Every second matters during a stroke, and for patients who do not speak English, language barriers can create dangerous delays during some of the most critical moments of care.
Neurologists at the Indiana University School of Medicine have developed a new app designed to help reduce communication barriers and improve stroke assessments and long-term outcomes for Spanish-speaking patients.
The app guides both physicians and patients through the National Institutes of Health Stroke Scale, a standardized tool used to quantify impairment caused by an acute stroke. It assesses key neurological functions including consciousness, vision, motor control, sensation and language, and is typically done first in the emergency department shortly after stroke symptoms appear.
Ann Jones, MD, assistant clinical professor of neurology, said the NIH Stroke Scale is used worldwide by healthcare professionals to determine the best course of treatment, but language differences can complicate the process.
“It’s supposed to be a universal communication tool on stroke severity, but it becomes challenging for physicians if they don’t speak the language of the person they’re assessing,” said Jones, medical director of the Telestroke program and of the Comprehensive Stroke Center at Indiana University Health Methodist Hospital.
“The hospitals have interpreters, but sometimes they aren’t available quickly, don’t always know what the stroke scale is, or they may unintentionally add their own interpretation. You don’t always know exactly how something is being translated and that can really impact how we score and treat a patient.”
Shaney Peña, MD, assistant professor of clinical neurology, said the new app is designed to help providers quickly complete the NIH Stroke Scale with Spanish-speaking patients when resources are limited, improving both the speed and accuracy of stroke evaluations in a time-sensitive emergency. Peña joined the Department of Neurology faculty last year after completing her vascular fellowship training at the IU School of Medicine.
“The NIH Stroke Scale exam requires clinicians to ask patients to perform specific tasks — such as raising an arm and holding it for 10 seconds or lifting a leg and keeping it elevated — so we can evaluate what they’re able to do and the severity of the stroke,” Peña said.
“With our app, the provider can select a command and a video appears. In the videos, I’m giving the instructions in Spanish while also demonstrating the movement the patient should perform. The commands are organized step-by-step, with English labels so providers know exactly what is being said in Spanish, and they can still complete the exam and score it appropriately.”
The app’s creation was the result of a capstone research project Peña conducted during her adult neurology residency training at the IU School of Medicine. She worked with Jones to study outcomes in terms of disabilities in non-English speaking stroke patients.
After reviewing more than 1,000 patient charts, the team identified incomplete or missing documents regarding demographic findings, including language preference, and gaps in follow-up care.
Though stroke is the fifth-leading cause of death in the country, it is the fourth-leading cause of death for Hispanic men and the third for Hispanic women, according to the American Stroke Association, a division of the American Heart Association. This disparity is driven by unmanaged health risk factors, limited access to health care, lower health literacy rates, cultural barriers and socioeconomic determinants of health.
“Going through a stroke is already scary, but that stress is even greater when patients and their families feel like they can’t fully communicate,” said Peña, who lived much of her childhood between Massachusetts and the Dominican Republic in a household where Spanish was her first language.
“My hope is that this app helps patients trust they are receiving the best possible stroke care, even if a Spanish-speaking provider cannot be there in-person right away.”
Jones said the new app could be especially valuable for IU Health hospitals across the state with fewer resources or less immediate access to interpreters.
“We want to bring equitable care to our rural hospitals that don’t necessarily need to do the NIH Stroke Scale as often,” Jones said. “They could use the app to access an English or Spanish assessment and work through the NIH Stroke Scale using a standardized method.”
The app is expected to begin initial testing soon in Indianapolis, Jones said, starting in lower-acuity settings before being introduced into acute stroke care situations.
If successful, she said the goal is to expand the technology to include additional languages.
“The NIH Stroke Scale has been around for a long time and has been tested extensively and proved to be a reliable measure in many different languages,” Jones said. “That gives us confidence that we could expand our app to other languages as well. French would probably be the next step, since we see a fair number of African French-speaking patients.”
Jones said the app project reflects IU’s broader approach to stroke care across Indiana.
“The multidisciplinary approach to stroke care at IU is truly unique,” she said. “We have experts caring for patients from the moment they arrive through recovery, providing world-class care. And those same experts are always willing to adapt and improve based on new research, and that’s inspiring to be part of.”
