Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach

Introduction

Aphasia, a language impairment impacting one's comprehension and production in spoken or written modality, is present in about one-third of the post-stroke population. People with aphasia (PWA) have difficulties in producing spoken discourse in various daily situations, impacting their participation in social/vocational contexts. The ability to communicate in different real-life contexts is regarded as one of the most important treatment goals in PWA. Therefore, there is a pressed need to develop ecologically valid assessment and treatment tools at discourse level.

Several assessment tools for measuring functional communication, based on discourse production in real-life contexts, have been developed for research or clinical purposes. Examples include the Communication Activities of Daily Living (CADL) and the Amsterdam-Nijmegen Test for Everyday Language (ANELT). Among these assessment tools, ANELT evaluates functional communication via monologic discourse production. In the original Dutch version of ANELT, 20 daily life scenarios tapping PWA's verbal responses are included, with standardized procedures, normative data, and two parallel versions, each consisting of 10 scenarios. Sample scenarios include, "You are now at the dry cleaners. You have come to pick this up and you get it back like this [present shirt with scorch mark]. What do you say?" and "The kids on the street are playing football in your yard. You have asked them before not to do that. You go outside and speak to the boys. What do you say?". These scenarios resemble realistic everyday communication situations in which monologic discourse is elicited from the PWA to fulfill different naturalistic communication goals in a conversation, such as to request, inform, instruct, or persuade the listener (in this case, the experimenter). Therefore, ANELT is also regarded as a test for verbal functional communication, the ability to convey ideas independently and effectively in everyday communication contexts.

Scoring of traditional ANELT is qualitative, based on two scales: Comprehensibility A-Scale and Intelligibility B-Scale. A-Scale refers to the content of the message conveyed by the PWA irrespective of its linguistic form, whereas B-Scale examines the perception of the utterance in such a way that words are recognizable regardless of their meaning. A five-point rating ranging from very good to very bad is used by the administrators based on their subjective judgment. With satisfactory internal consistency, test-retest reliability, and inter-rater reliability of A-Scale as established by the developers of the test, they suggested ANELT be used as a reliable and valid assessment of the verbal adequacy of the PWA.

For speakers of Chinese or Cantonese, standardized assessments on functional communication available for PWA in clinical or research contexts are rather limited. The Cantonese translated version of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA-FACS) has been developed and validated to evaluate PWA's communication independence and qualitative dimensions of communication based on clinician's observations in various naturalistic settings via a scale from 1 to 7. However, such detailed assessment is challenging in the local hospital setting, where only a 30-minute session for aphasia evaluation is allowed. Another available standardized assessment, the Main Concept Analysis (MCA) for oral discourse production, measures the informativeness and efficiency of verbal discourse production based on sequenced pictures. Nevertheless, the context (i.e., sequenced pictures) may not be naturalistic/typical in everyday communication. Doedens and Meteyard suggested that the "move from an in-vacuo task to a situated task" is necessary for functional assessment of PWA.

With regard to the lack of functional communication assessment to accommodate the above-mentioned limitations in rehabilitation settings in Hong Kong, an initiative to translate and develop a culturally appropriate ANELT in its Cantonese version was done by Law and Lo. They took into consideration the quantitative scoring system proposed in Ruiter et al, as it is argued that a quantitative measure is more sensitive in detecting language performance over time among PWA. In Law and Lo, speakers' performance was evaluated based on the number of content units (CU) produced. CU is defined as "a group of information that was always expressed as a unit by normal speakers." However, a closer examination of the word lists generated from such a criterion revealed that it consisted of many function words, including "then," "is," which are non-specific to the scenarios and contribute little to the informativeness of the messages conveyed. Moreover, the open-ended nature of the scenarios presented in CANELT has resulted in high variability in plausible responses, which may not be included in the pre-compiled and restricted word list suggested. For example, in one scenario, speakers were asked to give verbal expressions on how they would order a flower/fruit basket; acceptable

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