NIHSS Dysarthria Assessment 2 — Questions and Answers
Question 1: A patient reads the standard NIHSS word list but their speech is mildly slurred yet fully understandable. What NIHSS dysarthria score applies?
- 0 – Normal
- 1 – Mild to moderate dysarthria (Correct answer)
- 2 – Severe dysarthria or mute
- UN – Unable to test
Correct answer: 1 – Mild to moderate dysarthria
Slurred but understandable speech with no other explanation scores 1 (mild to moderate dysarthria) on NIHSS item 10.
Question 2: Which scenario correctly justifies an NIHSS dysarthria score of UN (unable to test)?
- Patient refuses to speak due to anxiety
- Patient is intubated and cannot vocalize (Correct answer)
- Patient speaks only in a foreign language
- Patient's voice is hoarse from a cold
Correct answer: Patient is intubated and cannot vocalize
UN is reserved for patients who have a physical barrier to speech testing, such as intubation, not for refusal or language barriers.
Question 3: On NIHSS item 10, the examiner asks the patient to read words aloud. Which list is used?
- A sentence list from the Boston Diagnostic Aphasia Examination
- The standard NIHSS word list printed on the scoring card (Correct answer)
- Any newspaper headline the examiner chooses
- The patient's name and address only
Correct answer: The standard NIHSS word list printed on the scoring card
The NIHSS protocol specifies reading the standardized word list provided on the NIHSS score card for dysarthria testing.
Question 4: A patient with severe dysarthria has speech so slurred it is unintelligible to the examiner. What score is assigned?
- 0
- 1
- 2 (Correct answer)
- UN
Correct answer: 2
Speech that is unintelligible or absent in a patient who is not aphasic earns a score of 2 on NIHSS dysarthria.
Question 5: Why is it important to distinguish dysarthria from aphasia when scoring NIHSS item 10?
- Aphasia scores are combined with dysarthria for a total language score
- Dysarthria reflects motor speech impairment while aphasia reflects language content impairment (Correct answer)
- Only aphasia affects the dysarthria score
- Dysarthria and aphasia are scored on the same NIHSS item
Correct answer: Dysarthria reflects motor speech impairment while aphasia reflects language content impairment
Dysarthria is a motor speech disorder (articulation problem) separate from aphasia (language content disorder), and both have distinct NIHSS items.
Question 6: A patient cannot read but is conversational with mildly slurred speech. How should NIHSS dysarthria be scored?
- 0 – assume normal because conversation is adequate
- 1 – based on conversational speech assessment (Correct answer)
- 2 – because the word list could not be completed
- UN – because reading was not possible
Correct answer: 1 – based on conversational speech assessment
If the patient cannot read, the examiner assesses articulation through conversational speech and scores accordingly.
Question 7: Which cranial nerves are most directly implicated in the motor impairment detected by NIHSS dysarthria assessment?
- CN II, IV, VI
- CN VII, IX, X, XII (Correct answer)
- CN III, V, VIII
- CN I, XI, XII
Correct answer: CN VII, IX, X, XII
Dysarthria in stroke typically involves CN VII (facial), IX (glossopharyngeal), X (vagus), and XII (hypoglossal) controlling articulators and phonation.
NIHSS Dysarthria Assessment 2
A patient reads the standard NIHSS word list but their speech is mildly slurred yet fully understandable.
What NIHSS dysarthria score applies?