 2 years old: a family member must be present 1st Question: how old are you? (correct if he indicates it verbally or with his fingers) 2nd Question: where is XX?, XX being the family member who accompanies him (correct if he says it, points at it with his hand, or looks at it). Intubated, etc. or severe dysarthria, score 1. If aphasic or stuporous (does not understand), score 2.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">1c. Orders. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-3\" id=\"formbox-field-3_1\"><label for=\"formbox-field-3_1\">Do both correctly<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-3\" id=\"formbox-field-3_2\"><label for=\"formbox-field-3_2\">Perform one correctly<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-3\" id=\"formbox-field-3_3\"><label for=\"formbox-field-3_3\">Does not perform any correctly<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">The child is asked to open and close his eyes and point to his nose. Substitute another order if you cannot use your hands for any reason. It is considered appropriate if the unequivocal intention to respond to the command is made even if it is not completed due to motor weakness. If the patient does not respond to the command, show him or her with mime what we ask him to do and write down the result. Only the initial response is considered.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">2. Eye movement, conjugate gaze.<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-4\" id=\"formbox-field-4_1\"><label for=\"formbox-field-4_1\">Normal<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-4\" id=\"formbox-field-4_2\"><label for=\"formbox-field-4_2\">Partial gaze paresis<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-4\" id=\"formbox-field-4_3\"><label for=\"formbox-field-4_3\">Total paresis or forced deviation of conjugated gaze<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">Only assess horizontal gaze voluntarily or with oculocephalic reflexes. If the patient has averted gaze but this is corrected voluntarily, with eye contact or in a reflex manner, score 1. If he or she has peripheral paresis of an oculomotor nerve (III, IV or VI), score 1.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">3. Visual field.<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-5\" id=\"formbox-field-5_1\"><label for=\"formbox-field-5_1\">No visual loss<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-5\" id=\"formbox-field-5_2\"><label for=\"formbox-field-5_2\">Partial Hemianopsia\/Quadrantanopsia<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-5\" id=\"formbox-field-5_3\"><label for=\"formbox-field-5_3\">Complete hemianospsia<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-5\" id=\"formbox-field-5_4\"><label for=\"formbox-field-5_4\">Bilateral hemianopsia (blindness, including cortical blindness)<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">The visual fields (upper and lower quadrants) are explored by confrontation, using finger counting (children over 6 years) or threat reflex (children 4 months-6 years). The patient should be encouraged, but if he or she is observed looking at the place where the fingers are moving, this is scored as a normal response. If there is unilateral blindness or enucleation, the visual fields in the preserved eye are evaluated. Score \u201c1\u201d only if clear asymmetry, including quadrantanopsia. If the patient is blind for any reason, score \u201c3\u201d. Perform double simultaneous stimulation to detect possible visual extinction. If extinction is demonstrated, it is scored \u201c1\u201d and these results are also used in question 11.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">4. Facial paralysis<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-6\" id=\"formbox-field-6_1\"><label for=\"formbox-field-6_1\">Normal symmetrical movement<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-6\" id=\"formbox-field-6_2\"><label for=\"formbox-field-6_2\">Mild paralysis (effacement of the nasolabial fold, asymmetry in the smile, flabby upper lip)<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-6\" id=\"formbox-field-6_3\"><label for=\"formbox-field-6_3\">Partial paralysis (total or almost total paralysis of the muscles of the lower half of the face)<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-6\" id=\"formbox-field-6_4\"><label for=\"formbox-field-6_4\">Complete paralysis on one or both sides (absence of facial movements in the upper and lower half of the face)<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size: 10px;font-weight: bold;box-shadow: none\">Ask (using mime if necessary) that the child show his teeth, raise his eyebrows, and close his eyes. Score the symmetry of the grimace in response to painful stimuli in patients who do not respond or do not understand the command. If facial trauma, bandages, orthotracheal tube or other physical barriers, try to remove them where possible to facilitate the evaluation of this section.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size: 18px;font-weight: bold;box-shadow: none\">5. Motor function of the arms (Upper extremity paresis)<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size: 10px;font-weight: bold;box-shadow: none\">The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Claudication is scored if the arm falls within 10 seconds. For children too immature to follow precise instructions or uncooperative for any reason, scoring is based on observation of spontaneous or elicited movement according to the same classification scheme, without regard to temporal criteria. In the aphasic patient, the response is encouraged by using urgency in the explorer's voice and pantomime, but not painful stimulation. Examine each arm separately, starting with the non-paretic arm. Only in the case of amputation or joint fusion or immobilization, a \"9\" can be scored and the examiner must clearly write the explanation to score as a \"9\".<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">RIGHT SIDE. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-7\" id=\"formbox-field-7_1\"><label for=\"formbox-field-7_1\">No fall, the arm remains elevated 90\u00ba (or 45\u00ba) for 10 seconds<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-7\" id=\"formbox-field-7_2\"><label for=\"formbox-field-7_2\">Claudication, the arm remains elevated at 90\u00ba (or 45\u00ba) but falls within 10 seconds, without falling completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-7\" id=\"formbox-field-7_3\"><label for=\"formbox-field-7_3\">The arm cannot be raised or maintained at 90\u00ba (or 45\u00ba), it falls to the bed, but some effort against gravity is observed<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-7\" id=\"formbox-field-7_4\"><label for=\"formbox-field-7_4\">No effort against gravity, the arm falls completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"4\" name=\"formbox-field-7\" id=\"formbox-field-7_5\"><label for=\"formbox-field-7_5\">no movement<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"9\" name=\"formbox-field-7\" id=\"formbox-field-7_6\"><label for=\"formbox-field-7_6\">Amputation, joint fusion<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">LEFT SIDE. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-8\" id=\"formbox-field-8_1\"><label for=\"formbox-field-8_1\">No fall, the arm remains elevated 90\u00ba (or 45\u00ba) for 10 seconds<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-8\" id=\"formbox-field-8_2\"><label for=\"formbox-field-8_2\">Claudication, the arm remains elevated at 90\u00ba (or 45\u00ba) but falls within 10 seconds, without falling completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-8\" id=\"formbox-field-8_3\"><label for=\"formbox-field-8_3\">The arm cannot be raised or maintained at 90\u00ba (or 45\u00ba), it falls to the bed, but some effort against gravity is observed<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-8\" id=\"formbox-field-8_4\"><label for=\"formbox-field-8_4\">No effort against gravity, the arm falls completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"4\" name=\"formbox-field-8\" id=\"formbox-field-8_5\"><label for=\"formbox-field-8_5\">no movement<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"9\" name=\"formbox-field-8\" id=\"formbox-field-8_6\"><label for=\"formbox-field-8_6\">Amputation, joint fusion<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:18px;font-weight:bold\">6. Motor function of the legs (Lower extremities paresis)<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">The limb is placed in the appropriate position: extend the leg 30\u00ba in a supine position. Claudication is scored if the leg falls within 5 seconds. For children who are too immature to follow precise instructions or are uncooperative for any reason, scoring is based on observation of spontaneous or elicited movement according to the same classification scheme, without regard to temporal criteria. In the aphasic patient, the response is encouraged by using urgency in the explorer's voice and pantomime, but not painful stimulation. Examine each leg separately, starting with the non-paretic leg. Only in the case of amputation or joint fusion or immobilization, a \"9\" can be scored and the examiner must clearly write the explanation to score as a \"9\".<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">RIGHT SIDE. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-9\" id=\"formbox-field-9_1\"><label for=\"formbox-field-9_1\">No fall, the leg remains elevated 30\u00ba for 5 seconds<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-9\" id=\"formbox-field-9_2\"><label for=\"formbox-field-9_2\">Claudication, the leg remains elevated at 30\u00ba but falls within 5 seconds, without falling completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-9\" id=\"formbox-field-9_3\"><label for=\"formbox-field-9_3\">The leg cannot be raised or maintained at 30\u00ba, it falls to the bed, but some effort against gravity is observed<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-9\" id=\"formbox-field-9_4\"><label for=\"formbox-field-9_4\">No effort against gravity, the leg falls completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"4\" name=\"formbox-field-9\" id=\"formbox-field-9_5\"><label for=\"formbox-field-9_5\">no movement<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"9\" name=\"formbox-field-9\" id=\"formbox-field-9_6\"><label for=\"formbox-field-9_6\">Amputation, joint fusion<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">LEFT SIDE. <\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-10\" id=\"formbox-field-10_1\"><label for=\"formbox-field-10_1\">No fall, the leg remains elevated 30\u00ba for 5 seconds<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-10\" id=\"formbox-field-10_2\"><label for=\"formbox-field-10_2\">Claudication, the leg remains elevated at 30\u00ba but falls within 5 seconds, without falling completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-10\" id=\"formbox-field-10_3\"><label for=\"formbox-field-10_3\">The leg cannot be raised or maintained at 30\u00ba, it falls to the bed, but some effort against gravity is observed<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-10\" id=\"formbox-field-10_4\"><label for=\"formbox-field-10_4\">No effort against gravity, the leg falls completely<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"4\" name=\"formbox-field-10\" id=\"formbox-field-10_5\"><label for=\"formbox-field-10_5\">no movement<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"9\" name=\"formbox-field-10\" id=\"formbox-field-10_6\"><label for=\"formbox-field-10_6\">Amputation, joint fusion<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">7. Ataxia of the limbs<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-11\" id=\"formbox-field-11_1\"><label for=\"formbox-field-11_1\">No ataxia<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-11\" id=\"formbox-field-11_2\"><label for=\"formbox-field-11_2\">Ataxia in one limb<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-11\" id=\"formbox-field-11_3\"><label for=\"formbox-field-11_3\">Ataxia in both limbs<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">This section explores the existence of a cerebellar lesion. It is evaluated with eyes open, using the \u201cfinger-nose-finger\u201d and \u201cheel-knee\u201d maneuvers on both sides. Ataxia is scored only if it is present and disproportionate to the degree of paresis. In children under 5 years old, it can be replaced by the task of reaching for a toy for the upper limb and kicking a toy that the explorer is holding in his or her hand. Patients who do not understand or present paresis are scored \u201c0\u201d.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">8. Sensitivity<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-12\" id=\"formbox-field-12_1\"><label for=\"formbox-field-12_1\">Normal, no sensory loss<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-12\" id=\"formbox-field-12_2\"><label for=\"formbox-field-12_2\">Weak or moderate loss of sensitivity (the patient notices the contact but does not perceive if it is the tip or the flat side)<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-12\" id=\"formbox-field-12_3\"><label for=\"formbox-field-12_3\">Anesthesia. The patient is not aware of being touched on the face, arm and leg<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">Sensation or grimace when pricked or withdrawal when faced with painful stimuli in patients with aphasia or stuporous patients. In children too young or uncooperative to grade loss of sensation, observe any response to the prick and score it according to the scoring scheme as a normal, diminished, or severely diminished response. Only loss of sensation attributable to the stroke is scored as abnormal and the evaluator must examine as many areas of the body (arms (not hands), legs, trunk and face) as necessary to adequately check for loss of sensation. A score of \u201c2\u201d is given only when severe or complete loss of sensation can be clearly demonstrated. Aphasic or stuporous patients score \u201c1\u201d or \u201c0\u201d.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">9a. Language (over 2 years old).<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-13\" id=\"formbox-field-13_1\"><label for=\"formbox-field-13_1\">Normal, without aphasia<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-13\" id=\"formbox-field-13_2\"><label for=\"formbox-field-13_2\">Mild or moderate aphasia: the patient has difficulties speaking and\/or understanding but what they say can be identified<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-13\" id=\"formbox-field-13_3\"><label for=\"formbox-field-13_3\">Severe aphasia: there is only minimal communication and it is very difficult to identify what the patient wants to say<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-13\" id=\"formbox-field-13_4\"><label for=\"formbox-field-13_4\">Global aphasia, mutism: no possibility of speaking or understanding<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">You will assess the understanding shown in all the previous tests. For children over 6 years old with normal prior language development; You are asked to describe what happens or the name of various objects shown, repeating words from a list. If vision loss interferes with testing, ask the patient to identify objects placed in the hand, repeat, and produce speech. Intubated patients are asked to write. The comatose patient (questions 1a = 3) arbitrarily scores \u201c3\u201d at this point. The examiner should choose a score in the patient with stupor or limited cooperation, but only score \u201c3\u201d if the patient is mute and does not obey simple commands. For children ages 2 to 6, scoring will be based on observations of speech and language comprehension during the screening.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">9b. Language (for children from 4 months to two years)<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-14\" id=\"formbox-field-14_1\"><label for=\"formbox-field-14_1\">Alerts to sound and visually orients or exhibits behavior toward the location of the sound<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-14\" id=\"formbox-field-14_2\"><label for=\"formbox-field-14_2\">Alert to sound, but does not have spatial orienting behavior toward sound<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"3\" name=\"formbox-field-14\" id=\"formbox-field-14_3\"><label for=\"formbox-field-14_3\">Is not alert to or oriented toward sound<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">10. Dysarthria<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-15\" id=\"formbox-field-15_1\"><label for=\"formbox-field-15_1\">Normal<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-15\" id=\"formbox-field-15_2\"><label for=\"formbox-field-15_2\">Mild or moderate dysarthria. Babbles at least a few words and can be understood with some difficulty<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-15\" id=\"formbox-field-15_3\"><label for=\"formbox-field-15_3\">Severe dysarthria: unintelligible in the absence of aphasia, or disproportionate to the degree of aphasia, or is mute or anarthric<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"9\" name=\"formbox-field-15\" id=\"formbox-field-15_4\"><label for=\"formbox-field-15_4\">Intubated or other physical barrier<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">Ask patients to read or repeat the words on the attached list. If the patient has severe aphasia, the clarity of spontaneous speech articulation can be evaluated. Only if the patient is intubated or has another type of physical barrier to speech production is it scored \"9,\" and the examiner must clearly write an explanation.<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\">11. Extinction (deletion, inattention) and negligence<\/div><div class=\"formbox__body\"><div class=\"formbox__field\" style=\"box-shadow: none\"><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"0\" name=\"formbox-field-16\" id=\"formbox-field-16_1\"><label for=\"formbox-field-16_1\">No alteration<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"1\" name=\"formbox-field-16\" id=\"formbox-field-16_2\"><label for=\"formbox-field-16_2\">Extinction in the face of simultaneous bilateral stimulation or neglect in one of the sensory modalities<\/label><\/div><div class=\"formbox__field-radio\"><input type=\"radio\" value=\"2\" name=\"formbox-field-16\" id=\"formbox-field-16_3\"><label for=\"formbox-field-16_3\">Severe hemi-extinction or neglect of more than one stimulus. Does not recognize your hand or only attends to one side of the space<\/label><\/div><\/div><\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title is-title-only\" style=\"font-size:10px;font-weight:bold\">It is assessed by the patient's reaction to a simultaneous and symmetrical bilateral painful stimulus (extinction), and by their reactions to visual, tactile, auditory, spatial or personal stimuli, in the previous tests (negligence).<\/div> <\/fieldset><fieldset class=\"formbox__container\"><div class=\"formbox__title\"><\/div><div class=\"formbox__body\"><div class=\"formbox__btn\"><button class=\"formbox__btn-calc\">Calculate<\/button><button type=\"reset\" class=\"formbox__btn-reset\">Clean<\/button><\/div><\/div> <\/fieldset>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<fieldset class=\"formbox__container has-result is-hidden\"><div class=\"formbox__title\">Total<\/div><div class=\"formbox__body\"><div class=\"formbox__field is-result\"><label 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