New Picture Stimuli for the NIH Stroke Scale: A Validation Study.

Area of Science:

• Neurology
• Medical Imaging
• Psycholinguistics

Background:

• The National Institutes of Health Stroke Scale (NIHSS) is a standard tool for neurological assessment in acute stroke.
• Existing NIHSS picture stimuli raise concerns regarding contemporary and global health contexts.
• New, globally relevant stimuli have been developed for stroke assessment.

Purpose of the Study:

• To validate new picture stimuli for the National Institutes of Health Stroke Scale.
• To assess the suitability of the "precarious painter" image and updated naming objects for global stroke assessment.
• To evaluate healthcare providers' preferences for new versus existing NIHSS stimuli.

Main Methods:

• A validation study involving 101 healthy English speakers from diverse countries (US, Germany, Canada, UK, Australia, Zambia).
• Participants described a new picture and named updated objects, with data collected in person or via video conferencing.
• Multivariate analyses of variance were used, supplemented by a survey of 299 International Stroke Conference attendees on stimulus preference.

Main Results:

• The new picture description yielded rich linguistic samples, with content units included by at least 5% of respondents across demographics.
• Performance was consistent across diverse participant groups, unaffected by age, sex, race, ethnicity, or education.
• New naming stimuli were universally recognized and identified, with highly convergent naming responses. The majority of stroke providers preferred the new stimuli.

Conclusions:

• The "precarious painter" image provides a robust basis for detecting language deficits in stroke patients.
• Updated NIHSS stimuli are suitable for contemporary and global stroke assessment.
• The new stimuli enhance the reliability and applicability of the NIHSS worldwide.