Test For Stroke Is No Joke
Chester J. Zelasko, Ph.D. | February 14, 2006

The distribution of urban legends on the internet is like a plague. Lately, there has been one going around about identifying someone with a stroke. This one happens to be based on more fact than fiction, but as with all e-mail, some versions have been embellished. If you haven’t read the e-mail, here are the facts as best I could discover.

Emergency Medical Technicians (EMTs) have used a simple test for identifying stroke victims called the Cincinnati Prehospital Stroke Scale (CPSS). It’s fairly simple and is composed of three basic observations.

Cincinnati Stroke Scale

Facial Droop

Normal: Both sides of face move equally
Abnormal: One side of face does not move at all

Arm Drift

Normal: Both arms move equally or not at all
Abnormal: One arm drifts compared to the other


Normal: Uses correct words with no slurring
Abnormal: Slurred or inappropriate words or mute

Keep the CPSS in mind because I think you can see how the stroke test in the e-mail was developed. Researchers tested the CPSS by giving laypeople instructions over the telephone as they observed mock patients (1). With a trained EMT giving them instructions, the accuracy was over 90%, but to implement this system for all 911 personnel would require massive training and is probably not practical.

However researchers from the University of North Carolina developed a test that appears to be based on the CPSS and when tested with laypeople, identified stroke victims with over 95% accuracy (2). It takes less than a minute and is very simple.

The stroke test consists of three simple parts:
  • First, ask the person to smile--a big smile so you can see his teeth. That identifies any muscle weakness in the face, especially on one side--a classic symptom of a stroke.

  • Second, ask the person to close his eyes and lift his arms out to the side to shoulder level. If he can’t, that identifies muscle weakness associated with strokes--again, primarily on one side.

  • Third, ask the person to repeat a simple statement to check for slurring of speech. Researchers used several familiar phrases such as “Don’t cry over spilled milk.”
During the study, the last two were more easily identified than the smile test with almost 100% identifying the symptom correctly. The reason may be that unless you know the person, you don’t know what his or her smile normally looks like. The comparisons to the CPSS are obvious and the directions are easy to follow.

The American Stroke Association does not endorse this test because it’s based on a very small subject sample. Here are the warning signs for stroke promoted by the ASA.
  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden vision problems in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause
The warning signs are geared to the victims, but if someone is experiencing confusion, he wouldn’t be the best judge of what his body is experiencing. However, if you feel any of those symptoms, get help immediately.

The stroke test is geared toward laypeople. They’ll make mistakes in their interpretation of symptoms, but it would be an error worth making if the person is indeed having a stroke. Why? Because the faster the person is treated, the less permanent the damage may be. Strokes can be debilitating, leaving a person speechless and paralyzed. Minutes count and this test would appear to help speed things up. There doesn’t seem to be any downside to it.

What do you do if you believe the test is positive? Call the emergency service number like 911 or if not near a phone, get to the victim to a hospital immediately. You may not just save his life--you may help him preserve a good quality of life.

  1. Liferidge AT, et al. Ability of laypersons to use the Cincinnati Prehospital Stroke Scale. Prehosp Emerg Care. 2004; 8(4):384-7.

  2. Hurwitz A et al. Untrained Adults Can Identify Symptoms of Stroke by Directed Use of the Cincinnati Prehospital Stroke Scale. Abstract presented at the 2003 International Stroke Conference.
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