The beaver, a river animal commonly found in Europe and North America. The pretzel, a salty snack. And the Egyptian sphinx, a mythical creature.

These objects may not be familiar to Singaporeans, but are used in a test to assess language problems in stroke patients. Not surprisingly, many Singaporeans were not able to identify them. Yet, their responses were crucial to an accurate assessment by speech therapists of their communication and language ​difficulties. Only then could a treatment plan be drawn up for their condition, also known as aphasia (neurological disorder caused by damage to the portions of the brain that are responsible for language).

Said Dr Valerie Lim, Senior Principal Speech Therapist, Speech Therapy Department, Singapore General Hospital (SGH), a member of the SingHealth​ group: “As it’s a language test, even though we speak English, there are cultural variations in the way we communicate, in terms of how words sound, the kind of materials that are relevant to our society, and so on."

“When shown a picture of a beaver, if the patient identifies it incorrectly, it may not mean that he has an impairment. Rather, it may mean that the animal is unfamiliar because he has not seen it before.”

The assessment tools, developed in English-speaking countries such as the US, Australia and the UK, require patients to be familiar with things that are found in those countries. The patient also has to be proficient in English.

The perfect fit: Adapt to local needs

To address the shortcomings of these tests, Dr Lim and other speech therapists at SGH have developed local tests. They are conducted in English and Mandarin to better reflect the common use of the ​two languages, and the Singapore cultural context. For instance, the team uses pictures of chopsticks, the Singapore flag and mahjong tiles – things which Singaporeans, especially the elderly, are more familiar with.

“We felt that it was time for us to come up with something more local to potentially improve diagnosis and the way that patients respond to the pictures and the tests,” she said.

The seeds of the project were sown in 2003. The speech therapists looked at adapting from the standard Western-developed test, but found that it was difficult and costly. They also looked at an existing test from Hong Kong when developing the Chinese version but, again, found it inappropriate as it required responses in Cantonese.

It was then that they decided to start from scratch. Six years later, the team received a $20,000 grant from the SGH Research Fund to develop the test and, in 2010, they began work, completing the project in 2012.

Said Dr Lim’s colleague, Principal Speech Therapist Deirdre Tay: “The local test was born out of need. We hope we have filled a gap.”

See next page for information on how this test can identify conditions affecting​ speech ​ability​.​​​