What is the management and treatment approach for a patient with mild to moderate dysarthria (difficulty articulating words) as indicated by slurring of words?

Mild to Moderate Dysarthria in the NIH Stroke Scale

Mild to moderate dysarthria (score of 1) on the NIH Stroke Scale is characterized by slurred but intelligible speech where the patient can read a list of words with noticeable articulation difficulties but can still be understood. 1

Characteristics of Mild to Moderate Dysarthria

• Slurred speech that remains intelligible to the listener 1
• Noticeable articulation difficulties but words can still be understood 1
• Patient can read provided word lists with impaired but comprehensible pronunciation 1
• Speech may sound thickened or imprecise but meaning is preserved 1

Clinical Assessment

• Assessment should be performed by having the patient read a standardized list of words 1
• The examiner listens for articulation difficulties while maintaining intelligibility 1
• Examples of mild to moderate dysarthria include:
  • Slightly slurred consonants (e.g., "p", "t", "k" sounds becoming less precise) 2
  • Thickened speech quality but words remain recognizable 1
  • Vowel distortions that don't prevent understanding 2

Differential Scoring on NIH Stroke Scale

• Score 0: Normal articulation with no speech abnormalities 1
• Score 1: Mild to moderate slurring but speech remains intelligible 1
• Score 2: Severe dysarthria where speech is unintelligible or patient is mute 1
• Score X: Used when patient is intubated or has a mechanical barrier to speech 1

Clinical Significance

• Dysarthria scoring on the NIHSS helps quantify neurologic deficits in stroke patients 1
• Mild to moderate dysarthria (score of 1) contributes to the overall NIHSS score, which ranges from 0-42 1
• NIHSS scores below 5 indicate small strokes, while scores above 20 suggest large strokes 1
• Early identification of dysarthria severity helps guide appropriate treatment planning 2, 3

Management Implications

• Speech and language therapy should be initiated as soon as possible during rehabilitation 2, 3
• Treatment should target the specific physiological systems affected (articulation, phonation, resonance) 2
• Therapy approaches should include exercises to improve articulation precision 2
• Communication partner training improves outcomes for patients with dysarthria 3
• Regular reassessment of dysarthria severity helps track recovery or progression 3

Important Considerations

• Progressive worsening of dysarthria after initial assessment may indicate stroke progression and requires immediate medical attention 3
• Dysarthria may have significant psychosocial impacts disproportionate to its physiological severity 2, 3
• Early treatment of dysarthria results in better outcomes, with recovery nearly twice that of untreated individuals when begun in the acute stage 3