Several items pertaining to dysphasia and dysarthria of the National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States, were identified as culturally unsuitable in Singapore. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between original versus alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria.
In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had NIHSS assessment for Items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates.
Error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (p<0.001). For dysphasia phrases and dysarthria words, error rates were low and there were no differences in error rates between original and alternative items.
There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable NIHSS version for English-speaking subjects in Singapore.