NIHSS Dysarthria Assessment 4 — Questions and Answers
Question 1: Which of the following word list items is a standard component of the NIHSS dysarthria reading card?
- 'Hippopotamus'
- 'Mama' (Correct answer)
- 'Baseball player'
- 'The cat sat on the mat'
Correct answer: 'Mama'
Simple words like 'mama,' 'tip-top,' and 'fifty-fifty' appear on the NIHSS word list to test labial and lingual articulation specifically.
Question 2: A patient scores 2 on dysarthria. Which clinical finding is most consistent with this score?
- Speech is mildly nasal but fully intelligible
- Speech sounds slightly slurred on consonants only
- Speech is completely unintelligible to the trained examiner (Correct answer)
- Voice pitch is higher than normal
Correct answer: Speech is completely unintelligible to the trained examiner
A score of 2 on NIHSS dysarthria indicates speech is so slurred it is unintelligible or the patient is mute.
Question 3: How does the NIHSS dysarthria score differ from item 9 (best language)?
- Dysarthria measures word-finding ability; language measures motor clarity
- Dysarthria measures motor articulation clarity; language measures comprehension and expression content (Correct answer)
- They are scored together as a combined aphasia-dysarthria item
- Language is scored only in left hemisphere strokes; dysarthria in right hemisphere strokes
Correct answer: Dysarthria measures motor articulation clarity; language measures comprehension and expression content
Item 9 (best language) tests linguistic content — word finding, comprehension, and fluency — while item 10 (dysarthria) tests purely the motor clarity of speech.
Question 4: A patient with locked-in syndrome is unable to produce any speech but is fully conscious. What NIHSS dysarthria score is appropriate?
- 0 – consciousness is intact
- 1 – mild, as some attempts are made
- 2 – severe/anarthria (Correct answer)
- UN – unable to test
Correct answer: 2 – severe/anarthria
Locked-in syndrome results in anarthria (complete absence of speech output) in a conscious patient, correctly scored as 2 on NIHSS dysarthria.
Question 5: Which brainstem structure, when damaged by stroke, most commonly causes acute dysarthria detected on NIHSS item 10?
- Medullary pyramid
- Pontine tegmentum and facial colliculus (Correct answer)
- Cerebral peduncle
- Superior colliculus
Correct answer: Pontine tegmentum and facial colliculus
The pontine tegmentum contains cranial nerve VII and VI nuclei; tegmental pontine stroke frequently produces dysarthria along with other cranial nerve signs.
Question 6: An NIHSS-trained nurse scores dysarthria as 1. Which documentation note best supports this score?
- 'Patient's speech is completely unintelligible'
- 'Patient's speech is slurred but all words understood with careful listening' (Correct answer)
- 'Patient is intubated and cannot speak'
- 'Patient refused to read the word list'
Correct answer: 'Patient's speech is slurred but all words understood with careful listening'
A score of 1 requires documentation of mild to moderate slurring where the patient is still intelligible, distinguishing it from scores 0 and 2.
Question 7: During a stroke code, the NIHSS examiner observes that the patient's dentures are out. What is the recommended approach?
- Score 2 because articulation will be abnormal without dentures
- Ask the patient to put dentures in before testing, if possible (Correct answer)
- Score UN because testing is invalid without dentures
- Skip item 10 and document 'dentures removed'
Correct answer: Ask the patient to put dentures in before testing, if possible
The NIHSS recommends that if dentures are available and can safely be placed, they should be inserted before testing to allow valid baseline articulation assessment.
NIHSS Dysarthria Assessment 4
Which of the following word list items is a standard component of the NIHSS dysarthria reading card?