Frenchay Aphasia Screen Test (FAST)

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:

Age	Raw Score
Up to 60	27
61+	25

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..

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

What does the tool measure?	The presence of a language deficit.
What types of clients can the tool be used for?	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).
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	ScreeningTesting for disease in people without symptoms.
Time to administer	The FAST takes approximately 3-10 minutes to administer.
Versions	Original FAST (This version has 4 subscales comprehension; verbal expression; reading; writing) and is scored out of a total of 20 points; Shortened Version of the FAST (only the comprehension and expression sections are administered).
Other Languages	None.
Measurement Properties
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 .	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.: No studies have examined 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. of the FAST. Test-retest: Two studies have 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. One study reported excellent test-retest using kappa statistics, and one study reported high test-retest using Kendall’s coefficient of concordance (W). Intra-rater: No studies have examined 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. of the FAST. Inter-rater: One study has 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 high 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 measured by Kendall’s coefficient of concordance (W).
ValidityThe degree to which an assessment measures what it is supposed to measure.	Criterion: Concurrent: 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 FAST and the Functional Communication Profile. Construct: 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 FAST and the Barthel Index. Convergent/Discriminant: Excellent correlations between the comprehension scores on the FAST and the receptive skills on the Sheffield ScreeningTesting for disease in people without symptoms. Test for Acquired Language Disorders (SST), between the expression scores on the FAST and the expressive skills on the SST, between the total scores of the FAST and the SST as well as with the total score of the Short Orientation, Memory and Concentration test (SOMC). Excellent correlations between the FAST and the total scores of 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), as well as with 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).
Floor/Ceiling Effects	No studies have examined the ceiling effects of the FAST.
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	One study compared the FAST to the examination by speech therapists (the “gold standardA measurement that is widely accepted as being the best available to measure a construct. ”) and reported 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%. One study compared the comprehensive and expressive subtests of the FAST to examination by an experienced clinician and reported 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%-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 61%-79%.
Does the tool detect change in patients?	Although the FAST is intended to be a screeningTesting for disease in people without symptoms. measure, one study reported that the FAST demonstrated significant change in the expected direction.
Acceptability	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. It has been recommended that when testing the very elderly, test scores be interpreted with caution and the cutoff point signifying the presence of language difficulties be lowered to avoid incorrect classification.
Feasibility	The administration of the FAST is quick and simple and can be administered by general practitioners, junior medical staff and other non-specialists and does not require any formal training. FAST stimulus and reading cards are required to complete the measure and can be purchased online. The FAST is simple to score and stratified cutoffs and normative data are available.
How to obtain the tool?	The FAST stimuli and reading cards are available from Wiley at: http://ca.wiley.com/WileyCDA/WileyTitle/productCd-1861564422.html

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.