Aphasia Assessments and Outcomes

Cross-linguistic and cross-cultural adaptations

The Group

The Aphasia Assessment & Outcomes group, led by Seรงkin Arslan [DE] and deputy lead Claudia Peรฑaloza [ES], is a multidisciplinary and international group of linguists, neuropsychologists, speech and language therapists (SLT) and people with aphasia (PWA) with more than 80 members from all around the world. The group, established in 2014 (initially funded by the European Cooperation of Science & Technology for the COST Action IS1208 and since 2017 by the Tavistok Trust For Aphasia) is organized in 26 language teams and aims to facilitate access to common comprehensive, normed and validated tests for their use across international aphasia trials in monolingual and multilingual contexts.

Our activities

The group follows a committee approach, supports activities related to assessment and outcome measures for aphasia, and provides expertise and infrastructural support to members interested in cross-linguistic and cross-cultural adaptations of assessment tools and outcome measures.

In the last years, the group has been focusing on:

  1. the assessment of SLT rehabilitation and management practices of monolingual and bilingual PWA
  2. the identification of the most frequently used assessment tools across countries
  3. the coordination of interdisciplinary language teams for linguistic and cultural adaptations of these tools.

Our language teams

For each language, local teams were formed and guidelines were established to facilitate cultural and linguistic adaptations of the target tools.

The teams are working in the following languages: Arabic (Morocco), Basque, Catalan, Croatian, Finnish, French, German, Greek, Cypriot Greek, Hungarian, Icelandic, Irish, Italian, Latvian, Lithuanian, Malaysian, Maltese, Norwegian, Portuguese, Punjabi, Russian, Serbian, Slovenian, Spanish, Swedish and Turkish.

The Multilingual Aphasia Practices (MAP) group

The Multilingual Aphasia Practices (MAP) project group is a subgroup of the Aphasia Assessments and Outcomes working group and is led by Maria Kambanaros and Monica Norvik. Currently, the group consists of 16 members, representing 11 countries.

The MAP group is working on three different projects, and have until now, focussed primarily on the first:

  • The first comprehensive and international evaluation directed to professional SLT/SLPS working with persons with aphasia.

The survey aims to :

  1. assess the degree of awareness of professional SLPs about multilingualism in their clinical practice
  2. determine the frequency of their clinical practice with multilingual persons with aphasia (MPWA) and their perceptions of readiness for the assessment and treatment of this population
  3. identify their common clinical practices and perceived challenges when providing clinical services to MPWA

The MAP survey is available in 14 different languages and can be accessed here: Online Survey Software | Qualtrics Survey Solutions

Based on the results of the survey, we will develop the two next projects:

  • Multilingual questionnaire: Developing a background questionnaire for multilingual individuals with aphasia
  • Best practice recommendations for multilingual aphasia

Facilitating the assessment of speakers from different language backgrounds

As a first step in meeting the needs for comparable assessment tools across countries and thus paving the way for more robust research on aphasia and aphasia rehabilitation, the Assessment & Outcomes group is working on the adaptation of several tools:

You want to contribute or learn more ?

  • Check the activities of the language teams and our publications below 
  • To join us click here
  • To go back to the research activities of the Collaboration click here

Snapshot from one of our last online meetings (February 2021)

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Language Teams

The languages the Assessment & Outcomes group is working on belong to a variety of language families. For each language, local, often interdisciplinary, teams have been established. For the adaptation process the individual language teams apply guidelines that have been jointly established and agreed upon through consensus. The group follows a committee approach in the adaptation process. Following the adaptation, each language versions are standardized and normed based on a common set of instructions.

Central to the adaptations is the variety of underlying variables reflected in the tools, especially culture- and language-related variables such as: phonological, semantic (e.g. imageability), syntactic and usage-based (e.g. frequency) variables. A key feature of the adaptation process is to ensure comparability across the various languages on the level of these underlying variables.

Team members: Amaia Munarriz-Ibarrola, University of the Basque Country UPV/EHU & ELEBILAB research group and Marie Pourquiรฉ, IKER-UMR 5478, CNRS & ELEBILAB research group.

Activities: In order to circumvent issues related to dialectal variation in Basque and reach the %85 threshold established by the CAT_WG2 network we had to run a second naming agreement task and a word-recognition task (with the same participants). We are currently analysing the data in order to decide which pictures will definitely be included in the Basque version of the CAT. Recently, the team has also led a study on the current situation in the Basque Country regarding aphasia assessment and treatment practices. To that aim, an online questionnaire was distributed among professionals from different areas involved in aphasia assessment in the Basque Country. Results revealed that although Basque speakers are usually assessed in their two languages, the quality of this assessment is poor (because professionals use their own translations for aphasia assessment in Basque or they do it in an informal way).  Therefore, professionals claim the need for more standardized tests to measure aphasia in Basque and express their interest in adaptating CAT for Basque (Villanueva et al., under review).

Team members: Io Salmons and Anna Gavarrรณ at the Universitat Autรฒnoma de Barcelona, and Adriร  Rofes at Rijksuniversiteit Groningen.

Activities: Having completed a first Catalan version of the CAT (Comprehensive Aphasia Test), the team has started piloting the adapted test with healthy adult speakers. In the past, the team has worked on the adaptation of other tools such as: a sentence repetition task for Catalan (Gavarrรณ, 2017), Catalan versions of the Grammar and Phonology Screening Test (GAPS, van der Lely, Tร pias & Gavarrรณ, 2010), the Aphasia Impact Questionnaire (AIQ, Rofes, Gavarrรณ & Salmons, 2016), the Token Test (Bastiaanse et al., 2016), and object and action naming tests for language mapping in awake surgery (Rofes, de Aguiar & Miceli, 2015).

The Croatian team secured the funding for new pictures from two projects (Adult language processing, Croatian Science Foundation HRZZ-2421 and Interdisciplinary approach to language model of dyslexia in adult, HR.3.2.01-0247 EU-ESF). 330 new pictures were drawn and downloaded to our shared Dropbox file. All languages are welcome to use them.

Next phase is pre-standardisation, i.e. piloting of the test on sample of health speakers with aim to test validity of items and pictures. First data of this phase will be present on out next Meeting in Tampere in February 2016.

The greatest challenges in the adaptation of CAT test are mostly related to tasks including words that had to be presented by the use of pictures. The target words had to have a certain level of imageability and frequency and therefore the tasks were not always simple to match with the original version of the test. For example, spoon and pineapple are marked as having low frequency and low imageability in English, which is not the case in Croatian. That is why we could not include those words in the same part of the task. Moreover, it is logical that most of the low imageable words are not that simple to draw. Consequently, it was a great challenge to do so, especially for the Naming objects task. Some examples of low imageable words in Croatian language are time, wind and galaxy.

Another challenge includes the Repetition of sentences task. For some items it was somewhat difficult to find sentences involving same number of content and functional words and still to preserve the exact meaning of the original sentences.

One more thing that has to be mentioned involves all the tasks in which the main imperative had to be put on word structure (e.g. phonological properties of the words; number of syllables; number of distinctive features etc.). As English and Croatian language differ significantly, in most cases the words in the adaptation of the test are different from the ones in the original form.

Considering all the above, it is reasonable that the English and the Croatian version differ significantly in certain tasks, but it is important to mention that all the given criteria have been met and fulfilled. Accordingly, it would be finally possible to carry out cross-linguistic studies analysing accomplishments of patients with various type of aphasia in different language

The team has adapted the AIQ-21 into Greek and currently piloting this version. The team has also adapted the SaQOL-39 from Greek into Cypriot Greek and piloted it on over 20 PWA with a tablet version the members developped.

Currently developing a Dutch version of the AIQ-21. There are already Dutch versions of the CAT, of the Scenario Test, of the SAQOL-39(g) and of the GHQ.

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At the moment we are gathering words for the imageability testing of the Finnish version of the CAT;we will then start the imageability testing soon. We are also checking through the existing CAT pictures โ€œwith Finnish eyesโ€ to make sure they have the same relevance abd applicability. Then we begin to test the imageability.

Team members: Eva Soroli, Associate professor of Psycholinguistics at the University of Lille; Grรฉgoire Python, Lecturer Geneva University; Charlotte Jacquemot, Neuropsychologist and Researcher at the Ecole Normale Supรฉrieure of Paris.

Activities: The team has finished the adaptation of the CAT into French, translated the manual and adapted the AIQ-21. New items and pictures have been created and tested for Name agreement. The team is in the process of norming the CAT. BPR, TST, SAQOL-39 and the GHQ adaptations are ongoing.

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We have finished the translation and adaptation of the language part of the CAT. We managed to make our subtests very similar to the original version. This was very challenging for several reasons. In the subtests focusing on words, in line with the original test, we had to control for a number of factors, such as frequency, animacy, imageability, and length. Although we have a web-based frequency database that we could use for item selection, we had to find a way to transform the Hungarian values into the unit โ€˜word per millionโ€™ to be able to compare our potential items to the English ones. Also, we have a limited number of nouns with one syllable, therefore finding words and minimal word-pairs with this length, that also meet all other criteria, took a lot of time and effort. Because there are substantial differences in morphology between English and Hungarian, we had to face some challenges also in the subtests aiming to examine the effects of morphological complexity and regularity. There is no imageability database in Hungarian, so we are preparing an imageability study to collect ratings for our potential items, after which we can finalize our wordlists. We have started to work on the adaptation of the cognitive screening as well.

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Team members: Hanne Gram Simonsen, University of Oslo, Monica Norvik, University of Oslo and Statped, Nina Hรธeg, Statped, Ingvild Rรธste, SLT.

Activities:

The Norwegian version of the CAT (Comprehensive Aphasia Test), CAT-N is now published in paper format, normed on 85 PWA and 84 healthy controls. CAT-N also includes the Aphasia Impact Questionnaire (AIQ). We plan to prepare an electronic version of CAT-N.

Work is ongoing to further validate the comparability of the CAT between languages, e.g. comparing the Croatian and Norwegian versions (CAT-HR and CAT-N) in collaboration with the Croatian team.

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Serbian adaptation of CAT has followed the general adaptation guidelines, and as a result, we have managed to create a translation of the CAT that is comparable to CAT in other European languages. Besides the usual challenges of crafting and adapting a complex multidimensional test, Serbian adaptation faced some language-specific challenges. Namely since Serbian has two letters, Cyrillic and Latin, which are used interchangeably, the issue of incorporating both letters in the test has arisen. Is order to overcome this issue, Serbian CAT will have additional items, some tasks will include both Cyrillic and Latin items, and some test will be administered with letters that the person feels more comfortable with.

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Team members: Silvia Martรญnez-Ferreiro, Carolina Mรฉndez Orellana, Yina Quique, Carlos Hernรกndez Sacristรกn

Activities: The Spanish team is currently norming the CAT, while starting the contacts for the publication of both a paper and an electronic version. Adaptations of the BPR have already been done and are available through the website. These include the Spanish aphasia friendly version and the Galician versions for people with and without aphasia. (Some of) the members of the team are also working in the adaptation of other tools (ALEA, ScreeLing, OCS, Dulip, ANELT and Scenario Test). These are all ongoing projects in different stages of realization.

Team members: Monica Blom Johansson, Ingrid Sรถr and Jenny Kimhag, Uppsala University; Ingrid Henriksson and Francesca Longoni, University of Gothenburg; Angelina Grรถnberg, Lund University; and Per ร–stberg, the Karolinska Institute.

Activities: The Swedish team has finished norming of CAT (language parts) with 64 PWA 1-month post onset, 40 PWA follow-up assessment 3 months post onset, 33 PWA follow-up assessment 12 months post onset, 21 controls with stroke without aphasia, and 100 controls without stroke. They are developing a preliminary e-CAT version in cooperation with the PLORAS team (UCL) but would also like to find a local publisher for a paper version of the CAT. Adaptations of AIQ-21, BPR, the Scenario test, SAQoL-39 and GHQ-12 are either ongoing or completed, however not yet publish

The adaptation of the CAT into Turkish has been completed. The test words have been arranged in terms of imagebility, frequency, length and according to category. Alternatives have also been identified. Almost 200 words have been translated and are now being validated for mental imagery, familiarity and age of acquisition. After this phase, the test words will be identified.

Our recent publications and dissemination activities

(the names of our members are in bold)

2021

  • Hansen, P. & Norvik, M. (2021). Creating language-assessment tools for North, South and in between. Thematic session organized for the Bilingualism/Multilingualism and Language Assessment Dilemmas Section of the International symposium on Bilingualism โ€“ ISB13, University of Warsaw, Poland July 9-14, 2021.
  • Fyndanis, V., Haman, E., ลuniewska, M., Gram Simonsen, H. (2021). Meeting a need for tools: Experiences from two international networks. Paper to be presented at the โ€œLanguage-assessment tools for North, South and in betweenโ€ thematic session of the International symposium on Bilingualism โ€“ ISB13, University of Warsaw, Poland July 9-14, 2021.
  • Hansen, P., Norvik, M., Soroli, E., Haman, E., Gram Simonsen, H. & Southwood F. (2021). Multilingual assessment through pictures: Guidelines for material selection. Paper to be presented at the โ€œLanguage-assessment tools for North, South and in betweenโ€ thematic session of the International symposium on Bilingualism โ€“ ISB13, University of Warsaw, Poland July 9-14, 2021.
  • Pourquiรฉ, M. & Munarriz, A. (2021). The place of minority languages in clinical settings: the case of Basque. Talk to be presented at the 18th International Conference of Minority Languages, Bilbao, 24-26 March, 2021

2020

  • Kees de Bot, Charlotta Plejert, Hanne Gram Simonsen, Valantis Fyndanis, Pernille Hansen, Monica Norvik, Bente Ailin Svendsen og Jan Svennevig (2020). Multilingualism and ageing. An Overview. Brill Academic Publisher
  • Wallace, S. J., Worrall, L., Le Dorze, G., Brandenburg, C., Foulkes, J., & Rose, T. A. (2020). Many ways of measuring: a scoping review of measurement instruments for use with people with aphasia. Aphasiology, 1-66. doi:10.1080/02687038.2020.1836318
  • Schwertfeger, J., Jakeman, L., Lin, S., Weaver, J., Heinemann, A., Kolakowsky-Hayner, S., Padula, W., Wallace, SJ., Wallace, SE., Sullivan, J., Cherney, L., Grampurohit, N., Bernhardt, J. (October, 2020). Showing You Care About Stroke Through Shared Measures: How to Improve Clinical and Research Outcomes by Implementing Core Outcomes Measure Sets and Common Data Elements. Symposium at the American Congress of Rehabilitation Medicine Annual Conference.
  • Martรญnez-Ferreiro, S., Sandoval-Leรณn, K., Cortรฉs-Rivera, B., Arraรฑo-Carrasco, L., Mery-Muรฑoz, F. & Mรฉndez-Orellana, C. (2020). Spontaneous Speech Evaluation in Spanish Speaking Patients with Brain Tumors and Vascular Malformations. PSYNEUROLING International Online Conference of Psycholinguistic and Neurolinguistic Research: Methods, Materials, and Approaches, University of Salamanca & Centre for Linguistic Justice and Endangered Languages, National Law University (Delhi), 17th-19th December.
  • Ali, M., Jesus, L., Cruice, M., Isaksen, J.,Visch-Brink, E., Grohmann K., Kukkonen, , Varlokosta, S., Hernandez-Sacristan, C., Rosell-Clari, V., Palmer, R., Martinez-Ferreiro, S., Godecke, E., Wallace, S., McMenamin, R., Copland, D, Soroli, E., Breitenstein, C., Bowen, A., Laska, A-C. & Brady, M. (submitted). An Aphasia Research Agenda โ€“ a Consensus Statement from the Collaboration of Aphasia Trialists. Aphasiology.
  • MaviลŸ I, Tunรงer AM, Selvi-Balo S, Tokaรง SD, ร–zdemir S, on behalf of Working Group 2 of the Collaboration of Aphasia Trialists (submitted). The Adaptation Process of CAT into CAT-Turkish: Psycholinguistic and Clinical considerations. Aphasiology Special Issue.
  • Hansen P., Norvik M., Fyndanis V., Mueller Gathercole V., Southwood F., Haman E., ลuniewska M., Gram Simonsen H., Soroli E., Oosthuizen H., White M., Brookes H., Dowling T., Pascoe M., Ndhambi M. & Alcock K. (accepted colloquium). Colloquium proposal โ€œCreating language assessment tools for North, South and in betweenโ€. Georgetown University Round Table conference on Multilingualism: Global south and global north perspectives. March 2020. Washington, DC, USA
  • Norvik, M., Hรธeg, N., Rรธste, I. & Gram Simonsen, H. (2020). Anbefalinger for beste praksis for afasi. http://www.aphasiaunited.org/wp-content/uploads/2016/05/Norwegian-Aphasia-unitedBPRs.pdf
  • Hansen P., Haman E., Soroli E., Southwood F., Kuvac-Kraljevic J., Matic A. Norvik M., Luniewska M., Mieszkowska K., Gram Simonsen H. (accepted conference presentation). Paper โ€œMultilingual assessment through pictures: Guidelines for material selectionโ€. GURT- Georgetown University Round Table conference on Multilingualism: Global south and global north perspectives. March 2020. Washington, DC, USA.

2019

  • Kuvaฤ Kraljeviฤ‡, Matiฤ‡, A., Lice, K. (2019). Putting the CAT-HR out: key properties and specificities. Aphasiology https://doi.org/10.1080/02687038.2019.1650160.
  • Bruehl, S, Breitenstein, C, Petra Jaecks, Lorenz A, Meinzer M, Rubi-Fessen I, Stahl B on behalf of the RELEASE Collaboration (2019). TIDieR-Beschreibungen sprachtherapeutischer Interventionen fรผr Menschen mit Aphasie โ€“ Ein Konsensus der RELEASE-Kollaboration. GAB conference, November 2019, Leipzig, Germany.
  • Shiggins, C, Soskolne, V, Olenik, D, Pearl, G, Haaland Johansen, L, Isaksen, J, Jagoe, C, McMenamin R, Horton, S. (2019). Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study British Aphasiology Society Clinical Symposium, September, 2019 Norwich, UK.
  • Mรฉndez-Orellana, C., Holme, C., Sandoval-Leรณn, K., Cortรฉs-Rivera, B., Mรฉndez-Orellana, P & Martรญnez-Ferreiro, S. (2019). Spontaneous Speech Analysis in Spanish-Speaking Adults: Normative data in healthy adults, elderly adults and patients with brain lesions. Science of Aphasia, Rome (Italy), 23-26 September.
  • Mรฉndez-Orellana, C., Holme, C., Sandoval-Leรณn, K., Cortรฉs-Rivera, B., Mรฉndez-Orellana, P & Martรญnez-Ferreiro, S. (2019). Spontaneous Speech Analysis in Spanish-Speaking Adults: Normative data in healthy adults, elderly adults and patients with brain lesions. Stem-, Spraak- en Taalpathologie, 24, Supplement, 260-263.
  • Martรญnez-Ferreiro, S. (2019). Recomendaciones de mejores prรกcticas para la afasia. Versiรณn espaรฑola para personas con afasia. http://www.aphasiaunited.org/best-practice-recommendations/
  • Martรญnez-Ferreiro, S. (2019). Recomendaciรณns sobre boas prรกcticas para a afasia. Versiรณn galega. http://www.aphasiaunited.org/best-practice-recommendations/
  • Martรญnez-Ferreiro, S. (2019). Recomendaciรณns sobre boas prรกcticas para a afasia. Versiรณn galega para persoas con afasia. http://www.aphasiaunited.org/best-practice-recommendations/.
  • Zakariรกs, L., Rรณzsa S., Lukรกcs, (2019). ร. CAT-H: รบj eljรกrรกs az afรกzia magyar nyelvลฑ diagnosztikรกjรกban. Rehabilitรกciรณ 29(2-3), 106-107. (conference proceeding)
  • Zakariรกs, L., Rรณzsa S., Lukรกcs, (2019). ร. CAT-H: รบj eljรกrรกs az afรกzia magyar nyelvลฑ diagnosztikรกjรกban, Magyar Rehabilitรกciรณs Tรกrsasรกg XXXVIII. Vรกndorgyลฑlรฉse, 2019. oktรณber 3-5.

2018

  • Pourquiรฉ, M., & Munarriz Ibarrola, A. (2018). Afasia euskaraz aztertzeko tresna berria bidean: CAT testaren euskal egokitzapenaren gakoak eta estandarizaziorako urratsak.[A new tool to assess aphasia in Basque: key elements for the Comprehensive Aphasia Test adaptation for Basque and steps towards standardization]. Osagaiz, 2(2), 13-24, DOI: http://doi.org/10.26876/osagaiz.2.2018.149
  • Rofes, A.; Zakariรกs, L.; Ceder, K.; Lind, M.; Blom Johansson, M.; De Aguiar, V.; Bjekiฤ‡, J.; Fyndanis, V.; Gavarrรณ, A.; Simonsen, H. G.; Hernรกndez Sacristรกn, C.; Kambanaros, M.; Kuvaฤ Kraljeviฤ‡, J.; Martรญnez-Ferreiro, S.; Mavis, I; Mรฉndez Orellana, C.; Salmons, I.; Sรถr, I.; Lukรกcs, A.; Tunรงer, M.; Vuksanovic, J.; Munarriz Ibarrola, A.; Pourquiรฉ, M; Varlokosta, S. & Howard, D. (2018). โ€œImageability ratings across languagesโ€. Behavior Research Methods, 50 (3), 1187-1197. DOI 10.3758/s13428-017-0936-0.
  • Swinburn K., Best W., Beeke S., Cruice M., Smith L., Pearce Willis E., Ledingham K., Sweeney J. & McVicker S.J. (2018) A concise Patient Reported Outcome Measure for people with aphasia: The Aphasia Impact Questionnaire Aphasiology DOI: 10.1080/02687038.2018.1517406

2017

  • Munarriz, A. & Pourquiรฉ, M. (2017) CAT: afasia aztertzeko tresnaren euskal egokitzapena. In Alegria, I., Latatu, A., Ormaetxebarria, M. J. & Salaberri, P. (Eds), II. IkerGazte. Nazioarteko Ikerketa Euskaraz: Giza zientziak eta artea. 80-87. Udako Euskal Unibertsitatea (UEU): Bilbo, ISBN: 978-84-8438-628-5.
  • Fyndanis V, Lind M, Varlokosta S, Kambanaros M, Soroli E, Ceder K, Grohmann K, Rofes A, Simonsen HG, Bjekiฤ‡ J, Gavarrรณ A, Kuvaฤ Kraljeviฤ‡ J, Martรญnez-Ferreiro S, Munarriz A, Pourquie M, Vuksanoviฤ‡ J, Zakariรกs L & Howard D (2017). Cross-linguistic adaptations of the Comprehensive Aphasia Test: Challenges and solutions. Clinical Linguistics and Phonetics, 697-710. DOI: 10.1080/02699206.2017.1310299.