What is the NIH (National Institutes of Health) scale score for a patient with severe dysarthria who is unable to communicate?

NIH Stroke Scale Score for Dysarthria in Patients Unable to Communicate

For patients who are unable to communicate due to severe dysarthria, the appropriate NIH Stroke Scale (NIHSS) score for item 10 (articulation) is 2, indicating severe dysarthria. 1

Understanding the NIHSS Dysarthria Assessment

• The NIHSS is a standardized stroke severity assessment tool with scores ranging from 0 to 42, where higher scores indicate more severe strokes 1
• Item 10 specifically evaluates articulation (dysarthria) using the following scoring criteria:
  • 0 = Normal articulation
  • 1 = Mild to moderate dysarthria
  • 2 = Severe dysarthria 1
• Severe dysarthria (score of 2) is characterized by slurred speech to the extent that the patient's speech is unintelligible in the absence of or out of proportion to any aphasia, or is mute/anarthric 1

Distinguishing Dysarthria from Aphasia in the NIHSS

• It's critical to differentiate between dysarthria (item 10) and aphasia (item 9) when scoring the NIHSS 1, 2
• Dysarthria (item 10) evaluates speech clarity and articulation, while aphasia (item 9) assesses language function 2
• A patient with severe dysarthria who cannot articulate words but understands language and has intact language function would receive:
  • Score of 2 for item 10 (severe dysarthria)
  • Score of 0 for item 9 (normal language function) if language comprehension and formulation are intact 1

Assessment Technique for Dysarthria

• The clinical assessment technique for evaluating dysarthria involves asking the patient to repeat standardized phrases such as "mama," "tip-top," "fifty-fifty," "thanks," "huckleberry," "baseball player," "caterpillar" 1
• If the patient cannot articulate these phrases clearly due to motor speech impairment, but language function is intact, the score should be 2 for severe dysarthria 1
• If the patient is intubated or has other physical barriers to speech, the examiner should score this item based on available information or mark as untestable 1

Common Pitfalls in Assessment

• Do not confuse dysarthria (motor speech disorder affecting articulation) with aphasia (language disorder affecting comprehension or expression) 2
• Avoid scoring dysarthria based on decreased consciousness; if the patient is unresponsive due to decreased consciousness, this should be reflected in the level of consciousness items (1A-C) 1, 3
• Remember that a patient can have both severe dysarthria (item 10 score of 2) and severe aphasia (item 9 score of 2 or 3) simultaneously 1

Clinical Significance

• Dysarthria is present in approximately 44% of acute stroke patients 4
• The presence of severe dysarthria contributes to the overall NIHSS score, with higher scores correlating with poorer outcomes 1
• Unilateral upper motor neuron dysarthria is the most common type following stroke, characterized by imprecise articulation of consonants, harsh voice quality, and audible inspiration 4

Reliability of NIHSS Dysarthria Assessment

• Studies have shown moderate to excellent interrater reliability for the dysarthria item of the NIHSS, with kappa values ranging from 0.55 to 0.80 1
• The reliability of dysarthria assessment via telemedicine has also been validated, showing comparable results to bedside assessment 1

By correctly scoring severe dysarthria as 2 on item 10 of the NIHSS, clinicians can accurately document the severity of motor speech impairment in stroke patients who are unable to communicate due to articulation difficulties.