NIH Stroke Scale Language Score for Broca's Aphasia
Patients with Broca's aphasia typically score 1 (mild to moderate aphasia) on the NIH Stroke Scale language assessment (Item 9), as they maintain the ability to produce meaningful, comprehensible language despite word-finding difficulties, hesitant speech, and simplified grammar. 1, 2
Understanding the NIHSS Language Scoring System
The NIH Stroke Scale Item 9 (Best Language) uses a 4-point scoring system 2:
- Score 0: Normal language with no impairment
- Score 1: Mild to moderate aphasia with noticeable difficulty but maintained comprehensibility 1, 2
- Score 2: Severe aphasia with fragmented language requiring examiner inference 2
- Score 3: Mute, global aphasia, or coma with no usable speech 2
Why Broca's Aphasia Typically Scores 1
Broca's aphasia is characterized by non-fluent, effortful speech with relatively preserved comprehension, which aligns with the mild to moderate aphasia category. 3 The key distinguishing features that place Broca's aphasia in the score 1 category include:
- Preserved meaningful communication: Patients can describe pictures, name objects, and read sentences with difficulty but remain comprehensible to the examiner 1
- Word-finding difficulties: Patients eventually produce correct words or close approximations despite hesitations 1
- Simplified grammar and agrammatism: Speech shows syntactic impairment and omission of grammatical elements, but the main message is conveyed 4, 3
- Intact or near-intact comprehension: Auditory comprehension is typically preserved at high levels (97% accuracy in word comprehension tasks), distinguishing it from more severe aphasia types 5
Assessment Technique
The clinical assessment involves 2:
- Asking the patient to describe a standardized picture
- Requesting the patient to name objects
- Having the patient read sentences aloud
In Broca's aphasia, patients will show hesitant, paraphasic speech with pauses but will convey the overall meaning clearly enough for understanding without excessive inference needed from the examiner. 1
Critical Distinctions to Avoid Scoring Errors
Do not confuse Broca's aphasia with dysarthria, which is a motor speech disorder affecting articulation rather than language processing and is scored separately on the NIHSS. 1, 2 Broca's aphasia involves impairment at the phonemic, syntactic, and lexical levels of language, not just motor execution 3.
Distinguish between inability to speak due to decreased consciousness versus true aphasia, as these require different scoring 2. Patients with Broca's aphasia are alert and attempting to communicate, whereas decreased consciousness would suggest a different etiology.
Clinical Implications
Approximately 45% of acute stroke patients present with some degree of aphasia 2. The presence of mild to moderate aphasia (score 1) contributes to the overall NIHSS score, which correlates with stroke severity and outcomes. 2 These patients should be referred immediately to a Speech-Language Pathologist for comprehensive assessment and intensive therapy, as early intervention improves outcomes 2, 6.