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 for an accurate language assessment by speech therapists. Only then could a treatment plan be drawn up for their language disorder, which is also known as aphasia (a neurological disorder caused by damage to parts of the brain responsible for language).

The Speech Therapy Department at Singapore General Hospital (SGH), a member of the SingHealth group explains: “As it’s a language test, even though we speak English, there are cultural differences 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: Adapting to local needs

To address the shortcomings of these tests, a team of speech therapists at SGH 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.

The speech therapy team felt that it was time to come up with something more local to potentially improve diagnosis and the way that patients respond to the pictures and tests. 
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 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. 

One Test, Many Uses

The test is now used by SGH speech therapists to assess patients for moderate to severe aphasia, but a research study, funded by the Ministry of Health, is necessary to validate the usefulness of the test. The data from the study will also help the team look for patterns, such as the range of scores to indicate the condition’s stages of severity.

Four other health care institutions are involved in the study: National University Hospital, Khoo Teck Puat Hospital, St Andrew’s Community Hospital and Changi General Hospital (CGH). Some 30 aphasia patients, mostly from SGH, have taken the test. The team hopes to test at least 120 more patients.

The test could also be useful for speech therapists in Malaysia, because of the cultural and other similarities between the country and Singapore. As it is a test for language and comprehension, it could be used to spot other conditions that affect language ability, such as dementia.

A significant number of stroke patients suffer from aphasia

"Language difficulties may occur if a stroke damages the brain’s left hemisphere, the part where most people’s language centre resides," says the Speech Therapy Department, Singapore General Hospital (SGH), a member of the SingHealth group.

Depending on the severity of the condition, known as aphasia, the patient may have problems understanding language, talking or expressing themselves in words, reading or writing. He may suffer from one, a combination or all of the functions.

To determine the type and severity of their condition, patients’ speech, voice and comprehension, as well as their ability to read and write, are evaluated.

Treatment will then depend on their needs and goals, and the severity of their condition. Some may suffer from mild symptoms, such as taking a long time to find the right words to express themselves, while others may experience more severe symptoms, such as not being able to vocalise their thoughts or being able to respond only by nodding.

Recovery depends on many factors, such as the severity of the stroke and the patient’s age. It is generally more difficult for older patients to make a full recovery.

About 30 to 40 per cent of stroke patients suffer from aphasia.


​Ref: Q24 (Edit)