Purpose

The ASHA-FACS is a measure of functional communication. It does not aim to measure impairment. Rather, the assessment aims to measure how specific speech, language, hearing and/or cognitive deficits affect the performance of daily life activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(Frattali, Holland, Thompson, Wohl, & Ferketic, 1995).

In-Depth Review

Purpose of the measure

The ASHA-FACS is a measure of functional communication. It does not aim to measure impairment. Rather, the assessment aims to measure how specific speech, language, hearing and/or cognitive deficits affect the performance of daily life activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(Frattali, Holland, Thompson, Wohl, & Ferketic, 1995).

Available versions

The ASHA-FACS was developed in 1995 by Frattali, Holland, Thompson, Wohl, and Ferketic.

Features of the measure

Items:
The ASHA-FACS consists of 43 items. The items within the ASHA-FACS address four domains: social communication; communication of basic needs; reading, writing and number concepts; and daily planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint” (Anderson, 2008, p. 17)
. It covers different activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (ADLs) such as understanding television and radio, responding in an emergency, and using a calendar (Frattali et al., 1995).

The ASHA-FACS is also subdivided into 2 scales: Communicative Independence and Qualitative Dimensions of Communication. These scales measure the level of independence, and the nature of the functional deficit, respectively (Frattali et al., 1995).

The ASHA-FACS is in an observational format, and requires that the examiner be familiar with the client prior to rating his/her communication. A major strength of the ASHA-FACS is that it has simple wording and behavioral operationalization of item content (Glueckauf, Blonder, Ecklund-Jonhson, Maher, Crosson & Gonzalez-Rothi, 2003).

The examiner can also solicit judgments from the significant others, in order to augment his/her observations (Frattali et al., 1995). It has been recommended that three observational sessions are required before ratings are made (Worrall & Yiu, 2000).

Scoring:
The items are rated after observing functional communication on the two scales.

The Communicative Independence Scale is rated on a 7-point scale ranging from 1) “does not perform the behavior” to 7) “does perform the behavior”. It reflects the extent of assistance the individual requires to perform routine verbal and nonverbal transactions. The Qualitative Dimensions of Communication Scale is rated on a 5-point scale reflecting adequacy, appropriateness, and promptness of communication and communication sharing.

The total score is obtained by summing the scores on each item and then dividing by the number of items (means). It is also possible to calculate both abovementioned scale scores by calculating the means of interest (Frattali et al., 1995).

Lower scores are indicative of greater impairment.

Time:
The ASHA-FACS takes, on average, 20 minutes to score. Administration will vary according to the time spent on the observational sessions (Frattali et al., 1995).

Subscales:
The ASHA-FACS is comprised of 2 subscales (Frattali et al., 1995):
– Communicative Independence
– Qualitative Dimensions of Communication

Equipment:
Not reported.

Training:
Not reported.

Alternative forms of the ASHA-FACS

None.

Client suitability

Can be used with:

• Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
• Clients with communicative deficits.

Should not be used in:

• The ASHA-FACS should not be used with clients that are not able to communicate.

In what languages is the measure available?

English (Frattali et al., 1995)

Summary

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the ASHA-FACS in individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. We identified 5 studies.

Floor/Ceiling Effects

No studies have reported floor or ceiling effects of the ASHA-FACS in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Reliability

Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More:
Frattali, Holland, Thompson, Wohl, and Ferketic (1995) verified the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the ASHA-FACS in 32 subjects with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and 26 with traumatic brain injury. Items with correlations lower than 0.70 were deleted. All the other item scores and domain scores correlated well with the overall score.

Intra-rater:
Frattali et al. (1995) analyzed the Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient, was excellent (r = 0.99).

Inter-rater:
Frattali et al. (1995) evaluated the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the ASHA-FACS. Speech language pathologists from five different centers throughout the US evaluated 32 subjects with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More and 26 with traumatic brain injury. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient, was excellent (r = 0.82).
Note: the exact number of therapists was not provided.

Validity

Content:
Davidson, Worral and Hickson (2003) analyzed the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the ASHA-FACS among 30 older Australians (15 with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and 15 healthy individuals). This observational study reported that the ASHA-FACS items are representative of the everyday communication of older individuals in Australia.

Criterion:
Concurrent:
No studies have reported the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the ASHA-FACS in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Predictive:
No studies have reported the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the ASHA-FACS in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/ SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
:
Ross and Wertz (2004) estimated the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the ASHA-FACS by comparing it with the AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Checklist Score (Ross and Wertz, 2004), as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
, in 10 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) checklist score is a diagnostic test that takes into account information collected from the medical records and the World Health Organization’s concepts of disability. In the Communication Independence scale a cut-off of 6.99 yielded a sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
of 90% and a specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 70%. In the Communications Dimensions scale a cut-off of 4.81 produced 100% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and 90% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
.

Construct:
Convergent/Discriminant:
Frattali et al. (1995) assessed the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the ASHA-FACS by comparing it to the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (Kertesz, 1982), the Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) (Adamovich & Henderson, 1992), and the communication domain of the Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987) and the Rancho Los Amigos Levels of Cognitive Functioning (Hagen, Malkmus, & Durham, 1972) in 32 subjects with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and 26 with traumatic brain injury. Correlations between the ASHA-FACS and all outcome measures were adequate.
Note: the authors did not report the correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
values.

Glueckauf, Blonder, Ecklund-Jonhson, Maher, Crosson and Gonzalez-Rothi (1993) assessed correlations between the scores of the ASHA-FACS, the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (Kertesz, 1982), the Functional Outcome Questionnaire for AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (FOQ-A) (Glueckauf et al., 1993) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) (Ware & Sherbourne, 1992). All outcome measures were scored by 18 caregivers of individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Correlations were found to be excellent between the social communication domain of the ASHA-FACS and the FOQ-A (r = 0.74) and poor between this domain and the AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient of the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery and the SF-36 (r = 18; r = 0.19, respectively). Correlations between the basic needs domain of the ASHA-FACS and the FOQ-A were adequate (r = 0.58), while correlations between the basic needs domain of the ASHA-FACS and the AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient of the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery and the SF-36 were poor (r = -16; r = 0.14), respectively.

Known groups:
Ross and Wertz (2003) verified the ability of the ASHA-FACS to discriminate between healthy elderly individuals (n = 18) and individuals who had experienced strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More and mild aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n = 18). Known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
, as calculated using Wilcoxon W, suggested that scores of healthy subjects were significantly higher than the scores of the participants with verbal communicative impairments. Therefore, the ASHA-FACS is able to differentiate between healthy individuals and individuals with mild aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada).

Responsiveness

No studies have reported the responsivenessThe ability of an instrument to detect clinically important change over time.
of the ASHA-FACS in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

References

• Adamovich, B.B. & Henderson, J. (1992). SCATBI – Scales of Cognitive Ability of Traumatic Brain Injury. Riverside.
• Blomert, L., Kean, M. L., Koster, C., & Schokker, J. (1994). Amsterdam-Nijmegen Everyday Language Test: construction, reliability and validity. Aphasiology, 8, 381-407.
• Davidson, B., Worrall, L., & Hickson, L. (2003). Identifying the communication activities of older people with aphasia: Evidence from naturalistic observation. Aphasiology, 17, 243-264.
• Frattali, C. M., Thompson, C. K., Holland, A. L., Wohl, C., & Ferketic, M. M. (1995). The FACS of Life. ASHA FACS — A Functional Outcome Measure for Adults. ASHA, 7, 40-46.
• Glueckauf, R. L., Blonder, L. X., Ecklund-Jonhson, E., Maher, L., Crosson, B., & Gonzalez-Rothi, L. (2003). Functional questionnaire for aphasia: overview and preliminary psychometric evaluation. Neurorehabilitation, 18, 281-290.
• Hagen, C., Malkmus, D., & Durham, P. (1972). Rancho Los Amigos Levels of Cognitive Functioning. Communication Disorders Service: Rancho Los Amigos Hospital.
• Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
• Kertesz, A. (1982). Western Aphasia Battery. NY: Grune & Stratton.
• Ross, K. B. & Wertz, R. T. (2003). Discriminative validity of selected measures for differentiating normal from aphasic performance. American Journal of Speech-Language Pathology, 12, 312-319.
• Ross, K. B. & Wertz, R. T. (2004). Accuracy of formal tests for diagnosing mild aphasia: An application of evidence-based medicine. Aphasiology, 18, 337-355.
• Ware, J. E. Jr. & Sherbourne, C. D. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 30, 473-483.
• Worrall, L. & Yiu, E. (2000). Effectiveness of functional communication therapy by volunteers for people with aphasia following stroke. Aphasiology, 14, 911-924.

See the measure

How to obtain the ASHA-FACS:

The ASHA-FACS can be purchased at the ASHA website and costs $USD165 for a certified non-ASHA member, and $USD124 for an ASHA member. This price does not include taxes and shipping.

Following is the website address for purchasing the ASHA-FACS: https://www.asha.org/

Purpose

The ANELT is designed to assess the level of verbal communicative abilities of individuals with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). A second goal of the ANELT is to estimate a client’s change on verbal communicative abilities over time (Blomert et al., 1994).

In-Depth Review

Purpose of the measure

The ANELT is designed to assess the level of verbal communicative abilities of individuals with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). A second goal of the ANELT is to estimate a client’s change on verbal communicative abilities over time (Blomert et al., 1994).

Available versions

The ANELT was published in 1994 by Blomert, Kean, Kosters, and Schokker. There are two available versions (ANELT I and ANELT II). Both versions have the same number of items, and the same difficulty level. The main difference is how the items are worded. Typically, the ANELT II is used as a re-evaluation of a client when the second assessment is performed within a short period of time. Therefore, it may prevent possible learning and memory effects.

Features of the measure

Items:
The ANELT I and II consist of 10 items each that characterize familiar everyday life situations. Before starting the test, the examiner should allow the client to practice by asking two items from the measure. During the practice trial, the examiner should provide instructions and correct the client if he or she does not appear to understand the instructions (Blomert et al., 1994).

The examiner should record the administration of the ANELT on audiotape for later scoring. The examiner presents each item verbally to the patient and must avoid conversing with the client during the administration of the test. Instead, the examiner should act as an interested listener, while the client answers the items as a monologue (Blomert et al., 1994).

The items-scenarios all have a strongly conventional script-like character. They engage the interest of the client, minimize stress in the testing situation, and encourage optimal performance. The ANELT I test items are as follows (Blomert et al., 1994):

1. You are now at the dry cleaner’s. You have come to pick this up and you get it back like this [present shirt with scorch mark]. What do you say?
2. The kids on the street are playing football in your yard. You have asked them before not to do that. You go outside and speak to the boys. What do you say?
3. You are in a store and want to buy a television. I am the salesperson here. ‘Can I help you?’
4. You go to the shoemaker with this shoe. [Present shoe] There is a lot wrong with this shoe, but for some reason you want him to repair only one thing. You may choose one. What do you say?
5. You have an appointment with the doctor. Something else has come up. You call up and what do you say?
6. You are in the drug store and this [present glove] is lying on the floor. What do you say?
7. You see your neighbor walking by. You want to ask him/her to come to visit some time. What do you say?
8. Your neighbor’s dog barks all day long. You are really tired of it. You want to talk to him about it. What do you say?
9. You have just moved in next door to me. You would like to meet me. You ring my doorbell and say…
10. You are at the florist. You want to have a bouquet of flowers delivered to a friend. I am the salesperson. What do you say?

Scoring:
Each item is scored from 0 to 5 on two different scales: One scale is used to score understandability and is also known as ANELT A. This scale assesses whether the content of the message given by the client is interpretable. The other scale, ANELT B, rates intelligibility. This scale is independent of content and assesses whether the words provided by the client are able to be perceived or clearly recognized (Blomert et al., 1994).

A score of 0 is given when the patient, due to severe aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), is incapable of taking instructions and/or producing an answer. A score of 5 indicates the client’s speech is unimpaired. The total score for each scale is obtained by summing all items. The total score on each scale (ANELT A & B) ranges from 0 to 50. Scores lower than 36, on each scale, are indicative of a moderate or severe verbal communicative deficit. Non-verbal responses should only be scored when they are provided by the client to reinforce or clarify a verbal response (Blomert et al., 1994).

Time:
The ANELT takes 15 to 25 minutes to administer (Blomert et al., 1994).

Subscales:
The ANELT is comprised of 2 subscales:
Understandability (ANELT A) and
Intelligibility (ANELT B).

Equipment:
The ANELT requires specific equipment, according to the items being used such as a stained shirt, a damaged shoe, and a pair of gloves.

Training:
Not reported.

Alternative forms of the ANELT

None

Client suitability

Can be used with:

• Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
• Clients with communicative deficits.

Should not be used in:

• The ANELT should not be used with clients that are not able to communicate.

In what languages is the measure available?

Dutch, Swedish, German and English (Blomert et al., 1994; Doesborgh, 2004; Laska, 2007).

Summary

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Amsterdam Nijmegen Everyday Language Test (ANELT) in individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. We identified 6 studies.

Floor/Ceiling Effects

Laska, Hellblom, Murray, Kahan and Von Arbin (2001) reported that ceiling effects may be present when administering the ANELT to clients with mild communication deficits.

Reliability

Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More:
Blomert, Kean, Kosters, and Schokker (1994) verified the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the ANELT I & II in 35 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Each version showed a Cronbach’s alpha > 0.90. This result suggests the possibility of some redundant items on the ANELT.

Test-retest:
Blomert et al. (1994) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ANELT I scales (A & B) in 30 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Participants were re-assessed within a 3 month interval. Stability over test-retest was measured using factor analysis. Comparisons for all items showed no significant differences, suggesting there was no change across two-repeated measures. These results suggest both ANELT I scales (A & B) are stable and reliable over time.

Inter-rater:
Blomert et al. (1994) evaluated the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the ANELT in 14 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Participant’s answers were rated by 6 evaluators, who were blinded to each other’s scores. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
on individual items was calculated using Krippendorff analysis. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was excellent for the understandability scale (0.92) and adequate for the intelligibility scale (0.70). Additionally, in the same study, the authors analyzed the correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between naïve and expert raters. In the first analysis when naïve evaluators rated a video performance and expert evaluators rated an audio performance, correlations between naïve and expert raters were excellent for the understandability (r = 0.83) and the intelligibility (r = 0.63) scales. When both naïve and expert evaluators rated audio performance, correlations for the understandability and the intelligibility scales were also excellent but with higher values (r = 0.99 and 0.97, respectively).

Validity

Content:
Blomert et al. (1994) began content validation with a large number of items that they administered to 60 healthy individuals. Twenty items were then selected based on a high response rate. After completion of the test, the 60 participants were questioned about the nature of the remaining items. All items were considered highly imaginable and recognizable, independent of biographical background, and representative of daily situations.

Criterion:
Concurrent:
Blomert el al. (1994) analyzed, in 254 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the ANELT by comparing it with the Aachener AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test (AAT) (Huber, Poeck, Weninger & Willmes, 1983) as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
. The AAT is a 10 minute semi-structured interview used to elicit information on the communicative level of the patient and also to diagnose aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) syndromes. Correlations between the ANELT and the AAT were excellent (r = 0.81).

Doesborgh, van de Sandt-Koenderman, Dipple, van Harskamp, Koudstaal and Visch-Brink (2002) assessed the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the ANELT by comparing it to semantic (word-meaning) and phonological (word-sounding) measures in 29 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). Regression analysis indicated that semantic measures, when compared to phonological measures, were better related with ANELT scores. The semantic component of the Aachener AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test (AAT) (Huber et al., 1983) explained 33% of variance of the ANELT scores.

Predictive:
Laska et al. (2001) assessed the ability of ANELT scores, measured shortly after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, to predict functional recovery at 18 months post-stroke in 119 clients. Linear regression analysis indicated that the ANELT scores were a significant predictor of functional recovery. Furthermore, less severe aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) at baseline was related to higher degrees of functional recovery.

Franzen-Dahlin, Laska, Larson, Wredling, Billing, and Murray (2007) examined, in 148 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More (71 with depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
and 77 with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada)), whether age, gender, need of assistance, personality change, state of aggression, ANELT scores, Barthel Index scores (Mahoney & Barthel 1965), severity of depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
, cohabitant/single and previous strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More were able to predict life situation of the significant other measured at 3 to 6 months post-stroke. Linear regression analysis indicated that ANELT scores were not a significant predictor of life situation of the significant other, which was best predicted by the need of assistance, personality change and living with the patient.

Laska, Bartfai, Hellblom, Murray and Kahan (2007) assessed the ability of the ANELT and the Coefficient in Norsk Grunntest for Afasi (Coeff) (Reinvang, 1985) to predict recovery at 6 months post-stroke. The Coefficient in Norsk Grunntest for Afasi is a measure of the severity of impairments on fluency, comprehension, naming and repetition in addition to writing and reading (Reinvang, 1985). Predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
was calculated by use of c-statistics to calculate the area under the Receiver Operating Characteristic (ROC) curve. A Coeff ≥ 49 (AUC = 0.82) and an ANELT ≥ 3.5 (AUC = 0.80) were both excellent on predicting recovery 6 months post-stroke. These results suggest that the percentage of patients correctly classified according to their recovery level at 6 months post-stroke is slightly lower when using the ANELT over the Coefficient in Norsk Grunntest for Afasi. Using an ANELT cut-off of 3.5 yields a sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
of 79% and a specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 83% to predicting recovery 6 months post-stroke.

Construct:
Convergent/Discriminant:
Blomert et al. (1994) assessed the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the ANELT subscales – understandability and intelligibility – in 254 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). Correlations between the understandability and intelligibility subscales were excellent (r = 0.70). However the strength of the association between the ANELT subscales varied according to the type of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada): excellent in clients with Wernicke’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (r = 0.66), adequate in clients with Global and Rest aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (r = 0.35; r = 0.33, respectively), and poor in clients with Anomic and Broca’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (r = 0.28; r = 0.27, respectively). These results suggest that within a large sample, with large variance, both scales are reflective of verbal communicative impairments. However, within certain types of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), the ANELT is able to measure two sub-constructs: understandability and intelligibility. In other words, these two scales are not completely independent; but each contributes uniquely to the overall validityThe degree to which an assessment measures what it is supposed to measure.
of the construct of verbal communication.

Laska et al. (2007) examined the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the ANELT by comparing it to Coefficient in Norsk Grunntest for Afasi (Reinvang, 1985) and the Scandinavian StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Supervision Scale, a measure of neurological impairment (Röden-Jüllig, Britton, Gustavsson, & Fugl-Meyer, 1994) at baseline and 6 months later. The number of participants ranged from 72 to 118. Correlations between the ANELT and the Coefficient in Norsk Grunntest for Afasi were excellent both at baseline and 6 months later. (r = 0.71; r =0.87, respectively). Adequate correlations were found between the ANELT and the Scandinavian StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Supervision Scale (r = 0.33; r = 0.53). This result suggests that aphasia’s severity level is directed associated with neurological impairments.

Longitudinal:
Doesborgh et al. (2004) analyzed the longitudinal validityLongitudinal validity is the extent to which changes on one measure will correlate with changes on another measure.
of the ANELT in 29 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) by comparing change scores on the ANELT with change scores in semantic and phonological measures within each group. Semantic measures, which reflects word-meaning, were composed of the Semantic Association Test (SAT) (Visch-Brink, Denes, & Stronks, 1996) and the Synonym Judgment subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
from the Psycholinguistic Assessment of Language Processing AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (PALPA) (Kay, Lesser, & Coltheart, 1992). Phonological measures, which are concerned about word-sounding, were represented by the Repetition Non-words and Lexical Decisions subscales from the PALPA. In the SAT the client is required to make a semantic association with the target (word or picture) by grouping the relevant information from a multiple choice set (words or pictures) while the PALPA assesses orthography, phonology, word and picture semantics, morphology and syntax and therefore is a complete assessment of language impairment. Participants were randomized into two groups: either semantic or phonological intervention. The group receiving semantic treatment demonstrated adequate change score correlations between the ANELT and both semantic measures (r = 0.58; 0.34, respectively), and poor correlations between the ANELT and both phonological measures (r = 0.04; 0.24, respectively). In the group receiving phonological intervention, change score correlations were adequate between the ANELT, the phonological measures and the Semantic Association Test (0.58, 0.50, 0.40, respectively) and poor between the ANELT and the Synonym Judgment subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
from the PALPA (r = 0.16).

Known groups:
Blomert et al. (1994) verified the ability of the ANELT to discriminate between healthy individuals (n = 60) and individuals who had experienced strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n = 252). Known group validityThe degree to which an assessment measures what it is supposed to measure.
, as calculated using ANOVA, suggested that scores of healthy subjects were significantly higher than the scores of the participants with verbal communicative impairments, thus supporting the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the ANELT.

Responsiveness

Laska et al. (2001) evaluated the responsivenessThe ability of an instrument to detect clinically important change over time.
of the ANELT in 119 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). Participants were assessed at four points in time: baseline, 3, 6, and 18 months post-stroke. Clients with fluent aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) had greater ANELT score changes than clients with non-fluent aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (p<0.0001). Additionally, ANELT score changes were more significant in the 3 first months of recovery (p<0.0001) as would be expected based on what is known about post-stroke recovery.

Doesborgh et al. (2004) assessed the responsivenessThe ability of an instrument to detect clinically important change over time.
of the ANELT in 55 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Participants were assessed at two points in time: at admission to a rehabilitation program and after 40 hours of treatment. In this study, the percentage of patients who showed a clinically significant improvement (> 8 points) was 39% after semantic treatment (focusing on word-meaning) compared with 35% after phonological treatment (focusing on word-sounding).
Note: A clinically significant improvement > 8 points was determined by Blomert, Koster, and Kean in 1995. However the original publication is in Dutch. (Blomert L, Koster Ch, Kean ML. Amsterdam-Nijmegen Test voorAlledaagse Taalvaardigheid. Lisse, Netherlands: Swets & Zeitlinger).

Laska et al. (2007) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the ANELT in 148 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). Participants were evaluated at baseline and at 6 months post-stroke. Changes on ANELT scores were significant for all participants (p<0.0001) from baseline to 6 months suggesting that the ANELT is responsive to clinical improvement.

References

• Blomert, L., Kean, M.L., Koster, C., & Schokker, J. (1994). Amsterdam-Nijmegen Everyday Language Test: construction, reliability and validity. Aphasiology, 8, 381-407.
• Franzen-Dahlin, A., Laska, A.C., Larson, J., Wredling, R., Billing, E., & Murray, V. (2008). Predictors of life situation among significant others of depressed or aphasic stroke patients. Journal of Clinical Nursing, 17, 1574-1580.
• Frattali, C., Thompson, C.K., Holland, A.L., Wohl, C., & Ferketic, M.M. (1995). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Older Adults (ASHA FACS). Rockville MD: ASHA.
• Doesborgh, S.J.C., van de Sandt-Koenderman, W.M.E., Dipple, D.W.J., van Harskamp, F., Koudstaal, P.J., & Visch-Brink, E.G. (2002). The impact of linguistic deficits on verbal communication. Aphasiology, 16, 413-423.
• Doesborgh, S.J.C., van de Sandt-Koenderman, M.W.E., Dippel, D.W.J., van Harskamp, F., Koudstaa, P.J., & Visch-Brink, E.G. (2004). Effects of semantic treatment on verbal communication and linguistic processing in aphasia after stroke. A randomized controlled trial. Stroke, 35, 141-146.
• Huber, W., Poeck, K., Weninger, D., & Willmes, K. (1983). Der Aachener Aphasietest Gottingen: Hogrefe.
• Kay, J., Lesser, R., & Coltheart, M. (1992). Psycholinguistic Assessment of Language Processing in Aphasia. Hove, UK: Lawrence Erlbaum Associates Ltd.
• Mahoney, F. I., Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-5.
• Laska, A.C., Hellblom, A., Murray, V., Kahan, T., & Von Arbin, M. (2001). Aphasia in acute stroke and relation to outcome. J Intern Med, 249, 413-422.
• Laska, A.C., Bartfai, A., Hellblom, A., Murray, V., & Kahan, T. (2007). Clinical and prognostic properties of standardized and functional aphasia assessments. J Rehabil Med, 39, 387-392.
• Reinvang, I. (1985). Aphasia and brain organisation. New York: Plenum Press.
• Röden-Jüllig, Ã…., Britton, M., Gustavsson, C., Fugl-Meyer, A. (1994). Validation of four scales for acute stage of stroke. J Intern Med, 236, 125-136.
• Visch-Brink, E.G., Denes, G., & Stronks, D. (1996). Visual and verbal semantic processing in aphasia. Brain Lang, 55, 130-132.

See the measure

How to obtain the ANELT:

The ANELT I can be obtained on the website: http://www.hogrefe.nl/site/?/test/show/52/

The complete pack consists of the manual, 20 forms, instruction card and CD-ROM. It costs 150.00 Euros, excluding taxes and postage.

Purpose

The BDAE is designed to diagnose aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and related disorders. This test evaluates various perceptual modalities (auditory, visual, and gestural), processing functions (comprehension, analysis, problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
) and response modalities (writing, articulation, and manipulation). The BDAE can be used by neurologists, psychologists, speech language pathologists and occupational therapists (Goodglass & Kaplan, 1972).

In-Depth Review

Purpose of the measure

The BDAE is designed to diagnose aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and related disorders. This test evaluates various perceptual modalities (auditory, visual, and gestural), processing functions (comprehension, analysis, problem-solving"Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available" (Luria, 1966; as cited in (Rath et al., 2004))
) and response modalities (writing, articulation, and manipulation). The BDAE can be used by neurologists, psychologists, speech language pathologists and occupational therapists (Goodglass & Kaplan, 1972).

Available versions

The BDAE was developed in 1972 by Goodglass and Kaplan. A second edition was published in 1983 by the same authors. The most recent edition was published in 2001 by Goodglass, Kaplan, and Barresi and contains both a shortened and extended version of the BDAE.

Features of the measure

Items and scoring:
Items and scoring on the BDAE is as follows (Goodglass & Kaplan, 1972):

1. Fluency:

In this section the client should be encouraged to engage in a free narrative and an open-ended conversation. The following features are then assessed:

Melodic line: The examiner should observe the intonational pattern in the entire sentence.

Phrase length: The examiner should observe the length of uninterrupted runs of words.

Articulatory agility: The examiner should observe how the client articulates phonemic sequences.

Grammatical form: The examiner should observe the variety of grammatical construction.

Paraphasia in running speech: The examiner should observe substitutions or insertions of semantically erroneous words in running conversation.

Word-finding: The examiner should observe the client’s capacity to evoke needed concept names and informational content in the sentences.

All features are scored on a 7-point scale where 1 is the maximum abnormality and 7 the minimum abnormality.

2. Auditory Comprehension

Word discrimination: Consists of a multiple choice task and samples six categories of words: objects, geometric forms, letters, actions, numbers and colors. Five words are written on cards and the client is asked to identify among them the word requested by the examiner. Clients are given 2 points for correctly identifying the word within 5 seconds, 1 point for correct identification taking longer than 5 seconds, half a point for localizing the right category. The maximum score is 72. The examiner should record in writing all incorrect choices by the client.

Body-part identification: Includes 24 items, the first 18 are related to body part names, and the remaining 8 with right-left comprehension. The client is asked to identify on his own body the body part named by the examiner. One point is given for correctly identifying the body within 5 seconds. When more time is required on identifying the body parts only a half point is scored. For right-left comprehension, the examiner requires the client to identify the right forearm, for example. One point is given for correctly identifying the side within 5 seconds. When more time is required on identifying the side of the body only one point is scored.

Commands: The client is requested to carry out commands. The score in this subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
ranges from 0 to 15.

Complex ideational material: In this section the examiner asks general questions such as “will a stone sink in water?” and the client is required to understand and express agreement or disagreement. Each item consists of two questions, one having yes and the other no as response options. One point is scored for each item with both questions correctly answered. Score ranges from 0 to 10.

3. Naming

Responsive naming: The examiner asks the client a question containing a key word associated with the expected answer. Then the client should answer the question using the following words: nouns (watch, scissors, match, drugstore); colors (green, black), verbs (shave, wash, write) and a number (twelve). Three points are given when the response is provided within 3 seconds, 2 points within 3 to 10 seconds, 1 point within 10 to 30 seconds, and 0 if the client provides an improper answer. Maximum score is 30.

Visual Confrontation: The client should name the images presented by the examiner. The visual stimulus items are from cards 2 and 3 and represent objects, geometric forms, letters, actions, numbers, colors and body parts. Three points are given when the response is given within 3 seconds, 2 points within 3 to 10 seconds, 1 point within 10 to 30 seconds, and 0 if the client is unable to provide the correct answer. Maximum score is 105.

Animal naming: The first word “dog” is provided by the examiner to stimulate the client. Then the client should provide all animals name that he/she knows within 60 seconds. The score consists of counting the number of different animals named by the client.

Body part naming: The examiner points to 10 body parts to be named on him/her. Three points are given when the response is given within 3 seconds, 2 points within 3 to 10 seconds, 1 point within 10 to 30 seconds, and 0 if the client if the client provides the wrong answer. Maximum score is 30.

4. Oral Reading

Word reading: The examiner indicates a word from card 5 that should be read by the client. Three points are given when the word is read within 3 seconds, 2 points within 3 to 10 seconds, 1 point within 10 to 30 seconds, and 0 if the client provides the wrong answer. Maximum score is 30.

Oral sentence: Ten sentences should be read from cards 6 and 7. The sentences are scored as pass (score of 1) or fail (score of 0).

5. Repetition

Words: A wide sampling of word types is presented, including a grammatical function word, objects, colors, a letter, numbers, an abstract verb of three syllables and a tongue twister. An item is scored correct if all phonemes are in correct order and recognizable. One point is allowed per item for a total of 10.

High and low probability sentences: The sentences should be repeated by the client, alternating between a high- and a low-probability item. One point is given for each sentence correctly repeated and high- and low- probability sections are scored separately from 0 to 8.

6. Automatic speech

Automatized sequences: Four sequences are tested: days of the week, months of the year, number from one to twenty-one and the alphabet. Two points maximum are given for complete recitation of any series and 1 point is given for unaided runs of 4 consecutive words when reciting days, 5 consecutive words when reciting months, 8 consecutive words when reciting numbers and 7 consecutive words when reciting the alphabet.

Reciting: Several nursery rhymes are suggested to elicit completion responses. A score of 0 is given if the client is unable to recite, 1 for impaired recitation and 2 for good recitation.

7. Reading Comprehension

Symbol discrimination: Cards 8 and 9 contain 10 items each. The examiner shows the word or letter centered above the five multiple-choice responses and asks the client to select the equivalent. One point is given to each correct item.

Word recognition: Using cards 10 and 11 the client is requested to identify the one word, out of 5, which matches the word said previously by the examiner. This task is repeated another 7 times and a score of 1 point is given to each correct answer.

Oral spelling: The client should recognize 8 words spelled by the examiner. One point is given for each correct recognition.

Word-picture matching: Ten words are selected from card 5 to be identified on cards 2 and 3. One point is given for each correct recognition.

Sentences and paragraphs: The examiner reads 10 sentences from cards 12 to 16. The client is requested to complete the ending of a sentence with a four multiple choice options. One point is given for each correct sentence.

8. Writing

Mechanics: The client is requested to write his/her name and address with the stronger hand. In case he/she is not able to do so, then the examiner can write the sentence and the client should then transcribe it. Score ranges from 0 to 3 according to performance level.

Serial writing: The client should write the alphabet and numbers from 1 to 21. The score is the total number of different, correct letters and numbers, combined for a maximum score of 47.

Primer-level dictation: The client should write the letters, numbers and primer words that are dictated by the examiner. A score is given by adding the number of correct words.

Spelling to dictation: The client should write the words dictated by the examiner. Score is based on the amount of correct words written by the client.

Written confrontation naming: The patient should write the name of the figure that is shown from cards 2 and 3 by the examiner. The examiner should show 10 figures. One point is given for each correctly spelled response.

Sentences to dictation: The client should write the three sentences dictated by the examiner. Scores for each sentence range from 0 to 4.

Narrative writing: Card 1 has a picture of a cookie theft which is shown to the client who must then write as much as he/she can about what he/she sees in the picture. The client should be encouraged to keep writing for 2 minutes. Scores for this section range from 0 (no relevant writing) to 4 (full description in grammatical sentences).

Sixteen stimulus cards are enclosed with the BDAE. These cards include a range of images, words and sentence that are shown to the client during the assessment.

Detailed administration guidelines are in the test manual that should be purchased.

Time:
The BDAE takes 90 to 120 minutes to administer. The extended format of the BDAE may take up to 2 1/2 hours (Sbordone, Saul & Purisch, 2007). The shortened version takes 30 to 45 minutes (Goodglass & Kaplan, 2001).

Subscales:
The BDAE is comprised of 8 subscales:

• Fluency
• Auditory comprehension
• Naming
• Oral reading
• Repetition
• Automatic speech
• Reading comprehension
• Writing

Equipment:
The BDAE requires specialized equipment that should be purchased in specialized stores or online.

Training:
The test costs approximately US$450.00 and includes the full test battery, manual and instructional video.

Alternative forms of the BDAE

Shortened version: described as “a brief, no frills assessment.”

Extended version: includes an assessment of praxis in addition to the standard assessment.

Client suitability

Can be used with:

• Adults with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More
• Adults with communication and language impairments

Should not be used with:

• Not reported

In what languages is the measure available?

English, Spanish, Portuguese, French, Hindi, Finnish, and Greek (Radanovic & Scaff, 2002; Rosselli, Ardila, Florez & Castro, 1990; Tsapkini, Vlahou & Potagas, 2009/2010).

Summary

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Boston Diagnostic AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Examination (BDAE) in individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. We identified 5 studies.

Floor/Ceiling Effects

No studies have examined the ceiling effects of the BDAE in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Reliability

No studies have examined the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the BDAE in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Validity

Content:
No studies have examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the BDAE in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Criterion:
Concurrent:
No studies have examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the BDAE in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Predictive:
No studies have examined the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the BDAE in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Construct:
Convergent/Discriminant:
Larson, Kirschner, Bode, Heinemann and Goodman (2005) analyzed the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the BDAE by comparing it to the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (Randolph, 1998) in 88 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Correlations between the Repetition subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the BDAE and the Attention, Language, Immediate Memory, and Delayed Memory Indexes of the RBANS were adequate (r = 0.45; 0.42; 0.40; 0.38, respectively), while correlations between the Repetition subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the BDAE and the Visuospatial Index of the RBANS were poor (r = 0.25). Correlations between the Commands subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the BDAE and the Language and Immediate Memory Indexes of the RBANS were adequate (r = 0.38; 0.37, respectively) while between the Commands subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the BDAE and the Delayed Memory, Attention and Visuospatial Indexes of the RBANS correlations were poor (r = 0.30; 0.24; 0.14, respectively).

Wilde, (2006) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the BDAE by comparing it to the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (Randolph, 1998) in 22 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. The BDAE showed an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Language Index of the RBANS (r = 0.40) and a poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Visuospastial Index of the RBANS (r = 0.19).

Tucker et al. (2012) developed modified versions of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Impact Scale (SIS), Medical Outcomes Study Short Form-36 (SF-36), Activity Card Sort (ACS) and the Reintegration to Normal Living Scale to improve the use of the measures with patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The authors examined the relationship between patients’ performance on these modified measures and the severity of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) as measured using the BDAE-3 Short Form, in a sample of 29 community-dwelling people with subacute or chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The BDAE Expressive component demonstrated excellent correlations with the SIS Communication, ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More and StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Recovery domains (r=0.72, 0.66, 0.60 respectively), and adequate correlations with the SIS Physical domain (r=0.46) and the ACS total, Instrumental and Low Demand Leisure scores (r=0.55, 0.53, 0.57 respectively). The BDAE Auditory Comprehension component demonstrated adequate correlations with the SIS Communication, ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More and StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Recovery domains (r=0.57, 0.50, 0.45 respectively) and the ACS total, Instrumental and Low Demand Leisure scores (r=0.51, 0.48, 0.47 respectively). The BDAE Language Competency Index (LCI) demonstrated excellent correlations with the SIS Communication and ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More domains (r=0.67, 0.61 respectively) and adequate correlations with the SIS StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Recovery domain (r=0.56) and the ACS total, Instrumental and Low Demand Leisure scores (r=0.55, 0.53, 0.55 respectively). Correlations with other SIS domains, ACS scores and the SF-36 and Reintegration to Normal Living Scale were not significant.

Peristeri and Tsapkini (2011) examined correlations between similar subtests of the BDAE-3 Short Form (Greek version) and the Bilingual AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test (BAT) (Greek version) in 9 patients with agrammatic aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), including 7 with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Correlations between tests of automated sequences, listening comprehension (BDAE complex ideational material subtest) and reading were excellent (r=0.75; 0.75; 0.88, respectively). Correlations between tests of fluency, commands, verbal auditory discrimination, word repetition, sentence repetition and naming were not significant.

Known groups:
Tsapkini, Vlahou and Potagas (2009/2010) examined the discriminative (known group) validityThe degree to which an assessment measures what it is supposed to measure.
of the BDAE-SF (Greek version) by comparing the performance of healthy community-dwelling adults and patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, using Wilcoxon’s rank sum test (W). Participants were matched according to education, age and gender. Significant differences between healthy adults and individuals with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) were seen in subgroups of middle-aged individuals (40-59 years) of middle education and higher education on subtests of auditory comprehension (W=32, p=0.005; W=20, p=0.015 respectively), oral expression (W=32, p=0.005; W=20, p=0.015 respectively) and reading (W=24, p=0.003; W=10, p=0.035 respectively), and in a subgroup of older individuals (60 years+) with low education on subtests of auditory comprehension (W=56.5, p=0.009) and oral expression (W=51, p=0.005).

Responsiveness

No studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BDAE in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

References

• Borod, J.C., Goodglass, H., & Kaplan, E. (1980). Normative data on the Boston Diagnostic Aphasia Examination, Parietal Lobe Battery, and the Boston Naming Test. Journal of Clinical Neuropsychology, 3, 209-215.
• Enderby, P.M., Wood, V.A., Wade, D.T., & Hewer, L.R. (1987). The Frenchay Aphasia Screening Test: A short, simple test for aphasia appropriate for nonspecialists. International Journal of Rehabilitation Medicine, 8, 166-170.
• Goodglass, H. & Kaplan, E. (1972). The assessment of aphasia and related disorders. Philadelphia, Boston: Lea & Febiger.
• Larson, E.B., Kirschner, K., Bode, R., Heinemann, A., & Goodman, R. (2003). Construct and predictive validity of the repeatable battery for the assessment of neuropsychological status in the evaluation of stroke patients. Journal of clinical and experimental neuropsychology, 27, 16-32.
• Peristeri, E., & Tsapkini, K. (2011). A comparison of the BAT and BDAE-SF batteries in determining the linguistic ability in Greek-speaking patients with Broca’s aphasia. Clinical Linguistics & Phonetics, 25 (6-7): 464-479.
• Radanovic, M. & Scaff, M. (2003). Speech and language disturbances due to subcortical lesions. Brain and language, 84, 337-352.
• Randolph, C. (1998). The Repeatable Battery for the Assessment of Neuropsychological Status. San Antonio, TX: The Psychological Corporation.
• Rosselli, M., Ardila, A., Florez, A., & Castro, C. (1990). Normative data on the Boston Diagnostic Aphasia Examination in a Spanish-speaking population. Journal of Clinical and Experimental Neuropsychology, 12, 313-322.
• Sbordone, R.J., Saul, R.E., & Purisch, A.D. Neuropsychology for Psychologists, Health Care Professionals, and Attorneys. Boca Raton, FL: Taylor and Francis Group. Tucker, F.M., Edwards, D.F., Mathews, L.K., Baum, C.M., & Connor, L.T. (2012). Modifying Health Outcome Measures for People With Aphasia. American Journal of Occupational Therapy, 66, 42-50.
• Tsapkini, K., Vlahou, C.H., & Potagas, C. (2009/2010). Adaptation and validation of standardized aphasia tests in different languages- Lessons from the Boston Diagnostic Aphasia Examination – Short Form in Greek. Behavioural Neurology, 22, 111-119.
• Tucker, F.M., Edwards, D.F., Mathews, L.K., Baum, C.M., & Connor, L.T. (2012). Modifying Health Outcome Measures for People With Aphasia. American Journal of Occupational Therapy, 66, 42-50.
• Wilde, M.C. (2006). The validity of the repeatable battery of neuropsychological
  status in acute stroke. The clinical neuropsychologist, 20, 702-715.

See the measure

How to obtain the BDAE:

The BDAE can be obtained in the following websites and costs from US$ 435 to US$ 496.

• http://www4.parinc.com/Products/Product.aspx?ProductID=BDAE
• http://pearsonassess.com/haiweb/cultures/en-us/productdetail.htm?pid=015-8358-600
• http://www.linguisystems.com/itemdetail.php?id=670

Purpose

The Frenchay AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) ScreeningTesting for disease in people without symptoms.
Test (FAST) was developed to provide healthcare professionals working with patients who might have aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) with a quick and simple method to identify the presence of a language deficit. The FAST was intended to be used as a screeningTesting for disease in people without symptoms.
device to identify those patients having communication difficulties who should be referred for a more detailed evaluation performed by a speech and language pathologist.

In-Depth Review

Purpose of the measure

The Frenchay AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) ScreeningTesting for disease in people without symptoms.
Test (FAST) was developed to provide healthcare professionals working with patients who might have aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) with a quick and simple method to identify the presence of a language deficit. The FAST was intended to be used as a screeningTesting for disease in people without symptoms.
device to identify those patients having communication difficulties who should be referred for a more detailed evaluation performed by a speech and language pathologist.

Available versions

The FAST was first published in 1987 by Enderby, Wood, Wade, and Hewer. This version has 4 subscales (comprehension; verbal expression; reading; writing) and is scored out of a total of 30 points.

Features of the measure

Items:
The FAST assesses language in four major areas: comprehension, verbal expression, reading, and writing. Testing is focused around a single, double-sided stimulus card depicting a scene on one side and geometric shapes on the other and five written sentences. All instructions or item tasks presented to the respondent are of graded length and difficulty.

The instructions for administering each section of the FAST are as follows:

Comprehension (out of 10).
Show patient the card with the river scene and say: ‘Look at the picture. Listen carefully to what is said and point to the things I tell you to.‘

(a) River scene
Practice item: “Point to the river“. Do not score this item. Repeat until patient understands what is required.
1. “Point to a boat”
2. “Point to the tallest tree”
3. “Point to the man and point to the dog”
4. “Point to the man’s left leg and then to the canoe”
5. “Before pointing to a duck near the bridge, show me the middle hill”

(b) Shapes
Practice item: “Point to the circle“. Repeat until patient understands task.
1. “Point to the square”
2. “Point to the cone”
3. “Point to the oblong and the square”
4. “Point to the square, the cone and the semicircle”
5. “Point to the one that looks like a pyramid and the one that looks like a segment of orange”

Verbal expression (out of 10).
(a) Show the patient the river scene and say: ‘Tell me as much about the picture as you can.’ If the patient does not appear to understand, say: ‘Name anything you can see in the picture.’

(b) Remove picture card from view and inform patient that you are now going to attempt something a little different. Ask the patient to name as many animals as he/she can think of in 1 minute. If the patient appears doubtful, explain that you want the names of any kind of animal, wild or domestic, and not just those which may have been seen in the picture. Start timing with the stopwatch as soon as the patient names their first animal and allow the patient to list for 60 seconds before stopping the task.

Reading (out of 5).
Check that the patient is wearing their correct eyeglasses for reading purposes. Show the patient the river scene and first reading card. Ask the patient to read the sentence to him/herself, not aloud, and do whatever it instructs him/her to do. Proceed in the same manner with the remaining four reading cards.

Writing (out of 5).
Show patient river scene and say: ‘Please write as much as you can about what is happening in the picture’. If the patient does not appear to understand say: ‘Write anything that you can see in the picture’. If their dominant hand is affected, ask the patient to attempt the test with their non-dominant hand. Encourage the patient if he/she stops prematurely. Allow a maximum of 5 minutes to complete this section.

Scoring:
Points are awarded based on the correctness or completeness of the response. Scores from each test area are summed to provide a total score.

How to score comprehension section:
Score 1 point for each item performed correctly. If instructions require repeating, score as an error. Unprompted self-correction may be scored as correct. This section is scored out of a total score of 10 points.

How to score verbal expression section:
The verbal expression section is scored out of a total score of 10 points.

Part (a):

1. unable to name any objects intelligibly
2. names 1 – 2 objects
3. names 3 – 4 objects
4. names 5 – 7 objects
5. names 8 or 9 objects or uses phrases and sentences, but performance not normal (e.g. hesitations, inappropriate comments, etc.)
6. Normal – uses phrases and sentences, naming 10 items

Part (b):

1. None named
2. Names 1 – 2
3. Names 3 – 5
4. Names 6 – 9
5. Names 10 – 14
6. Names 15 or more

How to score reading section:
Score 1 point for each items completed correctly for a total score of 5 points.

How to score writing section:
The writing section is scored out of a total score of 5 points.

1. Able to attempt task but does not write any intelligible or appropriate words
2. Writes 1 or 2 appropriate words
3. Writes down names of 3 objects or a phrase including 2 or 3 objects
4. Writes down names of 4 objects (correctly spelled), or 2 or 3 phrases including names of 4 items
5. Uses phrases and sentences, including names of 5 items, but not considered ‘normal’ performance, e.g. sentence is not integrating people and actions
6. Definitely normal performance, e.g. sentence integrating people and actions

Total score interpretation:
The presence of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) is indicated if the patient scores below the following cutoff points:

A significant inverse relationship between age and FAST total score has been reported (O’Neill, Cheadle, Wyatt, McGuffog, and Fullerton, 1990). Although stratified cutoffs and normative data are available for both the complete and shortened versions of the FAST for three age groups; =60 years, 61-70 years and =71 years, this is based on the assessment of a small sample (n=123) of normal individuals aged 21-81. As there was limited representation of the very elderly within the normative sample, it has been recommended that test scores be interpreted with caution and the cutoff point signifying the presence of language difficulties in this group be lowered to avoid the incorrect classification of very elderly patients (O’Neill et al., 1990).

Time:
The FAST takes 3-10 minutes to complete (Enderby et al., 1987).

Subscales:
There are 4 subscales to the FAST: comprehension; verbal expression; reading; writing

Equipment: Completion of the FAST requires the following items:

• Double-sided stimulus card with attached reading cards
• Pencil and paper
• Stopwatch or watch with second hand

Training:
The FAST is suitable for use by general practitioners, junior medical staff, and other non-specialists (Enderby et al., 1987).

Alternative Forms of the FAST

• Shortened version of the FAST (Enderby, Wood, Wade, Langton Hewer, 1987).
  To reduce administration time, only the comprehension and expression sections of the test can be administered, for a total combined score of 20. A score of 13 or less out of 20 indicates aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
  An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The classification sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  of this shortened version of the FAST is reported to be similar to that for the complete assessment.

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.

Should not be used with:

• The specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  of the FAST appears to be adversely affected by the presence of visual field deficits, visual neglect or inattention, illiteracy, deafness, poor concentration or confusion and therefore should be used with caution in patients with these conditions (Enderby, 1987; Al-Khawaja, Wade, & Collin, 1996; Gibson, MacLennan, Gray, & Pentland, 1991).

In what languages is the measure available?

To our knowledge, the FAST is only available in English.

Summary

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the FAST.

Reliability

Test-retest:
Philip, Lowles, Armstrong, and Whitehead (2002) administered the FAST to 50 older patients with repeat administration one or two weeks later by a nurseIn charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)
. Using kappa statistics, the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the FAST was found to be excellent (kappa = 1.00). A kappa value of 1.0 represents perfect agreement between the two test administration times.

Enderby, Wood, Wade, and Langton Hewer (1987) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the FAST and reported a high Kendall’s coefficient of concordance (W) (W = 0.97).

Inter-rater:
Enderby, Wood, Wade, and Langton Hewer (1987) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the FAST and reported a high Kendall’s coefficient of concordance (W) (W = 0.97).

Sweeney, Sheahan, Rice, Malone, Walsh, and Coakley (1993) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the FAST and reported 93% agreement between raters.

Validity

Criterion:
Concurrent:
Enderby, Wood, Wade, and Langton Hewer (1987) examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the FAST with the Functional Communication Profile in patients 15 days post-stroke, and in patients with chronic aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). Excellent correlations between the two measures were reported for both groups (r = 0.87 and r = 0.96, respectively).

Construct:
Al-Khawaja, Wade, and Collin (1995) administered the FAST to 50 patients who were suspected to have aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The FAST had an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Barthel Index (r=0.59). The authors state that these findings confirm reports that language disorders are associated with the severity of disability (i.e. patients who were incontinent, unable to transfer/walk and required help for personal care, showed more significant speech and language disorders on screeningTesting for disease in people without symptoms.
).

Convergent:
Al-Khawaja, Wade, and Collin (1995) examined the relationship between the FAST with the Sheffield ScreeningTesting for disease in people without symptoms.
Test for Acquired Language Disorders (SST) (Syder, Body, Parker, & Boddy, 1993). The SST is another measure that has been developed to detect the presence of language disorders in adults. The comprehension scores on the FAST had an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with receptive skills on the SST (r = 0.74) and with expression scores on the FAST with expressive skills on the SST (r = 0.92). The total scores of the two tests also had an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r = 0.89). In this study, the FAST was also compared to the Short Orientation, Memory and Concentration test (SOMC) (Katzman, Brown, Fuld, Peck, Schechter, and Schimmel, 1983). An excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the total score on the FAST and the SOMC (r = 0.86), and between the total scores on the SST and SOMC (r = 0.91) were reported.

Enderby and Crow (1996) examined correlations between the FAST, the Functional Communication Profile and the shortened Minnesota Test for Differential Diagnosis of AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and reported excellent correlations between the FAST and the total scores on both of these measures (r = 0.73 and r = 0.91, respectively). The correlations between the FAST and subtests of the Minnesota Test for Differential Diagnosis of AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) ranged from 0.70 to 0.82 and are considered ‘excellent‘.

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/ SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
:
Al-Khawaja et al. (1995) compared the presence (or absence) of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) as confirmed by speech therapists (the “gold standardA measurement that is widely accepted as being the best available to measure a construct.
”) to the FAST and reported that the FAST has an overall sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of 87% and a specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 80% using age-stratified cut-off scores.

O’Neill, Cheadle, Wyatt, McGuffog, and Fullerton (1990) compared the comprehensive and expressive subtests of the FAST to clinical examination by an experienced clinician. Using a cutoff score of < 25 out of 30 to identify the presence of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), at one day post-stroke, a sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of 96% and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 61% was reported. At one week post-stroke, a sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of 100% and a specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 79% were observed. However, in this study, lower specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
was associated with FAST than with clinical examination, suggesting that administration of the FAST confers no real advantage over the careful examination of an experienced clinician.

Responsiveness

Although the FAST is intended to be a screeningTesting for disease in people without symptoms.
measure, the first published study on the FAST examined repeat administration of the test over time and found that the FAST demonstrated significant change in the expected direction (Enderby, 1987). However, the responsivenessThe ability of an instrument to detect clinically important change over time.
of the FAST to change has not been evaluated in more detail.

References

• Enderby, P. M., Wood, V. A., Wade, D. T., Langton Hewer, R. (1987). The Frenchay Aphasia Screening Test: A short, simple test for aphasia appropriate for nonspecialists. International Journal of Rehabilitation Medicine, 8, 166-170.
• Enderby, P., Crow, E. (1996). Frenchay Aphasia Screening Test: Validity and comparability. Disability and Rehabilitation, 18, 238-240.
• Gibson ,L., MacLennan, W. J., Gray, C., Pentland, B. (1991). Evaluation of a comprehensive assessment battery for stroke patients. International Journal of Rehabilitation Research, 14, 93-100.
• Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., Schimmel, H. (1983). Validation of a short Orientation-Memory-Concentration test of cognitive impairment. Am J Psychiatry, 140, 734-739.
• O’Neill, P. A., Cheadle, B., Wyatt, R., McGuffog, J., Fullerton, K. J. (1990). The value of the Frenchay Aphasia Screening Test in screening for dysphasia: Better than the clinician? Clinical Rehabilitation, 4, 123-128.
• Philp, I., Lowles, R. V., Armstrong, G. K., Whitehead, C. (2002). Repeatability of standardized tests of functional impairment and well-being in older people in a rehabilitation setting. Disability and Rehabilitation, 24, 243-249.
• Salter, K., Jutai, J., Foley, N., Hellings, C., Teasell, R. (2006). Identification of aphasia post stroke: A review of screening assessment tools. Brain Injury, 20(6), 559-568.
• Sweeney, T., Sheahan, N., Rice, I., Malone, J., Walsh, J. B., Coakley, D. (1993). Communication disorders in a hospital elderly population. Clinical Rehabilitation, 7, 113-117.
• Syder, D., Body, R., Parker, M., Boddy, M. (1993). Sheffield screening test for acquired language disorders. Manual: Nfer-Nelson.

See the measure

How to obtain the FAST:

The FAST test manual and stimulus and reading cards can be purchased by accessing the Stass publications website.

Purpose

The Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (WAB) is a diagnostic tool used to assess the linguistic skills and main nonlinguistic skills of adults with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). This provides information for the diagnosis of the type of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and identifies the location of the lesion causing aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada).

In-Depth Review

Purpose of the measure

The Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (WAB) was developed by Kertesz in 1979 based on the original format of the Boston Diagnostic AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Examination (Goodglass & Kaplan, 1972). It was designed as an assessment tool to examine linguistic skills (information content, fluency, auditory comprehension, repetition, naming and word finding, reading, and writing) and main nonlinguistic skills (drawing, block design, calculation, and praxis) of adults with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The observed language behaviours facilitate diagnosis by classifying the patient as having 1 of 8 types of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (Global, Broca’s, Transcortical motor, Wernicke’s, Transcortical sensory, Mixed transcortical, Conduction, and Anomic) according to primary aspects of language functioning (Risser & Spreen, 1985). The WAB is also used to determine the location of the lesion.

The WAB is one of the most commonly used assessment tools by speech language pathologists in Canada (Korner-Bitensky et al., 2006).

Available versions

The WAB was originally developed by Kertesz in 1979. It was revised in 1982 and then again in 2006, when it was published as the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery-Revised (WAB-R). The WAB-R has a number of improvements including supplemental tasks, revision of the items, more modern equipment (e.g. spiral-bound stimulus book replacing loose stimulus cards), as well as revised directions and scoring guidelines for clarity. The WAB-R also includes a bedside screeningTesting for disease in people without symptoms.
tool.

Features of the measure

Subscales:

The WAB is comprised of 8 subscales, the WAB-R includes an additional subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
:

1. Spontaneous speech
2. Auditory verbal comprehension
3. Repetition
4. Naming and word finding
5. Reading
6. Writing
7. Apraxia
8. Contructional, visuospatial, and calculation tasks
9. Supplemental writing and reading tasks (WAB-R only)

Items and scoring:

The WAB consists of two parts:

Composite scores:

In addition to the subscales scores, there are three additional composite scores (note that the following do not include the supplemental subtest of the WAB-R):

1 – Language Quotient (LQ):

This is the newest summary score that encompasses auditory comprehension, oral expression, reading, and writing performance (Shewan, 1986). The first two elements relate to spoken language performance and the latter two elements relate to written language performance. The LQ uses a 60:40 ratio of spoken to written language performance, in light of the fact that people more regularly use spoken language skills.

Computation: The LQ uses the scores from all subtests of the first part of the WAB (Spontaneous speech, Auditory verbal comprehension, Repetition, Naming and word finding) and the first two subtests of the second part of the WAB (Reading, Writing). The LQ score can range from 0 to 100. Each subtest score is a portion of the total score according to their respective maximum scores, as follows:

Accordingly, the LQ is calculated as the sum of each subtest revised score.

2. Cortical Quotient (CQ):

The CQ is a weighted average of all subtest scores. Since the non-language portion is included in this summary score, it is not a sound indicator of language ability and its severity in aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). The LQ score can range from 0-100.

Computation: Like the LQ, each subtest’s score is a portion of the total score.

3. AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient (AQ):

The AQ is a weighted average of all subtest scores relating to spoken language, measuring language ability. It is a sum of all subtest scores from the first part of the WAB (Spontaneous speech, Auditory verbal comprehension, Repetition, Naming and word finding). The examiner can use the AQ score to classify the client’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) as 1 of 8 types (Kyoung Kang et al, 2010).

Taxonomic Table of the Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (Kertesz, 1982)

Note: However, Risser and Spreen (1984) commented that WAB criteria for classification force assignments to types of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) based on idealized subtest scores and avoids the term ‘mixed’ aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) that accounts for a proportion of the aphasic population.

What to consider before beginning:

• The client should be well rested and should be allowed frequent breaks during the assessment.
• The examiner may want to video or the testing session to allow for later review of the client’s performance.
• The examiner must remember to place all pictures and objects within the client’s visual field.
• The examiner must be aware of the client’s self-corrections and must always record the client’s responses, whether or not it is correct.
• The examiner may repeat the instructions once, unless otherwise instructed in the manual.
• The examiner must not let the client know how they are doing on the test and should be aware not to give cues unless instructed to.
• Before administering the supplemental section of the WAB-R, the examiner must see the client’s performance on the previous Reading and Writing tasks. The examiner may choose to not administer this last section if the client did not perform satisfactorily, because the level of difficulty is increased. The supplemental section is used to distinguish whether a client has semantic and phonological dyslexia. The examiner may also gather information about spelling dyslexia

Time:

Part 1 of the WAB takes approximately 30-45 minutes; Part 2 takes approximately 45-60 minutes to administer.

The WAB-R includes a Bedside Screener that takes about 15 minutes to administer.

Training requirements:

None typically reported.

Equipment:

The WAB requires specialized equipment, in addition to unlined paper, a pen and pencil, and a stopwatch. The complete set includes 25 record forms, 57 stimulus cards and a test manual. Stimulus cards include a range of images, words and sentences that are shown to the client during the assessment.

The WAB-R contains a pack of 25 bedside record forms, a Raven’s Coloured Progressive Matrices test booklet and manipulative set (cup, comb, flower, matches, screwdriver, 4 Koh’s blocks, watch, hammer, telephone, ball, knife, safety pin, toothbrush, eraser, padlock, key, paperclip, rubber band, spoon, tape, fork).

Detailed administration guidelines are provided in the test manual.

Alternative forms of the Assessment

There are no alternate forms, although there is a bedside screener in the WAB-R in case of time constraints. This bedside screener can be administered in a comfortable setting. The record form provides administration and scoring guidelines. The score retrieved can determine a client’s abilities and functioning before surgery or any other medical procedure.

Can be used with:

• Patients between the ages of 18 and 89 with acquired neurological disorders due to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, a head injury, or dementia.
• Alzheimer’s disease (Risser & Spreen, 1984)
• Nonaphasic right hemisphere lesions (Risser & Spreen, 1984)

In what languages is the measure available?

• Published in English (Risser & Spreen, 1984).
• Published in Japanese (WAB AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
  An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test Construction Committee, 1986).
• Available in Hungarian, French, Portuguese, and two Indian language translations (Risser & Spreen, 1984); translated into Turkish (Keklikoglu, Selcuki & Keskin, 2009), translated into Korean (Kim and Na, 2004) (Unpublished).
• Standardized Cantonese version (CAB; Yiu, 1992).
• Hebrew version (Kasher, Batori, Soroker, Graves & Zaidel, 1999).

Summary

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the WAB relevant to individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Thirteen studies were found.

Floor/Ceiling Effects

No studies have reported on floor or ceiling effects of the WAB specific to clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More:
Shewan and Kertesz (1980) examined internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of WAB Spontaneous Speech, Auditory Comprehension, Repetition, Naming, Reading and Writing subtests (reported by Shewan (1986) as the WAB-LQ) with 140 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Cronbach’s alpha and Bentler’s coefficient theta. Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of all subtests was excellent (a=0.905; q=0.974).

Kim and Na (2004) used the Korean Western AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Battery (K-WAB) to examine the relationships between the Naming subtest total score and tasks: Object Naming (ON), Word Fluency (WF), Sentence Completion (SC) and Responsive Speech (RS). There were excellent correlations between the Naming subtest total score and all tasks (ON: r=0.971; WF: r=0.693; SC: r=0.785; RS: r=0.797). There were excellent correlations between all tasks (r=0.606-0.726) except for an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the SC and WF tasks (r=0.534). These correlations suggest that all tasks are similar enough to be part of the same subtest, but not too similar to be redundant.

Test-retest:
Kertesz and McCabe (1977) assessed 1-year test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the WAB in 22 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson r correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient and reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
(r=0.992).

Shewan and Kertesz (1980) examined test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the WAB in a sample of up to 38 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. Participants were assessed on two occasions anywhere from 6 months to 6.5 years apart (average 12-23 months between testing). Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was excellent for the WAB-AQ (r=0.968), WAB-CQ (n=9, r=0.895), WAB-LQ subtests (also reported in Shewan, 1986): Spontaneous Speech – Information Content (r=0.947) and Fluency (r=0.941), Comprehension (r=0.881), Repetition (r=0.970), Naming (r=0.923), Reading (n=32; r=0.927) and Writing (n=25; r=0.956) and the Construction subtest (n=14, r=974). Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was adequate for the Praxis subtest (n=18, r=0.581).

Pederson, Vinter and Skyhoj Olsen (2001) examined 3½-month test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the WAB in a sample of 19 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient and reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
(r=0.96). There was no significant change in WAB scores across the two time points.

Kim and Na (2004) examined 5-day test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the K-WAB in a sample of 20 neurologically stable aphasic patients, using Pearson’s correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient. Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of composite scores and all subtests was excellent (AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient: r=0.976; Language Quotient: r=0.977; Cortical Quotient: r=0.920; Spontaneous Speech: r=0.96; Auditory Comprehension: r=0.967; Repetition: r=0.952; Naming: r=0.934; Reading: r=0.986; Writing: r=0.988; Praxis, r=0.908; Construction: r=0.922). These results suggest that all subtests of the K-WAB are stable and reliable over a short time period.

Pak-Hin Kong (2011) examined test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the Cantonese version of the WAB (CAB) in a sample of 16 participants with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Spearman’s rho correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
. Participants were examined on two occasions, 12 to 16 months apart. Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was excellent for the Spontaneous Speech subtest – Information, Fluency and total scores (r=0.83, 0.94, 0.96 respectively) and for the Naming subtest (r=0.91) and overall AQ (r=0.93). Participants did not demonstrate significant differences in CAB scores across the two evaluations.

Intra-rater:
Shewan and Kertesz (1980) reported on intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the WAB administered to 10 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More several months apart. Videotapes were viewed and scored by 3 judges. Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
was excellent for the WAB-AQ (r=0.986-0.997), WAB-CQ (r=0.992-0.998), all WAB-LQ subtests (also reported in Shewan, 1986): Spontaneous Speech – Information Content (r=0.926-944), Spontaneous Speech – Fluency (r=0.794-0.989), Comprehension (r=0.985-0.993), Repetition (r=0.993-0.997), Naming (r=0.995-0.999), Reading/Writing (r=0.985-0.998), and the Praxis (r=0.983-0.989) and Construction (0.948-0.996) subtests.

Inter-rater:
Shewan and Kertesz (1980) examined inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the WAB administered to 10 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More several months apart, using Pearson product moment correlationThe most commonly used method of computing a correlation coefficient between variables that are linearly related. Pearson's r is a measure of association which varies from -1 to +1, with 0 indicating no relationship (random pairing of values) and 1 indicating perfect relationship
coefficients. Videotapes were independently scored by 8 judges and correlations were averaged for each subtest. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was excellent for the WAB-AQ, WAB-CQ, WAB-LQ subtests (also reported in Shewan, 1986) and the Praxis and Construction subtests.

Kim and Na (2004) examined inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the K-WAB in a sample of patients, where 93.7% presented with acute or subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson’s correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient. Three certified Speech-Language Pathologists assessed video-recordings of participants’ language performance. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was excellent for the K-WAB composite scores and all subtests (AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient: r=1.000; Language Quotient: r=0.997; Cortical Quotient: r=1.000; Spontaneous Speech – Fluency: r=0.994; Spontaneous Speech – Content: r=0.993; Auditory Comprehension: r=1.000; Repetition: r=0.999; Naming: r=0.999; Reading: r=0.999; Writing: r=0.999; Praxis: r=1.000; Construction: r=0.998).
Note: The number of participants used to calculate inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was unclear.

Validity

Content:

Shewan and Kertesz (1980) reported that the WAB appears to meet subjective criteria for content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
as it measures language content areas common to all aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) batteries and has similar items to the BDAE.

Shewan (1986) examined content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the WAB-LQ by comparison with content of other aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) test batteries. WAB-LQ subtests (Spontaneous Speech, Auditory Comprehension, Naming, Repetition, Reading, Writing) span the domain of spoken and written language, are aspects typically addressed in rehabilitation, and are also included in common aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) test batteries in terms of area assessed, content and difficulty.

Criterion:

Concurrent:
Kim and Na (2004) examined concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the K-WAB Naming subtest and the Korean version of the Boston Naming Test (K-BNT) in 238 patients, where 93.7% (n=223) of patients presented with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. There were excellent correlations between the K-BNT score and K-WAB Object Naming (r=0.720) and Word Fluency (r=0.613) tasks and Naming subtotal score (r=0.719). There were adequate correlations between the K-BNT score and the K-WAB Sentence Completion (r=0.526) and Responsive Speech (r=0.553) tasks.

Predictive:
No studies have reported on predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the WAB with patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More.

Construct:

Kertesz and Phipps (1977) examined construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the WAB by factor analysis with a sample of 142 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using an r-type Principal Components Analysis. Results indicated that the five subtests contributing to the total AQ load relatively equally on Root 1, which accounts for 83% of total variance. The Fluency and Comprehension subtests were the principal components for Root 2, which accounted for 9% of total variance. Repetition and Information Content were principal components of Root 3, which accounted for 7% of total variance. Naming was the principal component for Root 4, which accounted for 2% of total variance.

Convergent/Discriminant:
Shewan and Kertesz (1980) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB by comparison with corresponding subtests of the Neurosensory Center Comprehensive Examination for AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (NCCEA) with a sample of 15 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. Correlations were excellent between: WAB Spontaneous Speech and NCCEA Description of Use and Sentence Construction (r= 0.817); WAB Comprehension and NCCEA Identification by Name and Identification by Sentence (r= 0.915); WAB Repetition and NCCEA Sentence Repetition (r= 0.880); WAB Naming and NCCEA Visual Naming and Word Fluency (r= 0.904); WAB Reading and NCCEA Reading subtests (r=0.919); WAB Writing and NCCEA Writing subtests (r=0.905); and WAB and NCCEA total scores (r=0.973). There was also an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the WAB-CQ (minus the Praxis and Construction subtests) and a comparable NCCEA score (minus the Tactile Naming-Right/Left, Articulation, Digit Repetition-Forward/Backward subtests) (r=0.964).

Shewan and Kertesz (1980) examined discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the WAB by comparison with Raven’s Coloured Progressive Matrices scores with a sample of 140 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), using Pearson product-moment correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. There was an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r=0.547) between the two tests, indicated that the WAB had some influence of intelligence.

Laures-Gore, DuBay, Duff and Buchanan (2010) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB AQ by comparison with measures of word productivity (WP) and error frequency (EF) in fluent speech in a sample of 14 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. WP was measured as the proportion of productive words to total words for each minute of a language sample, and EF was measured as the total number of errors divided by the total number of productive words across a 10-minute speech sample. There was an adequate positive correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between WAB AQ and WP (r=0.59) and an adequate negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between WAB AQ and EF (r=-0.54).

Bakheit, Carrington, Griffiths and Searle (2005) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB by comparison with the Communicative Effectiveness Index (CETI) in 67 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. Participants received multidisciplinary rehabilitation including conventional speech language pathology began on admission to a rehabilitation unit and continued on discharge from hospital. Measures were taken at baseline, 4 weeks, 8 weeks, 12 weeks and 24 weeks. There was an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the two assessments over all test periods (r=0.71), with adequate to excellent correlations at each time point (r= 0.70, 0.67, 0.53, 0.66 and 0.68, respectively).

Pederson, Vinter and Skyhoj Olsen (2001) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB by comparison with a Danish adaptation and translation of the Communicative Effectiveness Index (CETI) in 66 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. There was an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the CETI and the WAB AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient (r=0.76). There were adequate to excellent correlations between the CETI and WAB Information (r=0.73), Fluency (r=0.73), Comprehension (r=0.65), Repetition (r=0.53) and Naming (r=0.75) subtests. There were adequate to excellent correlations between the CETI and WAB reading (r=0.70), writing (r=0.69), apraxia (r=0.60), calculation (r=0.64), block design (r=0.34), drawing (r=0.41) and Raven Coloured Matrices (r=0.41) tasks.

Pederson, Vinter and Skyhoj Olsen (2001) examined discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the WAB AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient (WAB-AQ) and Raven Coloured Matrices by comparison with the Scandinavian StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More Scale (SSS), Barthel Index (BI) and Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index (FAI) with a sample of 66 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
. There was an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the WAB-AQ and the SSS (r=0.64) and adequate correlations between the WAB-AQ and the BI (r=0.44) and the FAI (r=0.50). There were adequate correlations between the WAB Raven Coloured Matrices and the BI (r=0.41) and FAI (r=0.48).

Kostalova et al. (2008) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB by comparison with the Czech version of the Mississippi AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) ScreeningTesting for disease in people without symptoms.
Test (MASTcz) in 45 patients with left hemisphere strokes with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), using Pearson product-limit correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
. There was an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the two tests (r= 0.933).

Ivanova and Hallowell (2012) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the WAB-R Spontaneous speech, Auditory verbal comprehension, Repetition and Naming subtests and AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient with an Eye Movement Working MemoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007)
(EMWM) task in a sample of 28 people with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. There were no significant correlations between tests following Holm correction to control for familywise alpha.

Pak-Hin Kong (2011) examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the Cantonese version of the WAB (CAB) with the main concept (MC) analysis in 16 participants with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Spearman’s rho coefficients. MC analysis captures the presence, accuracy, completeness and efficiency of content in oral narratives among Cantonese speakers with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), and scores included: number of accurate and complete concepts (AC); number of accurate but incomplete concepts (AI), number of inaccurate concepts (IN), number of absent concepts (AB), MC score (MC) and number of accurate and complete concepts per min (AC/min). Scores were correlated with the CAB Spontaneous Speech subtest Information, Fluency and total scores, Naming subtest and overall AQ. Participants were examined on two occasions, 12 to 16 months apart. At both time points there were adequate to excellent correlations between the CAB Spontaneous Speech Information score and most related MC measures (AC: r=0.54, 0.73; AI: r=0.60, 0.62; AB: r=-0.64, -0.75; MC score: r=0.64, 0.76), and excellent correlations between the CAB Spontaneous Speech Fluency score and most related MC measures (AC: r=0.94, 0.93; AB: r=-0.91, -0.87; MC score: r=0.94, 0.91; AC/min: r=0.94, 0.93), CAB Spontaneous Speech score and MC score (r=0.96, 0.90), CAB Naming subtest and related MC measures (AC: r=0.91, 0.89; AB: r=-0.85, -0.84; MC score: r=0.89, 0.92) and CAB overall AQ and related MC measures (AC: r=0.91, 0.89; AB: r=-0.93, -0.84; MC score: r=0.95, 0.91).

Known groups:
Shewan and Kertesz (1980) examined known-group validityThe degree to which an assessment measures what it is supposed to measure.
of the WAB with a sample of 117 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) and 122 control subjects without aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), using Newman-Keuls Shortest Significant Range Test. Patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) were categorized according to type: anomic aphasiaAnomic aphasia is the inability to name objects or to recognize written or spoken names of objects. It is also known as: nominal aphasia or amnesic (or amnestic) aphasia. (n=37), conduction aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n=13), Wernicke’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n=18), Broca’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n=25) or global type aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (n=24). Control subjects without aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) formed one of three groups: non-brain injured adults (n=31), individuals with non-dominant-hemisphere lesions (n=70) or individuals with diffuse brain lesions (n=21). Results indicated that the control groups differed significantly from all aphasic types, excluding the anomic group. The control groups did not differ significantly among themselves. All aphasic groups differed significantly among themselves, with the exception of the Broca’s and Wernicke’s aphasic types. The global aphasic group scored significantly lower than other aphasic groups.

Shewan (1986) examined change in WAB-LQ scores over time in a sample of 50 adults with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Participants were stratified according to aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) severity based on baseline WAB-AQ scores (mild, moderate, severe) and were assessed at baseline (2-4 weeks post-onset of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada)), 3 months, and at least 6 months post-baseline. Post-hoc analysis by Newman-Keuls shortest significant range test revealed significant differences among the three groups from baseline to final assessment (p<0.05). WAB-LQ scores changed in a similar fashion for the three severity levels across time. Greatest gains were seen among patients with moderate or severe aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada).

Ross and Wertz (2003) examined known-group validityThe degree to which an assessment measures what it is supposed to measure.
of the WAB with a sample of 18 healthy adults and 18 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, using Wilcoxon’s rank sum test (W). There were significant differences between groups for WAB aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) quotient and cortical quotient (p<0.000).

Ross and Wertz (2004) examined known-group validityThe degree to which an assessment measures what it is supposed to measure.
of the WAB in a sample of 10 healthy (non-brain-injured) adults and 10 patients with mild aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. There were significant differences between groups for the WAB aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) quotient and cortical quotient (p<0.000).

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/Specificity:
Ross and Wertz (2004) examined sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the WAB with a sample of 10 patients with mild aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and 10 healthy (non-brain-injured) adults. A prescribed score of 93.8 was used to determine ‘aphasic’ performance on the WAB AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient, with 60% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and 100% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
. A corresponding WAB Cognitive Quotient cutoff score of 95.32 resulted in 80% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
.

Kim and Na (2004) examined sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the K-WAB with a sample of 238 patients, where 93.7% (n=223) presented with acute or subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Patients were grouped according to age (15-74 years vs. ≥75 years) and years of education (0, 1-6, ≥7). The following results were found for the AQ:

• For patients between 15-74 years with 0 years of education an optimal cutoff score of 85.25 resulted in 93% diagnostic accuracy, 92% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 94% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (area under the curve (AUC) = 0.973);
• For patients between 15-74 years with 1-6 years of education an optimal cutoff score of 87.45 resulted in 96% diagnostic accuracy, 94% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 100% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC = 0.998);
• For patients between 15-74 years with over 7 years of education an optimal cutoff score of 93.25 resulted in 94% diagnostic accuracy, 93% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 96% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.986);
• For patients 75 years and older with 0 years of education an optimal cutoff score of 74.05 resulted in 94% diagnostic accuracy, 100% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 94% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.976);
• For patients 75 years and older with 1-6 years of education an optimal cutoff score of 86.00 resulted in 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=1.000);
• For patients 75 years of age and older with over 7 years of education an optimal cutoff score of 88.30 resulted in 93% diagnostic accuracy, 94% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 90% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.975).

The following results were found for the LQ:

• For patients between 15-74 years with 1-6 years of education an optimal cutoff score of 79.96 produced 96% diagnostic accuracy, 94% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 100% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.982);
• For patients between 15-74 years with over 7 years of education an optimal cutoff score of 89.05 produced 94% diagnostic accuracy, 96% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 93% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.977);
• For patients 75 years and older with 1-6 years of education an optimal cutoff of 65.9 produced 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=1.000);
• For patients 75 years and older with over 7 years of education an optimal cutoff of 72.7 produced 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=1.000).

The following results were found for the CQ:

• For patients between 15-74 years with 1-6 years of education the optimal cutoff score of 77.65 produced 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=1.000);
• For patients between 15-74 years of age, with over 7 years of education the optimal cutoff score of 90.85 produced 95% diagnostic accuracy, 94% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and 96% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=0.986);
• For patients 75 years and older with 1-6 years of education the optimal cutoff score of 69.72 produced 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
  and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
  (AUC=1.000);

For patients 75 years and older with over 7 years of education the optimal cutoff score of 75.86 produced 100% diagnostic accuracy, sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
(AUC=1.000).

Responsiveness

Shewan (1986) examined change in WAB-LQ scores over time in a sample of 50 adults with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) secondary to acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, who received treatment (n=42) or no treatment (n=8). Participants were assessed at baseline (2-4 weeks post-onset of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada)), 3 months, and at least 6 months post-baseline. There was a significant main effect for time (F=43.33, df=2.96, p<0.0001), and post-hoc analysis by Newman-Keuls shortest significant range test revealed significant differences in the mean scores for the three tests (p<0.01). These significant increases in WAB-LQ scores with recovery support its validityThe degree to which an assessment measures what it is supposed to measure.
as a measure of severity.

Aftonomos, Steele, Appelbaum and Harris (2001) used the WAB to measure change in communication at the impairment level following a community-based Language Care Center (LCC) Treatment Program with a sample of 50 patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), 49 secondary to subacute or chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Participants’ mean scores improved significantly from pre- to post-treatment on all WAB subtests, with absolute percentages ranging from 6.5% to 13% improvement (p values ranging from p<0.01 to p<0.0001). Participants were categorized according to pre-treatment WAB AQ scores: (a) < 25 (n=13); (b) 25-50 (n=16); (c) 50-75 (n=12); and (d) ≥ 75 (n=9). Mean AQ scores improved by +8.8, +11.2, +13.6 and +7.9 (respectively), whereby participants with scores in the two middle groups showed greater gains than those with scores at the extremes.

References

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• Bakheit, A.M.O., Carrington, S., Griffiths, S., & Searle, K. (2005). High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients. Disability & Rehabilitation, 27(6), 287-291.
• Goldstein, G., Beers, S. R., & Hersen, M. (2004). Comprehensive Handbook of Psychological Assessment: Intellectual and Neuropsychological Assessment. New Jersey: John Wiley & Sons.
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• Kertesz, A. (1982). Western Aphasia Battery Test Manual. New York: Grune and Stratton.
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• Shewan, C.M. (1986). The language quotient (LQ): A new measure for the Western Aphasia Battery. Journal of Communication Disorders, 19(6), 427-439.
• Shewan, C.M., & Kertesz, A. (1980). Reliability and validity characteristics of the Western Aphasia Battery (WAB). Journal of Speech and Hearing Disorders, 45(3), 308-324.
• WAB Aphasia Test Construction Committee (1986). The Japanese version of the Western Aphasia Battery. Tokyo:Igaku-Shoin Ltd.
• Yiu, E.M.L. (1992) Linguistic assessment of Chinese-speaking aphasics: Development of a Cantonese aphasia battery. Journal of Neurolinguistics, 7, 379-424.

See the measure

How to obtain the WAB

The WAB-R can be purchased online at Pearson Assessment & Information