NIH Stroke Scale Score for Dysarthria in Patients Unable to Communicate

Understanding the NIHSS Dysarthria Assessment

The NIHSS is a standardized stroke severity assessment tool with scores ranging from 0 to 42, where higher scores indicate more severe strokes 1, 2
Item 10 specifically evaluates articulation (dysarthria) using the following scoring criteria:
- 0 = Normal articulation
- 2 = 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 is mute/anarthric 1, 2

It's critical to differentiate between dysarthria (item 10) and aphasia (item 9) when scoring the NIHSS, as dysarthria evaluates speech clarity and articulation, while aphasia assesses language function 2
A patient with severe dysarthria who cannot articulate words but understands language and has intact language function would receive a score of 2 for item 10 (severe dysarthria) and a score of 0 for item 9 (normal language function) if language comprehension and formulation are intact 1, 2

The clinical assessment technique for evaluating dysarthria involves asking the patient to repeat standardized phrases, and if the patient cannot articulate these phrases clearly due to motor speech impairment, but language function is intact, the score should be 2 for severe dysarthria 1, 2

Studies have shown moderate to excellent interrater reliability for the dysarthria item of the NIHSS, with kappa values ranging from 0.55 to 0.80 3
The reliability of dysarthria assessment via telemedicine has also been validated, showing comparable results to bedside assessment 3

The presence of severe dysarthria contributes to the overall NIHSS score, with higher scores correlating with poorer outcomes 1

Approximately 20% of stroke patients present with dysarthria, with varying types and characteristics depending on lesion site and severity 4
Dysarthria can negatively affect social participation, psychosocial well-being, and quality of life 4
Speech and language therapy is recommended for individuals with motor speech disorders, such as dysarthria, for proper stroke evaluation and rehabilitation planning 4, 5