What is the National Institutes of Health (NIH) scale score for a patient with severe language impairment who can barely be understood but is able to pronounce words?

NIH Stroke Scale Score for Best Language (Item 9) in Patients Who Can Barely Be Understood But Can Pronounce Words

For a patient who can barely be understood but is able to pronounce words, the appropriate NIH Stroke Scale score for item 9 (Best Language) is 2, indicating severe aphasia. 1

Understanding the NIHSS Language Assessment (Item 9)

• The NIH Stroke Scale item 9 (Best Language) specifically evaluates language function using the following scoring criteria:

  • 0 = Normal language
  • 1 = Mild to moderate aphasia
  • 2 = Severe aphasia
  • 3 = Mute, global aphasia, or coma 1

• When a patient can barely be understood but is still able to pronounce some words, this represents severe aphasia (score of 2), as they are attempting verbal communication but with severely limited comprehensibility 1

• A score of 3 would only be appropriate if the patient was completely mute or had global aphasia with no meaningful verbal output 1

Clinical Assessment Technique

• The assessment technique for evaluating language function involves asking the patient to:

  • Describe a standardized picture
  • Name objects
  • Read sentences 1

• When scoring, consider that:

  • If the patient can produce some words but they are barely understandable, this indicates severe impairment but not complete inability (score of 2) 1
  • The ability to pronounce words, even if barely understandable, distinguishes this from complete muteness (score of 3) 2

Distinguishing Language from Speech Articulation

• It's critical to differentiate between aphasia (item 9) and dysarthria (item 10) when scoring the NIHSS:

  • Aphasia assesses language function (word finding, comprehension, grammar)
  • Dysarthria evaluates speech clarity and articulation 3

• A patient with severe language impairment who can barely be understood due to language deficits (not just motor speech problems) would receive a score of 2 for item 9 1

• If the difficulty in understanding the patient is primarily due to slurred speech rather than language impairment, this would be scored under item 10 (dysarthria) instead 3

Common Pitfalls in Assessment

• Do not confuse inability to speak due to decreased consciousness with aphasia 1

• Distinguish between language deficits and motor speech problems (dysarthria) 3

• Avoid scoring based solely on fluency; consider all aspects of language function including naming, repetition, and comprehension 1

• Remember that patients with severe aphasia may have intact comprehension despite severely impaired expression 1

Clinical Significance and Implications

• The presence of severe aphasia contributes significantly to the overall NIHSS score 1

• Higher NIHSS scores correlate with poorer outcomes, with language deficits being an important prognostic factor 1

• Early identification of language deficits is crucial for appropriate referral to speech-language therapy 1

• Approximately 45% of acute stroke patients present with some degree of aphasia, making accurate assessment critical 1