Cultural adaptation and psychometric testing of the Scenario Test for people with aphasia
with insight on cognitive aspects of
independent communication
Lara Galante Supervised by Dr. Katerina Hilari and Dr. Lucy Dipper
• In more severe aphasia, some people can become socially isolated as day-to-day tasks become challenging.
• Language recovery may not be a realistic option for some, and other methods of communication (i.e. drawing, writing, gesture, technological aids) may be adopted. This is called total communication (Rautakoski, 2012).
Background
Background → Research Aims → Method → Current Progress → Questions
The Scenario Test is a new assessment of total communication originally developed at the Rijndam Institute, The Netherlands (van der Meulen et al., 2010).
It has 6 real-life settings comprising of 20 individual ‘scenes’ where a certain message must be communicated, with the help of a communicative partner (the examiner). These consist of usually one, but sometimes two elements.
“You are in a shop, looking for a sweater. The woman asks, “Can I help you?” What do you do?” (Examinee must communicate ‘sweater’).
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Items are scored based on whether proposition(s) are correctly communicated, and the amount of help needed. • Prompting to use another mode of communication • Open questions to gain more/clarify information • Yes/No questions as a last resort.
Test is video recorded to allow examiner to better focus on examinee and scored later. Why is The Scenario Test important? • Many existing aphasia tests focus on language only, ignoring full communicative ability (total communication), resulting in floor effects (van der Meulen et al., 2010). • Many assessments do not capture the interactive nature of communication (monologues only) or are not sensitive to communicative abilities for all modalities in severe aphasia
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Two central factors are:
• Praxis (skilled hand movement) mainly required for accurate, meaningful gestures (Koski et al., 2002).
• Non-verbal cognition, particularly executive functions (responsible for planned, goal-oriented behaviour), but also working memory and attention (Hester and Garavan, 2005).
• Preliminary studies have suggested a link between non-verbal cognition and the ability to more proficiently learn new communicative strategies in people with aphasia (Nicholas et al. 2005; Fridrikkson et al. 2006; van de Sandt‐Koenderman et al. 2007)
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Various factors may contribute to total communicative effectiveness, potentially resulting in individual differences across people with similar language deficits.
In short, the aims of the present study are: 1. To evaluate the psychometric properties of an English version of The
Scenario Test: • Validity (does it accurately test overall communication as it is supposed
to?) • Reliability (does it give consistent scores from the same scorer and
between different judges? Also, does the same individual achieve a similar score twice in a row?)
• Sensitivity to change (does a person’s score differ over time according to changes in their condition?)
2. To investigate the contribution of praxis and non-verbal cognition to independent, effective total communication.
Research Aims
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Participants
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Main cohort and control participants
Sensitivity to change subgroup
• ~65 in main cohort (9 pilot) • 20 control participants (stroke but no aphasia)
• Recruited from community stroke groups
• Longer time (usually >6 months) post-onset
• 20 participants
• Recruited from NHS rehabilitation centre* (?)
• Shorter time post-onset (3 months or less)
Main cohort and control participant procedure
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• Lots and lots of assessments
• Two sessions of 1 ½ hours each
Session 1 Session 2
Additionally, a family member, friend or carer will be asked to complete the ASHA-FACS, a questionnaire on the participant’s communication skills.
FAST (to screen for aphasia) CAT (to screen for severe cognitive problems and for aphasia)
TEA Elevator with distraction test (selective attention) The Scenario Test Tower of London (cognition) CLQT (cognition) ARAT, BCUS praxis screen, Limb Apraxia Screen (praxis)
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Sensitivity to change subgroup procedure
• Will receive FAST, CAT cognitive screen, Scenario Test and partner-rated ASHA-FACS only • Seen before 3 months post-onset because the most significant recovery from aphasia due to stroke occurs in the first few months.
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Current progress
• Ethical approval obtained from City University • Pilot of 9 participants (3 mild aphasia, 3 moderate-severe aphasia, 3 controls without aphasia) completed Summer 2013. • Data collected from 26 participants with aphasia, and 5 controls. We aim for minimum 50 PWA but the more the better.
• Initial session with 1 sensitivity to change participant completed, who was recruited from the Stroke Association. Recruiting through the NHS is proving more difficult than anticipated.
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Request for participants!
• As this is a psychometric study, the more participants we can recruit, the better.
• Most importantly, we are looking for sensitivity to change participants who are up to 3-months post stroke.
• Happy to share data if it is useful to you (i.e. as an outcome measure)
• We also welcome participants who are longer post-stroke for the main study group.
Thank you!! All help is greatly appreciated.
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References Fridriksson, J., Nettles, C., Davis, M., Morrow, L., & Montgomery, A. (2006). Functional communication and executive function in aphasia. Clinical linguistics & phonetics, 20(6), 401-410. Hester, R., & Garavan, H. (2005). Working memory and executive function: The influence of content and load on the control of attention. Memory & Cognition,33(2), 221-233. Koski, L., Iacoboni, M., & Mazziotta, J. C. (2002). Deconstructing apraxia: understanding disorders of intentional movement after stroke. Current opinion in neurology, 15(1), 71-77. Nicholas, M., Sinotte, M., & Helm-Estabrooks, N. (2005). Using a computer to communicate: Effect of executive function impairments in people with severe aphasia. Aphasiology, 19(10-11), 1052-1065. Rautakoski, P. (2011). Training total communication. Aphasiology, 25(3), 344-365. van der Meulen, I., van de Sandt‐Koenderman, W. M., Duivenvoorden, H. J., & Ribbers, G. M. (2010). Measuring verbal and non‐verbal communication in aphasia: reliability, validity, and sensitivity to change of the Scenario Test.International Journal of Language & Communication Disorders, 45(4), 424-435. van de Sandt‐Koenderman, W. M. E., Wiegers, J., Wielaert, S. M., Duivenvoorden, H. J., & Ribbers, G. M. (2007). High‐tech AAC and severe aphasia: Candidacy for TouchSpeak (TS). Aphasiology, 21(5), 459-474.
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Any questions?
[email protected] 0207 040 8820
