Language Screening Test Research Articles

Epidemiological, Clinical and Radiological Profiles of Post-stroke Aphasia in Neurology in Abidjan from April to September 2022

Background and purpose: Aphasia is a language disorder that frequently occurs after a cerebrovascular accident. This prospective descriptive study aimed to describe the epidemiological, clinical and radiological profiles of post-stroke aphasia. Materials and method: Patients presenting aphasia after a stroke documented by brain imaging, hospitalized from April to September 2022 in the neurology departments of the Cocody and Treichville University Hospitals were included. Aphasia was screened using the Language Screening Test (LAST). Epidemiological, clinical and radiological data were collected through clinical observation. Results: Of the 217 stroke patients admitted to neurology during the period, 32 presented aphasia (14.7%). The average age was 56 years, with a male predominance (M/F sex ratio of 2.2). The majority of patients had primary or no schooling (87.5%). Arterial hypertension was the most frequent cardiovascular risk factor (50%) and hemiplegia, the most common physical sign (93.8%). The average LAST score for aphasic patients was 5.3 out of 15. We observed that naming and repetition were the most affected components of speaking, with scores below normal in 87.5%. and 88% of cases. Regarding oral comprehension, order execution was the component most affected for 75.1% of patients. In the acute phase of stroke, 50% of cases of aphasia were severe. Radiologically, 75% of patients presented an ischemic stroke with the predilection of the middle cerebral artery. Conclusion: this study highlights the importance of early detection of aphasia in post-stroke patients and rapid treatment to optimize their linguistic recovery.

The brief executive language screen: sensitivity and specificity in acute to early sub-acute stroke

ABSTRACT Introduction Propositional language and underlying executive functions can be impaired post-stroke and affect communication and quality of life. Current stroke screening tools are largely tailored to patients with aphasia, being either non-verbal or focussed on core language skills such as naming and repetition. The Brief Executive Language Screening Test (BELS) is a newly developed cognitive screening tool that assesses memory, oral apraxia, core language, as well as propositional language and associated executive functions that can be impacted and overlooked in stroke patients without aphasia. This study examines BELS sensitivity and specificity, and performance in acute to early sub-acute stroke relative to controls. Method Cross-sectional BELS data from 88 acute left and right hemisphere stroke patients (within 7 weeks of stroke) and 116 age-matched healthy controls were compared using independent samples t-tests. ROC Curve Analysis was performed to determine a cutoff score for the BELS. Results Left and right stroke patients were reduced on all propositional language subtests, and executive function subtests of inhibition, strategy, and selection. Differences were also observed for Oral Apraxia, Naming, and Memory. By contrast, Word Comprehension and Repetition, and Sentence Completion Initiation (after corrections applied) did not differ between groups. A total BELS score of 79.25/100 was highly sensitive (.89) and specific (.89) when classifying stroke patients and healthy controls. Conclusion The BELS is brief, sensitive, suitable for bedside administration, and can aid in detection and rehabilitation of subtle executive language impairments. This in turn will help improve relationships and quality of life post-stroke.

Correlation between Language Screening Test and Frenchay Aphasia Screening Test for Aphasia Screening in Ischemic Stroke

Aphasia is a communication disorder that occurs after brain damage. Delays in diagnosing aphasia can lead to depression, decrease quality of life, and raise hospital stays and costs. Ischemic stroke aphasia screening instruments have been widely developed but are still difficult to interpret. Nowadays, the Language Screening Test (LAST) is reportedly quick, easy to understand, straightforward, and suitable for use by nurses. However, the LAST subtests are different from the Frenchay Aphasia Screening Test (FAST), which has been used in the past to evaluate aphasia. This study aims to determine the relationship between LAST and FAST in ischemic stroke aphasic patients for aphasia screening. The study used an analytic observational method with a cross-sectional approach. The population in this study were stroke patients at Tugurejo Semarang Hospital who had their CT Scan checked. The sample was taken using a purposive sampling technique. Bivariate data analysis with Spearman Rank Correlation test. We obtained 50 samples 19 male patients and 31 female patients with the highest age range of 51-60 years as many as 26 patients. The highest Education and profession is primary school and housewife. Patients who experienced aphasia with LAST and FAST scored as many as 27 and 29 people, while the rest not have aphasia. The Spearman's Rank test obtained p-values of 0,000 and < 0,05 respectively. Meanwhile, the correlation coefficients of LAST and FAST on aphasia were 0,678 and 0,678 respectively. There is a positive correlation between the LAST and FAST in ischemic stroke aphasic patients for aphasia screening. Nurses can use the LAST instrument to collect data and establish nursing diagnoses of verbal communication disorders.

Long-term prognosis and health-related quality of life for people with Aphasia in Sweden

ABSTRACT Background People with aphasia (PWA) after ischemic stroke often have difficulties in communication and social participation. To individualise rehabilitation and optimise recovery, there is a need for knowledge regarding prevalence of aphasia, and language functions in relation to long-term recovery and health-related quality of life (HRQoL). In this study, we examined these issues in a Swedish setting. Methods We screened consecutive persons with first-ever ischemic stroke admitted to Skåne University Hospital, Sweden, at baseline (median day 4 post stroke onset) for aphasia with the Language Screening Test (LAST). We then performed a detailed follow-up of PWA at 1, 3, and 12 months after stroke onset with the Swedish version of the Comprehensive Aphasia Test (CAT) for evaluation of cognition and language, and with the self-reported Aphasia Impact Questionnaire (AIQ) for evaluation of HRQoL. We analysed aphasia recovery and potential associations between aphasia severity, language functions, stroke severity according to National Institutes of Health Stroke Scale (NIHSS), and HRQoL. Results Initial aphasia was present in 27% (n = 60 of 221) of stroke persons in the acute phase. At 1 month after stroke onset, 74% (n = 40 of 54 survivors with initial aphasia) had remaining aphasia, at 3 months 67% (n = 34 of 51) had aphasia and at 12 months post stroke 61% (n = 30 of 49) had remaining aphasia. Improvement of aphasia was greatest during the first months after onset, with significant improvement regarding naming (p= 0.01), repetition (p= 0.03) and comprehension of written language (p= 0.01). HRQoL remained significantly associated with aphasia severity after adjusting for stroke severity and age. At 3 months, 87% (n = 26) of PWA reported that aphasia affected their ability to communicate with the environment, had negative consequences on level of participation (73%, n = 22), and their emotional well-being (87%, n = 26). There were no significant temporal changes regarding HRQoL between 3 and 12 months post stroke. Conclusion Chronic aphasia was observed in 61% of all alive persons presenting with baseline aphasia after ischemic stroke. Aphasia has negative consequences on HRQoL for PWA and aphasia severity impacts HRQoL regardless of stroke severity.

Brazilian Portuguese Adaptation and Validation of the Language Screening Test for Poststroke Patients.

There is a lack of standardized assessment tools for poststroke aphasia in Brazil, particularly bedside screenings for early identification of patients with suspected language disorders. The Language Screening Test (LAST) is a valid and reliable method for screening hospitalized patients following a stroke. This tool was first developed in French and then translated and validated in other languages. This study aimed to translate, culturally adapt, and validate the LAST into Brazilian Portuguese. Following a systematic, multistep approach to translation and cultural adaptation of language instruments, this study developed the two parallel versions of the Brazilian Portuguese LAST (pLAST) Versions A and B. The final versions were applied to 70 healthy and 30 poststroke adults across age and educational levels. Subtests of the Boston Diagnostic Aphasia Examination (BDAE) were used to assess the external validity of the pLAST. Findings showed that the two versions (A and B) of the pLAST were equivalent (intraclass correlation coefficient = .91; p < .001). No floor or ceiling effects were observed, and internal validity was excellent (Cronbach's α = .85). Moreover, its external validity against the BDAE was moderate to strong. Test sensitivity and specificity were 0.88 and 1, respectively, and accuracy was 0.96. The Brazilian Portuguese version of the LAST is a valid, simple, easy, and rapid test to screen poststroke aphasia in hospital settings. https://doi.org/10.23641/asha.23548911.

A Study on Multicultural Mothers’ Comprehension and Satisfaction with Language Screening Test Applications by Type of Information Provision

Objectives: The purpose of this study is to find out whether there is a significant difference in comprehension and satisfaction with language screening test application according to the information provision type (text, video). Methods: This study examined the difference in comprehension and satisfaction with Language Screening test Applications according to the type of information provision for 20 Vietnamese mothers (10 in the text group and 10 in the video group) who have lived in Korea for more than 5 years, and raised children in pre-school age. Results: First, there was no statistically significant difference in the interaction between the information provision type and the pre- and post-evaluation, but there was a statistically significant difference in the pre- and post-comprehension and satisfaction according to the type of information provision. Second, as a result of the pre-post-statistics of the subcategory of the comprehension questionnaire, the text group showed significant differences in 2 out of 6 categories and the video group in 5 out of 6 categories. Third, as a result of the pre-post-statistics of the subcategory of the satisfaction questionnaire, the text group showed significant differences in 4 out of 5 categories and the video group in 4 out of 5 categories. Conclusion: It was found that the type of information provision had a positive effect on comprehension and satisfaction. Furthermore, this study suggests that by increasing the accessibility of the screening test application, the possibility of early screening and early intervention for children from multicultural families can be increased.

A Study of Validity and Satisfaction of Tele-assessment

Objectives: This study aims to examine the validity of two types of remote language screening tests (indirect questionnaire type vs direct observational type), and differences in performance of children as well as satisfaction of their mothers between these two types of remote language screening test. Methods: In total 40 children without any language deficits aged 3 to 6 and their mothers participated in this study. For statistical analysis, a Pearson correlation was conducted between the remote language screening tests (indirect questionnaire type and direct observation type); a PRES (Preschool Receptive-Expressive Language Scale) to find out the concurrent validity, and a paired t-test was conducted to find out if there are significant differences in the performance of the children and satisfaction of their mothers between the two types of screening tests. Additionally as a qualitative analysis, mothers’ preference among two types of the test was asked using an open ended survey. Results: The two types of tests (indirect, direct) showed strong positive correlation with one another. Regarding concurrent validity, both test types showed strong positive correlation with a standardized language test as well. There was no significant difference between the two types in both the performance of the children and the satisfaction of mothers as well. However, 85% percent of mothers preferred the direct observation type citing better accuracy as their reasoning. Conclusion: It is hoped that remote language screening tests can contribute to the implementation of non-face-to-face screening in clinical settings since it is highly validated. Furthermore both two types of tests can be used and complement each other.

Cognitive Assessment is Feasible After Acute Stroke and Can Identify Co-occurrence of Spatial Neglect (P5-12.003)

<h3>Objective:</h3> 1) Determine whether beside screening of aphasia, delirium, spatial neglect (SN), global cognitive impairment (GCI), and depression is feasible in the stroke unit. 2) Determine the incidence and co-occurrence of these disorders <h3>Background:</h3> Most people are unaware of cognitive problems. Aphasia, delirium, SN, global cognitive impairment (GCI), and depression are common in the days after stroke, however even experienced clinicians can miss signs without systematic cognitive assessment. It is crucial to identify co-occurrence of these conditions; the disorders are individually associated with worse functional outcomes. <h3>Design/Methods:</h3> Bedside psychometric assessments were completed during acute stroke care (606 patients) with standardized and validated screening: 1) 3D-CAM for delirium, 2) Language Screening Test for aphasia, 3) Catherine Bergego Scale (short form) for SN, 4) Montreal cognitive assessment for GCI, and 5) Patient Health Questionnaire-8 for depression. We used standardized cutoffs to identify deficits, and summary statistics to determine the incidence/co-occurrence of deficits. <h3>Results:</h3> More than 98% of patients could be assessed with at least one screener, with &gt; 95% completion rate on each measure (good feasibility). Of 565 patients completing all screening instruments, 94% met criterion for GCI, 53% for SN, 27% for aphasia, 22% for depression, and 15% for delirium; 9% of patients presented with no deficits, 30% had one deficit and 61% had two or more deficits. Of the 183 individuals with two deficits, the most common combination (116 patients, 63%) was SN and GCI. <h3>Conclusions:</h3> Bedside assessment of cognitive disorders is feasible after acute stroke. Multiple deficits are common: more than half of patients assessed had two or more deficits. SN and GCI commonly occurred together after stroke. Future research can examine whether stroke patients with abnormal MoCA scores may have undiagnosed SN and how co-occurring deficits affect risk of later dementia, functional decline and increased caregiver burden. <b>Disclosure:</b> Dr. Hickle has nothing to disclose. Ms. Hellmann has nothing to disclose. Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE. The institution of Dr. Loring has received research support from NIH. Dr. Loring has received publishing royalties from a publication relating to health care. Dr. Saurman has nothing to disclose. Dr. Benameur has nothing to disclose. The institution of Shilpa Krishnan has received research support from National Instuitutes of Health. Shilpa Krishnan has received personal compensation in the range of $10,000-$49,999 for serving as a Research Consultant with The Board of Medicine. Dr. Nahab has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Consultation. Dr. Nahab has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Barrett has received research support from Veterans Health Association.

Effects of cognitive styles on the academic performance of primary school pupils with aphasia in Sokoto State, Nigeria

The manner and ways in which learners perceive and internalize information have been the subject of discussion by many scholars. This paper investigated the effects cognitive styles had on the academic performance of primary school pupils with aphasia in Sokoto State, Nigeria. A correlation research design was used in the conduct of the study. The population used for the study covered all primary school pupils in Sokoto state which numbered 706,064 and the study drew its sample using four stages of sampling. Primary four pupils numbering (9,369) in 63 primary schools that had symptoms of Aphasia were handpicked using a sampling technique called purposive before subjecting them to screening using the Language Screening Test and a total of 69 pupils were screened as aphasic across nine (9) Local Education Authorities from the three (3) educational zones of Sokoto State. The adapted version of the Language Screening Test, Group Embedded Figure Test, and Academic Performance Test designed by the researchers were the instruments used for data collection. The data collected was analyzed using PPMC. Instruments used for the study were validated by the developers and designers of the standardized instruments while academic performance test was validated using assessment and corrections by experts and they were found to have a face and content validity. The reliability of the instruments was realized using test-retest techniques, the correlation index found were, (0.71), (0.77), and (0.80). Findings of the research indicated that; there existed a positive, strong, and significant connection and the relationship between cognitive styles (field dependent) and academic outcomes/performance as well as a negative, weak, and insignificant relationship existed between cognitive styles (field-independent) and academic performance. It was concluded that children with Aphasia have language and communication disorder that affected their expressive and receptive language abilities, and the repetition of phrases and words. The researchers recommended that effort should always be made by teachers to identify pupils with aphasia in their classes whose mode of perceiving and processing information is holistic and global toward problems and match it with an individualistic and self-directed teaching approach in a well-structured learning environment.

Normative Data for Healthy French-Speaking Persons Aged 80Years and Older for the DTLA Language Screening Test.

The objective of the present study was to develop norms for the population older than 80years of age for the DTLA. We extend the original normative data to include 149 healthy, community-dwelling, French-speaking adults aged 80years old and older from the same countries. For the total score of the screening test, we calculated the 5th, 15th, 25th, and 50th percentiles for two education groups. The analyses allowed the identification of cutoff and alert scores based on education level. With the present study, solid normative data for the DTLA derived from the performance of 694 healthy, community-dwelling adults, and elderly people are now available to clinicians and researchers.

Point-of-Care Testing Using a Neuropsychology Pocketcard Set: A Preliminary Validation Study.

Neurocognitive screening instruments usually require printed sheets and additional accessories, and can be unsuitable for low-threshold use during ward rounds or emergency workup, especially in patients with motor impairments. Here, we test the utility of a newly developed neuropsychology pocketcard set for point-of-care testing. For aphasia and neglect assessment, modified versions of the Language Screening Test and the Bells Test were validated on 63 and 60 acute stroke unit patients, respectively, against expert clinical evaluation and the original pen-and-paper Bells Test. The pocketcard aphasia test achieved an excellent area under the curve (AUC) of 0.94 (95% CI: 0.88–1, p < 0.001). Using an optimal cut-off of ≥2 mistakes, sensitivity was 91% and specificity was 81%. The pocketcard Bells Task, measured against the clinical neglect diagnosis, achieved higher sensitivity (89%) and specificity (88%) than the original paper-based instrument (78% and 75%, respectively). Separately, executive function tests (modified versions of the Trail Making Test [TMT] A and B, custom Stroop color naming task, vigilance ‘A’ Montreal Cognitive Assessment item) were validated on 44 inpatients with epilepsy against the EpiTrack® test battery. Pocketcard TMT performance was significantly correlated with the original EpiTrack® versions (A: r = 0.64, p < 0.001; B: r = 0.75, p < 0.001). AUCs for the custom Stroop task, TMT A and TMT B for discriminating between normal and pathological EpiTrack® scores were acceptable, excellent and outstanding, respectively. Quick point-of-care testing using a pocketcard set is feasible and yields diagnostically valid information.

Relationship between Cognitive Styles and Emotional Status of Primary four Pupils with Aphasia in Sokoto State, Nigeria

This paper examined relationship between cognitive styles and emotional status of primary four pupils with aphasia in Sokoto State. The population targeted for this study consists of all primary four pupils in Sokoto state which is 9,369. Multi-stage sampling techniques was used to arrive at the sample. Four stages of sampling techniques were employed to arrive at the sample of 69 pupils using purposive sampling and screening using Language Screening Test. The instruments used for data collection were adopted version of Language Screening Test (LAST), adopted version of Group Embedded Figure Test and adopted version of Junior Eysenck Personality Questionnaire (short version). The reliabilities of the standardized were re-established using test re-test method of establishing reliabilities in two schools in Sokoto metropolis and the reliabilities index realized were Language Screening Test (0.71), Group Embedded Figure Test (0.80) and Junior Eysenck Personality Questionnaire (0.89). The data was analyzed using Pearson Product Moment Correlation. The result revealed that: there was weak, positive and no significant relationship between field dependent cognitive styles and emotional stability among others. Finally, it was recommended among others that; Pupils with aphasia should be encouraged to have holistic and global perception towards problems and develop their extrinsic motivation to enable them stabilized their emotion and catch up with their peers.

Predictive Validity and Factors of Direct and Indirect Language Screening Measures for Children Using Panel Data

Objectives: The purpose of this study was to examine whether language abilities, measured by examiners and parents, at age 2 significantly predict later language skills. In addition, this study investigated whether the results of two language screening tests were consistent and which factors affected the agreement of the two measures.Methods: This study analyzed data from 1,739 Korean children who participated in the 3rd (T1, age 2), 6th (T2, age 5), and 10th (T3, age 8) Panel Study of Korean Children (PSKC). The Korean-Denver II test, the Korean-Ages and Stages Questionnaires (K-ASQ), the Receptive &amp; Expressive Vocabulary Test (REVT), and the Multi-Factor Intelligence Test (M-FIT) were utilized to measure children’s language skills. To examine the predictive validity of the two language screening measures, a simple regression analysis was conducted. To investigate the factors affecting the agreement between the results of two measures, parental education level, parental style, knowledge of child development, and child temperament data were used.Results: Both the results of the Korean-Denver II test and K-ASQ at T1 significantly predicted children’s language skills at T2 and T3. It was also found that only parental style was significantly different between the groups classified by the agreement of the two language screening measures at T1.Conclusion: The results of this study revealed that both two language screening measures were valid tools for significantly predicting children’s later language skills. In addition, it was confirmed that the social interaction parental style was a factor affecting parents’ accurate evaluation of their children’s language skills.

Abstract WP66: Acute Stroke Screening For Cognitive Disorders And Depression

Introduction: As stroke survivors transition from acute to post-acute care, and finally to community settings, the Centers for Disease Control reports ~65% receive NO rehabilitation. Even more receive rehabilitation too late, after critical brain changes for recovery are complete. Stroke survivors with invisible disabilities of cognition and depression are especially vulnerable to experience poor recovery. We launched a dedicated process to identify invisible disabilities. Our long-term objective is to make acute and post-acute, evidence-based intervention accessible. Hypothesis: &gt;50% of acute stroke patients have cognitive deficits, or depression. Methods: Our comprehensive stroke center completes bedside psychometric assessment with standardized instruments for aphasia (Language Screening Test, LAST), spatial neglect (Catherine Bergego Scale, CBS), memory/global cognition (Montreal Cognitive Assessment, MoCA), delirium (3-Minute Diagnostic Interview for the Confusion Assessment Method, 3D-CAM) and depression (Patient health questionnaire, PHQ-8). Patients unable to respond to questions are assessed for spatial neglect and delirium (standardized observations). Results: 105 ischemic stroke survivors were assessed in the first quarter of program launch (April-July, 2021). Of that group, patients met screening criteria for spatial neglect (47%), aphasia (40%), delirium (19%) and depression (31%). Over 90% had memory / global cognitive impairment (MoCA&lt;26/30). Conclusions: Our initiative, which includes systematic acute stroke unit spatial neglect screening, confirmed the previously reported high rate of cognitive disorders and depression (Champod, Eskes, Barrett, 2020). Our current step implements uniform recommendations for patients with deficits, and will examine post-acute outcomes, number receiving rehabilitation and medical follow-up, and treatment disparities (right/left stroke, under-represented groups).

Comparison of the Diagnostic Evaluation of Language Variation-Screening Test Risk Subtest to Two Other Screeners for Low-Income Prekindergartners Who Speak African American English and Live in the Urban South.

PurposeWe compared the Risk subtest of the Diagnostic Evaluation of Language Variation–Screening Test (DELV–Screening Test Risk) with two other screeners when administered to low-income prekindergartners (pre-K) who spoke African American English (AAE) in the urban South.MethodParticipants were 73 children (six with a communication disorder and 67 without) enrolled in Head Start or a publicly funded pre-K in an urban Southern city. All children completed the DELV–Screening Test Risk, the Fluharty Preschool Speech and Language Screening Test–Second Edition (FLUHARTY-2), and the Washington and Craig Language Screener (WCLS). Test order was counterbalanced across participants.ResultsDELV–Screening Test Risk error scores were higher than those reported for its standardization sample, and scores on the other screeners were lower than their respective standardization/testing samples. The 52% fail rate of the DELV–Screening Test Risk did not differ significantly from the 48% rate of the WCLS. Fail rates of the FLUHARTY-2 ranged from 34% to 75%, depending on the quotient considered and whether scoring was modified for dialect. Although items and subtests assumed to measure similar constructs were correlated to each other, the three screeners led to inconsistent pass/fail outcomes for 44% of the children.ConclusionsLike other screeners, the DELV–Screening Test Risk subtest may lead to high fail rates for low-income pre-K children who speak AAE in the urban South. Inconsistent outcomes across screeners underscore the critical need for more study and development of screeners within the field.

The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury

ABSTRACT Primary objective: The assessment of language in patients post-comatose patients is limited by their reduced behavioral repertoire. We developed the Brief Evaluation of Receptive Aphasia (BERA) tool for assessing phonological, semantic and morphosyntactic abilities in patients with severe brain injury based on visual fixation responses. Research design: Prospective cross-sectional study and case reports. Methods and procedure: The BERA and Language Screening Test were first administered to 52 conscious patients with aphasia on two consecutive days in order to determine the validity and reliability of the BERA. Four post-comatose patients were further examined with the BERA, the Coma Recovery Scale-Revised (CRS-R), positron emission tomography and structural magnetic resonance imaging. Main outcome and results: The BERA showed satisfactory intra- and inter-rater reliability, as well as internal and concurrent validity in patients with aphasia. The BERA scores indicated selective receptive difficulties for phonological, semantic and particularly morphosyntactic abilities in post-comatose patients. These results were in line with the cortical distribution of brain lesions. Conclusions: The BERA may complement the widely used CRS-R for assessing and diagnosing patients with disorders of consciousness by providing a systematic and detailed characterization of residual language abilities.

Validity and Reliability of the Persian Version of Language Screening Test (LAST) for Patients in the Acute Phase of Stroke

Background &amp; Objectives: Aphasia is one of the most common consequences of a stroke; thus, screening tests for early diagnosis of the problem are necessary when dealing with aphasia patients. One of these screening tests is the Language Screening Test (LAST). The purpose of this study was to translate, validate, and utilize this test in the Persian language for patients after stroke. Methods: The original version of LAST was translated into Persian, and then administrated on 100 patients in the acute phase by two examiners at the patient’s bedside in order to check the inter-rater reliability. To assess the agreement between the two forms (a and b) of the LAST, Concordance Correlation Coefficient (CCC), weighted Kappa, and Intraclass Correlation Coefficient (ICC) were used. Also, the Persian version of LAST and the Western Aphasia Battery (WAB) were performed at the chronic phase with two independent examiners with blind scoring. Results: Inter-rater reliability between Rater 1 and Rater 2 on LAST-a and LAST-b score were very good for both phases. The CCC for LAST-a and LAST-b, respectively, were 0.874 and 0.865 for the acute phase and 0.923 and 0.927 for the chronic phase. The weighted Kappa for LAST-a and LAST-b, respectively, were 0.750 and 0.740 for the acute phase, and 0.822 and 0.846 for the chronic phase. Conclusion: The obtained results showed that LAST is a very simple, fast, and valid test and can be used as a reliable tool in stroke patients. Lack of cultural and language dependency are the advantages of using this test.

Accuracy of NIH Stroke Scale for diagnosing aphasia.

ObjectivesThe National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke.MethodsConsecutive patients with acute first‐ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skåne University Hospital, Sweden. Exclusion criteria were: (a) non‐native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0–3, where 1–3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients’ language function with the comprehensive language screening test (LAST, range 0–15 where 0–14 indicates aphasia). Data were analyzed using LAST as ‘reference standard’.ResultsWe examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score ≤14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8–14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59–0.83) and a specificity of 95% (0.91–0.98).ConclusionsWhen using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.

Development and application of a Chinese Version of the Language Screening Test (CLAST) in post-stroke patients.

Aphasia shows high incidence in stroke patients and seriously impairs language comprehension, verbal communication, and social activities. Therefore, screening aphasic patients during the acute phase of stroke is crucial for language recovery and rehabilitation. The present study developed a Chinese version of the Language Screening Test (CLAST) and validated it in post-stroke patients.The CLAST was adapted from the Language Screening Test developed by Constance et al to incorporate Chinese cultural and linguistic specificities, and administered to 207 acute stroke patients and 89 stabilized aphasic or non-aphasic patients. Based on the Western Aphasia Battery (WAB) test, its reliability and validity were assessed. A cut-off for the CLAST in Chinese patients was determined by ROC curve analysis.The CLAST comprised 5 subtests and 15 items, including 2 subscores, namely expression (8 points, assessing naming, repetition, and automatic speech) and receptive (7 points maximum, evaluating picture recognition, and verbal instructions) indexes. Analysis of the alternate-form reliability of the questionnaire showed a retest correlation coefficient of 0.945 (P < .001). Intraclass correlation coefficients of three rating teams were >0.98 (P < .001). Internal consistency analysis showed a Cronbach's alpha coefficient of 0.909 (P < .001). The non-aphasia group showed higher scores than the aphasia group (14.2 ± 1.3 vs 10.6 ± 3.8) (P < .01). The questionnaire showed good construct validity by factor analysis. ROC curve analysis showed high sensitivity and specificity for the CLAST, with a cut-off of 13.5.The CLAST is suitable for Chinese post-stroke patients during the acute phase, with high reliability, validity, sensitivity, and specificity.

Development and diagnostic validation of the Brisbane Evidence-Based Language Test

Purpose To describe the development and determine the diagnostic accuracy of the Brisbane Evidence-Based Language Test in detecting aphasia. Methods Consecutive acute stroke admissions (n = 100; mean = 66.49y) participated in a single (assessor) blinded cross-sectional study. Index assessment was the ∼45 min Brisbane Evidence-Based Language Test. The Brisbane Evidence-Based Language Test is further divided into four 15–25 min Short Tests: two Foundation Tests (severe impairment), Standard (moderate) and High Level Test (mild). Independent reference standard included the Language Screening Test, Aphasia Screening Test, Comprehensive Aphasia Test and/or Measure for Cognitive-Linguistic Abilities, treating team diagnosis and aphasia referral post-ward discharge. Results Brisbane Evidence-Based Language Test cut-off score of ≤157 demonstrated 80.8% (LR+ =10.9) sensitivity and 92.6% (LR− =0.21) specificity. All Short Tests reported specificities of ≥92.6%. Foundation Tests I (cut-off ≤61) and II (cut-off ≤51) reported lower sensitivity (≥57.5%) given their focus on severe conditions. The Standard (cut-off ≤90) and High Level Test (cut-off ≤78) reported sensitivities of ≥72.6%. Conclusion The Brisbane Evidence-Based Language Test is a sensitive assessment of aphasia. Diagnostically, the High Level Test recorded the highest psychometric capabilities of the Short Tests, equivalent to the full Brisbane Evidence-Based Language Test. The test is available for download from brisbanetest.org. Implications for rehabilitation Aphasia is a debilitating condition and accurate identification of language disorders is important in healthcare. Language assessment is complex and the accuracy of assessment procedures is dependent upon a variety of factors. The Brisbane Evidence-Based Language Test is a new evidence-based language test specifically designed to adapt to varying patient need, clinical contexts and co-occurring conditions. In this cross-sectional validation study, the Brisbane Evidence-Based Language Test was found to be a sensitive measure for identifying aphasia in stroke.