gaze testingThe NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.

But… how do you test gaze if your patient is aphasic or unable to follow commands?

Trick of the Trade

Use “selfie mode” on the camera of your mobile phone as a mirror during gaze testing


  • Open your smartphone’s camera app
  • Switch to the “selfie” photo mode
  • Place the screen in front of patient so that they have a visual of his/her own face
  • Move the phone from side-to-side to test horizontal eye gaze movement

The Science

Recent studies involving eye movement have shown that we are more likely to track towards the facial region.2 This preference for eye movements towards faces also exists in aphasic patients.3 Specifically, we tend to recognize and respond faster to familiar faces, including our own face, as well as the faces of friends and family members. This Trick of the Trade uses the “selfie mode” on a smartphone to engage the patient to recognize and respond to their own face — and to track this familiar face, even if aphasia is present.


Consider this Trick of the Trade the next time a stroke code is activated in the emergency department. If you are having difficulty testing the patient’s gaze, take out your mobile phone. The “selfie” camera mode may engage the patient to recognize and track their own face, even if aphasia is present.


Thumbnail photo © Can Stock Photo / Antonio_Diaz

Jauch E, Saver J, Adams H, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. [PubMed]
Bortolon C, Lorieux S, Raffard S. Self or Familiar-Face Recognition Advantage? New Insight Using Ambient Images. Q J Exp Psychol (Hove). May 2017:1-30. [PubMed]
Eggenberger N, Preisig BC, Schumacher R, et al. Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study. Rodriguez-Fornells A, ed. PLoS ONE. 2016;11(1):e0146583. doi: 10.1371/journal.pone.0146583
Katie Stiene

Katie Stiene

MD/MPH Candidate | Class of 2018
SUNY Downstate College of Medicine
Michael Gisondi, MD

Michael Gisondi, MD

Associate Professor and Vice Chair of Education
Department of Emergency Medicine
Stanford University
Editor, ALiEM EM Match Advice series