Dear Editor,
Stroke is a major cause of disability in adults worldwide. Studies have shown that between 20% and 38% of acute stroke survivors will experience aphasia (1). Aphasia is a linguistic disorder that damages comprehension, reading, writing, and speaking skills (2). It is very difficult and challenging to identify the aphasia in the acute phase of stroke (3). Thus, quick and easy to administer tools for screening stroke survivors are required to identify aphasia to make a decision to apply early interventions. Formal screening or bedside clinical assessments are frequently used to make an early diagnosis of aphasia, usually performed by health professionals, especially physicians, nurses, or speech-language pathologists. It is essential to use valid and quick screening tools to accurately and quickly diagnose aphasia and apply rehabilitation techniques to prevent complications such as aspiration (4). Most of the tools available to screen aphasia are not quick and easy to administer for stroke survivors in the acute stage.
There are many tests for the diagnosis of aphasia in stroke (5), but they take time to administer and thus are not suitable for bedside assessments in the acute phase of stroke. It follows that quick and easy to administer screening tools are required. The Language Screening Test (LAST), developed in French by Flamand-Roze (cited in Rohde et al.), is a useful clinical tool for early screening and detection of aphasia in the acute stage of stroke (5). It can be easily and quickly administered (~2 minutes) in the early stage of the stroke onset. The validated LAST comprises 5 subtests and 15 items with the expression index of 3 subtests and 8 items (Total score = 8) and receptive index of 2 subtests and 7 items (total score = 7) (6).
There are German (7), Chinese (8, 9), and English (4, 10) versions of LAST, whose reliability and validity are confirmed in line with the original French version. There are no valid tools in Persian to administer quickly for early detection of aphasia in the acute phase of stroke. A review of 11 tools indicated that LAST was the most accurate and rapid bedside tool for aphasia screening (10). Considering the usefulness of LAST, it is important to cross-culturally adapt it into Persian and determine its psychometric properties for use as a bedside screening tool to early diagnose aphasia in stroke survivors. The availability of the Persian version of LAST would help the clinicians in Iran and Persian-speaking countries to apply the early medical and rehabilitation interventions to prevent serious complications such as aspiration pneumonia. The availability of the Persian version of LAST will enable the Persian-speaking clinicians to provide early care after the stroke onset and participate in international research projects that use LAST as the main outcome measure.
References
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1.
Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil. 2010;91(2):196-202. [PubMed ID: 20159121]. https://doi.org/10.1016/j.apmr.2009.09.020.
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2.
Hallowell B, Chapey R. Introduction to language intervention strategies in adult aphasia. Language intervention strategies in aphasia and related neurogenic communication disorders. 5. 2008.
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Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord. 2013;46(3):238-48. [PubMed ID: 23642855]. https://doi.org/10.1016/j.jcomdis.2013.04.001.
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Flowers HL, Flamand-Roze C, Denier C, Roze E, Silver FL, Rochon E, et al. English adaptation, international harmonisation, and normative validation of the Language Screening Test (LAST). Aphasiology. 2014;29(2):214-36. https://doi.org/10.1080/02687038.2014.965058.
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Rohde A, Worrall L, Godecke E, O'Halloran R, Farrell A, Massey M. Diagnosis of aphasia in stroke populations: A systematic review of language tests. PLoS One. 2018;13(3). e0194143. [PubMed ID: 29566043]. [PubMed Central ID: PMC5863973]. https://doi.org/10.1371/journal.pone.0194143.
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Flamand-Roze C, Falissard B, Roze E, Maintigneux L, Beziz J, Chacon A, et al. Validation of a new language screening tool for patients with acute stroke: the Language Screening Test (LAST). Stroke. 2011;42(5):1224-9. [PubMed ID: 21487118]. https://doi.org/10.1161/STROKEAHA.110.609503.
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Koenig-Bruhin M, Vanbellingen T, Schumacher R, Pflugshaupt T, Annoni JM, Muri RM, et al. Screening for Language Disorders in Stroke: German Validation of the Language Screening Test (LAST). Cerebrovasc Dis Extra. 2016;6(1):27-31. [PubMed ID: 27194999]. [PubMed Central ID: PMC4868943]. https://doi.org/10.1159/000445778.
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Yang H, Tian S, Flamand-Roze C, Gao L, Zhang W, Li Y, et al. A Chinese version of the Language Screening Test (CLAST) for early-stage stroke patients. PLoS One. 2018;13(5). e0196646. [PubMed ID: 29727462]. [PubMed Central ID: PMC5935384]. https://doi.org/10.1371/journal.pone.0196646.
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Sun M, Zhan Z, Chen B, Xin J, Chen X, Yu E, et al. Development and application of a Chinese Version of the Language Screening Test (CLAST) in post-stroke patients. Medicine (Baltimore). 2020;99(37). e22165. [PubMed ID: 32925781]. [PubMed Central ID: PMC7489636]. https://doi.org/10.1097/MD.0000000000022165.
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Flowers HL, Casaubon LK, Arulvarathan C, Cayley A, Darling S, Girma N, et al. A Feasibility Study Involving Recruitment and Screening for Aphasia in Acute Stroke: Emerging Viability of the English Adaptation of the Language Screening Test (LASTen). Arch Rehabil Res Clin Transl. 2020;2(3):100062. [PubMed ID: 33543088]. [PubMed Central ID: PMC7853348]. https://doi.org/10.1016/j.arrct.2020.100062.