Factor Analysis of the National Institutes of Health Stroke Scale in Patients With Large Strokes

Abstract

The underlying structure of the NIHSS conforms to cerebral hemispheric lateralization, confirming previous findings in a new population of large hemispheric strokes. Left- brain strokes score 4 points higher on the NIHSS than right brain strokes of larger volume.

Common Behavioral Clusters and Subcortical Anatomy in Stroke

“…This conclusion is consistent with previous studies of the factor structure of the NIHSS (Lyden et al, 2004; Lyden et al, 1999). When we analyzed our patient sample using the NIHSS recorded at the same time as the behavioral battery, we obtained a similar factor structure to what previously reported (Table S8).…”

Common Behavioral Clusters and Subcortical Anatomy in Stroke

“…This conclusion is consistent with previous studies of the factor structure of the NIHSS (Lyden et al, 2004; Lyden et al, 1999). When we analyzed our patient sample using the NIHSS recorded at the same time as the behavioral battery, we obtained a similar factor structure to what previously reported (Table S8).…”

A low-dimensional structure of neurological impairment in stroke

“…middle vs. anterior cerebral vs. subcortical), but correlated deficits of both upper and lower extremity motor function. This is consistent with prior PCA studies on the NIHSS 4 , 5 and Corbetta et al 6 While traditional neuropsychological and neurophysiological investigations differentiate between sensory versus memory driven movements, and reaching versus grasping, 30–32 more recent studies emphasize the correlation among different kinds of ecological movements, and the low dimensionality of movements in terms of kinematic analysis, EMG activation, and even responses in motor cortex. A reaching movement for instance will require coordinated movements of shoulder, arm, elbow, wrist and fingers that occur together in patterns of neural activation (synergies).…”

“… 47 In addition, it has been repeatedly validated as an excellent predictor for patient outcome. 14 While previous studies on the factor structure of the sole NIH stroke scale 4 , 5 have identified two factors, one for each hemisphere, this study combining the NIHSS and OCS replicates the 3-factor structure identified in Corbetta et al 6 This implies that to capture cognitive impairment the NIHSS should be integrated with a more sensitive cognitive screen.…”

Behavioural clusters and predictors of performance during recovery from stroke

“…Interestingly, while the presence of a left hemisphere and right hemisphere cluster of impairment had been previously reported by a similar data-driven correlation analysis of the NIHSS 6,7 , a widely used impairment scale used in stroke care, the presence of a cognitive cluster that includes language and memory impairment is novel, and suggests that current assessments of impairment with the NIHSS should be integrated with more in-depth examination of language and memory, especially since this seems to be the most consistent over time.…”

Common Behavioral Clusters and Subcortical Anatomy in Stroke

“…This conclusion is consistent with previous studies of the factor structure of the NIHSS (Lyden et al, 2004; Lyden et al, 1999). When we analyzed our patient sample using the NIHSS recorded at the same time as the behavioral battery, we obtained a similar factor structure to what previously reported (Table S8).…”

A low-dimensional structure of neurological impairment in stroke

“…middle vs. anterior cerebral vs. subcortical), but correlated deficits of both upper and lower extremity motor function. This is consistent with prior PCA studies on the NIHSS 4 , 5 and Corbetta et al 6 While traditional neuropsychological and neurophysiological investigations differentiate between sensory versus memory driven movements, and reaching versus grasping, 30–32 more recent studies emphasize the correlation among different kinds of ecological movements, and the low dimensionality of movements in terms of kinematic analysis, EMG activation, and even responses in motor cortex. A reaching movement for instance will require coordinated movements of shoulder, arm, elbow, wrist and fingers that occur together in patterns of neural activation (synergies).…”

“… 47 In addition, it has been repeatedly validated as an excellent predictor for patient outcome. 14 While previous studies on the factor structure of the sole NIH stroke scale 4 , 5 have identified two factors, one for each hemisphere, this study combining the NIHSS and OCS replicates the 3-factor structure identified in Corbetta et al 6 This implies that to capture cognitive impairment the NIHSS should be integrated with a more sensitive cognitive screen.…”

Behavioural clusters and predictors of performance during recovery from stroke

“…Interestingly, while the presence of a left hemisphere and right hemisphere cluster of impairment had been previously reported by a similar data-driven correlation analysis of the NIHSS 6,7 , a widely used impairment scale used in stroke care, the presence of a cognitive cluster that includes language and memory impairment is novel, and suggests that current assessments of impairment with the NIHSS should be integrated with more in-depth examination of language and memory, especially since this seems to be the most consistent over time.…”

Common Behavioral Clusters and Subcortical Anatomy in Stroke

“…This conclusion is consistent with previous studies of the factor structure of the NIHSS (Lyden et al, 2004; Lyden et al, 1999). When we analyzed our patient sample using the NIHSS recorded at the same time as the behavioral battery, we obtained a similar factor structure to what previously reported (Table S8).…”

A low-dimensional structure of neurological impairment in stroke

“…middle vs. anterior cerebral vs. subcortical), but correlated deficits of both upper and lower extremity motor function. This is consistent with prior PCA studies on the NIHSS 4 , 5 and Corbetta et al 6 While traditional neuropsychological and neurophysiological investigations differentiate between sensory versus memory driven movements, and reaching versus grasping, 30–32 more recent studies emphasize the correlation among different kinds of ecological movements, and the low dimensionality of movements in terms of kinematic analysis, EMG activation, and even responses in motor cortex. A reaching movement for instance will require coordinated movements of shoulder, arm, elbow, wrist and fingers that occur together in patterns of neural activation (synergies).…”

“… 47 In addition, it has been repeatedly validated as an excellent predictor for patient outcome. 14 While previous studies on the factor structure of the sole NIH stroke scale 4 , 5 have identified two factors, one for each hemisphere, this study combining the NIHSS and OCS replicates the 3-factor structure identified in Corbetta et al 6 This implies that to capture cognitive impairment the NIHSS should be integrated with a more sensitive cognitive screen.…”

Behavioural clusters and predictors of performance during recovery from stroke

“…Interestingly, while the presence of a left hemisphere and right hemisphere cluster of impairment had been previously reported by a similar data-driven correlation analysis of the NIHSS 6,7 , a widely used impairment scale used in stroke care, the presence of a cognitive cluster that includes language and memory impairment is novel, and suggests that current assessments of impairment with the NIHSS should be integrated with more in-depth examination of language and memory, especially since this seems to be the most consistent over time.…”