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Hemispheric Stroke Scale


R.J. Adams, K.J. Meador, K.D. Sethi, J.C. Grotta, D.S. Thomson (1986)

Background and Development:

The HSS is a graded neurologic assessment instrument and was designed for noncomatose adults with signs of acute ischemia or infarction in carotid circulation.  The HSS includes the Glasgow Coma Scale because the GCS is an accepted method for assessing the level of consciousness in neurologically impaired patients.  The score from the GCS is inverted so that higher scores equate to more severe symptoms.  The resulting GCS score (0-12) is combined with scores from other sections that assess deficiencies in Language (0-20), visual fields, neglect, and cranial nerve function (0-17), motor function (0-40), and sensory function (0-11) yielding a total score (0-100).  Although motor examination is emphasized, the HSS includes assessment of both dominant and nondominant hemisphere functions.  Unlike a complete neurologic examination, the HSS is specifically designed to examine the deficits found in this patient population.

Validation in Elderly Populations:

The initial tested population ranged in age from 35 to 80 years.   Patients were examined by two clinicians and many of them had an additional exam 5-15 days later.  Interobserver reliability of the five factors ranged from 0.75 to 0.95, with overall reliability of 0.95. Correlation of the overall score with the Barthel Index is high.

Validation in Minority Populations:

The HSS was not validated specifically with minority populations.

Subsequent Studies:

Formisano et al. (2005) and Clarke et al. (1999) have used the HSS to assess changes in ability in patients recovering from strokes.

Design Strengths and Weaknesses:

The HSS was designed so that clinicians in different facilities would be able to assess stroke patients using a common format that varies little between observers.

Contact Information:

The HSS is published as three figures in Adams et al. (1986).


R.J. Adams, K.J. Meador, K.D. Sethi, J.C. Grotta, D.S. Thomson (1986) Graded neurologic scale for the use in acute hemispheric stroke treatment protocols. Stroke 18, 665-669.

Formisano R. Pantano P. Buzzi MG. Vinicola V. Penta F. Barbanti P. Lenzi GL (2005) Late motor recovery is influenced by muscle tone changes after stroke. Archives of Physical Medicine & Rehabilitation. 86(2):308-11.

Clarke PJ. Black SE. Badley EM. Lawrence JM. Williams JI (1999) Handicap in stroke survivors. Disability & Rehabilitation. 21(3):116-23.

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