Article
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background In clinical practice and in research, aphasia measurement instruments are used for many reasons: to screen and diagnose, to identify deficits and strengths, and to measure outcomes. A proliferation in available measurement instruments presents challenges to both the aphasia clinician and researcher and forms a barrier to optimal practice. There is a need for a comprehensive review of measurement instruments to identify the diversity of constructs measured by available tools and their cultural and linguistic applicability to the international aphasia community. Aims (1) To identify all available standardised measurement instruments which have been developed or tested with people with aphasia; and (2) To describe the construct/s measured, method of report, structure (components and scoring system), and availability of cultural/linguistic adaptations, of identified instruments. Methods and Procedures This scoping review is reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were identified through searches of PUBMED, EMBASE, and CINAHL databases. Secondary searches of individual measurement instruments and hand searching were also undertaken. Two reviewers independently assessed titles, abstracts, and full-text articles. Inclusion criteria: studies reporting psychometric properties of measurement instruments, participants with aphasia (or their proxies), English language full-text journal articles. Data extracted: purpose, structure, and method of report of each instrument. The construct(s) reported to be measured by each instrument was classified according to the International Classification of Functioning, Disability and Health (ICF). Outcomes and Results A total of 3642 articles were identified through database searches. Following the removal of duplicates, 2879 articles were screened by title and abstract; with 334 articles undergoing full-text review. Secondary searches of individual measurement instruments and hand searching identified a further 99 publications. In total, 284 references for 143 measurement instruments were included in this review. Measurement instruments were classified by ICF component; the majority were reported to be measures of Body Functions (n = 94); followed by Activity/Participation (n = 23); Environmental Factors (n = 5); and quality of life/other constructs not within the ICF (n = 16). Five measured multiple ICF components. Conclusions and Implications This review identified 143 measurement instruments, developed or tested with people with aphasia. Classified according to the ICF, these instruments primarily measure Body Functions (n = 94). Some measurement instruments have undergone extensive cultural and linguistic translation/adaptation, however most have not. The resulting corpus of instruments provides a basis for the selection of measurement instruments in clinical and research settings.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Wallace et al. (2019) provided such a COS for aphasia treatment research. This group of authors (Wallace et al., 2020) complemented this consensus collection with a comprehensive scoping review of measurement instruments in general for use with people with aphasia (PWA). ...
... A second goal of this revision was an update and adjustment of the psychometric qualities and the norm data, which is a desideratum for any diagnostic assessment procedure. A third aim was to provide a description in English of the IT-AAT and its properties to avoid future exclusion from international reviews of aphasia measurement instruments (e.g., Wallace et al., 2020). ...
... On the other hand, these tests do not compare individual performance or present error analysis across language modalities. It has to be acknowledged that, the scores obtained from these tests may not hold any direct equivalence to the assessment tools utilized in the Englishspeaking population due to their language-specific nature (Wallace et al., 2020). ...
Article
Background and Aim Cross-linguistic adaptations of aphasia assessment tools in Turkey are needed to improve aphasia assessment and rehabilitation with individuals speaking languages other than well-resourced languages. Aligned with this need, we conducted several studies to propose an adaptation of “The Comprehensive Aphasia Test” (CAT) into Turkish. Methods During this adaptation process; (a) lexical/linguistic and visual stimuli in CAT’s Language Battery subtests were evaluated by examining their imageability, familiarity, and name agreement features through rating studies, and two pilot studies for (b) Cognitive Screening and (c) Language Battery sections were carried out. In the stimuli norming studies, 71 undergraduate students (aged 20–24) rated 236 words in the Imageability and Familiarity tasks; 40 participants (aged 30–60) named 244 pictures in the Name Agreement task. Two sections of the CAT-TR were administered to different groups of subjects with aphasia (PWA) and matched controls. Fourteen PWA (and 14 controls) were presented the Cognitive Screening section, and a different group (PWA = 20, controls = 20) completed the Language Battery section. Results The imageability and familiarity ratings of 236 words and name agreement (% – H statistic) values of 244 pictures were calculated. Imageability and familiarity ratings of the words had a positive strong correlation with each other. Items with a name agreement of 85% or more were considered high name agreement. As anticipated, the control groups both in the Cognitive Screening and the Language Battery sections performed better than the PWA group. As a result, no further adaptive changes were suggested for these sections. Conclusion Results of these studies have shown that the Comprehensive Aphasia Test-Turkish is culturally and linguistically appropriate for Turkish speakers with aphasia. Therefore, future studies should assess its validity and reliability, and establish norms for its clinical interpretation.
Article
Full-text available
Background: Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders. Aim: To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia. Methods: Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416). Results: The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety. Conclusion: Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
Article
Full-text available
Purpose A core outcome set (COS; an agreed minimum set of outcomes) was developed to address the heterogeneous measurement of outcomes in poststroke aphasia treatment research. Successful implementation of a COS requires change in individual and collective research behavior. We used the Theoretical Domains Framework (TDF) to understand the factors influencing researchers' use and nonuse of the Research Outcome Measurement in Aphasia (ROMA) COS. Method Aphasia trialists and highly published treatment researchers were identified from the Cochrane review of speech and language therapy for aphasia following stroke and through database searches. Participants completed a theory-informed online survey that explored factors influencing COS use. Data were analyzed using descriptive statistics and qualitative content analysis. Results Sixty-four aphasia researchers from 13 countries participated. Most participants (81%) were aware of the ROMA COS, and participants identified more facilitators than barriers to its use. The TDF domain with the highest agreement (i.e., facilitator) was “knowledge” (84% agree/strongly agree). Participants had knowledge of the measures included in the ROMA COS, their associated benefits, and the existing recommendations. The TDF domains with the least agreement (i.e., barriers) were “reinforcement” (34% agree/strongly agree); “social influences” (41% agree/strongly agree); “memory, attention, and decision processes” (45% agree/strongly agree); and “behavioral regulation” (49% agree/strongly agree). Hence, participants identified a lack of external incentives, collegial encouragement, and monitoring systems as barriers to using the ROMA COS. The suitability and availability of individual measurement instruments, as well as burden associated with collecting the COS, were also identified as reasons for nonuse. Conclusions Overall, participants were aware of the benefits of using the ROMA COS and believed that its implementation would improve research quality; however, incentives for routine implementation were reported to be lacking. Findings will guide future revisions of the ROMA COS and the development of theoretically informed implementation strategies. Supplemental Material https://doi.org/10.23641/asha.16528524
Article
Full-text available
Background The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. Objective The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. Methods 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures. Results About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories. Conclusion Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.
Article
Full-text available
Background: A systematic review of core outcome sets (COS) for research is updated annually to populate an online database. It is a resource intensive review to do annually but automation techniques have potential to aid the process. The production of guidance and standards in COS development means that there is now an expectation that COS are being developed and reported to a higher standard. This is the fifth update to the systematic review and will explore these issues. Methods: Searches were carried out to identify studies published or indexed in 2018. Automated screening methods were used to rank the citations in order of relevance. The cut-off for screening was set to the top 25% in ranked priority order, following development and validation of the algorithm. Studies were eligible for inclusion if they reported the development of a COS, regardless of any restrictions by age, health condition or setting. COS were assessed against each of the Core Outcome Set-STAndards for Development (COS-STAD). Results: Thirty studies describing the development of 44 COS were included in this update. Six COS (20%) were deemed to have met all 12 criteria representing the 11 minimum standards for COS development (range = 4 to 12 criteria, median = 10 criteria). All 30 COS studies met all four minimum standards for scope. Twenty-one (70%) COS met all three minimum standards for stakeholders. Twenty-three studies (77%) included patients with the condition or their representatives. The number of countries involved in the development of COS ranged from 1 to 39 (median = 10). Six studies (20%) met all four minimum standards [five criteria] for the consensus process. Conclusion: Automated ranking was successfully used to assist the screening process and reduce the workload of this systematic review update. With the provision of guidelines, COS are better reported and being developed to a higher standard.
Article
Full-text available
Aim: Primary aims of this systematic review were to: (1) identify the range of subjective memory measures used in the stroke and stroke-related aphasia literature and (2) critically appraise their psychometric properties as well as (3) the methodological qualities of studies that included them, (4) investigate whether such measures provide an accurate reflection of memory impairments (i.e., in comparison to norms from age-matched, neurotypical participants), (5) document the representation of individuals with stroke-related aphasia, and (6) examine the extent to which subjective memory measures correlate with objective memory measures. Methods: Systematic review of the literature from 1970 to June 2019 using a comprehensive range of relevant search terms in EMBASE, Medline, PsychINFO, SCOPUS, and Web of Science. Eligibility criteria were for studies to include adults who had suffered of clinical stroke, to report a subjective memory measure that was completed by the stroke survivors, to be reported in a peer-reviewed journal, and to be published in English or Dutch. Quality appraisal was carried out for the included studies as well as the subjective memory measures they employed. Results: A total of 7,077 titles or abstracts were screened, with 41 studies included in the quantitative and qualitative synthesis. Twenty-six subjective memory measures were used in the included studies. The critical appraisal of their psychometric properties and the methodological quality of the included studies revealed significant shortcomings; for example, neurotypical participants were included in only 14 of the 41 studies. When statistical comparisons were made, different outcomes arose. Only eight studies statistically compared subjective with objective memory measures. Conclusions: This literature domain currently provides an unclear picture as to how memory limitations affect participation in stroke and stroke-related aphasia. • IMPLICATIONS FOR REHABILITATION • A broad range of subjective memory measures have been used to determine stroke survivors’ perceptions of their everyday memory issues. • Because of psychometric weaknesses such as inadequate reliability and cross-cultural validity among subjective memory measures, there remains a need to carefully review a given measure’s properties to determine if it is appropriate for use with a given stroke survivor. • Stroke survivors with aphasia have been infrequently included or inadequately described in studies of subjective memory measures, and thus how these individuals perceive their everyday memory abilities requires further investigation. • Although the relationship between subjective and objective memory measures has been infrequently investigated by stroke researchers, both types of measures should be considered as they likely offer complementary rather than redundant information about stroke survivors’ memory abilities.
Article
Full-text available
Purpose: To explore the relationship between the two components of spontaneous speech in the Brief Aphasia Evaluation (BAE) and the rest of the scale represented by its three main factors: The Expression, Comprehension, and Complementary factors. Methods: BAE has proven validity and reliability. The evaluation of spontaneous speech in this scale comprises two components: Performance Rank (score: 0-3) and Type of Disorder (Fluency [F], Content [C], or Mixed [FC]) when rank < 3. Sixty-seven patients with left brain damage and 30 demographically matched healthy participants (HP) were studied. It was analyzed the correlation between Performance Rank and the three BAE factors and, recoding 3 as 0 and < 3 as 1, the sensitivity/specificity of this component for each factor. The effect of Type of Disorder on the three factors was analyzed. Results: 1) Performance Rank: Correlations of 0.84 (Expression), 0.81 (Comprehension), and 0.76 (Complementary) were observed, with a sensitivity and specificity ≥ 78% for any factor; 2) Type of Disorder: The performance significantly decreased from FC to C and from C to F in Expression (FC < C < F), from FC to C and from FC to F also in Comprehension and Complementary, from patients with any type of disorder to HP. Conclusion: Performance Rank was a relevant indicator of aphasia by its consistency with valid and comprehensive dimensions of acute language impairments. A degree difference between F and C was observed, being F a milder disorder; i.e., fluency problems were less severe than retrieval or anomia ones.
Article
Full-text available
Objective We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies. Methods First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure. Results We extracted 144 outcome measures from 243 post-stroke arm rehabilitation trials. The Fugl-Meyer Assessment Upper Extremity section (used in 79/243 trials; 33%), Action Research Arm Test (56/243; 23%), and modified Ashworth Scale (53/243; 22%) were most frequently used. Stroke survivors (n = 43), carers (n = 10) and clinicians (n = 58) identified 66 unique, important outcomes related to arm impairment following stroke. Between one and three outcomes considered important by the stakeholders were captured by the three most commonly used assessments in research. Conclusion Post-stroke arm rehabilitation research would benefit from a reduction in the number of outcome measures currently used, and better alignment between what is measured and what is important to stroke survivors, carers and clinicians.
Article
Full-text available
Objectives The Mississippi Aphasia Screening Test (MAST) is a brief screening tool for assessing the expressive and receptive language abilities of patients with aphasia. The goal of this study was to adapt and validate the MAST into the Estonian language. The discriminant validity and internal consistency of the test were examined, as well as its sensitivity and specificity. Methods The MASTest was administered in 50 left hemisphere stroke patients with aphasia (LHA+ group) in the acute phase after the stroke and 126 healthy volunteers in a control group (CG), stratified by age and level of education. Nonparametric tests were used to get normative values, compare the values of the MASTest scores between the LHA+ group and the CG, and to assess the discriminant validity, internal consistency, sensitivity, and specificity of the MASTest. Results The summary scores: total score (MASTest‐T), expressive score (MASTest‐E), and receptive score (MASTest‐R) correlated with age and educational level, and the normative values were adjusted accordingly. The LHA+ group showed more impairment than the CG in all subtests and summary scores. The internal reliability of the MASTest was high for the whole sample and LHA+ group. The sensitivity and specificity of the MASTest using the 5th percentile were 74% and 94%, respectively, but using receiver operating characteristic (ROC) analysis, it was 89% and 80%. Conclusion The MASTest is a valid screening tool for evaluating expressive and receptive language abilities in Estonian patients with aphasia in early stroke. The MASTest is the first validated aphasia screening test for Estonian‐speaking people, who number less than one million worldwide.
Article
Full-text available
Background Aphasia is a neurogenic communication disorder with significant deficits in various domains of language and communication. One such type of aphasia, which impacts the quality of life significantly is Broca's aphasia, where the individual is aware of the communication difficulty. Objective To compare the Quality of Communication Life (QoCL) between individuals with Broca's aphasia and normal individuals. Methods The first phase of the study translated and validated QCL scale in Tamil. The second phase involved administration of the Tamil QCL scale on 12 individuals with Broca's aphasia and 12 age matched normal adults. The marked responses were analysed on a visual analogue scale independently. Statistical Analysis Three domains of QoCL were compared between the two groups using Mann–Whitney U-test. Results The QoCL scores across three domains were observed to be lower in individuals with Broca's aphasia, when compared to normal adults. Individuals with Broca's aphasia expressed greater challenges in socialization/activities domain of QoCL than confidence/self-concept and roles and responsibilities domains. Conclusions Information obtained on self-reported QCL scale in familiar or native language will facilitate in planning client-oriented management of aphasia.
Article
Full-text available
Background and purpose: Aphasia is a common outcome of stroke affecting one-third of the post-stroke population in China. While the quality of life (QOL) may be affected, care is often inadequately guided due to lack of validated measure for Chinese population with stroke-induced aphasia. This study aimed to develop a Chinese-version of the Stroke and Aphasia Quality of Life-39 generic version (SAQOL-39g) and evaluate its feasibility, reliability, and validity in Chinese patients with stroke-induced aphasia. Methods: The process of translation and adaptation suggested by WHO was used to develop the Chinese-version of SAQOL-39. We evaluated the feasibility, reliability, and validity of the scale in 84 aphasia patients and their proxies by assessing the internal consistency of the test items, test-retest consistency, and the structural validity of data. Results: The self-report and the proxy-report form were completed within 21.4 and 13.3 min on average, respectively. Physical, communication, and psychological subdomains were extracted as three common factors. The Cronbach's alpha coefficients of overall domain and subdomains for both forms ranged from 0.879 to 0.950, indicating high internal consistency. The intraclass correlation coefficients ranged from 0.804 to 0.987 for overall domain and subdomains of the forms. No significant difference was found between two forms. Conclusions: The Chinese-version SAQOL-39g has excellent reliability, validity, and feasibility for measuring the QOL of Chinese post-stroke aphasia patients. The consistency between self-report and proxy-report forms was good, implying that the proxy-report form can be used to assess the QOL of post-stroke aphasia patients.
Article
Full-text available
Background: There are many validated and widely used assessments within aphasiology. Few, however, describe language and life with aphasia from the perspective of the person with aphasia. Across healthcare, patient experience and user involvement are increasingly acknowledged as fundamental to person-centred care. As part of this movement, Patient Reported Outcome Measures (PROMs) are being used in service evaluation and planning. Aims: This paper reports the quantitative aspects of a mixed methods study that developed and validated a concise PROM, the Aphasia Impact Questionnaire (AIQ), co-produced with People with Aphasia (PWA). Methods & Procedures: The AIQ was developed within the social model of disability and all stages of the development of the AIQ were performed in partnership with PWA. It was adapted from a pre-existing and lengthier PROM for PWA, the Communication Disability Profile. The first iterations of the AIQ focused on domains of communication, participation and well-being/emotional state. Subsequently the AIQ was extended to include additional items relating to reading and writing (AIQ-21). The research design was iterative. Initially, concurrent validity, internal consistency, and sensitivity of the AIQ-prototype were obtained. The AIQ-prototype was modified to become the AIQ-21. Statistical testing with a new group of PWA was performed, investigating internal consistency and concurrent validity of the AIQ-21. Outcomes & Results: Results for both the AIQ-prototype and AIQ-21 showed statistically significant concurrent validity and good internal consistency. Repeated measurement using the AIQ-prototype demonstrated statistically significant change after PWA accessed a community intervention. Conclusions: The AIQ-21 is a PROM that has great potential to be one of the core set of aphasia tests for clinical and research use. Results can be used alongside language assessment to enable person-centred goal setting and partnership working for people with aphasia.
Article
Full-text available
Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
Article
Full-text available
Background Discourse in adults with aphasia is increasingly the focus of assessment and therapy research. A broad range of measures is available to describe discourse, but very limited information is available on their psychometric properties. As a result, the quality of these measures is unknown, and there is very little evidence to motivate the choice of one measure over another. Aims To explore the quality of a range of discourse measures, targeting sentence structure, coherence, story structure and cohesion. Quality was evaluated in terms of the psychometric properties of acceptability (data completeness and skewness), reliability (inter‐ and intra‐rater), and validity (content, convergent, discriminant and known groups). Methods & Procedures Participants with chronic mild‐to‐moderate aphasia were recruited from community groups. They produced a range of discourses which were grouped into Cinderella and everyday discourses. Discourses were then transcribed orthographically and analyzed using macro‐ and microlinguistic measures (Story Grammar, Topic Coherence, Local Coherence, Reference Chains and Predicate Argument Structure—PAS). Data were evaluated against standard predetermined criteria to ascertain the psychometric quality of the measures. Outcomes & Results A total of 17 participants took part in the study. All measures had high levels of acceptability, inter‐ and intra‐rater reliability, and had good content validity, as they could be related to a level of the theoretical model of discourse production. For convergent validity, as expected, 8/10 measures correlated with the Western Aphasia Battery—Revised (WAB‐R) spontaneous speech scores, and 7/10 measures correlated with the Kissing and Dancing Test (KDT) scores (r ≥ 0.3), giving an overall positive rating for construct validity. For discriminant validity, as predicted, all measures had low correlations with Raven's Coloured Progressive Matrices (RCPM) and WAB‐R Auditory Verbal Comprehension scores (r < 0.3), giving an overall positive rating for construct validity. Finally, for known groups validity, all measures indicated a difference between speakers with mild and moderate aphasia except for the Local Coherence measures. Overall, Story Grammar, Topic Coherence, Reference Chains and PAS emerged as the strongest measures in the current study because they achieved the predetermined thresholds for quality in terms of each of the psychometric parameters profiled. Conclusions & Implications The current study is the first to psychometrically profile measures of discourse in aphasia. It contributes to the field by identifying Story Grammar, Topic Coherence, Reference Chains and PAS as the most psychometrically robust discourse measures yet profiled with speakers with aphasia. Until further data are available indicating the strength of other discourse measures, caution should be applied when using them.
Article
Full-text available
Background: Reading difficulties often present as a consequence of aphasia. The specific nature of reading deficits varies widely in manifestation, and the cause of these deficits may be the result of a phonological, lexical semantic, or cognitive impairment. Several treatments have been developed to address a range of impairments underlying reading difficulty. Aims: The purpose of this review is to describe the current research on reading comprehension treatments for persons with aphasia, assess the quality of the research, and summarize treatment outcomes. Methods & Procedures: A systematic review of the literature was conducted based on a set of a priori questions, inclusion/exclusion criteria, and pre-determined search parameters. Results were summarized according to treatment type, methodologic rigor, and outcomes. Outcomes & Results: Fifteen studies meeting criteria were identified. A variety of reading comprehension treatments was implemented including: oral reading, strategy-based, cognitive treatment, and hierarchical reading treatments. Quality ratings were highly variable, ranging from 3 to 9 (on a 12-point scale). Overall, 14 of the 18 individuals for whom individual data were provided demonstrated some degree of improvement (oral reading 4/5 participants, strategy based 4/6, and cognitive treatment 6/7). Gains were also evident for hierarchical reading treatment administered to participant groups via computer; however, the degree to which improvement reached statistical significance varied among studies. Conclusions: Reading comprehension treatments have the potential to improve reading comprehension ability in persons with aphasia; however, outcomes were variable within and among treatment methods. We suggest focusing future research on factors such as participant candidacy and treatment intensity using increased methodological rigor.
Article
Full-text available
There is a severe lack of aphasia screening tools for bedside use in Chinese. A number of aphasia assessment tools have recently been developed abroad, but some of these scales were not suitable for patients with acute stroke. The Language Screening Test (which includes two parallel versions [a/b]) in French has been proven to be an effective and time-saving aphasia screening scale for early-stage stroke patients. Therefore, we worked out a Chinese version of the LAST taking into consideration Chinese language and culture. Two preliminary parallel versions (a/b) were tested on 154 patients with stroke at acute phase and 107 patients with stroke at non-acute phase, with the Western Aphasia Battery serving as a gold standard. The equivalence between the two parallel versions and the reliability/validity of each version were assessed. The median time to complete one preliminary Chinese version (each had some item redundancy) was 98 seconds. Two final parallel versions were established after adjustment/elimination of the redundant items and were found to be equivalent (intra-class correlation coefficient: 0.991). Internal consistency is(Cronbach α for each version [a/b] was 0.956 and 0.965, respectively) good. Internal validity was fine: (a) no floor or ceiling effect/item redundancy; (b) construct validity revealed a 1-dimension structure, just like the French version. The higher educated subjects scored higher than their lower educated counterparts (p
Article
Full-text available
In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L,-M and-NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability (τ ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity (τ = −0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and-L subtests, particularly in patients who demonstrate severe functional deficits.
Article
Full-text available
Background and purpose Accurate aphasia diagnosis is important in stroke care. A wide range of language tests are available and include informal assessments, tests developed by healthcare institutions and commercially published tests available for purchase in pre-packaged kits. The psychometrics of these tests are often reported online or within the purchased test manuals, not the peer-reviewed literature, therefore the diagnostic capabilities of these measures have not been systematically evaluated. This review aimed to identify both commercial and non-commercial language tests and tests used in stroke care and to examine the diagnostic capabilities of all identified measures in diagnosing aphasia in stroke populations. Methods Language tests were identified through a systematic search of 161 publisher databases, professional and resource websites and language tests reported to be used in stroke care. Two independent reviewers evaluated test manuals or associated resources for cohort or cross-sectional studies reporting the tests’ diagnostic capabilities (sensitivity, specificity, likelihood ratios or diagnostic odds ratios) in differentiating aphasic and non-aphasic stroke populations. Results Fifty-six tests met the study eligibility criteria. Six “non-specialist” brief screening tests reported sensitivity and specificity information, however none of these measures reported to meet the specific diagnostic needs of speech pathologists. The 50 remaining measures either did not report validity data (n = 7); did not compare patient test performance with a comparison group (n = 17); included non-stroke participants within their samples (n = 23) or did not compare stroke patient performance against a language reference standard (n = 3). Diagnostic sensitivity analysis was completed for six speech pathology measures (WAB, PICA, CADL-2, ASHA-FACS, Adult FAVRES and EFA-4), however all studies compared aphasic performance with that of non-stroke healthy controls and were consequently excluded from the review. Conclusions No speech pathology test was found which reported diagnostic data for identifying aphasia in stroke populations. A diagnostically validated post-stroke aphasia test is needed.
Article
Full-text available
Background: This study explores the psychometric properties of The Scenario Test UK, a culturally adapted version of the Dutch original (The Scenario Test) developed by van der Meulen et al. in 2010, which evaluates functional, daily-life communication in aphasia. The Scenario Test assesses communication in an interactive context with a supportive communication partner. Aims: To evaluate the reliability (internal consistency, interrater and test-retest reliability) and construct validity (convergent, discriminant and known-groups validity) of The Scenario Test UK. Methods & procedures: The Scenario Test UK and other language, cognition and praxis assessments were administered to persons with aphasia after stroke (3+ months post-stroke) and to non-aphasic controls. Participants were recruited primarily through community stroke groups. Measures were completed in an interview format. Standard psychometric criteria were used to evaluate reliability and construct validity. Outcomes & results: A total of 74 participants with aphasia and 20 participants without aphasia took part in The Scenario Test UK. The test showed high levels of reliability. Internal consistency (Cronbach's α = 0.92), interrater reliability (ICC = 0.95) and test-retest reliability (ICC = 0.96) were excellent. Interrater agreement in scores on the individual items ranged from good to excellent (κ = 0.41-1.00) for all but two items (item 4c κ = 0.38, item 6c κ = 0.36). The test demonstrated good levels of convergent (ρ = 0.37-0.75) and discriminant validity (ρ = -0.04 to 0.23). There was strong evidence for known groups validity (U = 132.50, p < .001), with those with aphasia scoring significantly lower [median (interquartile range-IQR) = 47 (39.8-51.0)] than those without aphasia [53 (52-54)]. Conclusions & implications: The data support the reliability and validity of the Scenario Test UK as an assessment of functional, daily-life communication for persons with aphasia. Further testing is needed in independent samples on the measure's psychometric properties, including its sensitivity to change. Pending this testing, The test can be used as an assessment tool to evaluate communication skills with people with aphasia, to guide goal setting for therapy and to measure outcomes in response to therapy.
Article
Full-text available
This paper describes a quick aphasia battery (QAB) that aims to provide a reliable and multidimensional assessment of language function in about a quarter of an hour, bridging the gap between comprehensive batteries that are time-consuming to administer, and rapid screening instruments that provide limited detail regarding individual profiles of deficits. The QAB is made up of eight subtests, each comprising sets of items that probe different language domains, vary in difficulty, and are scored with a graded system to maximize the informativeness of each item. From the eight subtests, eight summary measures are derived, which constitute a multidimensional profile of language function, quantifying strengths and weaknesses across core language domains. The QAB was administered to 28 individuals with acute stroke and aphasia, 25 individuals with acute stroke but no aphasia, 16 individuals with chronic post-stroke aphasia, and 14 healthy controls. The patients with chronic post-stroke aphasia were tested 3 times each and scored independently by 2 raters to establish test-retest and inter-rater reliability. The Western Aphasia Battery (WAB) was also administered to these patients to assess concurrent validity. We found that all QAB summary measures were sensitive to aphasic deficits in the two groups with aphasia. All measures showed good or excellent test-retest reliability (overall summary measure: intraclass correlation coefficient (ICC) = 0.98), and excellent inter-rater reliability (overall summary measure: ICC = 0.99). Sensitivity and specificity for diagnosis of aphasia (relative to clinical impression) were 0.91 and 0.95 respectively. All QAB measures were highly correlated with corresponding WAB measures where available. Individual patients showed distinct profiles of spared and impaired function across different language domains. In sum, the QAB efficiently and reliably characterized individual profiles of language deficits.
Article
Full-text available
Typically, processing is more accurate and efficient for concrete than abstract concepts in both healthy adults and individuals with aphasia. While, concreteness effects have been thoroughly documented with respect to noun processing, other words classes have received little attention despite tending to be less concrete than nouns. The aim of the current study was to explore concrete-abstract differences in verbs and identify their neural correlates in post-stroke aphasia. Given the dearth of comprehension tests for verbs, a battery of neuropsychological tests was developed in this study to assess the comprehension of concrete and abstract verbs. Specifically, a sensitive verb synonym judgment test was generated that varied both the items' imageability and frequency, and a picture-to-word matching test with numerous concrete verbs. Normative data were then collected and the tests were administered to a cohort of 48 individuals with chronic post-stroke aphasia to explore the behavioural patterns and neural correlates of verb processing. The results revealed significantly better comprehension of concrete than abstract verbs, aligning with the existing aphasiological literature on noun processing. In addition, the patients performed better during verb comprehension than verb production. Lesion-symptom correlational analyses revealed common areas that support processing of concrete and abstract verbs, including the left anterior temporal lobe, posterior supramarginal gyrus and superior lateral occipital cortex. A direct contrast between them revealed additional regions with graded differences. Specifically, the left frontal regions were associated with processing abstract verbs; whereas, the left posterior temporal and occipital regions were associated with processing concrete verbs. Moreover, overlapping and distinct neural correlates were identified in association with the comprehension and production of concrete verbs. These patient findings align with data from functional neuroimaging and neuro-stimulation, and existing models of language organisation.
Article
Full-text available
Objetivo: Estudiar la relación entre la percepción del cuidador sobre el deterioro en el habla espontánea del paciente, según un ítem de cuatro preguntas administradas mediante entrevista semiestructurada, y el desempeño del paciente en la Evaluación Breve de la Afasia (EBA). Método: Se examinaron 102 pacientes diestros, con lesiones cerebrales focales de diferente tipo y localización. EBA es un instrumento válido y confiable para la medida de la afasia. Se correlacionó la percepción del cuidador con el ítem de habla espontánea, la puntuación total y los tres principales factores de EBA: el factor de Expresión, el de Comprensión y el Complementario. Se analizó la precisión (sensibilidad-especificidad) de la percepción del cuidador sobre el habla espontánea del paciente, respecto de la presencia o ausencia de trastorno, según el profesional, en el ítem de habla espontánea de EBA. Resultados: La correlación estudiada fue satisfactoria, siendo mayor (superior al 80%) para los siguientes indicadores: el ítem de habla espontánea, el factor de Expresión y la puntuación total de la escala; la correlación fue un poco menor (superior al 70%) para el factor de Comprensión y el Complementario. Comparando dos puntos de corte que evaluaron la precisión en la percepción del cuidador, se observaron resultados satisfactorios en términos de sensibilidad y especificidad (>70%), con cocientes de probabilidad superiores a 3. Usando la mediana como punto de corte, se obtuvieron discriminaciones diagnósticas más satisfactorias. Conclusión: Entrevistar al cuidador específicamente sobre el habla espontánea del paciente, en forma abreviada, proporciona información relevante para el diagnóstico de la afasia.
Article
Full-text available
Background Nonlinguistic cognitive impairment has become an important issue for aphasic patients, but currently there are few neuropsychological cognitive assessment tests for it. To get more information on cognitive impairment of aphasic patients, this study aimed to develop a new cognitive assessment test battery for aphasic patients, the Non-language-based Cognitive Assessment (NLCA), and evaluate its utility in Chinese-speaking patients with aphasia. Methods The NLCA consists of five nonverbal tests, which could assess five nonlinguistic cognitive domains such as visuospatial functions, attention test, memory, reasoning, and executive functions of aphasic patients. All tests are modified from the nonverbal items of the current existed tests with some changes to the characteristics of Chinese culture. The NLCA was tested in 157 participants (including 57 aphasic patients, 50 mild cognitive impairment (MCI) patients, and 50 normal controls), and was compared with other well-established relative neuropsychological tests on the reliability, validity, and utility. Results The NLCA was fully applicable in the MCI patients and the normal controls, almost working in the aphasic patients (57/62 patients, 91.9%). The NLCA scores were 66.70 ± 6.30, 48.67 ± 15.04, and 77.58 ± 2.56 for the MCI group, the aphasic group, and the control group, respectively, and a significant difference was found among three groups (F = 118.446, P < 0.001). The Cronbach's alpha of the NLCA as an index of internal consistency was 0.805, and the test-retest and interrater reliability was adequate (r=0.977 and r= 0.970, respectively). The correlations of the cognitive subtests and their validation instruments were between 0.540 and 0.670 (all P < 0.05). Spearman's correlation analysis indicated that the coefficient of internal consistency of each subtest itself was higher than other subtests. When choosing the Montreal Cognitive Assessment score of <26 as the diagnostic criteria of cognitive impairment, the area under the curve for all participants in the control and MCI groups was 0.942 (95% confidence interval: 0.895–0.989), and an optimal cutoff point of 75.00 seemed to provide the best balance between sensitivity and specificity. Age (r = −0.406, P < 0.001) was the main influence factor for the NLCA. Conclusions The NLCA could efficiently differentiate the cognitive impairment patients from the normal controls and is a reliable and valid cognitive assessment test battery to specially find nonlinguistic cognitive function for aphasic patients.
Article
Full-text available
Objectives: To validate a non-verbal self-report measure of mood - the Dynamic Visual Analogue Mood Scales (D-VAMS) - against the Hospital Anxiety and Depression Scale (HADS) and assess its suitability as an outcome measure or screening measure for depressed mood following stroke. Design: Cross-sectional observational cohort study. Participants: Forty-six stroke survivors (24% with aphasia) recruited from online, from stroke clubs and via an NHS rehabilitation service. Methods: A set of seven bipolar scales was developed enabling users to report mood by modifying facial expression images using a slider. Participants completed a tablet/computer task, reporting their mood on these scales mixed randomly with versions which used only words. The HADS was then completed, followed by a repeat run of the two versions in a different, random sequence. Results: Exploratory factor analysis identified one factor consistent with pleasantness of mood accounting for 80% of the variance. Internal consistency of D-VAMS was high ( α = 0.95), and there was a high correlation between face-only D-VAMS scores and HADS total scores ( r = -0.80, P < 0.001), as well as HADS-D/HADS-A subscale scores ( r = -0.73, P < 0.001; r = -0.71, P < 0.001). D-VAMS showed good sensitivity and specificity against HADS, with means of 85%/77% (sensitivity/specificity) against the HADS-D and 80%/77% against the HADS-A across nine cut-offs. Conclusion: D-VAMS is a valid and reliable measure likely suitable for assessment of depressed mood in aphasia following stroke. Though D-VAMS performed well as a screening measure in this study sample, further study is needed in the acute stage post-stroke.
Article
Full-text available
Background: Depression is one of the most researched emotional responses after stroke and shows that the emotional impact of aphasia can have a marked negative impact on recovery, response to rehabilitation, and psychosocial adjustment. There is an evident dearth of validated instruments to assess depression in people with aphasia including Hindi, the national language of the country. Aims: The aim of this study was to translate and adapt the original English version of widely used hospital version of Stroke Aphasia Depression Questionnaire (SADQ-10) to Hindi. Subjects and methods: English version of SADQ-10 was translated and adapted for the use in Hindi-speaking population in concordance to the WHO guidelines. Statistical analysis used: The intraclass correlation coefficient (ICC) analysis of the data was performed using SPSS, version 16, to compute the test-retest reliability. Results: The Hindi version of SADQ-10 yielded an overall high test-retest reliability (ICC = 0.91) as well as internal consistency (α = 0.98), which in turn were comparable to the original instrument in English. Conclusions: SADQ10-Hindi may assist the identification of depressed mood in patients with speech and language impairment in an Indian population as well. It is an easy to administer and quick test which can be used by health-care professionals in a hospital- or community-based settings.
Article
Full-text available
A range of methods in clinical research aim to assess treatment-induced progress in aphasia therapy. Here, we used a crossover randomized controlled design to compare the suitability of utterance-centered and dialogue-sensitive outcome measures in speech-language testing. Fourteen individuals with post-stroke chronic non-fluent aphasia each received two types of intensive training in counterbalanced order: conventional confrontation naming, and communicative-pragmatic speech-language therapy (Intensive Language-Action Therapy, an expanded version of Constraint-Induced Aphasia Therapy). Motivated by linguistic-pragmatic theory and neuroscience data, our dependent variables included a newly created diagnostic instrument, the Action Communication Test (ACT). This diagnostic instrument requires patients to produce target words in two conditions: (i) utterance-centered object naming, and (ii) communicative-pragmatic social interaction based on verbal requests. In addition, we administered a standardized aphasia test battery, the Aachen Aphasia Test (AAT). Composite scores on the ACT and the AAT revealed similar patterns of changes in language performance over time, irrespective of the treatment applied. Changes in language performance were relatively consistent with the AAT results also when considering both ACT subscales separately from each other. However, only the ACT subscale evaluating verbal requests proved to be successful in distinguishing between different types of training in our patient sample. Critically, testing duration was substantially shorter for the entire ACT (10–20 min) than for the AAT (60–90 min). Taken together, the current findings suggest that communicative-pragmatic methods in speech-language testing provide a sensitive and time-effective measure to determine the outcome of aphasia therapy.
Article
Full-text available
Background: Brain damage can impair the use of all languages in bilingual persons. For effective management of aphasia (i.e., impaired language) in such persons, assessment of all languages is essential. The most widely used test for this purpose – the Bilingual Aphasia Test – is cumbersome and requires considerable amount of time for administration. To overcome this limitation, a Short Version of the BAT has been recommended. Objective: The objective of this study was to derive a short version of BAT for Malayalam-English bilingual persons with aphasia and to establish the test-retest reliability as well as the content and construct validities of this version. Materials & Methods: Following the recommendations of the test developers, we used seven subtests from the draft of an adapted full version of Malayalam BAT. These subtests in Malayalam and their counterparts in English were administered on a group of 22 Malayalam-English bilingual participants with aphasia. The scores obtained from these two languages were used to establish content and construct validities of the short version of the BAT in Malayalam. Further, we re-administered the short version of BAT in a group of 10 participants with aphasia to examine the test-retest reliability within 14 days from the date of first administration. Conclusions: The short version of BAT in Malayalam revealed high test-retest reliability as well as content and construct validities. The administration time ranged between 30-45 minutes. Thus, the short version the BAT in Malayalam can be considered a valid and reliable language test that can be quickly administered in Malayalam-English bilingual persons with aphasia.
Article
Full-text available
Background: Discourse is fundamental to everyday communication, and is an increasing focus of clinical assessment, intervention, and research. Aphasia can affect the information a speaker communicates in discourse. Little is known about the psychometrics of the tools for measuring information in discourse, which means it is unclear whether these measures are of sufficient quality to be used as clinical outcome measures or diagnostic tools. Aims: The current review aimed to profile the measures used to describe information in aphasic discourse, and assess the quality of these measures against standard psychometric criteria. Methods: A scoping review method was employed. Studies were identified using a systematic search of Scopus, Medline, and Embase databases. Standard psychometric criteria were used to evaluate the measures’ psychometric properties. Main contribution: The current review summarises and collates the information measures used to describe aphasic discourse, and evaluates their quality in terms of the psychometric properties of acceptability, reliability, and validity. Seventy-six studies described 58 discourse information measures, with a mean of 2.28 measures used per study (SD= 1.29, range 1-7). Measures were classified as functional measures (n= 33), which focused on discourse macrostructure, and functional and structural measures (n= 25), which focused on microlinguistic and macrostructural approaches to discourse as described by Armstrong (2000). There were no reports of the acceptability of data generated by the measures (distribution of scores, missing data). Test-retest reliability was reported for just 8/58 measures with 3/8 > 0.80. Intra-rater reliability was reported for 9/58 measures and in all cases % agreement was reported rather than reliability. Percent agreement was also frequently reported for inter-rater reliability, with only 4/76 studies reporting reliability statistics for 12/58 measures; this was generally high (> .80 for 11/12 measures). The majority of measures related clearly to the discourse production model described by Sherratt (2007), indicating content validity. 36/58 measures were used to make 41 comparisons between PWA and NHP, with 31/41 comparisons showing a difference between the groups. Four comparisons were made between genres, with two measures showing a difference between genres, and two measures showing no difference. Conclusions: There is currently insufficient information available to justify the use of discourse information measures as sole diagnostic or outcome measurement tools. Yet the majority of measures are rooted in relevant theory, and there is emerging evidence regarding their psychometric properties. There is significant scope for further psychometric strengthening of discourse information measurement tools.
Article
Full-text available
Background: Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear. Aim: The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them. Materials and methods: Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB. Results: Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patient's bedside clinical impression and WAB classification of aphasia, with a P < 0.001. Conclusion: Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.
Article
Background: Speech-language pathologists (SLPs) measure outcomes to gauge the impact of their interventions and to inform best care for clients. Previous research has explored outcome measurement practices in aphasia rehabilitation, however the factors driving clinician behaviour have not been examined. Aim: To explore current clinical practice and perceived barriers and facilitators to aphasia outcome measurement. Methods and Procedures: Australian SLPs who worked clinically with people with aphasia completed a cross-sectional online survey. Current practice was explored using a combination of multiple-choice questions (with open-text response options) and Likert rating scales. Barriers and facilitators to outcome measurement were explored through ratings of statements aligned with the Theoretical Domains Framework. Data were analysed using descriptive statistics and cross-tabulations. Outcome and Results: Data from 74 Australian SLPs were included. All SLPs reported measuring outcomes and these most frequently related to communication and language. SLPs reported using a diverse range of outcome measures across construct areas and stage-post stroke of service provision, with more than 80 unique instruments/approaches identified. The most frequently used outcome measurement instruments/approaches were: The Western Aphasia Battery – Revised (WAB-R) for language; the Therapy Outcome Measures/Australia Therapy Outcome Measures (TOMs/AusTOMS) for communication, participation, and quality of life; and Goal Attainment Scaling for psychological and carer/significant other outcomes. Overall, SLPs identified more facilitators than barriers to outcome measurement. The main barriers related to the theoretical domains “behavioural regulation” (managing or changing actions) and “memory, attention and decision-making processes” (ability to retain information, focus selectively and choose between alternatives). The main facilitators related to the theoretical domains “beliefs about consequences” (acceptance of the truth, reality, or validity about outcomes of a behaviour) and “social/professional role and identity” (a coherent set of behaviours and displayed personal qualities in a social or work setting). Conclusions: All SLPs reported measuring outcomes with clients with aphasia and these primarily related to language and communication. The outcome measurement instruments/approaches used were heterogeneous within construct areas. SLPs see outcome measurement as part of their role and believe it to be an important activity, however report a need for training and workplace systems and strategies to support optimal practices. The results of this study may inform the development of theoretically informed implementation interventions which seek to improve SLP outcome measurement practice in aphasia rehabilitation.
Article
Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure’s psychometric properties. Method: Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) (n = 455). A representative sample of statements was identified from the data set (n = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy. Result: Internal consistency and test–retest reliability were excellent for both clinician (α = 92; ICC = 0.93) and patient versions of A-STAM (α = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity (rs = 0.75; rs = 0.77). Conclusion: The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure’s psychometric properties in larger samples.
Article
More than 50 years of research has demonstrated the profound effect that aphasia has on people with the condition and their family members. In the International Classification of Functioning, Disability and Health, the World Health Organization described the impact of an individual's health condition on a significant other as "third-party disability." Recent research has described how third-party disability can occur in family members of people with aphasia post-stroke. Despite the extensive history and ongoing relevance of these findings, family-centered rehabilitation has been slow to integrate into clinical practice and policy. The aims of this article are (1) to provide an overview of third-party disability in family members of people with aphasia; (2) to consider how third-party disability can be addressed through family-centered care and to identify some of the barriers to family-centered care; and (3) to describe The Family Aphasia Measure of Life Impact (FAMLI), a tool for measuring third-party functioning and disability in family members of people with aphasia, identifying family rehabilitation needs, and measuring outcomes of family-centered care.
Article
Aphasia is a devastating brain disorder, detrimental for medical care and social interaction. The early diagnosis of language disorders and accurate identification of patient-specific deficits are crucial for patients’ care, as aphasia rehabilitation is more effective when focused on patient-specific language deficits. We developed the Core Assessment of Language Processing (CALAP), a new scale combining screening and detailed evaluation to rapidly diagnose and identify patient-specific language deficits. This scale is based on a model of language processing distinguishing between the comprehension, production, and repetition modalities, and their different components: phonology (set of speech-sounds), morphology (how the sounds combine to form words), lexicon (words), syntax (how words combine to form sentences), and concept (semantic knowledge). This scale was validated by 189 participants who underwent the CALAP, and patients not unequivocally classified as without aphasia by a speech-language pathologist underwent the Boston Diagnosis Aphasia Evaluation as the gold standard. CALAP-screening classified patients with and without aphasia with a sensitivity of 1 and a specificity of 0.72, in 3.14 ± 1.23 min. CALAP-detailed evaluation specifically assessed the language components in 8.25 ± 5.1 min. Psychometric properties including concurrent validity, internal validity, internal consistency and interrater reliability showed that the CALAP is a valid and reliable scale. The CALAP provides an aphasia diagnosis along with the identification of patient-specific impairment making it possible to improve clinical follow up and deficit-based rehabilitation. It is a short and easy-to-use scale that can be scored and interpreted by clinicians nonexpert in language, in patients with fatigue and concentration deficits.
Article
Background: The psychometric properties of the Dutch version of the Stroke and Aphasia Quality Of Life-scale (SAQOL-39NL) have previously been assessed for people with aphasia after stroke, but not yet for stroke survivors without aphasia. Objective: The objective is to evaluate the psychometric properties of the SAQOL-39NL in a stroke sample with and without aphasia. Methods: The SAQOL-39NL was administered to survivors of stroke (N = 141) who received rehabilitation in specialized rehabilitation facilities, 3 and 6 months after the start of rehabilitation. Acceptability was explored by assessing floor and ceiling effects and missing items. For internal consistency, Cronbach’s alpha and item-total correlations were computed. For internal validity, intercorrelations between domains, and between domains and total score, were assessed. Convergent validity was evaluated by correlation with EuroQoL-5D scores. Responsiveness to change was investigated using d′ and SRM-scores. Results: Mean age was 60.4 years (SD = 11.1), 62.4% were male. Mean total SAQOL-39NLg score was 3.94 (SD = 0.68, scale 1–5). No floor or ceiling effects and 2.4% missing data were found. Internal consistency was excellent (Cronbach’s alpha = 0.96). Intercorrelations between domains and total scale were moderate to excellent (r = 0.57–0.88). Intercorrelations between domains were low to moderate (r = 0.22–0.63). The correlation with the EQ-5D was moderate (r = 0.57). Only small changes in SAQOL-39NLg scores were found between 3 and 6 months. Conclusions: These data provide further evidence for the acceptability, internal consistency, and initial promising data on validity of the SAQOL-39NLg. Further research on structural validity and responsiveness to change is needed.
Article
Background: A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective: The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies. Methods: This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results: Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). Discussion: Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. Conclusion: The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I-IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.
Article
Objective: To evaluate an observational-behavioral pain tool among individuals with acute poststroke aphasia. Methods: We performed a randomized, double-blind, controlled study of experimental pain assessment among 36 adult patients with acute poststroke aphasia. Patients were administered 3 levels of mechanical pain, including placebo. The behavioral responses were video recorded and then evaluated by 3 neurology nurses using the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC-II). Pain-specific facial action units were quantified with FaceReader version 6.1. Results: Median PACSLAC-II ratings for 0-, 2-, and 4.5-lb weight stimuli were 2 (0, 3), 1 (0, 3), and 2 (1, 5), respectively. Overall, differences were not detected (p = 0.06). Pairwise comparisons with the Wilcoxon method demonstrated significance in differentiating PACSLAC-II ratings of patients experiencing the 4.5-lb stimulus vs either the 2-lb weight (p = 0.03) or placebo (p = 0.05). Overall interrater reliability by the Cronbach α was strong at 0.87, 0.94, and 0.96 for weights of 0, 2, and 4.5 lb, respectively. Pain-specific facial activation and negative valence were observed similarly in placebo and experimental pain groups. Conclusions: Among our cohort with acute poststroke aphasia, the PACSLAC-II was not able to overall differentiate patients experiencing experimental mechanical pain, although differences in those experiencing the strongest pain stimulus were significant. The detection of pain-specific facial activation and negative valence in the placebo group indicates that pain and distress are unmet needs among stroke patients who are unable to verbally communicate.
Article
Aim: To develop a time-efficient Arabic test battery for adult-onset chronic aphasia that provides information about the type and the severity of the disorder. Patient and methods: A total of 90 participants were recruited and divided into 3 groups. The groups consisted of 30 adult-onset post-stroke chronic aphasic patients, 30 adult non-aphasic adults with central neurological disorders, and a group of 30 non-brain-damaged healthy adults. All participants were assessed using the Mansoura Arabic Screening Aphasia Test (MASAT), which consists of 4 main sections: (1) language expression abilities including repetition and naming items, (2) language comprehension questions, (3) fluency, and (4) reading, writing and calculation items. The content validity, internal consistency, clinical validity, and convergent validity of the MASAT were evaluated. Results: The MASAT demonstrated statistically high reliability and validity. The high α-values in all subtotal scores among the 3 groups were judged to denote excellent intercorrelation among the screening test items. Conclusion: The MASAT is a valid and a reliable brief assessment tool that can be completed on the first clinic appointment that detects the type and severity of Arabic-speaking aphasic patients.
Article
Purpose: To study the relationship between the caregiver’s perception about the patient’s impairment in spontaneous speech, according to an item of four questions administered by semi-structured interview, and the patient’s performance in the Brief Aphasia Evaluation (BAE). Methods: 102 right-handed patients with focal brain lesions of different types and location were examined. BAE is a valid and reliable instrument to assess aphasia. The caregiver’s perception was correlated with the item of spontaneous speech, the total score and the three main factors of the BAE: Expression, Comprehension and Complementary factors. The precision (sensitivity/ specificity) about the caregiver’s perception of the patient’s spontaneous speech was analyzed with reference to the presence or absence of disorder, according to the professional, on the BAE item of spontaneous speech. Results: The studied correlation was satisfactory, being greater (higher than 80%) for the following indicators: the item of spontaneous speech, the Expression factor and the total score of the scale; the correlation was a little smaller (higher than 70%) for the Comprehension and Complementary factors. Comparing two cut-off points that evaluated the precision of the caregiver’s perception, satisfactory results were observed in terms of sensitivity and specificity (>70%) with likelihood ratios higher than three. By using the median as the cut-off point, more satisfactory diagnostic discriminations were obtained. Conclusion: Interviewing the caregiver specifically on the patient’s spontaneous speech, in an abbreviated form, provides relevant information for the aphasia diagnosis.
Article
Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia. Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated. Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α = 0.98; ICC = 0.95) and subscales (α = 0.89 for the communicating basic needs (CBN), α = 0.92 for the making routine requests (MRR), α = 0.96 for the communicating new information (CNI), α = 0.93 for the attention/other communication skills (AO); ICC = 0.95 for CBN, ICC = 0.96 for MRR, ICC = 0.97 for CNI and ICC = 0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity. Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia. • Implications for Rehabilitation • Functional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia. • This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life. • Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.
Article
The Birmingham Cognitive Screen (BCoS) is a neuropsychological battery designed to assess impairment to a variety of cognitive domains including language in patients with brain injuries. Twenty-two stroke participants and 16 gender-, age-, and education-matched controls were recruited in Hong Kong. The stroke participants were administered HK-BCoS as well as standardized batteries of cognitive and language functions validated for the Cantonese-speaking population in Hong Kong, including the Cantonese version of the Western Aphasia Battery, Cantonese Mini-Mental State Examination, and the Hong Kong–Montreal Cognitive Assessment. Results showed that HK-BCoS demonstrated good concurrent validity with all standardized batteries. HK-BCoS could discriminate between cognitive impairments in stroke patients and normal participants. Furthermore, HK-BCoS was found to have excellent intrarater and interrater reliabilities, good test–retest reliability, and fair split-half reliability as judged according to international criteria. In sum, HK-BCoS is a valid and reliable tool for assessing cognitive processing in Cantonese speakers in Hong Kong.
Article
Finding, testing and demonstrating efficacy of new treatments for stroke recovery is a multifaceted challenge. We believe that to advance the field, neurorehabilitation trials need a conceptually rigorous starting framework. An essential first step is to agree on definitions of sensorimotor recovery and on measures consistent with these definitions. Such standardization would allow pooling of participant data across studies and institutions aiding meta-analyses of completed trials, more detailed exploration of recovery profiles of our patients and the generation of new hypotheses. Here, we present the results of a consensus meeting about measurement standards and patient characteristics that we suggest should be collected in all future stroke recovery trials. Recommendations are made considering time post stroke and are aligned with the international classification of functioning and disability. A strong case is made for addition of kinematic and kinetic movement quantification. Further work is being undertaken by our group to form consensus on clinical predictors and pre-stroke clinical data that should be collected, as well as recommendations for additional outcome measurement tools. To improve stroke recovery trials, we urge the research community to consider adopting our recommendations in their trial design.
Article
Objective: 1) To develop a systems level quality improvement tool targeting communicative access to information and decision-making for stroke patients with language disorders and 2) to evaluate the resulting tool - Communicative Access Measures for Stroke (CAMS). Design: Survey development and evaluation was in line with accepted guidelines, and included item generation and reduction, survey formatting and composition, pre-testing, pilot-testing, and reliability assessment. Setting: Development and evaluation were carried out in hospital and community agency settings. Participants: The project utilized a convenience sample of 31 participants for the survey development, and 63 participants for the CAMS reliability study (broken down into 6 administrators/managers, 32 frontline staff, 25 participants with aphasia). The number of eligible participants invited to the reliability study included 45 community-based organizations in Ontario as well as 4400 individuals from communities of practice. Interventions: Not applicable. Main outcome measure(s): Data were analyzed using kappa statistics and intraclass correlations for each item score on all surveys. Results: A tool, the Communicative Access Measures for Stroke (CAMS), comprising three surveys, was developed for health facilities from the perspectives of 1) administrators/policy makers, 2) staff/frontline health care providers, and 3) patients with aphasia (using a communicatively accessible version). Reliability for items on the CAMS Administrator and CAMS Staff surveys was moderate to high (Kappa/ICCs ranging from 0.54 to 1.00). As expected, reliability was lower for the CAMS Patient survey with most items having ICCs between 0.4 and 0.6. Conclusion: (s): These findings suggest that CAMS may provide useful quality improvement information for health care facilities with an interest in improving care for patients with stroke and aphasia.
Article
The need for quick tools to sketch an early but accurate cognitive profile of patients who suffered brain damage or head trauma is of primary importance. Nonetheless, in the Italian context, the most-diffused screening tools are still those originally devised to diagnose dementia. The present pilot study then aimed at investigating the potential and feasibility of a novel screening battery, the Cognitive Assessment for Stroke Patients (CASP), in a sample of Italian patients by comparing it to Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) tests. A total of 29 neurology patients took part in the study. Participants underwent a screening procedure including the administration of MMSE, MoCA, and CASP. Data analysis suggested that the scores of the Italian version of the CASP are relatively less affected by the presence of language difficulties—common sequelae of stroke and head traumas—with respect to MMSE and MoCA ones. Furthermore, CASP scores proved to be highly correlated with both MMSE and MoCA scores, showing good clinical potential. Finally, the outcomes of administered tests proved not to be influenced by etiology or gender, and CASP scores showed a diminishing trend related to patients’ age and a positive association with patients’ education.
Book
1. Approaches to the Study of Aphasia.- 2. Operationalization of a Model.- 3. Types of Aphasia.- 4. Selective Aphasias.- 5. Memory and Learning Deficits.- 6. Defects of Visual Nonverbal Abilities.- 7. Localization of Lesion in Aphasia.- 8. Recovery and Prognosis.- 9. The Organized Response of the Brain to Injury.- References.
Article
Purpose: Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. Method: Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. Results: Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. Conclusions: This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. • Implications for Rehabilitation • Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. • A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). • People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). • People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.
Article
Introduction: The Birmingham Cognitive Screen (BCoS) is designed for use with individuals who have acquired language impairment following stroke. Our goal was to develop a Russian version of the BCoS (Rus-BCoS) by translating the battery following cultural and linguistic adaptations and establishing preliminary data on its psychometric properties. Method: Fifty patients with left-hemisphere stroke were recruited, of whom 98% were diagnosed with mild to moderate aphasia. To check whether the Rus-BCoS provides stable and consistent scores, internal consistency, test– retest, and interrater types of reliability were determined. Eight participants with stroke and 20 neurologically intact participants were assessed twice. To inspect the discriminative power of the battery, 63 participants without brain impairment were tested with the Rus-BCoS. Additionally, the Russian version of the Montreal Cognitive Assessment (MoCA), Quantitative Assessment of Speech in Aphasia, and Luria's Neuropsychological Assessment Battery were used to examine convergent validity, sensitivity, and specificity of the Rus-BCoS. Results: The internal consistency as well as test–retest and interrater reliability of the Rus-BCoS satisfied criteria for the research use. Performance on a majority of tasks in the battery correlated significantly with independently validated tests that putatively measure similar cognitive processes. Critically, all patients with aphasia returned nonzero scores in at least one task in all the Rus-BCoS sections, with the exception of the Controlled Attention section where two patients with severe executive control deficits could not perform. Conclusions: The Rus-BCoS shows promise as a comprehensive cognitive screening tool that can be used by clinicians working with Russian-speaking persons experiencing poststroke aphasia after much further validation and development of reliable normative standards. Given a lack of quantitative neuropsychological assessment tools in Russia, however, we contend the Rus-BCoS offers potential benefits to clinicians and patients. However, data from research studies with a broader sample of Russian speakers are needed.
Article
Purpose: We developed and explored the feasibility and user acceptance of the Cognitive Assessment for Aphasia App: a non-immersive virtual reality cognitive assessment for stroke survivors, designed to be inclusive of individuals with aphasia. Methods: Participants were assessed on a battery of pen-and-paper cognitive tests and the Cognitive Assessment for Aphasia App. Feasibility was explored by quantifying missing data for test completion, determining user acceptance for the app by measuring participants’ preferred testing method, enjoyment and perceived task difficulty and time-taken to complete the test. Results: Sixty-four stroke participants (35 with aphasia, 29 without aphasia) and 32 controls were recruited. Only one participant with aphasia was unable to complete all the Cognitive Assessment for Aphasia App tasks, whereas 13 participants were unable to complete all pen-and-paper tasks. Only 14% of participants preferred the pen-and-paper tests, and preference did not significantly differ between groups. Ninety-five per cent of participants were neutral or enjoyed the app and 4% perceived it to be very difficult. Higher age was negatively associated with user acceptance measures. Conclusion: The study shows preliminary evidence for the Cognitive Assessment for Aphasia App to be a feasible cognitive assessment for stroke survivors with and without aphasia. The app is currently being validated in stroke.
Article
Purpose: Evaluation of the Naming and Oral Reading for Language in Aphasia 6-point scale (NORLA-6), a scoring system of oral reading and naming performance in aphasia. Method: Data were drawn from 91 participants with non-fluent aphasia secondary to left-hemisphere stroke across four treatment studies. To assess validity, Spearman's correlations were calculated between the NORLA-6 and the Gray Oral Reading Test-Fourth Edition (GORT-4) Accuracy score, GORT-4 Rate score and the Boston Naming Test (BNT). Inter-rater and test-retest reliability were evaluated using correlations. Sensitivity to change following oral reading intervention was analysed using Wilcoxon Signed Rank tests between pre- and post-treatment NORLA-6 scores. Result: NORLA-6 performance was significantly correlated (p < 0.001) with all reference tests (GORT-4 Accuracy, rs=0.84; GORT-4 Rate, rs= 0.61; and BNT, rs= 0.92). Inter-rater (ICC ≥0.90) and test-retest (r > 0.92) reliability were both excellent. Sensitivity following oral reading intervention was demonstrated in both oral reading accuracy and rate (p < 0.004). Conclusion: The NORLA-6 is a valid and reliable measure of oral reading and naming performance. It also demonstrates sensitivity to change in treatment-targeted behaviours. Therefore, the NORLA-6 scale may enhance outcome measurement in both clinical practice and aphasia research.
Article
Purpose: The purpose of this article is to identify outcome constructs that aphasia researchers consider essential to measure in all aphasia treatment research. Method: Purposively sampled researchers were invited to participate in a 3-round e-Delphi exercise. In Round 1, an open-ended question was used to elicit important outcome constructs; responses were analyzed using inductive content analysis. In Rounds 2 and 3, participants rated the importance of each outcome using a 9-point rating scale. Outcomes reaching predefined consensus criteria were further analyzed using International Classification of Functioning, Disability and Health coding. Results: Eighty researchers commenced Round 1, with 72 completing the entire survey. High response rates (≥ 85%) were achieved in subsequent rounds. Consensus was reached on 6 outcomes: (a) language functioning in modalities relevant to study aims, (b) impact of treatment from the perspective of the person with aphasia (PWA), (c) communication-related quality of life, (d) satisfaction with intervention from the perspective of the PWA, (e) satisfaction with ability to communicate from the perspective of the PWA, and (f) satisfaction with participation in activities from the perspective of the PWA. Conclusions: Consensus was reached that it is essential to measure language function and specific patient-reported outcomes in all aphasia treatment research. These results will contribute to the development of a core outcome set.