13. NIHSS: Dysarthria

In item 10, dysarthria,
we test the patient's articulation

and clarity of speech.

It's important that you don't explain
the purpose of this exam.

Ask the patient to read
or repeat the words

from the word card provided
with the stroke scale.

I'd like you to pronounce
these words for me.

Mama.

Tip-top.

Fifty-fifty.

Thanks.

Uckleberry.

Baseball player.

(man)
Okay.

(female speaker) For scale item 10,
this patient scored a 1.

Let's look at how
this scale item is scored.

Score a 0 for patients with normal speech
who read all words without slurring.

Score a 1 for patients
with mild to moderate speech defects,

and some slurring,
but who can be understood.

Would you read
those words for me, please.

Mama.

Tip-tip-top.

Fifity-fiftedy.

Thanks.

Huckleb-berry.

(man)
Good.

Baseball p-play-er.

(man)
Alright, very good.

(female speaker) A score of 2
is reserved for the patient

who cannot be understood
in any meaningful way,

or who is mute.

Would you ask her to say 'mama.'

Ask her to say 'mama.'

Mama, li 'mama.'

Ma...ma.

Ma...ma.

(man)
Okay.

An unresponsive patient
receives a score of 2 on this item.

A patient scoring of 3
on level of consciousness 1A

are scored 2 on this scale item.

The item is untestable only
if the patient is intabated,

or has other physical barriers
to producing speech.

Remember to clearly document
and explain this problem on the form.

Aphasic patients
and patients who do not read

may be scored based on listening
to the speech they do produce,

or by asking them to repeat the words
after you read them out loud.

In some cases,
the speech may be hard to understand

due to dental
or other non neurological causes.

Nevertheless, score the item a 1
to optimize reliability among examiners

that might have varying
degrees of experience.