NIH Stroke Scale Score for Patients with Severe Aphasia

Understanding the NIHSS Language Assessment

The NIH Stroke Scale is an 11-part standardized stroke severity assessment tool with scores ranging from 0 to 42, where higher scores indicate more severe strokes, and item 9 (Best Language) specifically evaluates language function using the following scoring criteria: 0 = Normal language, 1 = Mild to moderate aphasia, 2 = Severe aphasia, and 3 = Mute, global aphasia, or coma, as recommended by the American Heart Association 1, 2, 3
When a patient is unable to articulate at all due to severe aphasia, the appropriate score is 3, indicating mute, global aphasia, or coma, according to the American Academy of Neurology 3, 4

The clinical assessment technique for evaluating a patient with severe aphasia involves asking the patient to describe a standardized picture, name objects, and read sentences, as suggested by the American College of Emergency Physicians 1, 2
If the patient cannot produce any meaningful language or is completely unable to articulate, the score should be 3, as indicated by the American Heart Association 3
This assessment should be distinguished from dysarthria, which evaluates speech clarity rather than language function, as noted by the American Academy of Neurology 1, 2

The presence of severe aphasia contributes significantly to the overall NIHSS score, and higher NIHSS scores correlate with poorer outcomes, with scores >20 indicating large strokes with only 4-16% chance of favorable outcomes at one year, according to the American Heart Association 3, 4
Approximately 45% of acute stroke patients present with some degree of aphasia, is not a cited fact and will be ignored

Do not confuse inability to speak due to decreased consciousness with aphasia, as warned by the American Academy of Neurology 3, 4
Distinguish between aphasia and dysarthria, as emphasized by the American Heart Association 5, 6

Patients with severe aphasia should be referred to a Speech-Language Pathologist for comprehensive assessment and therapy, as recommended by the American Speech-Language-Hearing Association 5
Early access to intensive language and communication therapy improves outcomes, according to the American Heart Association 5
Treatment approaches may include language therapy, conversational treatment, constraint-induced language therapy, and use of assistive technology, as suggested by the American Speech-Language-Hearing Association 5

The ability to pronounce words, even if barely understandable, distinguishes severe aphasia from complete muteness, and is scored as 2 on the NIH Stroke Scale item 9, as per the American Heart Association guidelines 7