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CANADIAN NEUROLOGICAL SCALE - STROKE ASSESSMENT SYSTEM
Date Level of consciousness O rientation M entation Speech G o to A 1 G o to A 2 M otor Functions: A1 Fac e Symm etrical 0.5 As ymm etrical 0.0 Arm : Proxim al No Communication D efic it Arm : Dis tal Non e 1.5 Mild 1.0 Sign ifican t 0.5 Total 0.0 Non e 1.5 Mild 1.0 Sign ifican t 0.5 Total 0.0 Leg: P roximal None 1 .5 Mild 1.0 Sign ifican t 0.5 Total 0.0 Leg: D istal None 1.5 Mild 1.0 Sign ifican t 0.5 Total 0.0 M otor Response: A2 Com prehens ion D efic it Legs Fac e Symm etrical 0.5 As ymm etrical 0.0 Arm s Equ al 1.5 Un equal 0.0 Eq ual 1.5 Un equal 0.0 Total Score + = r eacts Pu pil Reac tion - = no r eaction Sl = sluggish C = clos ed Left Right Size Reac tion Size Reac tion Tim e-> Alert 3.0 Drow sy 1.5 Or iented 1.0 Disoriented or N /A 0 .0 Norm al 1.0 Rec eptive defic it 0.0 G o to A 1 Expr ess ive deficit 0.5

Hear t Rate Vital Signs Blood Pressure Tem perature Res piration O 2 Satu ration Initials ->

5 9 8.GRAPH TOTAL SCORE OF C ANADIAN NEURO LOGIC SCALE STROKE ASSESSMENT SYSTEM Date: Time-> 11.5 4 3.5 5 4.5 Initials -> ** Plot total points from calculated score directly on the vertical line that corresponds with the total score for each time tested.5 3 2.5 7 6.5 6 5. Draw a line to connect all points.5 11 10.5 10 9.5 8 7. This allows for early recognition of deterioration or improvement in patient’s condition. .5 2 1.

Normal Consciousness ii) Drowsy . .If patient can not answer place and time questions.Effective Use of the Stroke Assessment System (SAS) SAS is only used for the stoke patient who is either alert or drowsy. ask the patient “what do you do with a key?. If the patient names all three objects.) Apply resistance at midpoint between shoulder and elbow. then they are normal speech. Example: hospital or city plus month and year. Monitor for weakness.90 degrees. submit both limbs to same testing. If they answer only 2 or less. ii) Expressive .. Can be slurred but intelligible. and ask patient to elevate arms to 45 . iii) Receptive . Is it symmetrical (even)? Present: Ask the patient to show their teeth and grin.Ask patient to follow three commands: Close your eyes. partial answer or cannot express answer in words or intelligible speech.) Patient makes fists and elevates arms. If it is within first few days of a new month. (C) Speech . point to the ceiling. the previous month is acceptable. key and watch.Testing for speech deficits.) If patient follows all three. Speech can be mispronounced or slurred.To both place and time. Only mark for the side with the greatest deficit or variation. then proceed to expressive deficit testing. (Do not mimic commands.No Comprehension Deficit (Expressive Deficit) NOTE: When evaluating strength and range of motion in limbs. and wiggle toes.None: Ask the patient to show their teeth and grin.and a pencil? If the patient answers all three.Proximal: (Test in sitting position if possible. (A) Face . Section: Mentation (A) Level of Consciousness i) Alert . Ask the patient to name all 3 objects.. If patient makes one or more errors and/or mispronounces words (slurred speech) or non intelligible words (severe dysarthria) record as expressive deficit and proceed to A1. (B) Orientation i) Oriented . ii) Disoriented or Non Applicable .Wakens when stimulated verbally but tends to doze off to sleep. “R” or “L” identifies side with weakness. NOTE: Use the Glasgow Coma Scale for patients who are Stuporous (responds to loud stimuli but does not become alert) or Comatose (responds to deep pain only). then proceed to apply resistance separately to both fists while stabilizing the patient’s arm firmly. Proceed to A1 . with extended wrists. Example: doesn’t know the answer. then they are expressive speech. Check for full range of motion in both wrists. If unable to obey all 3 commands.. score receptive deficit and proceed to section A2 . i) Normal .Distal: (Test in sitting or lying position. Section: A1 Weakness .a watch?. Is it asymmetrical (uneven)? (B) Arm .Answers all questions and commands.Show patient 3 objects: pencil.. Arm . but intelligible.

Comprehension Defect (Receptive Deficit) (A) Face .g.one limb at a time.Patient can maintain the fixed posture equally in both limbs for a few seconds or withdraws equally on both sides to pain.Symmetrical: Ask the patient to show their teeth and grin. Distal: ii) Dorsi Flexion of foot . Note ability to maintain a fixed posture for 3 . Is it symmetrical (even)? . ii) Unequal . Apply resistance to one foot at a time. Section A2 Motor Response . Note ability to maintain a fixed posture for 3 .No detectable weakness ii) Mild .Normal range of motion against gravity but succumbs to resistance either partially or totally.Patient cannot maintain fixed position equally on either side or unequal withdrawal to pain. Is it asymmetrical (uneven)? Note side.Have patient point toes and foot upwards. (B) Arm .Flex thighs with knees flexed at 90 degrees. compare motor response to a noxious stimulus (e. toenail).Have patient flex thighs toward trunk with knees flexed at 90 degrees. . (C) Legs . Apply resistance.Place the arms outstretched at 90 degrees .Absence of motion or only muscle contraction without movement. iii) Significant . If patient is unable to cooperate. one thigh at a time. to test for weakness.Cannot completely overcome gravity in range of motion (only partial movement) iv) Total . to test for weakness. pressure on fingernail. Grading level of Weakness i) None .5 seconds.Section A1 Weakness (Continued) (C) Leg: (Test patient lying in bed) Proximal: i) Hip Flexion .5 seconds. Grading Level of Motor Response: i) Equal . one limb at a time.Asymmetrical: Ask the patient to show their teeth and grin. Facial response (grimacing) to pain is tested by applying pressure to the sternum. Note side.

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