Developing an Impairment-Based Measure for Aphasia

Heather Harris Wright

Arizona State University
INTRODUCTION

Figure 1. Picture used for obtaining a spontaneous speech

sample.

The Kentucky Aphasia Test (KAT) is an impairment-based measure

designed for use in fast-paced managed care environments where
time is limited. Administration time for the KAT ranges from 20-30
minutes regardless of severity of aphasia. Non-brain-damaged
(NBD) individuals perform at or near ceiling levels on the test; and,
the KAT identifies persons with severe, moderate, and mild aphasia.
The KAT has been found to have sufficient test-retest and scoring
reliability for use in clinical environments.

No new impairment-based aphasia test battery has been developed

since the Western Aphasia Battery (WAB; Kertesz, 1982).

Impairment-based tests that clinicians learned about in graduate

school are too time consuming for use in todays managed care
environment and often lack the necessary top or bottom for use
with patients at the upper and lower ends of the severity continuum
(Darley, 1982).

The KAT was developed to provide clinicians with an impairmentbased test that could be (a) administered to patients at all severity
levels, and (b) completed within a time frame accepted by managed
care administrators.

Table 1. The 10-items for the Following Directions subtest for

KAT-2.
Item Number
Practice
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

RATIONALE

Robert C. Marshall
University of Kentucky

Administration and Scoring

To determine whether to administer KAT-1, KAT-2, or KAT3, the patient is asked to tell what is happening in the Dual
Task picture (i.e., picture description task, See Figure 1).

Based on number of content units produced by the patient,

the patient is administered KAT-1 (0-5 units), KAT-2 (6-10
units), or KAT-3 (11+ units).

The KAT consists of three separate, but parallel test batteries, KAT1, KAT-2, and KAT-3 for use with patients having severe, moderate,
and mild aphasia, respectively.

Each battery consists of six, 10-item subtests: picture naming,

following commands, repetition, defining words, yes/no questions,
and word-to-picture matching.

Materials for the test include:

Picture for obtaining a spontaneous speech sample from the

patient (Figure 1)

Test kit

Test booklet

Box

Bear

Table

Circle

Foot

After giving the picture description task and determining

which version of the KAT to administer, the patient
completes a 10-item orientation test.

The orientation test consists of simple tasks involving

reading, pointing, and writing.

It provides a warm-up prior to administration of the KAT

proper.

bag

Figure 3. Example pictures for KAT-2 word-to-picture matching

subtest.

Scoring

A picture (Figure 1) has been developed for the KAT to obtain a

narrative speech sample from the patient.

(pear)

(banana)

(apple)

Test Kit

The test kit contains pictures for the picture naming and word-topicture matching subtests.

Pictures are controlled for imageability (Pavio, Yuille, & Madigan,

1968) and frequency of occurrence (Kucera & Francis, 1967)

Examples of items for KAT-2 picture naming and word-to-picture

matching subtests are shown in Figures 2 and 3.

Mean

The patients responses are scored with a 0-5 point

multidimensional scoring system: 0 = no response; 1 =
attempt to respond, but error; 2 = correct response after reinstruction; 3 = self-corrected response; 4 = correct
response after delay; 5 = correct and prompt response.

Total Scores
(grapes)

(orange)

Test Booklet

The test booklet contains space for recording patient

information, includes a brief orientation test, as well as
materials for administering all subtests except the picture
naming and word-to-picture matching tasks.
See Table 1 for an example of the test items for the following
commands subtest for KAT-2.

The maximum score attainable on the KAT is 350.

The maximum score for each subtest and the orientation

test is 50.

Results

To test the hypothesis that NBD subjects would perform at

ceiling levels on the KAT, all three batteries were
administered to 30 NBD individuals.

KAT Test Battery (350 max score)

KAT-2

KAT-3

343.10

336.74

334.42

5.92

9.22

11.70

Participants with Aphasia

38 individuals with chronic aphasia were administered the KAT;

19 completed the KAT on two occasions to determine test-retest
reliability for the instrument.

Selection for which KAT battery to administer was based on

number of content units provided by subjects based on their
description of the Cookie Theft picture (Goodglass & Kaplan,
1983).
Individuals that provided 0-5, 6-10, and 11+ content units were
administered KAT-1, KAT-2, or KAT-3, respectively.

Table 3. KAT Total scores for participants with aphasia across two
test administrations.

Mean
SD

KAT Test Battery (350 max score)

KAT-1 (N = 12)
KAT-2 (N = 4)
KAT-3 (N = 3)
Session 1 Session 2 Session 1 Session 2 Session 1 Session 2
212.4
217.0
278.5
289.0
227.3
240.7
80.0
75.2
37.0
34.5
114.0
119.2

Table 4. KAT Total scores for participants with aphasia.

KAT Test Battery (350 max score)
Mean
SD

KAT-1 (N = 20)
222.9
14.5

KAT-2 (N = 10)
270.9
38.4

KAT-3 (N = 8)
250.4
78.1

Additional Results

Inter- and intra-examiner agreement scores for the picture

naming, yes/no questions, and repetition subtests were 93% and
98% for the NBD group and 85% and 94% for the aphasic
group.

The NBD group performed significantly better on all subtests and

for the total score than the aphasia groups for each KAT level.

DISCUSSION

The KAT provides clinicians with an objective score that may be

useful for determining the severity of the patients aphasia and
useful in measuring changes due to intervention and other
factors.

The test can be administered quickly and in its entirety to most

persons with aphasia.

The KAT provides an alternative to traditional impairment-based

measures for clinicians in managed care settings.

Participants without Brain Damage

KAT-1
SD

Orientation

Picture Description Task

Results indicate that the NBD group performed near ceiling level
on all three levels.

Table 2. KAT total scores for NBD subjects (N = 31)

Level of Severity
Figure 2. Example pictures for KAT-2 picture naming subtest.

DESCRIPTION

Score
Make a fist with your left hand
Close your right eye
Put your hand on your left knee
Raise your left hand
Touch your nose with your left thumb
Move your tongue to the right side of your mouth
Clap your hands three times
Hold up your right pointing finger
Put your finger in your ear
Touch your shoulder with your right hand
Open your mouth real wide