{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:34:24Z","timestamp":1764786864726,"version":"3.46.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["P50 DC014664"],"award-info":[{"award-number":["P50 DC014664"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["R01 DC05375"],"award-info":[{"award-number":["R01 DC05375"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000052","name":"NIH Office of the Director","doi-asserted-by":"publisher","award":["1S10OD021648"],"award-info":[{"award-number":["1S10OD021648"]}],"id":[{"id":"10.13039\/100000052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    In January 2024, the picture stimuli used to elicit language on the NIH Stroke Scale were updated. Descriptions elicited using the now-retired\n                    <jats:italic>Cookie Theft<\/jats:italic>\n                    picture are informative regarding the size and location of stroke. An important dimension of validation for the new stimuli is to demonstrate that the language patients produce when describing the new\n                    <jats:italic>Precarious Painter<\/jats:italic>\n                    picture that is now part of the NIH Stroke Scale is similarly informative. Participants included 62 patients with acute ischemic stroke (24 left and 38 right) compared with 10 control participants hospitalized following transient ischemic attack. Descriptions of the\n                    <jats:italic>Precarious Painter<\/jats:italic>\n                    image were analyzed for content and structure. Bilateral regions of interest were selected based on their role in language processing, and lesion volume and location were measured on diffusion-weighted imaging. Analyses of variance were used to contrast discourse performance across groups, and correlations between discourse characteristics and proportion of region lesioned were calculated. Patients with left hemisphere strokes included less content from the right side of the picture, F(2) = 7.4, p\u2009=\u20090.001, \u03b7\n                    <jats:sup>2<\/jats:sup>\n                    <jats:sub>P<\/jats:sub>\n                    \u2009=\u20090.19, than those in the other groups. Informational efficiency had a strong inverse relationship with extent of lesion to the left, but not right, IFG. Correlations between discourse variables and lesion locations were grossly consistent with those previously reported and evidenced relationships between discourse variables and the bilateral extended language network. Features of picture description that may be appraised without specialized training in communication, such as how many things a patient includes, their location, and the inclusion of inferences or summarizing statements in the description, provide insight into stroke location and severity. The samples elicited using the new\n                    <jats:italic>Precarious Painter<\/jats:italic>\n                    stimulus perform similarly to those elicited using the retired\n                    <jats:italic>Cookie Theft<\/jats:italic>\n                    stimulus.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0337429","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:31:32Z","timestamp":1764786692000},"page":"e0337429","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lesion volume and location can be estimated by analysis of the new NIH Stroke Scale picture description"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-1236","authenticated-orcid":true,"given":"Melissa D.","family":"Stockbridge","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5661-5639","authenticated-orcid":true,"given":"Voss","family":"Neal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isidora","family":"Diaz-Carr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9593-1091","authenticated-orcid":true,"given":"Joseph S.","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreia V.","family":"Faria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5192-1171","authenticated-orcid":true,"given":"Argye E.","family":"Hillis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"issue":"7","key":"pone.0337429.ref001","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":"T Brott","year":"1989","journal-title":"Stroke"},{"issue":"6","key":"pone.0337429.ref002","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1001\/archneur.1989.00520420080026","article-title":"Interrater reliability of the NIH stroke scale","volume":"46","author":"LB Goldstein","year":"1989","journal-title":"Arch Neurol"},{"issue":"11","key":"pone.0337429.ref003","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1161\/01.STR.25.11.2220","article-title":"Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group","volume":"25","author":"P Lyden","year":"1994","journal-title":"Stroke"},{"issue":"4","key":"pone.0337429.ref004","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1161\/01.STR.0000013069.24300.1D","article-title":"Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke?","volume":"33","author":"JN Fink","year":"2002","journal-title":"Stroke"},{"issue":"1","key":"pone.0337429.ref005","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1212\/WNL.53.1.126","article-title":"Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)","volume":"53","author":"HP Jr Adams","year":"1999","journal-title":"Neurology"},{"issue":"7","key":"pone.0337429.ref006","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1212\/WNL.55.7.952","article-title":"Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial","volume":"55","author":"MR Frankel","year":"2000","journal-title":"Neurology"},{"issue":"1","key":"pone.0337429.ref007","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1161\/01.STR.0000106761.94985.8B","article-title":"Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models","volume":"35","author":"C Weimar","year":"2004","journal-title":"Stroke"},{"issue":"5","key":"pone.0337429.ref008","doi-asserted-by":"crossref","first-page":"101459","DOI":"10.1016\/j.rehab.2020.10.010","article-title":"Prevalence of 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