The Hemispheric Stroke Scale (HSS) of Adams et al

eyes open

spontaneously

4

to speech

3

to pain

2

does not open

1

best verbal response

oriented

5

confused

4

inappropriate

3

incomprehensible

2

none

1

best motor response

obeys commands

6

localizes pain

5

flexion withdrawal

4

flexion to pain

3

extension to pain

2

no response to pain

1

comprehension

can do all 3

0

can do 2

2

can do 1

4

none

5

naming

can name 3 items

0

can name 2 items

3

can name 1 item

4

cannot name any of the items

5

repetition

can repeat all 3

0

can repeat 2

2

can repeat 1

4

cannot repeat any

5

fluency

normal

0

mild decrease

1

moderately severe decrease

3

essentially no verbal output

5

visual fields

normal

0

mild defect (cannot detect 2 simultaneous stimulations)

1

moderate (can see a moving finger but not a stationary one)

2

severe (unable to recognize a moving hand; no response to threat)

3

gaze

normal

0

gaze preference or difficulty with far lateral gaze

1

gaze palsy or persistent deviation

2

facial expression

normal

0

mild (asymmetry on smile)

1

moderate (asymmetry at rest)

2

severe (drooling)

3

dysarthria

normal (none)

0

moderate

1

severe

2

dysphonia

normal (none)

0

moderate

1

severe

2

neglect syndrome

can bisect a line in the middle

0

deviates towards good side when tries to bisect a line

1

anosognosia or denial of body part

2

visual construction

can copy a 3 dimensional cube

0

can copy a cross

1

can copy a square

2

cannot copy any of the above figures

3

muscle strength affected side, proximal arm

normal

0

positive drift with arm outstretched

1

mild weakness

2

moderate weakness

3

moves against gravity but no resistance

4

motion without gravity

5

trace movement only

6

no movement

7

distal arm

normal

0

positive drift with arm outstretched

1

mild weakness

2

moderate weakness

3

moves against gravity but no resistance

4

motion without gravity

5

trace movement only

6

no movement

7

proximal leg

normal

0

positive drift with leg outstretched

1

mild weakness

2

moderate weakness

3

moves against gravity but no resistance

4

motion without gravity

5

trace movement only

6

no movement

7

distal leg

normal

0

positive drift with leg outstretched

1

mild weakness

2

moderate weakness

3

moves against gravity but no resistance

4

motion without gravity

5

trace movement only

6

no movement

7

deep tendon reflexes

normal

0

hyperactive

2

hypoactive

2

pathologic reflexes

normal

0

Babinski OR other pathologic reflex

1

Babinski AND other pathologic reflex

2

muscle tone

normal

0

increased

2

decreased

2

gait

normal

0

minimally abnormal

1

mildly abnormal; can walk without assistance but with reduced speed

2

moderately abnormal; no assistance other than a cane required but distance limited

3

severely abnormal; walking distance limited even with support

4

can stand with support but cannot walk

5

unable to stand unsupported or cannot evaluate

6

upper extremity

normal

0

mild hypesthesia or dysethesia

1

moderate hypesthesia or deficit

2

extinction

2

severe hypesthesia

3

anesthesia

4

lower extremity

normal

0

mild hypesthesia or dysethesia

1

moderate hypesthesia or deficit

2

extinction

2

severe hypesthesia

3

anesthesia

4

stereognosis

can distinguish a penny from a nickel

0

can distinguish a penny from a quarter

1

can distinguish a coin from a key

2

unable to distinguish

3