Singapore hospitals to get locally-made aphasia tests

SINGAPORE — Two made-in-Singapore tests to assess language impairment in stroke patients will be made available to hospitals here.

One of them, the Singapore Aphasia Test (SGAT), is developed by a team of speech therapists at Singapore General Hospital (SGH). It is designed to provide speech therapists with a better understanding of the extent of language and speech problems in local stroke patients, a condition known as aphasia.

This aphasia tool is being tested in a multi-centre trial at various healthcare institutions, including SGH, National University Hospital (NUH), Changi General Hospital, Khoo Teck Puat Hospital and St Andrew’s Community Hospital. It is available in English and Mandarin.

The SGAT is expected to be commercially available to other hospitals as early as the end of next year, said Dr Valerie Lim, senior principal speech therapist at SGH.

Another local aphasia test in the pipeline is the National University Health System Aphasia Screening Test (NUHS-AST), developed by NUH speech therapists in collaboration with the department of psychology at National University of Singapore. It is expected to be commercially ready in approximately one to two years.

While the SGAT offers an in-depth assessment of the extent of the patient’s aphasia, the NUHS-AST screens stroke patients for the condition.

Available in English, Mandarin and Malay, the NUHS-AST can also be used to screen for aphasia in patients after a traumatic brain injury or in cases of brain tumours, said Ms Emily Guo, senior speech therapist at Department of Rehabilitation at NUH.

Screening can be completed in about 15 to 20 minutes, so the tool is useful when having to manage time constraints and patient fatigue, said Ms Guo.

CURRENT TOOLS NOT SUITABLE FOR NON-ENGLISH SPEAKERS

SGH and NUH see an average of 1,200 and 900 stroke patients, respectively, every year. The No 4 killer in Singapore, stroke is the leading cause of aphasia, which can occur when a stroke damages the left side of the brain.

About half of all stroke victims will suffer from some form of aphasia, said Dr Lim of SGH. “In the most severe forms of aphasia, some patients can’t speak or understand what you’re saying or follow simple instructions. If you show them a pen or a cup, they may not know what to do with it.”

The experts said current language assessment tools used by local speech therapists were developed in countries such as the United States, the United Kingdom and Australia, and are catered mainly for English-speaking patients.

“Those were not always suitable for our local population. There is also the issue of cultural differences, which could interfere with an accurate diagnosis,” shared Dr Lim.

Ms Deirdre Tay, principal speech therapist at SGH, added: “For instance, there was a picture of a pretzel used in one US test we previously used. Some patients were not able to name it accurately because they were unfamiliar with the food item and not because of their aphasia.

“In the SGAT, we’ve included illustrations that our local population is more familiar with. The test has helped us pick up language and speech deficits in patients more accurately.”

EARLY INTENSIVE TREATMENT IMPROVES RECOVERY

Catching aphasia early and offering appropriate treatment is critical for recovery. This is because patients usually improve the most within the first six months following a stroke, said Ms Tay.

She explained: “After a stroke, the brain typically undergoes some spontaneous recovery. The earlier we start treatment, the more time the patient has to learn to use other parts of the brain to re-learn certain functions that he has lost.”

Ms Guo added that studies have shown that intensive therapy over a short span of time has a greater impact on recovery, compared with less intensive therapy over a longer period.

More importantly, early assessment and intervention can help family members and caregivers understand what the patient might be going through, said Ms Tay.

Language is critical for a person’s socio-emotional well-being and communication, added Ms Guo.

She said: “People with aphasia are still able to think independently and are fully conscious of their needs, but have difficulty expressing themselves. As such, they might be at a higher risk of social isolation and depression. With adequate support, they are often able to communicate successfully even with their underlying language deficits.”