We studied the validity of the aphasia item of a widely used stroke scale – the Scandinavian Stroke Scale (SSS) – in discriminating between aphasia and normal language function in 33 stroke patients of an acute stroke unit. They were assessed by a nurse using the aphasia item from the SSS and by a speech and language therapist carrying out a full evaluation of the language function. The latter served as the ‘gold standard’. The agreement between the nurses’ and the speech and language therapist’s scoring was good (weighted kappa = 0.74, 95% CI 0.51–0.97), and the sensitivity and specificity of the SSS aphasia item were also satisfactory. However, the predictive value of a positive test was as low as 0.55 (95% CI 0.23–0.83), indicating nearly every second of the positives being false positive. Using the aphasia score of the SSS as a diagnostic aid for aphasia after stroke results in a high rate of false positives and inflates the prevalence figures for aphasia in epidemiological studies of stroke.

Wade DT, Hewer RL, David RM, Enderby PM: Aphasia after stroke: Natural history and associated deficits. J Neurol Neurosurg Psychiatry 1986;49:11–16.
Enderby P, Wood VA, Wade DT, Hewer RL: Aphasia after stroke: A detailed study of recovery in the first 3 months. Int Rehabil Med 1987;8:162–165.
Mackenzie C: The diversity of speech and language therapy services for aphasic adults in the United Kingdom. Disabil Rehabil 1992;14:146–151.
Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol 1995;38:659–666.
Edwards DF, Chen YW, Diringer MN: Unified Neurological Stroke Scale is valid in ischemic and hemorrhagic stroke. Stroke 1995;26:1852–1858.
Muir KW, Weir CJ, Murray GD, Povey C, Lees KR: Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke 1996;27:1817–1820.
de Haan R, Limburg M, Bossuyt P, van der Meulen J, Aaronson N: The clinical meaning of Rankin ‘handicap’ grades after stroke. Stroke 1995;26:2027–2030.
Cote R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V: The Canadian Neurological Scale: Validation and reliability assessment. Neurology 1989;39:638–643.
Anonymous: Multicenter trial of hemodilution in ischemic stroke: Background and study protocol. Scandinavian Stroke Study Group. Stroke 1985;16:885–890.
Thommessen B, Thoresen GE, Bautz-Holter E, Laake K: Screening by nurses for aphasia in stroke: The Ullevaal Aphasia Screening (UAS) test. Disabil Rehabil 1999;21:110–115.
Cicchetti DV: Assessing inter-rater reliability for rating scales: Resolving some basic issues. Br J Psychiatry 1976;129:452–456.
Reinvang I, Engvik H: Manual of the Norwegian Basic Aphasia Assessment. Oslo, Scandinavian University Books, 1980.
Eisenson J: Examining for Aphasia. New York, New York Psychological Corporation, 1954.
Rose FC, Whurr R, Wyke MA: Aphasia. London, Whurr, 1988.
Wade DT, Langton Hewer R, Skilbeck CE, David RM: Stroke: A Critical Approach to Diagnosis, Treatment and Management. London, Chapman & Hall, 1985.
Goldstein LB, Samsa GP: Reliability of the National Institutes of Health Stroke Scale: Extension to non-neurologists in the context of a clinical trial. Stroke 1997;28:307–310.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.