{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:58:17Z","timestamp":1787169497163,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The 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%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.11622\/smedj.2021126","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T11:37:07Z","timestamp":1633347427000},"page":"563-566","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["National Institutes of Health Stroke Scale: comparison of original and modified versions for Singapore culture"],"prefix":"10.4103","volume":"64","author":[{"given":"Shu Han","family":"Lim","sequence":"first","affiliation":[{"name":"Duke-NUS Medical School, Singapore"},{"name":"Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai Yan","family":"Guek","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fung Peng","family":"Woon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre Danyi","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Speech Therapy, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu Swen","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szu Chyi","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deidre Anne","family":"De Silva","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10,3]]},"reference":[{"key":"R1-20240829","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction:A clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"R2-20240829","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/ijs.12196","article-title":"Troubleshooting the NIHSS:Question-and-answer with one of the designers","volume":"10","author":"Martin-Schild","year":"2015","journal-title":"Int J Stroke"},{"key":"R3-20240829","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3988\/jcn.2012.8.3.177","article-title":"Validity and reliability of a Korean version of the National Institutes of 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adaptation and structured interviewing","volume":"27","author":"Cincura","year":"2009","journal-title":"Cerebrovasc Dis"},{"key":"R7-20240829","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.ijnurstu.2005.07.004","article-title":"Assessing reliability and validity of the Chinese version of the stroke scale:Scale development","volume":"43","author":"Sun","year":"2006","journal-title":"Int J Nurs Stud"},{"key":"R8-20240829","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jns.2015.07.022","article-title":"Arabic cross cultural adaptation and validation of the National Institutes of Health Stroke Scale","volume":"357","author":"Hussein","year":"2015","journal-title":"J Neurol Sci"},{"key":"R9-20240829","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4103\/0028-3886.93587","article-title":"Validation of the Hindi version of National Institute of Health Stroke Scale","volume":"60","author":"Prasad","year":"2012","journal-title":"Neurol 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Stroke"},{"key":"R13-20240829","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1037\/0278-7393.6.2.174","article-title":"A standardized set of 260 pictures:Norms for name agreement, image agreement, familiarity, and visual complexity","volume":"6","author":"Snodgrass","year":"1980","journal-title":"J Exp Psychol Hum Learn"}],"container-title":["Singapore Medical 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