ItemScore
1. Facial palsy
Facial movement is normal, symmetric0
Facial gesture when showing the teeth or smiling is slightly asymmetrical1
Facial gesture when showing the teeth or smiling is completely asymmetrical2
2. Arm motor function
Maintain the arm against gravity >10 seconds0
Maintain the arm against gravity <10 seconds1
Cannot maintain the arm against gravity and drops immediately2
3. Leg motor function
Maintain the leg against gravity >5 seconds0
Maintain the leg against gravity <5seconds1
Cannot maintain the leg against gravity and drops immediately2
4. Head and gaze deviation
Absent0
Present1
5A. Agnosia / Negligence (if left hemiparesis)
Asomatognosia (do not recognize the left part of his/her body)
Anosognosia (do not recognize his/her weakness)
There is no asomatognosia nor anosognosia0
There is asomatognosia or anosognosia1
There is asomatognosia and anosognosia2
5B. Aphasia / Language (if right hemiparesis)
Ask the patient: “Close your eyes” and “Make a fist”
Perform both tasks correctly0
Perform one task correclty1
Perform neither tasks2

You can download the table in pdf.