Assessing dysarthria across multiple countries. Translation of a list of words in the National Institute of

Health Stroke Scale (NIHSS): A Challenging Task

Rendu E1, Cooke C2, Lyden P3, Acquadro C1, Conway K1

1Mapi Institute, Lyon, France; 2Pfizer, Sandwich, UK; 3Department of Neurology,

Cedars-Sinai Medical Center Los Angeles, US

Background

The National Institutes of Health Stroke Scale (NIHSS) was developed in the US to assess stroke severity across 11 categories.

1a. Level of Consciousness (LOC): tests stimulation.

1b. LOC Questions: tests the patient's ability to answer questions correctly.

1c. LOC Commands: tests the patient's ability to perform tasks correctly.

2. Best Gaze: tests horizontal eye movements.

3. Visual: tests visual fields.

4. Facial Palsy: tests the patient's ability to move facial muscles.

5. Motor Arm: tests motor abilities of the arms.

6. Motor Leg: tests motor abilities of the legs.

7. Limb Ataxia: tests coordination of muscle movements.

8. Sensory: tests sensation of the face, arms, and legs.

9. Best Language: tests the patient's comprehension and communication.

10. Dysarthria: tests the patient's speech.

11. Extinction and Inattention: tests patient's recognition of self.

Dysarthria

To test Dysarthria, sample of patient speech is obtained based on a predefined “list of words”, each one testing different movements and combination of movements of the lips, tongue and jaws.

If the patient has severe aphasia, the clarity of articulation or spontaneous speech can be rated. The Scale Definitions are:

0 = Normal – no difficulties with speaking or forming the words

1 = Mild to moderate dysarthria – patient slurs at least some words and, at worst, can be understood with some difficulty.

2 = Severe Dysarthria – patient’s speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.

UN – Intubated or other physical barrier that prevents a proper evaluation.

Source: http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale_Booklet.pdf

Background

List of Words testing movements of the lips and the tongue

Words Test

MAMA A bilabial nasal, this word tests the lips.

TIP - TOP This word tests the lips and the tongue. Two strong “Ts” should be used in the language versions.

FIFTY - FIFTY This word tests the lips and the tongue. Here a fricative should be used.

THANKS In this word, the strength of the tongue is tested: the tongue should come from the front to the back of the mouth.

HUCKLE-BERRY Lips and tongue are tested. In this word “k” is a plosive velar and "b" a plosive bilabial.

BASEBALL PLAYER Lips and tongue are tested. In this word “b” & “p” are bilabial plosives.

Places of articulation

Objective

To present the methodology used to translate the list of words into:

Bulgarian

Canadian French

Korean

US Spanish

And to present the results

The aim of the translation was:

not to find conceptual equivalents

but words testing the same difficulties in articulation

and using similar phonological features as the original terms

Methods

Team

• Mapi Institute’s local consultant

• Neurologist• Speech therapist

(native speakers of the target languages)

• Dr Lyden, NIHSS developer• Mapi Institute’s local consultant• Mapi Institute’s Linguistic

Validation projet manager

Process

• Identification ofcandidate words usingthe same phonologicalfeatures as theoriginal US

• Literal backtranslation

• Review of candidates• Proposal of alternative

words (if needed)• Final decision

Results

MAMA

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian None MAMA(BT: mom)

[mama]

Canadian French None MAMAN(BT: mom)

[mamɑ̃]

Korean None 엄마(BT: mom)

[Əm ma]

US Spanish None MAMÁ(BT: mom)

[ma 'ma]

*BT: backtranslation

Results

TIP - TOP

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian None ТИП-ТОП(BT: Tip Top)

[tiptop]

Canadian French None TAM-TAM(BT: tom tom)

[tamtam]

Korean None 똑딱 똑딱(BT: tick tack)

[t'ok. t'ak. t'ok.

t'ak]

US Spanish None TIPITAPA(BT: name of a city in Nicaragua)

[tipi 'ta pa]

*BT: backtranslation

Results

FIFTY - FIFTY

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian None ФАНФАР(BT: trumpet)

[fanfar]

Canadian French Consonantic sound [ft] is not present in French

FLAFLA(BT: something insignificant)

[flafla]

Korean No equivalent Korean sound to /f/ in English

너 잡고 나 잡고(BT: I hold you and you hold me)

[nƏ jab go na jab

go]

US Spanish None FINAL FELIZ(BT: happy ending)

[fi 'nal.fe 'lis]

*BT: backtranslation

Results

THANKS

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian The English sound made by the English “th” [θ] doesn’t exist in Bulgarian

ТЕНИС(BT: tennis )

[tenis]

Canadian French The English sound made by the English “th” [θ] doesn’t exist in French

TAXES(BT: taxes)

[taks]

Korean The English sound made by the English “th” [θ] doesn’t exist in Korean

테니스(BT: tennis )

[tenis]

US Spanish The English sound made by the English “th” [θ] doesn’t exist in Spanish

DANDO(BT: giving)

['daN do]

*BT: backtranslation

Results

HUCKLE-BERRY

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian None ХЪКЪЛБЕРИ(BT: huckle-berry )

[h’klberi]

Canadian French The sound [ckle] found in “huckleberry” not followed by a vowel is not found in French

ONCLE BORIS(BT: uncle Boris)

[ɔ̃kl.bɔris]

Korean None 허수아비(BT: scarecrow)

[hƏ su a bi]

US Spanish None CASCABEL(BT: bell)

[kas ka 'βel]

*BT: backtranslation

Results

BASEBALL PLAYER

Language Issue Translation (BT)*

Phonetic transcription

Bulgarian None БЕЙЗБОЛНО ПОЛЕ(BT: baseball playground)

[beizbɔ:lnœ.pole]

Canadian French None PLACE AU BASEBALL(BT: make way for baseball )

[plas o beis.bɔ:l]

Korean None 비빔밥과 고추장(BT: bibimbop and chili paste)

[bi bim bop gwa go

chu jang]

US Spanish None BARBILLA(BT: chin)

[bar βi λa]

*BT: backtranslation

Summary of discussions

Example 1 : Canadian French

The sound [kl] in ‘huckleberry’, not followed by a vowel, does not exist in French. To test the same sounds that are used in this English word (sound using the lips and the tongue, with /k/ being a plosive velar and /b/ a plosive bilabial), a sequence of two words was found. A single word using these different articulations could not be found.

Different suggestions were made:

SOCLE DE BRIQUES (a base of bricks)

ONCLE BORIS (uncle Boris)

ONCLE BEN (uncle Ben)

UNCLE’S BEN (famous rice brand)

The first solution is not a very common expression, and the last one is not a French expression. ONCLE BORIS was chosen because “BORIS” has the same number of syllables as ‘berry’, though it may not be a very frequent name.

Example 2 : Korean

INFO TO BE ADDED

Conclusion

Necessity of adapting the classical linguistic validation process to translate the NIHSS list of words:

Not a forward translation based on sense

(conceptual equivalent)

But based on sound

(phonological equivalent)