What sentence should be used to test a patient's language and speech when assessing for stroke?

Optimal Sentences for Testing Speech in Stroke Assessment

The most effective sentence to ask a patient to repeat when testing for stroke is "You can't teach an old dog new tricks." 1

Rationale for Using Standardized Sentences

When assessing for potential stroke, language and speech evaluation is a critical component that helps identify potential neurological deficits. The Western Aphasia Battery and other standardized assessment tools include specific sentences designed to test various aspects of language function.

Why This Particular Sentence Works Well:

• It contains multiple word types and phonetic elements
• It's a familiar idiom that tests both repetition and comprehension
• It's of moderate length (not too short or too long)
• It includes consonant clusters that can reveal subtle articulation problems

Alternative Standardized Options

If the primary recommended sentence isn't appropriate for your patient, consider these alternatives:

1. "The telephone is ringing" - shorter and simpler
2. "The pastry cook was elated" - tests more complex articulation
3. "The spy fled to Greece" - tests specific consonant clusters

Assessment Protocol

When administering the sentence repetition test:

1. Speak clearly at a moderate pace
2. Ask the patient to repeat exactly what you say
3. Note any of these specific deficits:
   • Word substitutions or omissions
   • Articulation difficulties
   • Prosody changes (rhythm/intonation)
   • Inability to repeat despite apparent comprehension

Clinical Significance

The sentence repetition test is particularly valuable because:

• It can quickly identify language deficits that may indicate left hemisphere stroke 1
• Performance correlates with overall language function
• It's sensitive to specific brain dysfunction affecting attention and concentration 2
• Education level may affect performance, but age generally does not 2

Integration with NIHSS Assessment

The sentence repetition test complements the NIH Stroke Scale, which includes assessment of level of consciousness where:

• Score 0: Alert and responsive
• Score 1: Arousable to minor stimulation
• Score 2: Arousable to painful stimulation
• Score 3: Non-responsive or reflex responses only 3

Common Pitfalls to Avoid

• Don't use overly complex sentences with patients who may have comprehension difficulties
• Don't mistake anxiety-related speech issues for neurological deficits
• Don't overlook bilingual patients' language preferences - assessment in their primary language is preferable 1
• Don't rely solely on sentence repetition - it should be part of a comprehensive language assessment

Remember that language assessment procedures should vary depending on whether aphasia or cognitive-communicative problems associated with non-dominant hemisphere stroke are suspected 1. The sentence repetition test is just one component of a thorough stroke evaluation.