Putney Auditory Single Word Yes/No Assessment (PASWORD). Development of a reliable test of yes/no at a single word level in patients unable to participate in assessments requiring a specific motor response: an exploratory study.
BACKGROUND
There are very few formal language assessments aimed at the very severely neurologically impaired individual. These individuals often have multiple deficits on top of their communication impairment that demand a novel approach to assessment. The authors set out to devise a tool (PASWORD) to enable professionals in this field to screen their clients' ability to understand and respond to very simple, closed questions by using their preferred modality.


OBJECTIVE
PASWORD assessment was examined for its reliability as a tool for determining whether profoundly neurologically impaired individuals could indicate yes or no reliably to simple closed questions.


METHODS
The assessment comprises 20 high-frequency objects that can be presented visually, auditorily or in the tactile modality, depending on the subject's abilities. Subjects are then asked a one-word level closed question related to the object and were asked to give a yes or no response. Seventy control subjects with no neurological impairment first underwent the PASWORD test to assess for ambiguities in the test items (group 1, n = 74). Neurologically impaired subjects at the Royal Hospital for Neuro-disability in the two experimental groups were allocated according to the opinion of the experienced multidisciplinary team, which observed the subjects closely over a period of time, in different contexts. Those that the team agreed were reliably able to answer simple yes/no questions on observation (group 2, n = 9) and those the team agreed could not indicate yes/no reliably to closed questions (group 3, n = 7). The results of the PASWORD were then compared with the original opinion of the team. Groups 2 and 3 were studied on two occasions to examine test-retest reliability.


RESULTS
There were no real ambiguities in the test items and the results of the PASWORD reflected the opinion of the experienced multidisciplinary team. As there are no other tests of single-word closed questions, which can be presented in any of three modalities and during which the subject can respond in any augmentative or alternative fashion, the opinion of the team at the Royal Hospital, a centre of excellence for neurorehabilitation, was used against which to measure reliability.


CONCLUSIONS
The findings imply that PASWORD is a useful screening tool when assessing the basic language skills of neurologically impaired individuals, whose extensive physical, linguistic and cognitive deficits often render the administration of more traditional language assessments impossible.
Department of Speech and Language Therapy, Royal Hospital for Neuro-disability, London, UK. sophie.mackenzie@nhs.net
Sophie
S
MacKenzie
Emma
E
Gale
Ros
R
Munday
D000328:Adult; D001930:Brain Injuries / Q000209:etiology / Q000523:psychology*; D032882:Comprehension; D005260:Female; D006801:Humans; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D015203:Reproducibility of Results