Videoconference Administration of the Western Aphasia Battery cont'd

Figure Legends Figure 1: Counterbalance schema for WAB-R administration Figure 2. Adaptations of stimuli for videoconference administration of the WAB-R A. Written word-object choice matching B. Picture-written word choice matching Figure 3: Satisfaction Survey Results Comfort with technology use prior to the experiment B. Overall satisfaction with the videoconference assessment C. Rating of audio quality for video assessment D. Rating of video quality for video assessment: Survey results demonstrate comfort and overall satisfaction with the technology used during the videoconference and overall assessment experience. Appendices: Appendix A: Modifications for Videoconference Administration Appendix B: Clarifications to WAB-R Scoring for Inter-Rater Consistency within this Study Appendix C: Clarifications to WAB-R Administration for Inter-Rater Consistency within this Study Appendix D: Administration Fidelity Checklist Supplemental material: S1: WAB Validation questionnaire S2: Caregiver Testing Guidelines 23 Figure 1 Figure 2 Figure 3 Table 1 Table 1: Demographics M SD Age (years) 55 13.81 Education (years) 16 3 MPO* 67 49 Sex (M/F) 13/7 N/A Handedness (R/L) 18/2 N/A Etiology: Left-hemisphere stroke (N=17), TBI (N=2), Stroke + TBI (N=1) *Months post onset (Stroke/TBI) Table 2 Table 2: Intra-Class Correlations and T-Test Results In-person Videoconference ICC t-test r p Mean SD Mean SD WAB-AQ 68.11 22.17 68.75 22.68 0.989 0.403 WAB-LQ 67.95 21.19 68.42 21.32 0.993 0.401 WAB-CQ 71.35 18.85 71.38 19.36 0.993 0.943 Table 3 Table 3: AQ, LQ, and CQ for In Person and Videoconference Administrations Participant AQ LQ In Person CQ Aphasia Type Anomic Broca's Anomic Anomic Broca's Wernicke’s Anomic Conduction** Wernicke’s** Broca's Conduction Anomic Broca's Anomic** Anomic Anomic Anomic Anomic** Anomic** Broca's AQ Videoconference LQ CQ Aphasia Type 91.60 91.93 Anomic 39.80 48.98 Broca's 96.30 96.72 Anomic 74.60 78.92 Anomic 38.20 45.82 Broca's 48.00 47.53 Wernicke's 69.70 75.88 Anomic 74.30 76.60 Anomic** 56.40 63.18 Conduction** 65.60 69.90 Broca's 76.90 76.83 Conduction 94.40 93.42 Anomic 29.80 36.83 Broca's 70.10 71.37 TS+** 94.10 94.13 Anomic 83.20 87.90 Anomic 90.70 88.72 Anomic 69.6 74.47 Conduction** 72.90 73.82 Conduction** 32.20 34.72 Broca's Change AQ Change LQ 1 89.90 90.90 91.00 93.20 3.30 0.70 2 44.60 44.60 53.80 39.20 5.40* 4.80 3 98.20 94.40 95.53 98.10 0.10 1.90 4 84.10 74.10 76.42 85.40 1.30 0.50 5 37.80 36.70 45.07 40.40 2.60 1.50 6 49.80 47.10 48.28 49.30 0.50 0.90 7 73.60 66.20 74.08 76.90 3.30 3.50 8 74.40 74.70 77.00 74.60 0.20 0.40 9 56.20 56.20 62.38 57.80 1.60 0.20 10 51.00 65.30 68.28 54.40 3.40 0.30 11 72.60 74.80 74.87 75.20 2.60 2.10 12 94.00 93.50 93.62 94.20 0.20 0.90 13 27.80 26.80 35.77 28.40 0.60 3.00 14 71.80 73.00 74.17 71.10 2.70 3.90 15 93.00 94.70 94.58 91.70 1.30 0.60 16 89.50 83.30 87.70 90.20 0.70 0.10 17 80.90 84.60 84.32 89.60 6.70* 5.10* 18 69.10 72.10 76.05 69.2 0.10 2.50 19 77.40 75.40 78.27 69.80 7.60* 2.50 20 26.50 30.60 35.75 26.20 0.30 1.60 + Transcortical Sensory * Participants who showed more than 5-point change on the AQ and LQ between time point 1 and time point 2 ** Participants whose aphasia type changed between time point 1 and time point 2 Change CQ 0.93 4.82 1.19 2.50 0.75 0.75 1.80 0.40 0.80 1.62 1.96 0.20 1.06 3.80 0.45 0.20 3.40 1.58 4.45 1.03 Table 4 Table 4. Order of administration and administrators for each participant Participant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 First administration in person videoconference videoconference in person in person videoconference in person videoconference videoconference in person in person videoconference in person in person in person videoconference videoconference in person videoconference videoconference Administrator 1 Administrator 2 Administrator 1 Administrator 2 Administrator 1 Administrator 1 Administrator 2 Administrator 2 Administrator 3 Administrator 3 Administrator 1 Administrator 1 Administrator 2 Administrator 1 Administrator 3 Administrator 1 Administrator 1 Administrator 3 Administrator 3 Administrator 1 Administrator 1 Second Administration videoconference in person in person videoconference videoconference in person videoconference in person in person videoconference videoconference in person videoconference videoconference videoconference in person in person videoconference in person in person Administrator 2 Administrator 2 Administrator 1 Administrator 1 Administrator 1 Administrator 2 Administrator 1 Administrator 1 Administrator 1 Administrator 1 Administrator 3 Administrator 3 Administrator 1 Administrator 2 Administrator 1 Administrator 2 Administrator 2 Administrator 2 Administrator 2 Administrator 2 Administrator 2 Appendix A: Modifications for Videoconference Administration Section Conversational Questions Picture Description Yes/No Questions Auditory Word Recognition Modification If clarification needed, refer to clinician’s location [i.e. have you been here (in my office) before?]. Share screen with patient and provide instructions from record form. 10. Are the lights on in this room? If clarification needed, refer to clinician’s location. (i.e. “are the lights on in MY room”; “is the door closed in MY room”). 11. Is the door closed? Make sure the camera is positioned so the patient can see the door in the clinician’s room. Share screen and controls. Ask the patient to move the mouse to point to the objects displayed on the screen. Provide instructions from record form. Items 37-42: “Desk/bed” can be replaced with “table” if necessary. “Door” can be replaced with “floor” if necessary. Sequential Commands Object Naming Comprehension of Sentences Items 54-60: “Left knee” has been replaced with “left eyebrow” and “left ankle” has been replaced with “left eye.” 4. “Point to the window, then to the door”. Can be replaced with “point to the floor, then to the ceiling” if needed. Make sure the patient has the book, pen, and comb on the table, and ask the patient to align them in front ofhim/her. Ask the patient to position the camera so you can see their manipulation of objects. If needed, ask for caregiver assistance for accurate set-up. Show the objects in front of the camera. Tactile cues cannot be provided. Share screen and controls. Reading Commands Ask the patient to move the mouse to point to the words displayed on the screen. Provide instructions from record form. Share the screen and ensure you can see the patient at the same time. Provide instructions from the record form. The command “draw a cross with your foot” has been replaced with “draw a cross with your finger”. Written Word-Object Choice Share screen and controls. Matching Ask the patient to move the mouse to point to the objects displayed on the screen. Provide instructions from the record form. Written Word-Picture Share screen and controls. Choice Matching Ask the patient to move the mouse to point to the objects displayed on the screen. Provide instructions from the record form. Picture-Written Word Share screen and controls. Choice Matching Ask the patient to move the mouse to point to the objects displayed on the screen. Provide instructions from the record form. Writing Output Share screen with patient and provide instructions from record form. Writing Dictated Words Alphabet and Numbers Dictated Letters and Numbers Copying a Sentence Drawing Screenshot the patient’s output to save for scoring. Show the objects in front of the camera when needed. Screenshot the patient’s output to save for scoring. Screenshot the patient’s output to save for scoring. Screenshot the patient’s output to save for scoring. Share screen with patient and provide instructions from record form. Screenshot the patient’s output to save for scoring. Share screen with patient if needed to provide cues. Block Design Calculation Raven’s Coloured Progressive Matrices Screenshot the patient’s output to save for scoring. Share the screen and ask the patient to have the Koh’s blocks in front of him/her. Make sure the camera is positioned so the patient can see the Demonstration Item. Ask patient to position the camera so you can see his/her manipulation of objects. Depending on the type of webcam the patient is using, he/she may need to switch back and forth to be able to see the stimulus on the screen while completing the figure and then show the completed response. If needed, ask for caregiver assistance for set-up. Share screen and controls with patient. Provide instructions from record form. Share screen and controls with patient. Provide instructions from record form. Appendix B: Clarifications to WAB-R Scoring for Inter-Rater Consistency within this Study Section Question Conversational All Questions Scoring Rule Accept paraphasic errors if they are easily recognizable. Example/ Exception Exception: 4. What is your full address? Consider if you would be able to send a letter based on what the patient said. If the answer is no, do not accept it. Sequential commands Raise your Must raise one hand, score 0 if hand patient raises both hands. Shut your eyes Must shut both eyes for an extended period of time. Do not accept blinking. All No partial credit given in this section (i.e. score for #5 can be 0, 2, or 4). All No credit given for reversing command. 1. “Point to the pen” receives a score of 2 if the whole command is performed, would not receive 1 point for just pointing. 8. “Point to the pen with the comb.” If patient points with the comb to the pen, he/she would receive a score of 0. Repetition All Phonemic paraphasia defined as one phoneme in error or one consonant cluster in error. 13. “Deliciously fresh baked bread” Total score: 4/8 (Target: “Delicious freshly baked bread”) Object Naming All Word Fluency Reading Commands All Phonemic paraphasia defined as one phoneme in error or one consonant cluster in error. If phonemic paraphasia after cueing, score 0. There can be more than 1 phoneme in error as long as the animal is recognizable. If the patient gives you the category of the item as well as items in the category, count both the category and the items in the category. 5. Point to the Per manual, score “then to the chair and then door” as the underlined section. to the door Patient must read and perform full command to get full credit. “catsen” for cat “bird, parakeet, sparrow, seagull” Total points: 4 Patient read: “Point to the chair and open the door” Reading Score: 1/2 Patient pointed to the chair and opened door Command Score: 1/2 Writing Upon Request All Score 1 point for each section (cannot get full credit if not all elements are included): Writing Output All § § § § § § § § § § Writing to Dictation Apraxia All 2. Salute 9. Pretend to sniff a flower 10. Pretend to blow out a match 11. Pretend to use a comb First name Last name Street number Street name City State Scoring up to 10 points applies only to single words. Words in short sentences count until maximum of 34. Do not count perseverations as multiple points. Take off 0.5 for spelling, morphosyntactic and paraphasic errors in written output “the the the dog” (only count 1 “the”) “The boy is fly the ky” Total score: 7 (complete sentence .5 paraphasic error .5 morphosyntactic error) If patient writes ‘5’ instead of ‘five,’ give a point in this section. Patient does not have to release the salute for full credit. Patient does not have to imitate holding a flower for full credit. Patient does not have to imitate holding a match for full credit Patient’s hand cannot function as object. Exception: Pretend to make a phone call, hand can function as phone 12. Pretend to use a toothbrush 13. Pretend to use a spoon to eat 16.Pretend to start and drive a car 18.Pretend to fold a sheet of paper Patient’s hand cannot function as object. Patient does not have to open mouth for full credit. Patient does not have to open mouth for full credit. Patient does not need to gearshift, just turn on car and use steering wheel for full credit. Patient does not need to crease the paper for full credit. Appendix C: Clarifications to WAB-R Administration for Inter-Rater Consistency within this Study Section Question Administration Rule Example Conversational 6. Why are If patient is unclear about what you are “Why did we questions you here (in asking you can rephrase the question based ask YOU to the hospital)? on the current context. do this What seems to study”? be the trouble? Picture If patient does not spontaneously begin Description speaking in sentences, prompt for complete sentences when they have uttered 3-5 single words. Do not give this prompt during the initial instructions. Object All For compound words, only provide tactile Naming then semantic cue (not phonemic); for all other words only provide tactile then phonemic cue (not semantic). Compound words: safety pin, toothbrush, screwdriver, paper clip, rubber band. Writing All When to cue: Dictated If patient writes anything, do not cue; If no Words response or does not understand task, show object; If still no response or unrecognizable word written, then provide oral spelling. (unrecognizable: limited overlap with target form) Apraxia 17. Pretend to If patient knocks on a surface, cue them to knock at a “pretend” to do it. door and open it Drawing All Discontinue each item after 30 seconds. If you need to prompt patient to make drawing more complete, the prompt and subsequent changes to the drawing fall within the 30 seconds. If the patient draws the wrong figure (e.g., circle for square), show stimulus for 10 seconds and then restart 30 second timer. Appendix D: Administration Fidelity Checklist Participant code: Date of test administration: Administration type: (in person vs. videoconference) Administrator: Section Subtest Spontaneous speech Conversational Questions Picture Description Yes/No Questions Auditory Verbal Comprehension Date of fidelity check: Rater: *Rate 1 if all items in section administered accurately with accurate script *Rate 0 if any items in section not administered accurately or script inaccurate *Rate N/A if not able to rate (e.g., no video available) Specific General Specific Online Scoring Rate Scoring Notes Notes 1,0,NA Auditory Word Recognition Repetition Naming and Word Finding Sequential Commands Administer example if examinee appears not to understand Object Naming Administer hierarchy of tactile, phonemic, and Screen shared Clarify which environment you are referring to as needed Screen shared; ask examinee to adjust camera as needed to view responses Items aligned left to right from examinee angle; camera tilted for clinician view semantic cues if indicated Word Fluency Reading Sentence Completion Responsive Speech Comprehension of Sentences Reading Commands Writing Prompt with examples if needed Prompt examinee to point to item if examinee is not pointing to item Repeat directions as needed Written Word-Object Choice Matching Written Word-Picture Choice Matching Picture-Written Word Choice Matching Spoken Word-Written Word Choice Matching Spelled Word Recognition Administer example if examinee appears not to understand Spelling Administer example if examinee appears not to understand Writing Upon Request Prompt examinee to write complete address if they only write name Screen shared Screen shared Screen shared Screen shared Screen shared Screen shared Ask to see written output Writing Output Writing to Dictation Writing Dictated Words Prompt examinee to write in sentences as needed Break down sentence into smaller parts as needed Provide object or oral spelling if examinee appears not to understand Alphabet and Numbers Dictated Letters and Numbers Copying a Sentence Apraxia Constructional, Visuospatial, and Calculation Drawing Block Design Calculation Raven's Coloured Progressive Matrices Ask to see written output Ask to see written output Show object in front of camera if examinee appears not to understand Screen shared Provide model if examinee scores 0 or 1 independently Provide picture if examinee appears not to understand Complete demonstration of trial item; prompt examinee to complete demonstration of trial item Read aloud all 12 items Screen shared to provide picture if examinee appears not to understand Participant has been given blocks; examinee has matching color blocks on shared screen Screen shared Screen shared Overall No more than 1 repetition per item (unless extenuating circumstances such as interruption or audio issues) Test materials used accurately; working surface cleared of extra items; accurate items provided to patient Notes Total Correct Percentage Correct