Archetype : openEHR-EHR-OBSERVATION.nihss

Modellbiblioteket openEHR Fork

Name

NIH Stroke Scale (NIHSS)

Description

15-item neurologic examination stroke scale that provides a quantitative measure of stroke-related neurological deficit.

Keywords

scale neurological stroke assessment examination NIHSS

Purpose

To record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.

Use

Use to record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.

The total score is the arithmetic sum of all 15 responses, excluding any untestable responses.

References

NIH Stroke Scale [Internet]. Bethesda, MD: National Institute of Health; [cited 2023 Mar 04]. Available from: https://www.stroke.nih.gov/resources/scale.htm.

Validated translation of the NIHSS with cultural adaptation [Internet]. Sykepleien Forskning; [cited 2023 Mar 04]. Available from: https://sykepleien.no/forskning/2020/11/validert-oversettelse-av-nihss-med-kulturell-tilpasning

Archetype Id

openEHR-EHR-OBSERVATION.nihss.v0

Licencing

This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.

Original Author

Gustavo M Bacelar-Silva
Healthcare Designs

Date Originally Authored

To record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.

Language	Details
Norwegian Bokmal	Mikkel Johan Gaup Grønmo Regional forvaltning EPJ, Helse Nord
Portuguese (Brazil)	Osmeire Chamelette Sanzovo

Name	Card	Type	Description
LOC responsiveness	0..1	DV_ORDINAL	Observed level of consciousness of the patient. Constraint for DV_ORDINAL 0 : Alert 1 : Not alert, but arousable by minor stimulation 2 : Not alert, requires repeated stimulation or strong stimuli. 3 : Reflex reponses only or totally unreponsive
LOC questions	0..1	DV_ORDINAL	The patient is asked the month and his/her age. Constraint for DV_ORDINAL 0 : Both correct 1 : One correct 2 : Neither correct
LOC commands	0..1	DV_ORDINAL	The patient is asked to open and close the eyes and then to grip and release the non-paretic hand. Constraint for DV_ORDINAL 0 : Both correct 1 : One correct 2 : Neither correct
Horizontal eye movements	0..1	DV_ORDINAL	Horizontal eye movement observation. Constraint for DV_ORDINAL 0 : Normal 1 : Partial gaze palsy 2 : Forced deviation or total gaze paresis
Visual fields	0..1	DV_ORDINAL	Visual field test observation. Constraint for DV_ORDINAL 0 : No visual loss 1 : Partial hemianopia 2 : Complete hemianopia 3 : Bilateral hemianopia
Facial palsy	0..1	DV_ORDINAL	Facial palsy observation. Constraint for DV_ORDINAL 0 : Normal 1 : Minor paralysis 2 : Partial paralysis 3 : Complete paralysis of one or both sides
Motor - left arm	0..1	DV_ORDINAL	Observation of left arm motor function. Comment Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : No drift 1 : Drift 2 : Some effort against gravity 3 : No effort against gravity 4 : No movement 0 : UNTESTABLE
Reason left arm untestable	0..1	DV_TEXT	Narrative description about why the left arm motor function was untestable.
Motor - right arm	0..1	DV_ORDINAL	Observation of right arm motor function. Comment Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : No drift 1 : Drift 2 : Some effort against gravity 3 : No effort against gravity 4 : No movement 0 : UNTESTABLE
Reason right arm untestable	0..1	DV_TEXT	Narrative description about why the right arm motor function was untestable.
Motor - left leg	0..1	DV_ORDINAL	Observation of left leg motor function. Comment Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left leg untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : No drift 1 : Drift 2 : Some effort against gravity 3 : No effort against gravity 4 : No movement 0 : UNTESTABLE
Reason left leg untestable	0..1	DV_TEXT	Narrative description about why the left leg motor function was untestable.
Motor - right leg	0..1	DV_ORDINAL	Observation of right leg motor function. Comment Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right leg untestable' data element Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : No drift 1 : Drift 2 : Some effort against gravity 3 : No effort against gravity 4 : No movement 0 : UNTESTABLE
Reason right leg untestable	0..1	DV_TEXT	Narrative description about why the right leg motor function was untestable.
Limb ataxia	0..1	DV_ORDINAL	Observation of limb ataxia as evidence of a unilateral cerebellar lesion. Only in the case of amputation or joint fusion, the examiner should record the score as untestable (UN)and record the reason in the 'Reason limb ataxia untestable' data element. Comment Only in the case of amputation or joint fusion, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason limb ataxia untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : Absent 1 : Present in one limb 2 : Present in two limbs 0 : UNTESTABLE
Reason limb ataxia untestable	0..1	DV_TEXT	Narrative description about why limb ataxia was untestable.
Sensory	0..1	DV_ORDINAL	Observation of sensory loss. Constraint for DV_ORDINAL 0 : Normal 1 : Mild-to-moderate sensory loss 2 : Severe or total sensory loss
Language	0..1	DV_ORDINAL	Observation of language capability. Constraint for DV_ORDINAL 0 : No aphasia 1 : Mild-to-moderate aphasia 2 : Severe aphasia 3 : Mute, global aphasia
Speech	0..1	DV_ORDINAL	Observation about speech capability. Comment Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason speech untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. Constraint for DV_ORDINAL 0 : Normal 1 : Mild-to-moderate dysarthria 2 : Severe dysarthria 0 : UNTESTABLE
Reason speech untestable	0..1	DV_TEXT	Narrative description about why speech was untestable.
Extinction and inattention	0..1	DV_ORDINAL	Observation of any evidence of extinction or inattention. Comment Also known as 'neglect'. Constraint for DV_ORDINAL 0 : No abnormality 1 : Inattention, or bilateral extinction in one sensory modality 2 : Profound hemi-inattention or extinction to more than one modality
Total score	0..1	DV_COUNT	The total score is the arithmetic sum of all 15 responses, excluding any untestable responses. Constraint for DV_COUNT min: >= 0; max: <= 42

Name	Card	Type	Description
Extension	0..*	Slot (Cluster)	Additional information required to extend the model with local content or to align with other reference models or formalisms. Comment For example: local information requirements; or additional metadata to align with FHIR. Slot Slot

archetype (adl_version=1.4; uid=6359150e-4104-4044-b81d-855ba7c4b643)
	openEHR-EHR-OBSERVATION.nihss.v0

concept
	[at0000]	-- NIH Stroke Scale (NIHSS)
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["nb"] = <
			language = <[ISO_639-1::nb]>
			author = <
				["name"] = <"Mikkel Johan Gaup Grønmo">
				["organisation"] = <"Regional forvaltning EPJ, Helse Nord">
				["email"] = <"mikkel.johan.gaup.gronmo@helse-nord.no">
			>
			accreditation = <"Nasjonal IKT">
		>
		["pt-br"] = <
			language = <[ISO_639-1::pt-br]>
			author = <
				["name"] = <"Osmeire Chamelette Sanzovo">
				["email"] = <"osmeire.acsanzovo@hsl.org.br">
			>
		>
	>
description
	original_author = <
		["name"] = <"Gustavo M Bacelar-Silva">
		["organisation"] = <"Healthcare Designs">
		["email"] = <"mail@gustavobacelar.com">
		["date"] = <"2012-05-11">
	>
	details = <
		["nb"] = <
			language = <[ISO_639-1::nb]>
			purpose = <"For å registrere resultat av National Institutes of Health Stroke Score som en kvantitativ måling av slag-relaterte nevrologiske avvik.">
			use = <"Brukes for å registrere resultat av National Institutes of Health Stroke Score som en kvantitativ måling av slag-relaterte nevrologiske avvik.

Total skåren er en aritmetisk sum av alle 15 svarene, med alle Ikke testbar verdier ekskludert.">
			keywords = <"skala", "nevrologisk", "hjerneslag", "vurdering", "undersøkelse", "NIHSS", "pakkeforløp">
			misuse = <"">
			copyright = <"© openEHR Foundation">
		>
		["pt-br"] = <
			language = <[ISO_639-1::pt-br]>
			purpose = <"Para registrar uma medição sistemática quantitativa de déficit neurológico relacionados ao acidente vascular cerebral. A NIHSS foi originalmente concebida como uma ferramenta de pesquisa para medir os dados de referência sobre doentes em ensaios clínicos de AVC agudo. Atualmente, a escala é também amplamente utilizada como uma ferramenta de avaliação clínica para avaliar a acuidade dos pacientes com AVC, determinar o tratamento adequado e prever o resultado do paciente.">
			use = <"*Use to record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.

The total score is the arithmetic sum of all 15 responses, excluding any untestable responses. (en)">
			keywords = <"escala", "neurológico", "acidente vascular cerebral", "avaliação", "exame">
			misuse = <"">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.">
			use = <"Use to record the results of the National Institutes of Health Stroke Score as a quantitative measurement of stroke-related neurologic deficit.

The total score is the arithmetic sum of all 15 responses, excluding any untestable responses.">
			keywords = <"scale", "neurological", "stroke", "assessment", "examination", "NIHSS">
			misuse = <"">
			copyright = <"© openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Mikkel Johan Gaup Grønmo, Regional forvaltning EPJ, Helse Nord,  Norway (openEHR Editor)", "Gustavo Bacelar-Silva, Healthcare Designs, Portugal", "Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor)", "Rong Chen, Cambio Healthcare Systems, Sweden", "Ricardo Cruz-Correia, Faculty of Medicine of Porto University, Portugal", "Heather Leslie, Atomica Informatics, Australia (openEHR Editor)">
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"NIH Stroke Scale [Internet]. Bethesda, MD: National Institute of Health; [cited 2023 Mar 04].  Available from: https://www.stroke.nih.gov/resources/scale.htm.

Validated translation of the NIHSS with cultural adaptation [Internet]. Sykepleien Forskning; [cited 2023 Mar 04]. Available from: https://sykepleien.no/forskning/2020/11/validert-oversettelse-av-nihss-med-kulturell-tilpasning">
		["current_contact"] = <"Heather Leslie, Atomica Informatics<heather.leslie@atomicainformatics.com>">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"64079E512797368E7F78AF96E18C14A5">
		["build_uid"] = <"c6f59529-59e3-434c-a9de-15cfda83fd5f">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- NIH Stroke Scale (NIHSS)
		data matches {
			HISTORY[at0001] matches {    -- History
				events cardinality matches {1..*; unordered} matches {
					POINT_EVENT[at0002] occurrences matches {0..1} matches {    -- Baseline
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- LOC responsiveness
										value matches {
											0|[local::at0005],
											1|[local::at0006],
											2|[local::at0007],
											3|[local::at0008]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- LOC questions
										value matches {
											0|[local::at0010],
											1|[local::at0011],
											2|[local::at0012]
										}
									}
									ELEMENT[at0013] occurrences matches {0..1} matches {    -- LOC commands
										value matches {
											0|[local::at0014],
											1|[local::at0015],
											2|[local::at0016]
										}
									}
									ELEMENT[at0017] occurrences matches {0..1} matches {    -- Horizontal eye movements
										value matches {
											0|[local::at0018],
											1|[local::at0019],
											2|[local::at0020]
										}
									}
									ELEMENT[at0021] occurrences matches {0..1} matches {    -- Visual fields
										value matches {
											0|[local::at0022],
											1|[local::at0023],
											2|[local::at0024],
											3|[local::at0025]
										}
									}
									ELEMENT[at0026] occurrences matches {0..1} matches {    -- Facial palsy
										value matches {
											0|[local::at0027],
											1|[local::at0028],
											2|[local::at0029],
											3|[local::at0030]
										}
									}
									ELEMENT[at0031] occurrences matches {0..1} matches {    -- Motor - left arm
										value matches {
											0|[local::at0032],
											1|[local::at0033],
											2|[local::at0034],
											3|[local::at0124],
											4|[local::at0035],
											0|[local::at0036]
										}
									}
									ELEMENT[at0037] occurrences matches {0..1} matches {    -- Reason left arm untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0038] occurrences matches {0..1} matches {    -- Motor - right arm
										value matches {
											0|[local::at0039],
											1|[local::at0040],
											2|[local::at0041],
											3|[local::at0042],
											4|[local::at0043],
											0|[local::at0044]
										}
									}
									ELEMENT[at0045] occurrences matches {0..1} matches {    -- Reason right arm untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0046] occurrences matches {0..1} matches {    -- Motor - left leg
										value matches {
											0|[local::at0047],
											1|[local::at0048],
											2|[local::at0049],
											3|[local::at0050],
											4|[local::at0051],
											0|[local::at0052]
										}
									}
									ELEMENT[at0053] occurrences matches {0..1} matches {    -- Reason left leg untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0141] occurrences matches {0..1} matches {    -- Motor - right leg
										value matches {
											0|[local::at0054],
											1|[local::at0055],
											2|[local::at0056],
											3|[local::at0057],
											4|[local::at0058],
											0|[local::at0059]
										}
									}
									ELEMENT[at0060] occurrences matches {0..1} matches {    -- Reason right leg untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0061] occurrences matches {0..1} matches {    -- Limb ataxia
										value matches {
											0|[local::at0062],
											1|[local::at0063],
											2|[local::at0064],
											0|[local::at0065]
										}
									}
									ELEMENT[at0066] occurrences matches {0..1} matches {    -- Reason limb ataxia untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0067] occurrences matches {0..1} matches {    -- Sensory
										value matches {
											0|[local::at0068],
											1|[local::at0069],
											2|[local::at0070]
										}
									}
									ELEMENT[at0071] occurrences matches {0..1} matches {    -- Language
										value matches {
											0|[local::at0072],
											1|[local::at0073],
											2|[local::at0074],
											3|[local::at0075]
										}
									}
									ELEMENT[at0076] occurrences matches {0..1} matches {    -- Speech
										value matches {
											0|[local::at0077],
											1|[local::at0078],
											2|[local::at0079],
											0|[local::at0080]
										}
									}
									ELEMENT[at0081] occurrences matches {0..1} matches {    -- Reason speech untestable
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0082] occurrences matches {0..1} matches {    -- Extinction and inattention
										value matches {
											0|[local::at0083],
											1|[local::at0084],
											2|[local::at0085]
										}
									}
									ELEMENT[at0086] occurrences matches {0..1} matches {    -- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..42|}
											}
										}
									}
								}
							}
						}
					}
					POINT_EVENT[at0087] occurrences matches {0..1} matches {    -- 2 hours post treatment
						data matches {
							use_node ITEM_TREE /data[at0001]/events[at0002]/data[at0003]
						}
					}
					POINT_EVENT[at0088] occurrences matches {0..1} matches {    -- 24 hours post symptom onset
						data matches {
							use_node ITEM_TREE /data[at0001]/events[at0002]/data[at0003]
						}
					}
					POINT_EVENT[at0089] occurrences matches {0..1} matches {    -- 7–10 days
						data matches {
							use_node ITEM_TREE /data[at0001]/events[at0002]/data[at0003]
						}
					}
					POINT_EVENT[at0090] occurrences matches {0..1} matches {    -- 3 months
						data matches {
							use_node ITEM_TREE /data[at0001]/events[at0002]/data[at0003]
						}
					}
					EVENT[at0091] occurrences matches {0..*} matches {    -- Any event
						data matches {
							use_node ITEM_TREE /data[at0001]/events[at0002]/data[at0003]
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0092] matches {    -- Item tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0093] occurrences matches {0..*} matches {    -- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}




ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"NIH Stroke Scale (NIHSS)">
					description = <"15-item neurologic examination stroke scale that provides a quantitative measure of stroke-related neurological deficit.">
				>
				["at0001"] = <
					text = <"History">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Baseline">
					description = <"Baseline assessment.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"LOC responsiveness">
					description = <"Observed level of consciousness of the patient.">
				>
				["at0005"] = <
					text = <"Alert">
					description = <"Keenly responsive.">
				>
				["at0006"] = <
					text = <"Not alert, but arousable by minor stimulation">
					description = <"Not alert; but arousable by minor stimulation to obey, answer or respond.">
				>
				["at0007"] = <
					text = <"Not alert, requires repeated stimulation or strong stimuli.">
					description = <"Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements.">
				>
				["at0008"] = <
					text = <"Reflex reponses only or totally unreponsive">
					description = <"Responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid, and areflexic.">
				>
				["at0009"] = <
					text = <"LOC questions">
					description = <"The patient is asked the month and his/her age.">
				>
				["at0010"] = <
					text = <"Both correct">
					description = <"Patient answered both questions correctly.">
				>
				["at0011"] = <
					text = <"One correct">
					description = <"Patient answered one question correctly or is unable to communicate because of a problem not secondary to aphasia.">
				>
				["at0012"] = <
					text = <"Neither correct">
					description = <"Patient answered neither question correctly or is comatose or does not comprehend the question.">
				>
				["at0013"] = <
					text = <"LOC commands">
					description = <"The patient is asked to open and close the eyes and then to grip and release the non-paretic hand.">
				>
				["at0014"] = <
					text = <"Both correct">
					description = <"Patient performs both tasks correctly.">
				>
				["at0015"] = <
					text = <"One correct">
					description = <"Patient performs one task correctly.">
				>
				["at0016"] = <
					text = <"Neither correct">
					description = <"Patient performs neither task correctly.">
				>
				["at0017"] = <
					text = <"Horizontal eye movements">
					description = <"Horizontal eye movement observation.">
				>
				["at0018"] = <
					text = <"Normal">
					description = <"Normal eye movement.">
				>
				["at0019"] = <
					text = <"Partial gaze palsy">
					description = <"Gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.">
				>
				["at0020"] = <
					text = <"Forced deviation or total gaze paresis">
					description = <"Forced deviation or total gaze paresis is not overcome by the oculocephalic maneuver.">
				>
				["at0021"] = <
					text = <"Visual fields">
					description = <"Visual field test observation.">
				>
				["at0022"] = <
					text = <"No visual loss">
					description = <"No visual loss detected.">
				>
				["at0023"] = <
					text = <"Partial hemianopia">
					description = <"Partial hemianopia or complete quadrantanopia detected.">
				>
				["at0024"] = <
					text = <"Complete hemianopia">
					description = <"Complete hemianopia detected.">
				>
				["at0025"] = <
					text = <"Bilateral hemianopia">
					description = <"Blindness from any cause, including cortical blindness.">
				>
				["at0026"] = <
					text = <"Facial palsy">
					description = <"Facial palsy observation.">
				>
				["at0027"] = <
					text = <"Normal">
					description = <"Normal symmetrical movements.">
				>
				["at0028"] = <
					text = <"Minor paralysis">
					description = <"Flattened nasolabial fold, asymmetry on smiling.">
				>
				["at0029"] = <
					text = <"Partial paralysis">
					description = <"Total or near-total paralysis of lower face.">
				>
				["at0030"] = <
					text = <"Complete paralysis of one or both sides">
					description = <"Absence of facial movement in the upper and lower face.">
				>
				["at0067"] = <
					text = <"Sensory">
					description = <"Observation of sensory loss.">
				>
				["at0068"] = <
					text = <"Normal">
					description = <"No sensory loss.">
				>
				["at0069"] = <
					text = <"Mild-to-moderate sensory loss">
					description = <"Patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched.">
				>
				["at0070"] = <
					text = <"Severe or total sensory loss">
					description = <"Patient is not aware of being touched in the face, arm, and leg.">
				>
				["at0071"] = <
					text = <"Language">
					description = <"Observation of language capability.">
				>
				["at0072"] = <
					text = <"No aphasia">
					description = <"Normal">
				>
				["at0073"] = <
					text = <"Mild-to-moderate aphasia">
					description = <"Some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression.">
				>
				["at0074"] = <
					text = <"Severe aphasia">
					description = <"All communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener.">
				>
				["at0075"] = <
					text = <"Mute, global aphasia">
					description = <"No usable speech or auditory comprehension.">
				>
				["at0082"] = <
					text = <"Extinction and inattention">
					description = <"Observation of any evidence of extinction or inattention.">
					comment = <"Also known as 'neglect'.">
				>
				["at0083"] = <
					text = <"No abnormality">
					description = <"No abnormality observed.">
				>
				["at0084"] = <
					text = <"Inattention, or bilateral extinction in one sensory modality">
					description = <"Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities.">
				>
				["at0085"] = <
					text = <"Profound hemi-inattention or extinction to more than one modality">
					description = <"Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space.">
				>
				["at0086"] = <
					text = <"Total score">
					description = <"The total score is the arithmetic sum of all 15 responses, excluding any untestable responses.">
				>
				["at0092"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0031"] = <
					text = <"Motor - left arm">
					description = <"Observation of left arm motor function.">
					comment = <"Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0032"] = <
					text = <"No drift">
					description = <"Limb holds 90 (or 45) degrees for full 10 seconds.">
				>
				["at0033"] = <
					text = <"Drift">
					description = <"Limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.">
				>
				["at0034"] = <
					text = <"Some effort against gravity">
					description = <"Limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.">
				>
				["at0124"] = <
					text = <"No effort against gravity">
					description = <"Limb falls.">
				>
				["at0035"] = <
					text = <"No movement">
					description = <"There is no observed limb movement.">
				>
				["at0036"] = <
					text = <"UNTESTABLE">
					description = <"Amputation or joint fusion at the shoulder.">
				>
				["at0038"] = <
					text = <"Motor - right arm">
					description = <"Observation of right arm motor function.">
					comment = <"Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0039"] = <
					text = <"No drift">
					description = <"Limb holds 90 (or 45) degrees for full 10 seconds.">
				>
				["at0040"] = <
					text = <"Drift">
					description = <"Limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.">
				>
				["at0041"] = <
					text = <"Some effort against gravity">
					description = <"Limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.">
				>
				["at0042"] = <
					text = <"No effort against gravity">
					description = <"Limb falls.">
				>
				["at0043"] = <
					text = <"No movement">
					description = <"There is no observed limb movement.">
				>
				["at0044"] = <
					text = <"UNTESTABLE">
					description = <"Amputation or joint fusion at the shoulder.">
				>
				["at0046"] = <
					text = <"Motor - left leg">
					description = <"Observation of left leg motor function.">
					comment = <"Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left leg untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0047"] = <
					text = <"No drift">
					description = <"Leg holds 30-degree position for full 5 seconds.">
				>
				["at0048"] = <
					text = <"Drift">
					description = <"Leg falls by the end of the 5-second period but does not hit the bed.">
				>
				["at0049"] = <
					text = <"Some effort against gravity">
					description = <"Leg falls to bed by 5 seconds but has some effort against gravity.">
				>
				["at0050"] = <
					text = <"No effort against gravity">
					description = <"Leg falls to bed immediately.">
				>
				["at0051"] = <
					text = <"No movement">
					description = <"There is no observed leg movement.">
				>
				["at0052"] = <
					text = <"UNTESTABLE">
					description = <"Amputation or joint fusion at the hip.">
				>
				["at0141"] = <
					text = <"Motor - right leg">
					description = <"Observation of right leg motor function.">
					comment = <"Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right leg untestable' data element Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0054"] = <
					text = <"No drift">
					description = <"Leg holds 30-degree position for full 5 seconds.">
				>
				["at0055"] = <
					text = <"Drift">
					description = <"Leg falls by the end of the 5-second period but does not hit the bed.">
				>
				["at0056"] = <
					text = <"Some effort against gravity">
					description = <"Leg falls to bed by 5 seconds but has some effort against gravity.">
				>
				["at0057"] = <
					text = <"No effort against gravity">
					description = <"Leg falls to bed immediately.">
				>
				["at0058"] = <
					text = <"No movement">
					description = <"There is no observed leg movement.">
				>
				["at0059"] = <
					text = <"UNTESTABLE">
					description = <"Amputation or joint fusion at the hip.">
				>
				["at0061"] = <
					text = <"Limb ataxia">
					description = <"Observation of limb ataxia as evidence of a unilateral cerebellar lesion.

Only in the case of amputation or joint fusion, the examiner should record the score as untestable (UN)and record the reason in the 'Reason limb ataxia untestable' data element.">
					comment = <"Only in the case of amputation or joint fusion, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason limb ataxia untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0062"] = <
					text = <"Absent">
					description = <"No limb ataxia observed.">
				>
				["at0063"] = <
					text = <"Present in one limb">
					description = <"Limb ataxia observed in one limb.">
				>
				["at0064"] = <
					text = <"Present in two limbs">
					description = <"Limb ataxia observed in two limbs.">
				>
				["at0065"] = <
					text = <"UNTESTABLE">
					description = <"Amputation or joint fusion.">
				>
				["at0076"] = <
					text = <"Speech">
					description = <"Observation about speech capability.">
					comment = <"Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason speech untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'.">
				>
				["at0077"] = <
					text = <"Normal">
					description = <"Normal speech.">
				>
				["at0078"] = <
					text = <"Mild-to-moderate dysarthria">
					description = <"Patient slurs at least some words and, at worst, can be understood with some difficulty.">
				>
				["at0079"] = <
					text = <"Severe dysarthria">
					description = <"Patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.">
				>
				["at0087"] = <
					text = <"2 hours post treatment">
					description = <"Assessment carried out 2 hours post treatment.">
				>
				["at0088"] = <
					text = <"24 hours post symptom onset">
					description = <"Assessment carried out 24 hours post onset of symptoms (with tolerance of +-20 minutes).">
				>
				["at0089"] = <
					text = <"7–10 days">
					description = <"Assessment carried out 7-10 days after stroke.">
				>
				["at0090"] = <
					text = <"3 months">
					description = <"Assessment carried out 3 months after stroke.">
				>
				["at0091"] = <
					text = <"Any event">
					description = <"Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.">
				>
				["at0037"] = <
					text = <"Reason left arm untestable">
					description = <"Narrative description about why the left arm motor function was untestable.">
				>
				["at0045"] = <
					text = <"Reason right arm untestable">
					description = <"Narrative description about why the right arm motor function was untestable.">
				>
				["at0053"] = <
					text = <"Reason left leg untestable">
					description = <"Narrative description about why the left leg motor function was untestable.">
				>
				["at0060"] = <
					text = <"Reason right leg untestable">
					description = <"Narrative description about why the right leg motor function was untestable.">
				>
				["at0066"] = <
					text = <"Reason limb ataxia untestable">
					description = <"Narrative description about why limb ataxia was untestable.">
				>
				["at0081"] = <
					text = <"Reason speech untestable">
					description = <"Narrative description about why speech was untestable.">
				>
				["at0080"] = <
					text = <"UNTESTABLE">
					description = <"Intubated or other physical barrier.">
				>
				["at0093"] = <
					text = <"Extension">
					description = <"Additional information required to extend the model with local content or to align with other reference models or formalisms.">
					comment = <"For example: local information requirements; or additional metadata to align with FHIR.">
				>
			>
		>
		["pt-br"] = <
			items = <
				["at0000"] = <
					text = <"*NIH Stroke Scale (NIHSS) (en)">
					description = <"*15-item neurologic examination stroke scale that provides a quantitative measure of stroke-related neurological deficit.(en)">
				>
				["at0001"] = <
					text = <"*History(en)">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Base">
					description = <"Avaliação Básica">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"*LOC responsiveness(en)">
					description = <"*Observed level of consciousness of the patient.(en)">
				>
				["at0005"] = <
					text = <"Alerta">
					description = <"Profundamente responsivo">
				>
				["at0006"] = <
					text = <"*Not alert, but arousable by minor stimulation(en)">
					description = <"*Not alert; but arousable by minor stimulation to obey, answer or respond.(en)">
				>
				["at0007"] = <
					text = <"*Not alert, requires repeated stimulation or strong stimuli.(en)">
					description = <"*Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements.(en)">
				>
				["at0008"] = <
					text = <"*Reflex reponses only or totally unreponsive(en)">
					description = <"*Responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid, and areflexic.(en)">
				>
				["at0009"] = <
					text = <"*LOC questions(en)">
					description = <"*The patient is asked the month and his/her age.(en)">
				>
				["at0010"] = <
					text = <"*Both correct(en)">
					description = <"*Patient answered both questions correctly.(en)">
				>
				["at0011"] = <
					text = <"*One correct(en)">
					description = <"*Patient answered one question correctly or is unable to communicate because of a problem not secondary to aphasia.(en)">
				>
				["at0012"] = <
					text = <"*Neither correct(en)">
					description = <"*Patient answered neither question correctly or is comatose or does not comprehend the question.(en)">
				>
				["at0013"] = <
					text = <"*LOC commands(en)">
					description = <"*The patient is asked to open and close the eyes and then to grip and release the non-paretic hand.(en)">
				>
				["at0014"] = <
					text = <"*Both correct(en)">
					description = <"*Patient performs both tasks correctly.(en)">
				>
				["at0015"] = <
					text = <"*One correct(en)">
					description = <"*Patient performs one task correctly.(en)">
				>
				["at0016"] = <
					text = <"*Neither correct(en)">
					description = <"*Patient performs neither task correctly.(en)">
				>
				["at0017"] = <
					text = <"*Horizontal eye movements(en)">
					description = <"*Horizontal eye movement observation.(en)">
				>
				["at0018"] = <
					text = <"*Normal(en)">
					description = <"*Normal eye movement.(en)">
				>
				["at0019"] = <
					text = <"*Partial gaze palsy(en)">
					description = <"*Gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.(en)">
				>
				["at0020"] = <
					text = <"*Forced deviation or total gaze paresis(en)">
					description = <"*Forced deviation or total gaze paresis is not overcome by the oculocephalic maneuver.(en)">
				>
				["at0021"] = <
					text = <"*Visual fields(en)">
					description = <"*Visual field test observation.(en)">
				>
				["at0022"] = <
					text = <"*No visual loss(en)">
					description = <"*No visual loss detected.(en)">
				>
				["at0023"] = <
					text = <"*Partial hemianopia(en)">
					description = <"*Partial hemianopia or complete quadrantanopia detected.(en)">
				>
				["at0024"] = <
					text = <"*Complete hemianopia(en)">
					description = <"*Complete hemianopia detected(en)">
				>
				["at0025"] = <
					text = <"*Bilateral hemianopia(en)">
					description = <"*Blindness from any cause, including cortical blindness.(en)">
				>
				["at0026"] = <
					text = <"*Facial palsy(en)">
					description = <"*Facial palsy observation.(en)">
				>
				["at0027"] = <
					text = <"*Normal(en)">
					description = <"*Normal symmetrical movements.(en)">
				>
				["at0028"] = <
					text = <"*Minor paralysis(en)">
					description = <"*Flattened nasolabial fold, asymmetry on smiling.(en)">
				>
				["at0029"] = <
					text = <"*Partial paralysis(en)">
					description = <"*Total or near-total paralysis of lower face.(en)">
				>
				["at0030"] = <
					text = <"*Complete paralysis of one or both sides(en)">
					description = <"*Absence of facial movement in the upper and lower face.(en)">
				>
				["at0067"] = <
					text = <"*Sensory(en)">
					description = <"*Observation of sensory loss.(en)">
				>
				["at0068"] = <
					text = <"Normal">
					description = <"Nenhuma perda de sensibilidade">
				>
				["at0069"] = <
					text = <"Leva a moderada perda de sensibilidade">
					description = <"Paciente sente que a picada é menos acentuada ou maçante no lado afetado; ou há uma perda de dor superficial com a picada de agulha, mas paciente está consciente ao ser tocado">
				>
				["at0070"] = <
					text = <"Severa ou total perda de sensibilidade">
					description = <"Paciente não está ciente ao ser tocado na face, braço e perna">
				>
				["at0071"] = <
					text = <"*Language(en)">
					description = <"*Observation of language capability.(en)">
				>
				["at0072"] = <
					text = <"*No aphasia(en)">
					description = <"*Normal(en)">
				>
				["at0073"] = <
					text = <"*Mild-to-moderate aphasia(en)">
					description = <"*Some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression.(en)">
				>
				["at0074"] = <
					text = <"*Severe aphasia(en)">
					description = <"*All communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener.(en)">
				>
				["at0075"] = <
					text = <"*Mute, global aphasia(en)">
					description = <"*No usable speech or auditory comprehension.(en)">
				>
				["at0082"] = <
					text = <"*Extinction and inattention(en)">
					description = <"*Observation of any evidence of extinction or inattention.(en)">
					comment = <"*Also known as 'neglect'.(en)">
				>
				["at0083"] = <
					text = <"*No abnormality(en)">
					description = <"*No abnormality observed.(en)">
				>
				["at0084"] = <
					text = <"*Inattention, or bilateral extinction in one sensory modality(en)">
					description = <"*Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities.(en)">
				>
				["at0085"] = <
					text = <"*Profound hemi-inattention or extinction to more than one modality(en)">
					description = <"*Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space.(en)">
				>
				["at0086"] = <
					text = <"*Total score(en)">
					description = <"*The total score is the arithmetic sum of all 15 responses, excluding any untestable responses. (en)">
				>
				["at0092"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0031"] = <
					text = <"*Motor - left arm(en)">
					description = <"*Observation of left arm motor function. (en)">
					comment = <"*Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0032"] = <
					text = <"Nenhum Movimento">
					description = <"Membro permanece 90 (ou 45) graus por 10 segundos completos">
				>
				["at0033"] = <
					text = <"Movimento">
					description = <"Membro mantém 90 (ou 45) graus, mas desvia para o chão antes de completar 10 segundos; Não utilize a cama ou outro suporte.">
				>
				["at0034"] = <
					text = <"Um pouco de esforço contra a gravidade">
					description = <"Membro não pode obter ou manter 90 (ou 45) graus, mas tem um pouco de esforço contra a gravidade.">
				>
				["at0124"] = <
					text = <"Nenhum esforço contra a gravidade">
					description = <"Membro cai">
				>
				["at0035"] = <
					text = <"*No movement(en)">
					description = <"*There is no observed limb movement.(en)">
				>
				["at0036"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Amputation or joint fusion at the shoulder.(en)">
				>
				["at0038"] = <
					text = <"*Motor - right arm(en)">
					description = <"*Observation of right arm motor function. (en)">
					comment = <"*Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right arm untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0039"] = <
					text = <"*No drift(en)">
					description = <"*Limb holds 90 (or 45) degrees for full 10 seconds.(en)">
				>
				["at0040"] = <
					text = <"*Drift(en)">
					description = <"*Limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.(en)">
				>
				["at0041"] = <
					text = <"*Some effort against gravity(en)">
					description = <"*Limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.(en)">
				>
				["at0042"] = <
					text = <"*No effort against gravity(en)">
					description = <"*Limb falls.
(en)">
				>
				["at0043"] = <
					text = <"*No movement(en)">
					description = <"*There is no observed limb movement.(en)">
				>
				["at0044"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Amputation or joint fusion at the shoulder.(en)">
				>
				["at0046"] = <
					text = <"*Motor - left leg(en)">
					description = <"*Observation of left leg motor function. (en)">
					comment = <"*Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason left leg untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0047"] = <
					text = <"Nenhum movimento">
					description = <"Perna detém posição de 30 graus por 5 segundos completos">
				>
				["at0048"] = <
					text = <"Movimento">
					description = <"Perna cai ao final do período de 5 segundos, mas não bate na cama.">
				>
				["at0049"] = <
					text = <"Um pouco de esforço contra a gravidade">
					description = <"Perna cai na cama após 5 segundos, mas tem um pouco de esforço contra a gravidade">
				>
				["at0050"] = <
					text = <"Um pouco de esforço contra a gravidade">
					description = <"Perna cai na cama imediatamente">
				>
				["at0051"] = <
					text = <"*No movement(en)">
					description = <"*There is no observed leg movement.(en)">
				>
				["at0052"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Amputation or joint fusion at the hip.(en)">
				>
				["at0141"] = <
					text = <"*Motor - right leg(en)">
					description = <"*Observation of right leg motor function. (en)">
					comment = <"*Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason right leg untestable' data element Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0054"] = <
					text = <"Nenhum movimento">
					description = <"Perna detém posição de 30 graus por 5 segundos completos">
				>
				["at0055"] = <
					text = <"Movimento">
					description = <"Perna cai ao final do período de 5 segundos, mas não bate na cama.">
				>
				["at0056"] = <
					text = <"Um pouco de esforço contra a gravidade">
					description = <"Perna cai na cama após 5 segundos, mas tem um pouco de esforço contra a gravidade">
				>
				["at0057"] = <
					text = <"Um pouco de esforço contra a gravidade">
					description = <"Perna cai na cama imediatamente">
				>
				["at0058"] = <
					text = <"*No movement(en)">
					description = <"*There is no observed leg movement.(en)">
				>
				["at0059"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Amputation or joint fusion at the hip.(en)">
				>
				["at0061"] = <
					text = <"*Limb ataxia(en)">
					description = <"*Observation of limb ataxia as evidence of a unilateral cerebellar lesion.

Only in the case of amputation or joint fusion, the examiner should record the score as untestable (UN)and record the reason in the 'Reason limb ataxia untestable' data element. (en)">
					comment = <"*Only in the case of amputation or joint fusion, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason limb ataxia untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0062"] = <
					text = <"*Absent(en)">
					description = <"*No limb ataxia observed(en)">
				>
				["at0063"] = <
					text = <"*Present in one limb(en)">
					description = <"*Limb ataxia observed in one limb.(en)">
				>
				["at0064"] = <
					text = <"*Present in two limbs(en)">
					description = <"*Limb ataxia observed in two limbs.(en)">
				>
				["at0065"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Amputation or joint fusion.(en)">
				>
				["at0076"] = <
					text = <"*Speech(en)">
					description = <"*Observation about speech capability.

 (en)">
					comment = <"*Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as 'UNTESTABLE' and record the reason in the 'Reason speech untestable' data element. Implementation note: while the UNTESTABLE value has been included in this ordinal to allow for inclusion in user interface picklists, the NIHSS applies no numerical score from this selection to the 'Total score'. (en)">
				>
				["at0077"] = <
					text = <"*Normal(en)">
					description = <"*Normal speech.(en)">
				>
				["at0078"] = <
					text = <"*Mild-to-moderate dysarthria(en)">
					description = <"*Patient slurs at least some words and, at worst, can be understood with some difficulty.(en)">
				>
				["at0079"] = <
					text = <"*Severe dysarthria(en)">
					description = <"*Patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.(en)">
				>
				["at0087"] = <
					text = <"*2 hours post treatment(en)">
					description = <"*Assessment carried out 2 hours post treatment.(en)">
				>
				["at0088"] = <
					text = <"*24 hours post symptom onset (en)">
					description = <"*Assessment carried out 24 hours post onset of symptoms (with tolerance of +-20 minutes).(en)">
				>
				["at0089"] = <
					text = <"*7–10 days(en)">
					description = <"*Assessment carried out 7-10 days after stroke.(en)">
				>
				["at0090"] = <
					text = <"*3 months(en)">
					description = <"*Assessment carried out 3 months after stroke.(en)">
				>
				["at0091"] = <
					text = <"*Any event (en)">
					description = <"*Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time. (en)">
				>
				["at0037"] = <
					text = <"*Reason left arm untestable(en)">
					description = <"*Narrative description about why the left arm motor function was untestable.(en)">
				>
				["at0045"] = <
					text = <"*Reason right arm untestable(en)">
					description = <"*Narrative description about why the right arm motor function was untestable.(en)">
				>
				["at0053"] = <
					text = <"*Reason left leg untestable(en)">
					description = <"*Narrative description about why the left leg motor function was untestable.(en)">
				>
				["at0060"] = <
					text = <"*Reason right leg untestable(en)">
					description = <"*Narrative description about why the right leg motor function was untestable.(en)">
				>
				["at0066"] = <
					text = <"*Reason limb ataxia untestable (en)">
					description = <"*Narrative description about why limb ataxia was untestable.(en)">
				>
				["at0081"] = <
					text = <"*Reason speech untestable(en)">
					description = <"*Narrative description about why speech was untestable.(en)">
				>
				["at0080"] = <
					text = <"*UNTESTABLE(en)">
					description = <"*Intubated or other physical barrier.(en)">
				>
				["at0093"] = <
					text = <"*Extension(en)">
					description = <"*Additional information required to extend the model with local content or to align with other reference models or formalisms. (en)">
					comment = <"*For example: local information requirements; or additional metadata to align with FHIR. (en)">
				>
			>
		>
		["nb"] = <
			items = <
				["at0000"] = <
					text = <"NIH Stroke Scale (NIHSS)">
					description = <"15-punkts nevrologisk hjerneslagskalaundersøkelse som gir en kvantitativ måling av slag-relaterte nevrologiske avvik.">
				>
				["at0001"] = <
					text = <"History">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Baseline">
					description = <"Vurdering ved mottak.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Bevissthetsnivå">
					description = <"Observert bevissthetsnivå av individet.">
				>
				["at0005"] = <
					text = <"Våken og adekvat">
					description = <"">
				>
				["at0006"] = <
					text = <"Døsig, reagerer adekvat ved lett stimulering">
					description = <"">
				>
				["at0007"] = <
					text = <"Døsig, reagerer først ved kraftigere/gjentatt stimulering">
					description = <"">
				>
				["at0008"] = <
					text = <"Reagerer ikke, eller bare med ikke-målrettet bevegelse">
					description = <"">
				>
				["at0009"] = <
					text = <"Orientering">
					description = <"Individet spørres om måned og alder.">
				>
				["at0010"] = <
					text = <"Riktig svar på begge spørsmål">
					description = <"">
				>
				["at0011"] = <
					text = <"Riktig svar på ett spørsmål">
					description = <"">
				>
				["at0012"] = <
					text = <"Ingen riktige svar">
					description = <"">
				>
				["at0013"] = <
					text = <"Respons på kommando">
					description = <"Individet bes åpne og lukke øyne, og knyte hånd.">
				>
				["at0014"] = <
					text = <"Utfører begge kommandoer korrekt">
					description = <"">
				>
				["at0015"] = <
					text = <"Utfører en kommando korrekt">
					description = <"">
				>
				["at0016"] = <
					text = <"Utfører ingen korrekt">
					description = <"">
				>
				["at0017"] = <
					text = <"Blikkbevegelse">
					description = <"Horisontal bevegelse til begge sider.">
				>
				["at0018"] = <
					text = <"Normal øyebevegelse">
					description = <"">
				>
				["at0019"] = <
					text = <"Delvis blikkparese (eller ved øyemuskelparese)">
					description = <"">
				>
				["at0020"] = <
					text = <"Fiksert blikkdreining til siden eller total blikkparese">
					description = <"">
				>
				["at0021"] = <
					text = <"Synsfelt">
					description = <"Bevege fingre/fingertelling i laterale synsfelt.">
				>
				["at0022"] = <
					text = <"Normalt">
					description = <"">
				>
				["at0023"] = <
					text = <"Delvis hemianopsi">
					description = <"">
				>
				["at0024"] = <
					text = <"Total hemianopsi">
					description = <"">
				>
				["at0025"] = <
					text = <"Bilateral hemianopsi/blind">
					description = <"">
				>
				["at0026"] = <
					text = <"Ansikt">
					description = <"Individet spørres om å vise tenner, knipe igjen øynene og løfte øyenbryn.">
				>
				["at0027"] = <
					text = <"Normale symmetriske bevegelser">
					description = <"">
				>
				["at0028"] = <
					text = <"Utvisket nasolabalfure, asymmetri ved smil">
					description = <"">
				>
				["at0029"] = <
					text = <"Betydelig lammelse i nedre ansiktshalvdel">
					description = <"">
				>
				["at0030"] = <
					text = <"Total lammelse i halve ansiktet">
					description = <"">
				>
				["at0031"] = <
					text = <"Kraft i armen - venstre arm">
					description = <"Holde venstre arm utstrakt 45 grader i 10 sekunder.">
					comment = <"Bare i tilfeller så som amputasjon eller skulderleddfusjon, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar - venstre arm' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
				["at0032"] = <
					text = <"Ingen drifting">
					description = <"">
				>
				["at0033"] = <
					text = <"Drifter til lavere posisjon (treffer ikke underlag)">
					description = <"">
				>
				["at0034"] = <
					text = <"Noe bevegelse mot tyngdekraften, drifter til sengen">
					description = <"">
				>
				["at0035"] = <
					text = <"Ingen bevegelse">
					description = <"">
				>
				["at0036"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0037"] = <
					text = <"Beskriv Ikke testbar - venstre arm">
					description = <"Fritekstlig beskrivelse om hvorfor venstre arm er Ikke testbar.">
				>
				["at0038"] = <
					text = <"Kraft i armen - høyre arm">
					description = <"Holde høyre arm utstrakt 45 grader i 10 sekunder.">
					comment = <"Bare i tilfeller så som amputasjon eller skulderleddfusjon, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar - høyre arm' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
				["at0039"] = <
					text = <"Ingen drifting">
					description = <"">
				>
				["at0040"] = <
					text = <"Drifter til lavere posisjon (treffer ikke underlag)">
					description = <"">
				>
				["at0041"] = <
					text = <"Noe bevegelse mot tyngdekraften, drifter til sengen">
					description = <"">
				>
				["at0042"] = <
					text = <"Kun små muskelbevegelser, faller til sengen">
					description = <"">
				>
				["at0043"] = <
					text = <"Ingen bevegelse">
					description = <"">
				>
				["at0044"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0045"] = <
					text = <"Beskriv Ikke testbar - høyre arm">
					description = <"Fritekstlig beskrivelse om hvorfor venstre arm er Ikke testbar.">
				>
				["at0046"] = <
					text = <"Kraft i benet - venstre ben">
					description = <"Holde venstre ben utstrakt 30 grader i 5 sekunder.">
					comment = <"Bare i tilfeller så som amputasjon eller hofteleddfusjon, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar - venstre fot' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
				["at0047"] = <
					text = <"Ingen drifting">
					description = <"">
				>
				["at0048"] = <
					text = <"Drifter til lavere posisjon (treffer ikke underlag)">
					description = <"">
				>
				["at0049"] = <
					text = <"Noe bevegelse mot tyngdekraften, drifter til sengen">
					description = <"">
				>
				["at0050"] = <
					text = <"Ingen bevegelse mot tyngdekraften, faller til sengen">
					description = <"">
				>
				["at0051"] = <
					text = <"Ingen bevegelse">
					description = <"">
				>
				["at0052"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0053"] = <
					text = <"Beskriv Ikke testbar - venstre ben">
					description = <"Fritekstlig beskrivelse om hvorfor venstre ben er Ikke testbar.">
				>
				["at0054"] = <
					text = <"Ingen drifting">
					description = <"">
				>
				["at0055"] = <
					text = <"Drifter til lavere posisjon (treffer ikke underlag)">
					description = <"">
				>
				["at0056"] = <
					text = <"Noe bevegelse mot tyngdekraften, drifter til sengen">
					description = <"">
				>
				["at0057"] = <
					text = <"Kun små muskelbevegelser, faller til sengen">
					description = <"">
				>
				["at0058"] = <
					text = <"Ingen bevegelse">
					description = <"">
				>
				["at0059"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0060"] = <
					text = <"Beskriv Ikke testbar - høyre ben">
					description = <"Fritekstlig beskrivelse om hvorfor høyre ben er Ikke testbar.">
				>
				["at0061"] = <
					text = <"Ataksi">
					description = <"Finger-nese-finger test/kne-hæl test.">
					comment = <"Bare i tilfeller så som amputasjon eller leddfusjon, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar ataksi' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
				["at0062"] = <
					text = <"Ingen ataksi">
					description = <"">
				>
				["at0063"] = <
					text = <"Tilstede i en ekstremitet">
					description = <"">
				>
				["at0064"] = <
					text = <"Tilstede i to ekstremiteter">
					description = <"">
				>
				["at0065"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0066"] = <
					text = <"Beskriv Ikke testbar - ataksi">
					description = <"Fritekstlig beskrivelse om hvorfor ataksi er Ikke testbar.">
				>
				["at0067"] = <
					text = <"Sensibilitet">
					description = <"Sensibilitet for stikk.">
				>
				["at0068"] = <
					text = <"Normal">
					description = <"">
				>
				["at0069"] = <
					text = <"Mild til moderat utfall (kjenne stikk som mindre skarpt)">
					description = <"">
				>
				["at0070"] = <
					text = <"Alvorlig til total utfall (også ved coma, kvadriplegisk)">
					description = <"">
				>
				["at0071"] = <
					text = <"Språk">
					description = <"Tale, taleforståelse, leseforståelse, benevning.">
				>
				["at0072"] = <
					text = <"Ingen afasi">
					description = <"">
				>
				["at0073"] = <
					text = <"Mild til moderat afasi, samtale mulig">
					description = <"">
				>
				["at0074"] = <
					text = <"Alvorlig afasi, samtale svært vanskelig eller umulig">
					description = <"">
				>
				["at0075"] = <
					text = <"Ikke språk (også ved coma)">
					description = <"">
				>
				["at0076"] = <
					text = <"Dysartri">
					description = <"Spontan tale.">
					comment = <"Kun hvis individet er intubert eller har en annen fysisk sperre for å produsere tale, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar dysartri' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
				["at0077"] = <
					text = <"Ingen dysartri">
					description = <"">
				>
				["at0078"] = <
					text = <"Mild - moderat dysartri (lett snøvling)">
					description = <"">
				>
				["at0079"] = <
					text = <"Nær uforståelig tale eller stum/global afasi (også coma)">
					description = <"">
				>
				["at0080"] = <
					text = <"Ikke testbar">
					description = <"">
				>
				["at0081"] = <
					text = <"Beskriv Ikke testbar - dysartri">
					description = <"Fritekstlig beskrivelse om hvorfor dysartri er Ikke testbar.">
				>
				["at0082"] = <
					text = <"Neglekt">
					description = <"Bilateral simultan stimulering av syn og hudfølelse.">
				>
				["at0083"] = <
					text = <"Ingen neglekt (også ved hemianopsi med normal sensibilitet)">
					description = <"">
				>
				["at0084"] = <
					text = <"Neglekt i en sansemodalitet">
					description = <"">
				>
				["at0085"] = <
					text = <"Neglekt i begge sansemodaliteter">
					description = <"">
				>
				["at0086"] = <
					text = <"Total NIHSS-Score">
					description = <"Summen av ordinalverdier registrert for hver av de 15 komponentsvarene.">
				>
				["at0087"] = <
					text = <"2 timer etter behandling">
					description = <"Vurdering utført 2 timer etter behandling.">
				>
				["at0088"] = <
					text = <"24 timer etter symptomdebut">
					description = <"Vurdering utført 24 timer etter symptomdebut (med et slingringsmonn på +-20 minutter).">
				>
				["at0089"] = <
					text = <"7–10 dager">
					description = <"Vurdering utført 7-10 dager etter hjerneslag.">
				>
				["at0090"] = <
					text = <"3 måneder">
					description = <"Vurdering utført 3 måneder etter hjerneslag.">
				>
				["at0091"] = <
					text = <"Uspesifisert hendelse">
					description = <"Standard uspesifisert tidspunkt- eller intervallhendelse som kan defineres mer eksplisitt i et templat eller i en applikasjon.">
				>
				["at0092"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0093"] = <
					text = <"Tilleggsinformasjon">
					description = <"Ytterligere informasjon som trengs for å kunne registrere lokalt definert innhold eller for å tilpasse til andre referansemodeller eller formalismer.">
					comment = <"For eksempel: lokale informasjonsbehov eller ytterligere metadata for å kunne tilpasse til tilsvarende konsepter i FHIR.">
				>
				["at0124"] = <
					text = <"Kun små muskelbevegelser, faller til sengen">
					description = <"">
				>
				["at0141"] = <
					text = <"Kraft i benet - høyre ben">
					description = <"Holde høyre ben utstrakt 30 grader i 5 sekunder.">
					comment = <"Bare i tilfeller så som amputasjon eller hofteleddfusjon, bør helsepersonell registrere verdien 'Ikke testbar' og registrere beskrivelsen i 'Beskriv Ikke testbar - høyre fot' dataelementet.
Implementeringsnotat: selv om 'Ikke testbar' verdien er inkludert i ordinalen for å tillate inkludering i brukergrensesnittets nedtrekksmeny, tilegner NIHSS ikke en numerisk skår for 'Ikke testbar'-valget til total NIHSS-Score.">
				>
			>
		>
	>