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(Stroke. 2001;32:2958.)
© 2001 American Heart Association, Inc.

Letters to the Editor

3D Vector Component Analysis of the Modified National Institutes of Health Neurological Stroke Scale

Philip C. Njemanze, MD; Josephine Anozie, BSc Ifeyinwa Okadike, RN

Non-invasive Neurocybernetic Flow Laboratory, International Institutes of Advanced Research and Training, Chidicon Medical Center, Owerri, Nigeria

To the Editor:

The National Institutes of Health Stroke Scale (NIHSS) is the most widely used clinical instrument to measure the consequences of stroke for prognosis, follow-up, and assessment of therapeutic interventions. The neurological impairment associated with stroke reflects global and/or focal changes in brain vascular territories, eliciting syndromes in 3 major domains, including consciousness/orientation, sensorimotor functions, and speech/verbal communication. For a neurological scale to possess high validity, it should reflect changes in the different domains. First, the component items of the scale must represent specific domains without redundancy (ie, content validity), and most importantly the scale must have a high ability to detect meaningful change in clinical status over time (ie, convergent validity, a measure of responsiveness). Recently, Lyden et al¹ proposed a modified NIHSS (mNIHSS). Their goal was to increase both the reliability of the scale and its capacity to reflect more meaningful clinical information. However, the approach adopted by the authors could not examine responsiveness with respect to predicting within-individual changes. Recently, we have demonstrated the responsiveness of another scale, the United Form for Neurological Scoring of Hemispheric Stroke With Motor Impairment (UNSS),² using the 3D vector component analysis to overcome some of the limitations of using cumulative scores, which may represent widely different abnormalities in different domains. This work presents a method to represent the magnitude and direction of change in the various domains of the new mNIHSS in comparison with the original NIHSS with the aim of examining within-individual changes.

We present findings in 18 patients (14 men . . . [Full Text of this Article]