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Rehab Measures: Canadian Neurological Scale

Link to instrument

Measure available at Strokecenter.org (external link) 

Title of Assessment

Canadian Neurological Scale 

Acronym

CNS

Instrument Reviewer(s)

Summary Date

 

Purpose

Provides a standardized neurological assessment of cognitive and motor function in stroke patients (alert or drowsy).

Description

  • Used to assess alertness in stroke patients
  • Includes the following assessments:
    • Level of consciousness
    • Orientation
    • Aphasia
    • Motor strength
  • Assessments of motor function are separated into two sections:
    • A1: administered if patient is able to understand and follow instructions
    • A2: administered in the presence of comprehension deficits
  • Each motor item is rated for severity and each rating is weighted “according to the relative importance of a particular neurologic deficit” (Cote et al, 1989)
  • Scores submitted form each domain section are summed to provide a total score out of a possible 11.5
    • Lower scores are representative of increasing severity.
  • CNS scores can be converted into NIHSS Scores using: NIHSS = 23 –  (2 X CNS Score)

Area of Assessment

Aphasia; Cognition; Functional Mobility 

Body Part

Not Applicable 

ICF Domain

Body Function; Activity 

Domain

Cognition; Motor 

Assessment Type

Observer 

Length of Test

05 Minutes or Less 

Time to Administer

<5-10 minutes

Number of Items

Not applicable 

Equipment Required

None necessary

Training Required

No (see Cote et al, 1986 for more information)

Type of training required

No Training 

Cost

Free 

Actual Cost

Free
 
A full version of the measure can be found in:
Cote, R., V. Hachinski, et al. (1986). "The Canadian Neurological Scale: a preliminary study in acute stroke." Stroke 17(4): 731.

Age Range

Adult: 18-64 years 

Administration Mode

Paper/Pencil 

Diagnosis

Stroke 

Populations Tested

Stroke

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Acute Stroke: (Nilanont et al. 2010; n = 350; mean age = 63.4 (range 19 to 93) years; Thai sample)

Scale
Score Median (range)
CNS score
9 (1.5–11.5)
NIHSS score
 4 (0–26)
 
CNS scores can be reliably converted into NIHSS Scores using the following conversion:
NIHSS = 23 –  (2 X CNS Score)

Test-retest Reliability

Not Established
 

Interrater/Intrarater Reliability

Acute Stroke: (Bushnell at al. 2001; n = 59 retrospective study; Cote et al. 1989; n = 157; mean age = 68.8 years)
  • Excellent interrater reliability (ICC = 0.97; raters = 2 neurologists)
  • Excellent intra-rater reliability (r = 0.924; correlation of nurse and physician ratings)

Review of common stroke measures: (D'Olhaberriague et al, 1996)

  • Excellent Interrater Agreement; Kappa = 0.76

Internal Consistency

Acute Stroke: (Cote et al, 1986; n = 34; mean age = 61.2 years & Cote et al, 1989)
  • Excellent internal consistency (Cronbach's alpha = 0.89)
  • Excellent internal consistency (Cronbach's alpha = 0.79)

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Cote et al, 1989)
  • Excellent concurrent validity with Neurologic Examination (r = 0.775; mean of 3.71 hours between assessments)

Item
Number
Spearman r
95% CI
Level ofconsciousness
155
0.574*
0.384 - 0.764
Orientation
149
O.71S*
0.583 - 0.849
Speech
153
0.S91*
0.581 - 0.801
Weakneas
134
0.767*
0.695 - 0.839
Global score versus total score
155
0.776*
0.720 - 0.830
*p < .001

Excellent to moderate predictive validity with:
  • Death within 6 months (crude odds ratio = 0.73)
  • Cardio/CVA event within 6 months (crude odds ratio = 0.70)
  • Independence with ADLs within 6 months (crude odds ratio = 1.60)
  • Overall, low initial scores correlated with higher mortality, greater incidence of recurrent vascular events, and lower independence at 6 months post-stroke

Acute Stroke: (Muir et al, 1996; n = 344, median age = 69 years; CNS and other common measures used in stroke)

 
MCANS
NIHSS
Guy's
CNS
.977**
-.948**
.397*
** Excellent; * Adequate
MCANS = Middle Cerebral Artery Neurological Score
NIHSS = National Institutes of Health Stroke Scale
Guy's = Guy's prognostic score (from clinical data)

Construct Validity (Convergent/Discriminant)

Acute Stroke: (Cote et al, 1989)
  • Excellent correlation between the CNS and a standard neurologic examination (r = 0.769)

Content Validity

The scales content scale was validated by a panel of experts who agreed on the items to be included and their respective weights No statistical analysis provided (Cote et al, 1989).

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Acute Stroke: (Hagen et al, 2003; n = 136; mean age 70 (11) years; sensitivity compared across 3 measures)
 
Outcome measure (months)
Mean difference
SD
Min
Max
P-value~
SRM
Barthel Index (1–3)
1.1982
2.3696
-3
9
<0.001***
0.5057
CNS (1–3)
0.2072
0.7245
-1.5
2
0.004**
0.2860
MMSE (1–3)
1.0360
2.6317
-8
8
<0.001***
0.3937
Barthel Index (3–6)
0.1532
1.8887
-8
5
0.263
0.0811
CNS (3–6)
0.7115
0.7115
-2
3.5
 0.003**
0.2849
MMSE (3–6)
0.5586
2.2225
-5
8
0.011*
0.2513
CNS = Canadian Neurological Scale
MMSE = Mini-Mental State Examination
~Wilcoxon signed rank test; *P < 0.05; **P < 0.01; ***P < 0.001

Professional Association Recommendations

Considerations

Assessment using the CNS is focused on limb weakness over other possible neurological impairments (Cuspineda et
al, 2003; Muir et al, 1996)
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Bibliography

Bushnell, C., Johnston, D., et al. (2001). "Retrospective assessment of initial stroke severity: comparison of the NIH Stroke Scale and the Canadian Neurological Scale." Stroke 32(3): 656. Find it on PubMed

Cote, R., Battista, R., et al. (1989). "The Canadian Neurological Scale: validation and reliability assessment." Neurology 39(5): 638. Find it on PubMed

Cote, R., Hachinski, V., et al. (1986). "The Canadian Neurological Scale: a preliminary study in acute stroke." Stroke 17(4): 731. Find it on PubMed

Cuspineda, E., Machado, C., et al. (2003). "Predicting outcome in acute stroke: a comparison between QEEG and the Canadian Neurological Scale." Clinical EEG electroencephalography 34(1): 1-4. Find it on PubMed

D'Olhaberriague, L., Litvan, I., et al. (1996). "A reappraisal of reliability and validity studies in stroke." Stroke 27(12): 2331. Find it on PubMed

Hagen, S., Bugge, C., et al. (2003). "Psychometric properties of the SF-36 in the early post-stroke phase." J Adv Nurs 44: 461-468. Find it on PubMed

Muir, K., Weir, C., et al. (1996). "Comparison of neurological scales and scoring systems for acute stroke prognosis." Stroke 27(10): 1817. Find it on PubMed

Nilanont, Y., Komoltri, C., et al. (2010). "The Canadian Neurological Scale and the NIHSS: development and validation of a simple conversion model." Cerebrovasc Dis 30(2): 120-126. Find it on PubMed

Year published

1986 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 5/14/2014 3:27 PM  by Jason Raad