Signature/ Status Initials

CANADIAN NEUROLOGICAL SCALE - STROKE ASSESSMENT SYSTEM

Date Tim e->
Level of consciousness Alert 3.0
Drow sy 1.5
O rientation Or iented 1.0
M entation
Disoriented or N /A 0 .0
Speech G o to A 1 Norm al 1.0
G o to A 1 Expr ess ive deficit 0.5
G o to A 2 Rec eptive defic it 0.0
M otor Functions:
A1 Fac e Symm etrical 0.5
As ymm etrical 0.0
Arm : Proxim al Non e 1.5

No Mild 1.0

Commu- Sign ifican t 0.5

nication Total 0.0

D efic it Arm : Dis tal 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 Fac e Symm etrical 0.5
As ymm etrical 0.0
Com pre- Arm s Equ al 1.5
hens ion Un equal 0.0
D efic it Legs Eq ual 1.5
Un equal 0.0
Total Score
+ = r eacts Right Size
Pu pil - = no r eaction Reac tion
Reac tion Sl = sluggish Left Size
C = clos ed Reac tion

Hear t Rate
Vital Blood Pressure
Signs Tem perature
Res piration
O 2 Satu ration
Initials ->
 GRAPH TOTAL SCORE OF C ANADIAN NEURO LOGIC SCALE
STROKE ASSESSMENT SYSTEM

Date: Time->
11.5
11
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5

Initials ->

** Plot total points from calculated score directly on the vertical line that corresponds with the total
score for each time tested. Draw a line to connect all points. This allows for early recognition of
deterioration or improvement in patient’s condition.
 Effective Use of the Stroke Assessment System (SAS)

SAS is only used for the stoke patient who is either alert or drowsy.
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).

Section: Mentation

(A) Level of Consciousness

i) Alert - Normal Consciousness
ii) Drowsy - Wakens when stimulated verbally but tends to doze off to sleep.

(B) Orientation
i) Oriented - To both place and time. Example: hospital or city plus month and year. If it is within
first few days of a new month, the previous month is acceptable. Speech can be
mispronounced or slurred, but intelligible.
ii) Disoriented or Non Applicable - If patient can not answer place and time questions. Example:
doesn’t know the answer, partial answer or cannot express answer in words or intelligible
speech.

(C) Speech - Testing for speech deficits.

i) Normal - Answers all questions and commands. Can be slurred but intelligible. Proceed to A1 .

ii) Expressive - Show patient 3 objects: pencil, key and watch. 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. If the
patient names all three objects, ask the patient “what do you do with a key?...a watch?...and
a pencil? If the patient answers all three, then they are normal speech. If they answer only 2
or less, then they are expressive speech.

iii) Receptive - Ask patient to follow three commands: Close your eyes, point to the ceiling, and
wiggle toes. (Do not mimic commands.) If patient follows all three, then proceed to expressive
deficit testing. If unable to obey all 3 commands, score receptive deficit and proceed to section
A2 .

Section: A1 Weakness - No Comprehension Deficit (Expressive Deficit)

NOTE: When evaluating strength and range of motion in limbs, submit both limbs to same testing. “R”
or “L” identifies side with weakness. Only mark for the side with the greatest deficit or variation.

(A) Face - None: Ask the patient to show their teeth and grin. Is it symmetrical (even)?
Present: Ask the patient to show their teeth and grin. Is it asymmetrical (uneven)?

(B) Arm - Proximal: (Test in sitting position if possible.) Apply resistance at midpoint between shoulder
and elbow, and ask patient to elevate arms to 45 - 90 degrees. Monitor for weakness.

Arm - Distal: (Test in sitting or lying position.) Patient makes fists and elevates arms, with extended
wrists. Check for full range of motion in both wrists, then proceed to apply resistance
separately to both fists while stabilizing the patient’s arm firmly.
Section A1 Weakness (Continued)

(C) Leg: (Test patient lying in bed)

Proximal: i) Hip Flexion - Have patient flex thighs toward trunk with knees flexed at 90 degrees.
Apply resistance, one thigh at a time, to test for weakness.
Distal: ii) Dorsi Flexion of foot - Have patient point toes and foot upwards. Apply resistance
to one foot at a time, to test for weakness.

Grading level of Weakness

i) None - No detectable weakness
ii) Mild - Normal range of motion against gravity but succumbs to
resistance either partially or totally.
iii) Significant - Cannot completely overcome gravity in range of motion
(only partial movement)
iv) Total - Absence of motion or only muscle contraction without movement.

Section A2 Motor Response - Comprehension Defect (Receptive Deficit)

(A) Face - Symmetrical: Ask the patient to show their teeth and grin. Is it symmetrical (even)?
- Asymmetrical: Ask the patient to show their teeth and grin. Is it asymmetrical (uneven)?
Note side.

(B) Arm - Place the arms outstretched at 90 degrees - one limb at a time. Note ability to maintain a
fixed posture for 3 - 5 seconds.

(C) Legs - Flex thighs with knees flexed at 90 degrees, one limb at a time. Note ability to maintain a
fixed posture for 3 - 5 seconds.

If patient is unable to cooperate, compare motor response to a noxious stimulus (e.g. pressure on
fingernail, toenail). Facial response (grimacing) to pain is tested by applying pressure to the sternum.

Grading Level of Motor Response:

i) Equal - Patient can maintain the fixed posture equally in both limbs for a few seconds or withdraws
equally on both sides to pain.
ii) Unequal - Patient cannot maintain fixed position equally on either side or unequal withdrawal to
pain. Note side.