Examples of Dysarthria Scoring 2 on the NIH Stroke Scale
A score of 2 on the NIH Stroke Scale for dysarthria (item 10) represents severe dysarthria, 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 when the patient is mute/anarthric. 1
Characteristics of Severe Dysarthria (Score of 2)
- Speech that is so slurred that it becomes unintelligible, making it difficult or impossible to understand what the patient is saying 1
- Mute or anarthric presentation where the patient cannot produce intelligible speech due to motor speech impairment 1
- Imprecise articulation of consonants, harsh voice quality, and audible inspiration are common characteristics 2
- Speech impairment that is disproportionate to any language processing deficit (aphasia) 1
Distinguishing Dysarthria from Aphasia
- Dysarthria (item 10) evaluates speech clarity and articulation, while aphasia (item 9) assesses language function 1
- A patient with severe dysarthria may have intact language comprehension but cannot articulate words clearly due to motor speech impairment 1
- A patient scoring 2 on dysarthria may score 0 on aphasia if language function remains intact 1
Clinical Examples of Severe Dysarthria (Score of 2)
- A patient who attempts to repeat standardized phrases but produces speech that is completely unintelligible to the examiner 1
- A patient with unilateral upper motor neuron dysarthria who cannot articulate words clearly enough to be understood 2
- A patient with lesions in the corona radiata who demonstrates severely impaired articulation 3
- A patient with right hemisphere stroke affecting the frontal operculum resulting in severely slurred speech 4
- A patient with reduced tongue pressure (below 28.4 kPa) leading to severe articulation difficulties 3
Assessment Technique
- Ask the patient to repeat standardized phrases from the NIH Stroke Scale 1
- If the patient cannot articulate these phrases clearly due to motor speech impairment, but language function is intact, the score should be 2 1
- Evaluate maximum phonation time and maximum loudness, which often deviate significantly from normal in severe dysarthria 2
Clinical Significance
- Severe dysarthria contributes to the overall NIHSS score and correlates with poorer outcomes 1
- Approximately 20% of stroke patients present with dysarthria, with varying types and characteristics depending on lesion site and severity 5
- Dysarthria can negatively affect social participation, psychosocial well-being, and quality of life 5, 6
- About 27% of patients continue to have dysarthria three months after stroke 7
Common Pitfalls to Avoid
- Don't confuse dysarthria with aphasia - they are separate items on the NIHSS 1
- Ensure that the speech difficulty is due to motor impairment rather than language processing deficits 1
- Consider that some patients may have both dysarthria and aphasia simultaneously 7
Remember that accurate assessment of dysarthria is essential for proper stroke evaluation and rehabilitation planning, as speech and language therapy is recommended for individuals with motor speech disorders 5.