|Year : 2020 | Volume
| Issue : 2 | Page : 47-51
Construction of western aphasia battery in Nepali: A pilot study
Jyoti Shah1, Sureshwar Lal Karna2, Himanshu Verma3
1 Department of Audiology and Speech-Language Pathology, Ashtavakra Institute of Rehabilitation Sciences and Research, Rohini, Delhi, India
2 Department of Audiology and Speech Language Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
3 Speech-Language Pathologist and Audiologist, Speech and Hearing Rehabilitation Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||16-Sep-2020|
Department of Audiology and Speech Language Pathology, Ashtavakra Institute of Rehabilitation Sciences and Research, Rohini, Delhi
Source of Support: None, Conflict of Interest: None
Aim: The present study aims to construct the Western Aphasia Battery (WAB) in Nepali language. Method: Individuals for this study were ten Nepali speaking adults in the age range of 30 and above, out of which five were healthy and five were aphasics. The cortical quotient was not included in the present study as many of our population were illiterate and examining them on the tests of reading and writing was not possible. Result: The current study clearly shows that aphasic patients can be identified and classified into the types of aphasia and also the severity of the language deficits can be obtained in terms of the AQ using Nepali WAB. Conclusion: We can conclude that WAB-N gives detailed information about oral language abilities which further provides the baseline for therapy plan and recovery.
Keywords: Aphasia, aphasia quotient, Western Aphasia Battery in Nepali
|How to cite this article:|
Shah J, Karna SL, Verma H. Construction of western aphasia battery in Nepali: A pilot study. J Neurobehav Sci 2020;7:47-51
| Introduction|| |
Aphasia is an acquired communication disorder caused by brain damage, characterized by an impairment of language modalities – speaking, reading, listening, and writing. It is not the result of a sensory or motor deficit, a general intellectual deficit, confusion, or a psychiatric disorder. Aphasia syndrome can be classified in many ways. The most popular and clinically used classification is the Boston classification, where aphasia is classified into the following types: Broca's aphasia, Wernicke's aphasia, global aphasia, conduction aphasia, anomic aphasia, and transcortical aphasia.
Assessment is necessary to find the exact degree, nature, severity, and type of aphasia. It also indicates what aspects of language performance are most appropriate for treatment. One of the widely used comprehensive test batteries to diagnose degree, severity, and type of aphasia is Western Aphasia Battery (WAB) given by Shewan and Kertesz in 1980. WAB designed to evaluate both linguistic and nonlinguistic skills. A linguistic skill includes content, fluency, auditory comprehension, repetition, reading, writing, calculation, and naming. Nonlinguistic skill includes drawing, block design, and praxis. The scoring system provides the following overall measure of severity: the aphasia quotient (AQ) and cortical quotient (CQ). AQ is a measure of language ability, whereas CQ predicts about intellectual ability. WAB has eight subtests, and the total scoring is out of 100 where a data score below 93.8 is said to have aphasia and score 93.8–97.0 is questionable and score above 97 is considered to be normal. These scores were derived from the 215 aphasics, 63 normal controls, and 53 nonaphasic brain-damaged patients.
These above scores were derived from English speaking population. As no language has the same structure and syntax, so it is not possible to have a common test to assess and classify a disorder for all the languages. So far, WAB has been translated and developed in different languages, e.g., Korean, Cantonese, and Tagalog.
India is a multilingual country and has 780 languages including 350 major languages (Linguistic Survey of India, 2013). Till now, there are a limited number of tests available in Indian languages. So far, WAB has been developed in Telugu, Kannada Malayalam, and Bengali. However, there is no standardized test available in Nepali till now to assess linguistic and nonlinguistic skills for persons with aphasia.
Nepali is the eastern Pahari language of the Indo-Aryan language family. In some context, Nepali is also known as Gorkhali or Parbatiya (Burghart, 1984). According to Appendix 1, Chapter V of Census of India, 2011, Nepali language has 38 segmental phonemes which include 6 vowels. The report further stated that word-level analysis of Nepali language revealed that a word contains at least one syllable and at the most four syllables.
Need of the study
India is a large country with enormous number of languages being spoken. There are 350 major languages in India. According to Indian constitution, there are several officially recognized languages and Nepali is one of them. About 29,26,168 people speak Nepali language in India. Nepali is spoken mainly in Sikkim, hills of West Bengal, Assam, Darjeeling, Arunachal Pradesh, and Himachal Pradesh.
We cannot use a test in one language to assess all the different languages, and therefore, we need to develop them in all the different languages. Nepali is one among them where there is no standardized test to assess and classify aphasics.
Aim of the study
The present study aims to construct the Western Aphasia Battery in Nepali language (N-WAB) and to check for the construct validity of the test by testing the N-WAB on persons with aphasia.
| Materials and Methods|| |
A total of ten Nepali native speakers (age range: 39–82 years) participated in the present study. Among the ten participants, five were aphasics and five were healthy age-matched controls. Participants were selected irrespective of their age, sex, type, or severity of the problem. In the present study, the majority of the participants were illiterate or had very low education level, as shown in [Table 1]. Among the five aphasics, three were expressive aphasics tested 2–8 months postonset, one global tested 2 months postonset, and one was a receptive aphasic tested 3 months postonset. The computed tomography scan or magnetic resonance imaging reports on the site of lesion were obtained during the initial investigation period (i.e., soon after the brain insult), as shown in [Table 1]. All the participants were selected from one of the hospitals from Kathmandu, Nepal. All the aphasic participants were diagnosed by a neurologist and speech-language pathologist on the basis of speech-language characteristics and radiological study.
[Table 2] provides the demographic details of the control group. Among the five, two were graduates and one was engineer. All the participants from the control group undergone brain study and revealed normal brain study.
Construction of Nepali WAB
The English version of WAB has two parts. The first part of the test examines oral language abilities, which include auditory comprehension and spoken expression. Scoring of this part provides the aphasia quotient (AQ).
The second part of the test examines performance quotient, which includes reading and writing, praxis, calculation, and construction. For the present study, the second part of the test is not included because many of our population were illiterate and examining them on the tests of reading and writing was not possible. Further tests such as the Raven's colored progressive matrix as standardized data are not available for Indian population. Hence, the CQ, which calculates the combined scores on language and performance subtests, will not be included in the present N-WAB.
The N-WAB was developed similar to the original WAB. In N-WAB, each subtest was developed in Nepali. These materials were a translation of the English WAB. These translations were done using Brislin's methodology of cross-cultural translation (1970). During adaptation of WAB in Nepali language, some items were modifies based on the grammatical forms to suitable the linguistic profile of Nepali language and the cultural context. The constructed test was rated by three speech-language pathologists and two linguists on the basis of familiarity and culturally suitable. Less familiar and less culturally suitable words were replaced by most familiar and more culturally suitable words. However, the complexity of the original stimuli was maintained as far as practicable.
The Nepali version of WAB has four major subsections corresponding to the areas that have been most important in identifying aphasia syndrome:
- Spontaneous speech
- Auditory verbal comprehension
Section I – Spontaneous speech
This section was designed to check fluency and the information content of spontaneous speech. A patient was asked some general questions and also to describe the picture presented to him/her. Scoring was done for information content and fluency separately. Scores ranged from 0 to 10. Zero was for “no information” and ten for “correct response” to all questions and picture description. Similarly, for fluency, zero was for “nonfluent speech” (i.e., no words or short meaningless utterances) and ten for “normal fluency.” The total score for spontaneous speech was 20.
Section II – Auditory verbal comprehension
This section was designed to check the auditory comprehension and consists of three subsections. Those are yes/no questions, auditory word recognition, and oral commands. In the first subsection, some questions were asked to the participants and he/she was instructed to answer as “yes” or “no.” If he/she had difficulty in responding verbally, then yes/no gestures were accepted. Each correct response was given 3 points and the maximum score was 60.
In the second subsection, participants were asked to point out the real or drawn objects. Each correct response was scored “1” and the maximum score was 60. In the third subsection, a participant was asked to execute the commands and each command was scored according to its complexity. The maximum score for this subsection was 80. All scores of the three subsections were then added up. The total score for this section was 200.
Section III – Repetition
In this section, a patient was asked to repeat a few words and sentences. Each response was scored on the basis of its complexity as given in the test material. One point was cut for errors in order of word sequence or for each literal paraphasia. The total score for this section was 100.
Section IV – Naming
This section has four subsections – object naming, word fluency, sentence completion, and responsive speech.
In the first subsection, a participant was asked to name the objects presented in front of him/her. Maximum of 20 s was given for each item. Three points were given for each correct response, 2 points for recognizable phonemic paraphasia, and 1 point if a phonemic or tactile cue was required. The maximum score in this subsection was 60. In the second subsection, a participant was asked to name as many animals as he/she can in 1 min – 1 point for each animal named, even if distorted by literal paraphasia. The maximum score was 20 for this subsection. In the third subsection, the patient was asked to complete the incomplete sentences given by the clinician. Two points were scored for correct responses and 1 point was cut for phonemic paraphasia. The maximum score was 10 for this subsection. In the fourth subsection, a participant was asked some questions and scored 2 points for each acceptable response, 1 point was cut for phonemic paraphasia, and the maximum score in this subsection was 10.
The detailed case history included demographic details, and medical history was taken. This included etiology, onset, radiological reports, neurological reports, and other medical reports. The participants were instructed in their mother tongue (Nepali) before the administration of the test. The set of instructions is listed in each section for patient and well as for examiner. Participants' response for each item administered was recorder in the individual response sheets.
Then scoring was done as given in the score sheet. On the basis of the scores, the participants can be differentially diagnosed and classified as global, Broca's, Wernicke's, isolation, transcortical motor, transcortical sensory, conduction, or anomic aphasia.
Statistical analysis was done using SPSS 20.00 version (Chicago, Illinos, USA) to find whether the WAB in Nepali could differentiate aphasics from the normal participants. The mean, standard deviation, and percentile scores were computed using descriptive analysis. To find the significance level between the groups, an independent sample t-test was computed for all four subsections of WAB.
| Results and Discussion|| |
The Nepali version of WAB was administered in all the ten participants. The WAB scores obtained for both the groups are given in [Table 3]. The mean and standard deviation were computed for all subsections: fluency, auditory comprehension, repetition, and naming.
t-test was computed for all four subsections of WAB between the aphasic and control groups. The result showed a significant difference between normal adults and aphasic performance on given tasks, as shown in [Table 4]. Our result supports the findings of other studies of adaption of WAB in other languages such as Malayalam, Telugu, Kannada, and Bengali.
|Table 4: Demonstrating mean, standard deviation, and t values for control versus aphasic performance on test|
Click here to view
Aphasic quotient (AQ) for both the groups was calculated, and t-test was computed to measure the significance level between both the groups, as given in [Table 5].
Overall findings reveal that the control group has much better AQ than aphasics. The aphasic group showed a larger standard deviation as a broad spectrum of aphasic patients were taken irrespective of their type and severity. Similar findings were reported by other studies related to the adaption of WAB in other languages such as Korean, Kannada, and Bengali.
| Conclusion|| |
The current study clearly shows that aphasic patients can be identified and classified into the types of aphasia and also the severity of the language deficits can be obtained in terms of the AQ using Nepali WAB. The test gives detailed information about oral language abilities which further provides the baseline for therapy plan and recovery.
Limitations of the study
- The test does not include performance quotient which includes reading and writing, praxis, calculation, and construction because we do not have adequate valid norms for test such as the Raven's colored progressive matrix (RCPM) and a large number of our population are illiterate
- Standard normative data could not be established due to small sample size.
- Needs to be administered on the larger group of patients with brain injury to achieve good sensitivity & specificity of the test
- Performance quotient needs to be included in the test battery.
Patient informed consent: Informed consent was obtained.
Ethics committee approval: Its a pilot study at small level and doesn't involved any invasive procedure so didn't need ethical committe approval as such.
Financial support and sponsorship
No funding was received.
Conflicts of interest
There is no conflicts of interest to declare.
Author contribution area and rate:
Mrs Jyoti Shah: Formulate plan of the study, Data collection, Execution of data on excel sheet and wrote the manuscript. Mr. Sureshwar Lal karna: Data collection and help in data analysis Mr. Himanshu Verma: wrote the manuscript, collection of review of literature and Data analysis.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]