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What is the National Stroke Association NIH Stroke Scale (NIHSS) Certification Services?
National Stroke Association offers a paper version of the NIHSS exam that corresponds with the NINDS/NIH exam DVD. The paper version is a scantron exam that must be ordered through National Stroke Association. Click here for an order form and fact sheet.

National Stroke Association offers certification in NIHSS through two delivery mechanisms:

1.) Training and testing on-line with instant results, CME and Certificate. Click here to access online training and testing module. Please call the help line at (512)302-3113 or email campushelp@trainingcampus.com with any questions about the online system, including forgotten passwords, CME, re-printing certificates, etc.

2.) Training by NINDS/NIH DVD, and corresponding scantron exams provided by National Stroke Association for individual or classroom/group training and testing. Click for scantron exams order form and fact sheet.

National Stroke Association Stroke Center Network (SCN) members may order copies of the exam at no charge, which includes scoring and certificates of completion. Nonmembers pay $25 per exam. For more information on how to become an SCN member, contact pmembers@stroke.org or 303-754-0934.

The NINDS/NIH training and testing DVD can be obtained by contacting the National Institute of Neurological Disorders and Stroke at 1-800-352-9424 or the NINDS/NIH website.

How often should I renew my certification?
Currently there are no national standards in place as to how often an individual needs to re-certify for the NIH Stroke Scale. Hospital and clinical trial organizations determine their own protocol on certification standards. Although National Stroke Association recommends certification every 6 months, the average re-certification is 1 year. Some centers train and test their RNs on the NIHSS as a part of annual stroke nurse competencies.

The NINDS t-PA Study Trial Group initially certified its stroke trial investigators with the First Certification Tape (when tapes were available) and re-certified using the Second Certification Tape six months later. If your site is part of a clinical trial, it is up to the trial sponsor to set these guidelines. In the research arena, it is most common to certify yearly.

Where do I obtain the NIHSS Training and Testing DVD?
The NINDS/NIH training and testing DVD can be obtained from the National Institute of Neurological Disorders and Stroke. The cost of the 2-DVD set is $50. To order a DVD please call 1-800-352-9424 or visit the NINDS/NIH website

What is the NIHSS? The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit.  The NIHSS was originally designed as a research tool to measure baseline data on patients in acute stroke clinical trials.  Now, the scale is also widely used as a clinical assessment tool to evaluate acuity of stroke patients, determine appropriate treatment, and predict patient outcome. 

How long does it take to perform the NIHSS?
Performing the scale takes between 5-8 minutes.

Why should I become proficient at administering the NIHSS?
The NIHSS can be used as a clinical stroke assessment tool to evaluate and document neurological status in acute stroke patients. The stroke scale is valid for predicting lesion size and can serve as a measure of stroke severity. The NIHSS has been shown to be a predictor of both short and long term outcome of stroke patients. Additionally, the stroke scale serves as a data collection tool for planning patient care and provides a common language for information exchanges among healthcare providers. 

Who should perform the NIHSS?
The scale is designed to be a simple, valid, and reliable tool that can be administered at the bedside consistently by physicians, nurses or therapists.

When should I perform the NIHSS?
During the original t-PA clinical trial the NIHSS was completed at baseline prior to treatment, at 2 hours post-treatment, at 24 hours, at 7-10 days, and at 3 months. Today, hospital protocols vary in the frequency with which they perform the scale on acute stroke patients.

According to Laura Sauerbeck, Assistant Professor of Research at the Universityof Cincinnati, “The NIHSS should always be performed at baseline in the emergency room because of its tremendous predictive value. It should be performed again in conjunction with t-PA or other therapies, and should be repeated often in the first 24 hours. At the very least, the scale should be used at discharge and on a daily basis during a patient’s hospital stay to measure the effect of your treatments on the patients.”

Who should be certified to perform the NIHSS?
This decision is usually institutional but emergency physicians and nurses, neurologists, neuroscience nurses and other stroke team members are typical examples of who should be certified to perform the NIHSS.

How do I train my staff on administering the NIHSS?
Hospitals have a variety of different ways to train their staff on administering the NIHSS. With the advent of online training and testing, many clinicians prefer to certify individually and may learn better from their homes or offices. Some centers offer in-depth, classroom-style training. The following are a few examples of NIHSS training techniques from top Stroke Center Network sites.

University of Cincinnati, Cincinnati, OH
“Clinicians at the University Hospital are trained and tested on the NIHSS in a 3-hour classroom-style setting. The teacher utilizes the Quick and Easy video and stops to discuss each patient. Clinicians either take the exam in the classroom using the paper or online version. The University Hospital trains all staff nurses, residents, and faculty on the stroke team.”

Laura Sauerbeck, Assistant Professor of Research

Integris Southwest Medical Center, Oklahoma City, OK
“Integris offers its stroke team a 3-tiered NIHSS training. The first tier is an interactive group learning session that utilizes the NIHSS exam video tapes. The instructor shows a patient, stops the video, and as a group, everyone discusses and scores the patients together. I call this "debate and defend" your scores. I make this fun with prizes for those who get the score closest to the instructor. The second tier of training is a peer learning experience where the clinician practices administering the scale on actual patients with the instructor/mentor present. The last tier is back in the classroom and clinicians test as a group using the exam tapes and the paper version of the NIHSS exam. I find this 3-tiered training to be highly effective in cementing this skill into the learners. This system allows for questions, interaction with peers, and is highly iterative. We train all of our stroke nurses, neurologists and emergency medicine physicians.” 

Leigh Ann Morrill, Stroke Coordinator

Mid America Brain and Stroke Institute, Kansas City, MO
“We train all of our new stroke nursing staff on the NIHSS. This includes emergency medicine, neuroscience, medical ICU, and stroke center nurses. Our training is completed in one day and takes about 3 hours. First, I have developed a Power Point presentation that discusses the purpose of the scale and its utility as a complete neurological assessment tool. The NIHSS also can be used as a means to assess patients for rehabilitation and we use this data to guide the family in decision making. The second component of our training uses the NIH/NINDS training DVD and as a class we discuss the scoring of sample patients. Over the course of 3 months the nurses practice on stroke cases with a certified NIHSS clinician present. After about 3 months everyone takes the exam. I present the NIHSS training as a learning tool rather than a required task. I emphasize the benefit of delivering better patient care by being able to communicate with the neurologists through the common language of the NIHSS.”

Debbie Summers, Stroke Program Coordinator 



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