|Year : 2017 | Volume
| Issue : 3 | Page : 217-219
Short version of the bilingual aphasia test in Malayalam
Gopee Krishnan, Reema Elizabeth Mathew
Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||10-Aug-2017|
Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Brain damage can impair the use of all languages in bilingual persons. For effective management of aphasia (i.e., impaired language) in such persons, assessment of all languages is essential. The most widely used test for this purpose – the Bilingual Aphasia Test (BAT) – is cumbersome and requires a considerable amount of time for administration. To overcome this limitation, a short version of the BAT has been recommended. Objective: The objective of this study was to derive a short version of BAT for Malayalam-English bilingual persons with aphasia and to establish the test–retest reliability as well as the content and construct validities of this version. Methods: Following the recommendations of the test developers, we used seven subtests from the draft of an adapted full version of Malayalam BAT. These subtests in Malayalam and their counterparts in English were administered on a group of 22 Malayalam-English bilingual participants with aphasia. The scores obtained from these two languages were used to establish content and construct validities of the short version of the BAT in Malayalam. Further, we readministered the short version of BAT in a group of ten participants with aphasia to examine the test–retest reliability within 14 days from the date of first administration. Results: The short version of BAT in Malayalam revealed high test–retest reliability as well as content and construct validities. The administration time ranged between 30 and 45 min. Conclusions: Thus, the short version of the BAT in Malayalam can be considered a valid and reliable language test that can be quickly administered in Malayalam-English bilingual persons with aphasia.
Keywords: Aphasia, bilingual aphasia, Malayalam, stroke
|How to cite this article:|
Krishnan G, Mathew RE. Short version of the bilingual aphasia test in Malayalam. Ann Indian Acad Neurol 2017;20:217-9
| Introduction|| |
Aphasia, an impairment in the comprehension and/or expression of language, is experienced by one in every three persons with brain damage. In persons who speak two or more languages (i.e., bi-/multilinguals), brain damage could compromise all languages. In a world that is increasingly becoming bi-/multilingual in nature due to many reasons, the impact of brain injury on communication skills of such people is tremendous.
Bilingual aphasia is no more a rare condition in clinical settings. In general, people use distinct languages in various communicative contexts. For instance, the language used at work may be different from that used at home, which in turn may be different from the language used in social circles. Thus, all languages together contribute to the overall participation in the day-to-day life of bi-/multilingual people. To appraise the real impact of aphasia in the daily life of bi-/multilingual persons with aphasia, assessment of deficits in each language is essential.,
Bilingual Aphasia Test (BAT) is the most widely used clinical and research tool to evaluate the language deficits in bilingual people with aphasia. It includes three parts. Part A surveys the language background of the patient as well as his/her family. Part B evaluates the performance of the patient on various domains of languages through comprehension and expression modalities. Part C assesses the patient's ability to translate from one language to another to judge the grammaticality of items in these languages. The BAT is currently available in seventy languages across the world. This test is adapted to most languages based on the cultural-linguistic background, rather than merely translated into this language.
Despite its widespread popularity, a potential limitation of the BAT is its long administration time. The administration time of BAT is about 75 min in neurologically healthy individuals. It rises manifolds in bi-/multilingual persons with aphasia, depending on various factors such as the phase of their disease (i.e., acute vs. chronic) and the number of languages under assessment., To overcome this limitation, Paradis and Libben  recommended the use of a shorter version of Part B of BAT comprising five broader components (viz., auditory comprehension, reading, repetition, naming, and metalinguistic ability) of this test.
The short versions of BAT are derived from the existing full version in several languages. Some of these short versions also provide the psychometric properties (e.g., Russian). The short versions of BAT are effective in categorizing patients based on the severity of the linguistic deficits. Further, Paradis  opined that Part B and the short versions of the BAT may be used as independent tests in those languages where no instruments exist for the assessment of linguistic deficits in persons with aphasia.
The BAT has been adapted to several Indian languages. While some of these Indian adaptations are available from the official website of the BAT (https://www.mcgill.ca/linguistics/research/bat), others remain largely unpublished and inaccessible.
The Bilingual Aphasia Test in Malayalam
About 30 million people in the state of Kerala, a Southern state of India, speak Malayalam. This language belongs to the Dravidian language family. Currently, two adapted versions of BAT exist in Malayalam. As mentioned in the foregoing section, these versions were developed by student trainees., The first version was pilot tested in a small group of bilingual persons with aphasia. The second version, however, was not clinically tested in bilingual populations. In this context, based on the proposal of Paradis and Libben, the present study focused on deriving a shorter version of the BAT from the more recent version of the test. This investigation was deemed necessary as linguistically oriented tools for the assessment of people with aphasia are lacking for the Malayalam language.
| Methods|| |
Twenty-two Malayalam-English bilingual participants (mean age = 47.13; standard deviation = 14.71 years) were recruited to the current study. All the participants were diagnosed with aphasia by a qualified speech-language pathologist using Western Aphasia Battery (WAB) (Malayalam version). All of them experienced stroke and aphasia at least 3 months before the current study. They consisted of seven persons with global aphasia, six with Broca's aphasia, four with anomic aphasia, two each with Wernicke's and conduction aphasia, and one with transcortical sensory aphasia.
We followed the proposal of Paradis  in the compilation of the short version of BAT in Malayalam. Thus, this version included (a) the auditory verbal comprehension, (b) reading, (c) repetition, (d) naming, and (e) metalinguistic abilities subtests from the full version of Malayalam BAT.
A qualified bilingual (Malayalam-English) speech-language pathologist administered the selected subtests of BAT in both languages within 2 days from the day of initiation of assessment. The administration and scoring of the short versions were in accordance with the guidelines for the selected subtests in the full version. In addition to the BATs, we administered the WAB in Malayalam  and English for the purpose of computing the construct validity.
The data obtained from the administration of the short version of Malayalam BAT were used to compute the test–retest reliability as well as the content and construct validities. Within 14 days from the date of initial assessment, the tests were readministered on a subgroup of ten participants to compute the test–retest reliability. We compared the performance of the participants on Malayalam and English short versions to establish the content validity. The construct validity was obtained by comparing the scores from the subtests that are common to BAT and WAB in Malayalam.
| Results and Discussion|| |
On average, the participants completed the short version of Malayalam BAT in 30–45 min. The administration time of the short version of Malayalam BAT was shorter compared to the similar versions of BAT in other languages. For instance, the administration time of Russian short version  ranged from 60 to 90 min in the clinical group. The longer administration time may partly be attributed to the presence of visually confusing stimuli in the Russian version. In addition to this, these authors incorporated modifications either in the contents or scoring of a few items from original (English) version, which in turn might have contributed to the prolonged administration time of the Russian short version. On the other hand, the Malayalam short version used the existing items from the previous full version in the same language without modifying their content or scoring. This might have resulted in the shorter administration time in the current study [Table 1].
|Table 1: Performance of the participants across the subtests of short versions of Malayalam and English Bilingual Aphasia Tests |
Click here to view
The interclass correlation coefficient (ICC) yielded very high correlations between the first and second administrations of the short versions of BAT in Malayalam (ICC = 1; confidence interval [CI] [95%] = 0.99–1.00) as well as in English (ICC = 1; CI [95%] = 0.99–1.00). Further, the performance of the participants on the Malayalam and English short versions of the BAT was compared to examine the content validity of the former test. The comparison did not reveal any significant difference between the scores from the two languages (Wilcoxon signed-rank test: Z = 0, P> 0.05). This, in turn, confirmed the linguistic equivalency of the short versions of Malayalam and English BATs. To examine the construct validity of the short version of Malayalam BAT, the composite (i.e., receptive and expressive) scores of the subtests that are common to the WAB and short BAT in Malayalam were compared. This comparison did not show any significant difference between the two tests (Wilcoxon-signed rank test: Z = −1.306, P> 0.05), indicating that the scores from the short version of Malayalam BAT are comparable to those of other similar tests in this language, which in turn, established the construct validity of the short version of Malayalam BAT.
| Conclusions|| |
The short version of the BAT in Malayalam is a valid and reliable language test that can provide a sufficiently detailed profile of the linguistic abilities in Malayalam-English bilingual persons with aphasia. The short version of BAT in Malayalam and its English counterpart facilitate quick and comparative assessment of the linguistic skills in Malayalam-English bilingual speakers with aphasia.
The authors thank Prof. Michel Paradis (the author of BAT) for his continuous guidance from the inception of this study to the final report preparation and peer-review stages. Further, they thank all the participants as well as their caretakers for the cooperation during the data collection phase and Mr. Nidhin for sharing the Malayalam version of BAT with the authors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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