QAB Aphasia Bonus Episode

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[0:16] I'm Emily. And this is Eva. And you're listening to Speech Talk, where you're a research book club so you can do evidence-based practice in practice. So let's start talking. Hey, y'all. It's June, and it's National Aphasia Awareness Month. And could we even keep our licenses if we didn't do something to bring awareness to people about aphasia? Probably not. I don't think it. I think it's like an automatically revoked situation. And in case you need a refresher on aphasia, because all you've been doing is eating trials, here's a quick def from Asha. Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, typically the left hemisphere, that affects the functioning of core elements of language network. Aphasia involves varying degrees of impairment in four primary areas, spoken language expression, written language expression, spoken language comprehension, and reading comprehension. That was so beautiful. I'm still interviewing to be the next Siri.

[1:21] They really got to come up. Yeah, you're right. But in all seriousness, I really did want to do a research piece on aphasia because I feel like I've really lost a lot of my eval treatment skills with aphasia. We've recently had a few folks come in who were absolutely good candidates and it had just been so long that I really had to like take my time and like go back choose appropriate assessment methods make goals read some goal banks because I couldn't remember what good goals were, and then on top of that at my site our turnover is so fast I really struggled to come up with, like an appropriately timed plan of care and quick enough methods to assess aphasia that was better than some of my quick and dirty screens that I do. And I felt a little bit like I let those patients down. So Emily really came through and found this great article that has convinced me to start using the quick aphasia battery or the, Qwab. Q-A-B. Qwab. Qwab, Qwab. So the research we looked at, A Quick Aphasia Battery for Efficient, Reliable, and Multidimensional Assessment of Language Function by Lucienne et al.

[2:48] You got it. Maybe. I apologize. We tried to Google your name, but I apologize if it's not right. Truthfully. But the paper was great. The paper essentially is a complete breakdown in the usage of the quick aphasia battery and a description of how and why it was made. Yeah, it was actually built for researchers who are working with aphasia and follows key elements of currently validated aphasia batteries. In particular, it draws a lot from the web, but is completed in a fraction of the time. And what I loved was that the researchers' needs seemed to really reflect our own needs. having patients who can't tolerate long tests. Hello, dementia, you know, or people who are in chronic pain. Not necessarily knowing the patient well. Oh my God, do I not get any materials from like the hospital about speech docs? So some of the things that the researchers seem to need were exactly what I was thinking of when I'm like, There's no way my patients are sitting for a long aphasia test. That's not happening. Also, I don't have the time. I don't got like four hours to bill for an eval. Get out of here. That's like my New York vibe. I'm like, get out of here.

[4:02] Slams hand on desk instead of taxi. I can't be giving an eval that long. I digress. So in the introduction, here's how it describes the three criteria they use for building the assessment. They're looking for something that was time efficient and easily administered at bedside, having good inter-rater reliability, and it should show a multi-dimensional look at spared and impaired language. All right. So we have to, there's eight pieces that we have to break this down. Ready? I just need like a, I have to like. Like a drum roll, like a. Are you ready for these eight subtests? We have level of consciousness, connected speech, word comprehension, sentence comprehension, picture naming, repetition, reading aloud, and motor speech. Well done. So each subsection has a series of questions to ask the patient, including graded answers. That means if they can't get the answer right, they give you specific cues to follow. So you're not just like, uh, they said, when they were supposed to say, no, what do I do? No, then it tells you if the answer is incorrect or missing, then go to this part, this part, this part, and then move on.

[5:20] So then there's answers are scored from zero being the lowest and four as the highest. Yeah. And I really like this because, you know, I think our patients deserve credit for whatever communication capacities they have. So, for example, if even the first section, which is level of consciousness, if a patient is rousable, but they can't stay awake.

[5:46] There's two points for that, and it tells you whether or not to proceed or not to proceed in this section. And what I really appreciated is that is a real issue I run into. Like I go into a patient's room and they're asleep. I'm like, hello, Ms. Smith. I'm your speech therapist. No movement. Do a little arm rub. Hi. Increases volume. I'm your speech therapist. Moving on to sternal rub. We're like now shaking Ms. Smith. Like, hi, I'm your speech therapist. And she's like, opens her eyes. It's like, oh, it's nice to meet you. And then three minutes in, she's asleep again. So that's like not a good way for me to be assessing her language. But because they factored this into the evaluation format, I think it gives us a structured way to comment on it and how alertness and other behavioral factors contribute to our capacity to evaluate patients. Or maybe a reason to be like, gotta eval on another day. Turns out Ms. Smith literally cannot keep her eyes open.

[6:52] My favorite way to wake up like a dead patient is to just like push the bed, like button and like slowly rise them until they're at 90 and i'm like hello.

[7:03] Good morning that's hilarious it's like when i'm waking up my kid in the morning she doesn't want to get up and i just turn on all the lights and leave the door open and start cooking and be like someone's gonna get you up i don't know if it's the sound of me cracking eggs loudly or the lights from the hallway, but you're getting up. Although on the subject of waking up patients, my personal, personal favorite is when they pretend to sleep and then like open an eye to see if you're still there.

[7:33] It's so silly. And they do it all the time. I don't know. All the time. That's one of like the silliest things. I'm like, all right, Mr. Jones, I get it. I can take a hint. I get it. You don't want to talk to me. You and all my other caseload. The next subtest is connected speech. So personal conversation.

[7:58] And it leads you to a connected speech feature chart. And I like this one because they give you a set of eight questions up at the top to provide something to start a conversation. Yeah, like, what was your favorite childhood holiday? Yeah, tell me about when you got married. It's just like cute little questions. It's like, ooh, icebreaker time. Yeah, it's just great because we do need to break the ice with our patients. And having that gateway to naturalistic conversation and not just naturalistic, but personal conversation is such a great thing to build into an evaluation. I really liked it. I know. I liked it. I once had, I was giving the QAB and I had a sister. The quab? The quab. Quab. I was giving this test and the family was in the room and I was trying to do one of those prompts. And I was like, tell me about when you had your kids. And one of the family members chimes in. She goes, no, tell her who your favorite child is. And I'm like, that's not. Is it you? Do you want the name drop? You may stay for the evaluation, but shh.

[9:14] And I said, no, Pucky. I got a whole bag of shh with your name on it. Anyways, what's the next subtest? Word comprehension. So this is where there's a chart with, I think it's like a field of six pictures, and you say, show me the blank. And what's cool is that within that field are other pictures that have either semantic or phonetically similar pictures. Images. So like goat and coat would be our phonetic. And then once it's like a violin and a trombone, obviously they're semantically related as instruments. And so even if they're getting it wrong, they can still get points for being within the ballpark of semantic and phonemic opportunities.

[10:00] And so again, even though they're not getting the right answer, they're getting points and we're starting to understand to get a more nuanced picture of what they're expressive in, receptive language is looking like, which for us clinicians is like the best thing. This is your first opportunity in this test too, to have the patient looking at something solid. So there's two sets of three pictures, there's left, center, right. So if you notice that they're not paying attention to the left or right side, this is our first ability to see whether or not some kind of visual neglect situation might be happening. The next section is sentence comprehension. So this is a yes, no format going from really easy questions like, am I a man? Who knows? Yes. Yes, you are, Emily. You're a strong, independent man.

[10:54] So sentence comprehension. So it goes from super easy questions all the way, like very direct questions. Like, is bread delicious? Yes. To very difficult questions. Like if I say I'm going to meet you at the park later, am I already at the park? Causing them to really have to think about the nuances of those sentences. Yeah, which I like because when we're doing like the net health eval portion and you have to comment on their ability to respond to yes, no, Moira is a little hesitant because on the one hand, people can do yes, no really well for is the door open? Is it daytime? But then you start asking the more complex questions throughout your time with them, and it's really breaking down. So I love watching the complexity of yes-no increase, because I think it tells us a lot about even the most basic form of response, yes-no. So picture naming, that's next. They get to label pictures. And what I really liked about this subtest is because I think it's a good indicator for whether or not they can use a communication board.

[12:07] You're looking at their ability to see an image and correctly label it. If they do well on this, to me, that's like an indicator that next session, let's get out the comm board and see if this is going to help you improve your communication with your caregivers. And AAC. Oh, yeah. So, like, if they do really good on this one, my next session is the Lingraphica. There's, like, a testing app on Lingraphica that automatically starts a process for AAC. So even if they, you know, get really great language down the line, like, this will help bridge the gap for that, too. Man, you always know the apps. Gotta get them. My man. A tablet. I swear. It's everything. And that one's quick, too. They're a different podcast. But the next one they're going into is repetition. So, can they repeat back the words that you are saying to them? And it goes from single words all the way to long sentences. And this is.

[13:06] Don't shoot the messenger, but this is kind of where I tend to fall off on the QAB. I especially depend like if their impairment is pretty severe. If they're not able to say back one to two words, call in it. I'm ending that section. We're just going to go ahead and fill that sucker up with zeros because I'm not going to force you to. Okay, repeat me. the blue I forget the sentence I really loved the enthusiasm with which though you were like I'm going to come up with a sentence and not.

[13:44] Another another take on it is I if they are good with repetitions I think this is a great opportunity for scripting if they have other expressive language impairments so somebody who can repeat a lot but is not good at independent expressive language we can start doing repetitions for like hi my name is so and so I have aphasia. You know, I need the bathroom or whatever other phrases are you agree with your patient are important for them being able to navigate either their time and facility, communicating with their caregivers or, you know, goals for communicating with family. And kind of similarly, like for reading aloud, I think that, which by the way is the next subtest, is a great way that like if you're saying that they're doing good reading, great, let's like come up with some phrases that they can read, and maybe you can have an icon next to it, like, toilet icon phrase says, I need to use the bathroom, or I need to be changed, whatever is like appropriate for their toileting abilities. They can read it. If they can't come up with it, they can find the sentence that's appropriate and.

[14:52] Communicate their needs. Beautiful. Yeah. And that makes it a lot easier for like nursing and AIDS to just help them. Yeah, definitely. And then the last section, we made it all the way to number eight, our motor speech. They have you do like verbal agility and just range of motion tests and just to kind of tease apart the dysarthria, the possible apraxia, just to make sure your treatments are 100% aligned with aphasia because they can look a little bit similar, but they're definitely very different. And it makes you do it.

[15:32] Honestly, I don't do a lot of motor speech. Usually I just feel like I don't have time during evaluations. And then NetHealth always wants me to comment on motor speech and I'm always like, did not test because I don't do all of the things in that section and they are all mandatory for commenting if you did do motor speech. So the fact that it makes you do the patika and there's like a sustained awe that I can count and so on and so forth. I'm like, all right, I should be doing this anyways. So it makes me do the motor speech. I guess I got to fill it out. Whatever. Thanks for reminding me. Yeah, exactly. Um, and I mean, the reality is that like, I just don't see that many, like a motor speech impairments. I'm always like, who cares? But we should, cause like clinicians should care about everything. I know. I mean, but to that point, a motor speech impairment seems, I mean, it's a little off topic, but motor speech is always like, yeah, they have like weakness and we can over articulate, but they're just going to tease me when I try and target this. Like, you want me to talk like this? Yes. Actually, I do want you to talk like this. Just leave your lips in a poker for a long time while we say shushy sounds.

[17:02] Yeah, for real. I'm like, you're kidding. Anyways, I digress. Moving on. So was there research, did they deem the QAB to be effective? And the answer magnificently is yes. Ding, ding, ding. Okay. It showed that patients with a variety of aphasia profiles were, one, correctly diagnosed with aphasia, and two, had test results that matched their aphasia type. There were, along the way, a couple of misdiagnoses, but these patients were years post-stroke and had almost completely regained their language function to the point where only extended conversation really revealed those impairments. So I feel like it doesn't count.

[17:47] As you can tell, I'm already making excuses in favor of the test because I like it so much now. I know. I was just thinking like, how funny would it be if we did a deep dive on one of these articles and we got all the way to the end? And we were like, this enthusiastic. Was it effective? No. Forget everything that we just told you. Yeah. But it was. And they had limitations. For one, writing. As we stated and Asha reminds us, writing is a part of communication. So maybe include an informal thing. Just have them write their name. Write some automatics. A note section at the bottom, which is meant for the clinician. But it's also just a great little spot to be like, write a sentence. Choose a sentence. You write something down here. So you can work it in. Right. That's not that hard. And then there's a six second response time. So you give the patient six seconds to respond and then you got to move on.

[18:47] This kind of allows us to understand some response time, some auditory processing delays, maybe just to better prepare caregivers around to allow this person more time. So while it is a limitation, it limits people's scores. It also provides a lot of education, which I think is good. Yeah, definitely. I mean, they make it really clear that the six second response time is to help this be a really quick assessment. They're like, again, you want that 15 minute, like that quarter of an hour goal, that 15 minute goal. So you can technically move on after six seconds, but, you know, doing dynamic testing.

[19:26] See if they get it after 10 seconds. Do they get it after 20 seconds? And as what Emily was saying, that can then be a way in which we inform caregivers. Because I have a lot of people come up to me and be like, this person can't respond. And I'm like, did you try counting to 10 in your head? Because in real-time conversation, it can feel like forever for someone to respond if you are not expecting an auditory processing delay or an expressive aphasia where people are struggling to come up with a target word. And just reminding people that time is super important. Time is a good accommodation tool. Yeah. And the last limitation they talked about was minimal detail. And I'm like, meh, I think I like, I don't know if this is like a complex or something or like can't brag about yourself, but like, girl, you're good. Like, I like you. Like, like, let's hang out. I think your details good. Like, I'm enjoying what you're putting out.

[20:26] Emily is like trying to flirt with this test at a bar. It's like, girl, you're good enough. I'd also like to see you on the weekend. um but also it to that point like I've been doing the MS aphasia screen as my quick test and it is truly bare bones I mean the language profile I feel like I can describe after doing the MS aphasia screen is the bare minimum and this by comparison just gave me so much detail film and actually I like totally did the collab for the first time today.

[21:03] I was very inspired by our research project and I tried it out and I felt like I could really thoroughly comment on my patient's communication skills and that was just such an incredible feeling when after like the MSF Asia screen I still felt so in the dark about what my patient was capable of doing. I love that as we're growing as clinicians, because we're still baby speech, that we're still learning about things and we're bringing those things to you. This test is seven years old. So it's cool, though, because we're new speechies. Eva, this is only the first time you've done the QAB. I've ran this test at least four or five times. So I think it's fun that even though this is not a new test, it was made in 2018, it's new to us. So we can be excited and our listeners can be excited with us and learn with us. Yeah. And I've been in a few different speech departments and a lot of times I'm like, all right, where are the exams? And they're like.

[22:11] Whatever you have is what you have. And so, you know, my exposure to different types of evaluations and assessment methodologies has been fairly limited because if I'm not doing it at work, I have to do my own time. And being hashtag a mom, there's not a lot of my own time. So I'm glad we found it. Speaking of time, when giving the QAB, the part that typically takes the most time is the scoring. For me, it's because of the transcription part. Like I'm really going, I transcribe everything that my patients tell me when I'm giving the QAB. So I go back through all my scoring just to double check that I can't give them an extra point here or there. And these beautiful, these lovely, gorgeous, wonderful authors provided not only the QAB to us for free, but they also gave us a scoring guide for free. So you literally plug in the numbers into the spreadsheet and it gives you their scores, like all tallied up, totaled, and perfect. Which I did not know about. And I definitely spent like an extra 20 minutes panic reading the internet being like, I finished this assessment. How do I score it?

[23:34] And it turns out Emily had the answer all along. I should always ask Emily before I have any like major difficulties, what I should do.

[23:42] Always here for you. Aww. So applying that research, we are looking at screen versus evaluation. And this test really bridges that gap between something that's quick, but something that's pretty powerful. It gives us a lot of information. Yeah, it's a little bit rough, but frankly, it gives us a really detailed linguistic profile of our patients, given the amount of time you have to spend on it. And I think the subtests translate really well into goal writing. I mean, think about it, word comprehension, these are the errors, boom, goal. Repetition, they can do it or they can't do it. They can't do it, let's maybe try it out, boom, goal. So super effective in terms of translating to therapeutic objectives. Boom.

[24:33] And it's free. It's free. I wanted to get the click at work. That's not happening. That's a $300 test. Nobody buying that for me. Nobody's, they're not, they're buying nothing. Yeah. Free money. That's great. We love everything about this test. Yeah. And we hope you do too hit double thumbs up from eva and emily and now to wrap up you guys stay curious and stay caffeinated thanks for listening.

[25:04] You've been listening to Speech Talk. Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research. If you like this episode and you want to give us some love, please rate us on your favorite podcasting app. Leave a review and tell the world, because as podcasters, our love language is in positive affirmations. If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, Send us an email at hello at speech talk pod dot com. If you want even more speech talk content, check out our website at speech talk pod dot com, where you can find all of our resources we made for you. Copies of articles covered and Eva's blog following these topics and more. We're your hosts, Eva Johnson and Emily Brady. Our editor and engineer is Andrew Sims. Our music is by Omar Benzvi. Our executive producers are Erin Corney, Rob Goldman, and Shanti Brooke. To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers. Speech Talk is a proud member of the Human Content Podcast Network.

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