INTRODUCTION

METHOD SUMMARY

DISCUSSION

RESULTS (con’t)

REFERENCES

Based on the cognitive neuropsychological model of the Malay language, the National University Health System Aphasia Screening Test (NUHS-AST) was developed to assess all modalities of language processing (understanding, speaking, reading and writing) across ten subtests. Performance of neurologically-intact adults aged 40 – 60 years old who are Malay-English bilinguals (N=30) was recorded and tabulated. Neurologically-intact adults performed near ceiling on the test. The NUHS-AST Malay version demonstrates how the use of cognitive neuropsychological approach as a framework for a culturally and linguistically appropriate screener can assist clinicians to identify the breakdown of any processes to facilitate differential intervention.

• Aphasia is a neurological disorder that results from damage to the areas of the brain that control language and affects 30% to 38% of patients who experienced a stroke. (Dickey et al, 2010). • Early intervention can lead to improved neural reorganization and better functional abilities (Teasell, Bitensky, Salter & Bayona, 2005). Therefore, early and accurate assessment of language impairments is imperative in maximizing the benefits of rehabilitation. • Screeners have been developed to allow for fast and easy screening of patients suspected of having aphasia and may be in need of in-depth assessment. Four screeners are summarized in Figure 1. • They enable identification of a language deficit in a patient after a stroke and are useful for patients who are not able to sit for long sessions of assessments. • Another benefit for screeners is that they provide a baseline measure of the patient’s abilities and allow the tracking of progress over time (Kostalova et al. 2008).

Participants • 30 healthy Singaporeans who can read and write Malay were recruited for this normative study. Materials - Language Background Questionnaire • Adapted Language Background Questionnaire (Lim, Lincoln, Chan, Rickard Liow & Onslow, 2007) was used to determine the demographic, language dominance and literacy profile of participants. Materials - NUHS-AST Malay Version • The NUHS-AST Malay Version (Figure 2) consists of 10 subtests that examines competency in language comprehension and expression, as well as reading and writing. Figures 3, 4 and 5 are sample stimuli.

Dickey, L., Kagan, A., Lindsay, M.P., Fang, J., Rowland, A. & Black, S. (2010). Archives of Physical Medicine and Rehabilitation, 91(2), 196 – 202. Doesborg, S.J., Van De Sandt-Koenderman, W.M.E., Dippel, D.W.J., Van Harskamp, F., Koudstall, P.J. & Visch-Brink, E.G. (2003). Journal of Neurology, 250, 977 – 982. Enderby, P., Wood, V.A., Wade, D.T. & Langton, H.R. (1987). International Journal of Rehabilitation Medicine, 8, 166 – 170. Fabbro, F. (2001). Brain and Language, 71, 201 – 210. Jalil, S; Rickard Liow, S.J; Tng, S.K. (2011). Aphasiology, 25(4), 415 – 433. Kostalova, M., Bartkova, E., Sajgalikova, K., Dolenska, A., Dusek, L. & Bednarik, J. (2008). Brain Injury, 22(10), 793 – 80. Nakase-Thompson R., Manning E., Sherer M., Yablon S.A., Gontkovsky S.L.T. & Vickery C. (2002). Brain Injury, 9, 685–691. Teasell, R., Bitensky, J., Salter, K. & Bayona, N.A. (2005). Topics in Stroke Rehabilitation, 12 (3), 46 – 57. Thommessen, B., Thoresen, G.E., Bautz-Holter, E. & Laake, K. (1999). Disability & Rehabilitation, 21, 110 – 115.

• The NUHS-AST will enable clinicians to identify the breakdown of any language processing pathways. The normative data showed that neurologically healthy participants achieved near-perfect scores in all Time Trials. • The use of a cognitive neuropsychological approach as a framework can assist clinicians in providing specific and targeted early intervention of patients in the early stages of recovery from stroke. • It is also a culturally and linguistically appropriate screener to detect aphasia for use on the local population. • The normative data mined from the study establishes baseline for evaluation to help target intervention to specific areas of deficit. It will also provide a simple illustrated feedback and a systematic method to track progress over time. • Future research could look into increasing the sample size of the study. Normative data could also be mined from normal healthy participants aged 60 and above so that the tool can be used for patients within this age range as well.

A Normative Study On The National University Health System Aphasia Screening Test (NUHS-AST) for Malay Speaking Aphasics

Siti Khairiyah MD JAMIL, Susan RICKARD LIOW, Emily GUO & Nur Aisyah ABD NASSER

National University of Singapore, National University Health System

Fig 2. List of subtests in the NUHS-AST, categorized by receptive and

expressive aspects of language.

Receptive Language Expressive Language

Understanding (1) Yes/No Orientation Questions (Y/N) (2) Auditory Word Comprehension (AWC) (3) Auditory Sentence Comprehension (ASC) (8) Reading Comprehension (RC)

Speaking (4) Repetition (REP) (5) Picture Naming (PN) (6) Picture Description )PD)

Reading (7) Reading Aloud (RA)

Writing (9) Word Dictation (WD) (10) Sentence Dictation (SD)

Fig 3. Stimulus for Subtest 6 – Picture Description

Minyak Puli Fig 4. Stimulus for Subtest 7 – Reading of Words (Minyak / “Oil”) and Non

Words (Puli)

RESULTS Neurologically intact participants performed near ceiling on the test. Figures 6, 7 and 8 depicts the profile of maximum and minimum scores for Time Trials 1, 2 and 3 respectively.

Fig 6. Profile for maximum and minimum scores for Time Trial 1

Fig 8. Profile for maximum and minimum scores for Time Trial 3

Error Analysis Subtest 9 – Spelling • Non words tend to be misspelled, as there are several legal ways of spelling. Subtest 10 – Sentence Dictation • Non words tend to be misspelled, as there are several possible ways of spelling. • The older respondents aged 55 and above used the old Malay spelling system of Za’aba, and were accepted as correct responses.

Subtests

Subtests

Screener Sub Tests Norms? Appropriate

for local use?

Frenchay Aphasia Screening Test

(Enderby, Wood, Wade & Hewer, 1987)

Comprehension, Verbal expression, Reading,

Writing √ x

Ullevaal Aphasia Screening Test

(Thommessen, Thoresen, Bautz-

Holter & Laake, 1987)

Expression, Comprehension, Repetition, Reading,

Reproduction of a string of words, Writing,

Free Communication

x x

Mississippi Aphasia Screening Test

(Nakase-Thompson et al., 2002)

Naming, Automatic speech, Repetition,

Yes/no accuracy, Object recognition, Following

verbal instructions, Reading instructions,

Verbal fluency, Writing/spelling to dictation

x x

ScreeLing Test (Doesborgh et al., 2003)

Semantics, phonology, syntax x x

Fig 1. Summary of four aphasia screeners

• A major challenge faced by speech and language pathologists in Singapore is the availability of a localized and valid screener that is linguistically and culturally sensitive to assess the multilingual patient profile in the acute hospital setting. • This leads to the common practice of using translated tests developed and normed for monolingual English speakers (Jalil, Rickard Liow & Tng, 2011). This practice compromises the reliability and validity of the test, resulting in a negative impact on the standard and quality of intervention (Fabbro, 2001). • The National University Health System Aphasia Screening Test (NUHS-AST) was developed in parallel forms based on the three commonly used languages in Singapore – English, Mandarin and Malay. This study focuses on the development of the Malay version. Fig 7. Profile for maximum and minimum scores for Time Trial 2

Subtests

Time Trial Cronbach's Alpha

1 0.987

2 0.999

3 0.993

Fig 9. Internal reliability statistics for the three Time Trials of the NUHS-AST

Fig 5. Stimulus for Subtest 8 – Reading Comprehension

Internal consistency (Figure 9) of all subtests except Subtest 6 and 10 for each Time Trial was measured with Cronbach's alpha.

Siti Khairiyah Binte Mohamed Jamil . National University of Singapore . siti.khairiyah@nus.edu.sg

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