Patient Name: ______________________________

Clinician: _____________________ Address: ___________________________________

Date: ________________________ ID: ________________________________________

Complete Test

Subtests:

• Perceptual
• Auditory Comprehension
• Verbal Expression
• Reading
• Writing

Alexia Rohde, PhD

[email protected] brisbanetest.org
 Results Summary
SUBTEST SCORE COMMENTS TOTAL
PERCEPTUAL
1. Copying Gestures /2
2. Object to Object Matching /2
3. Demonstrating Object Use /2
4. Demonstrating Object Use from Pictures /2
5. Object to Picture Matching /2
6. Picture to Picture Matching (semantic links) /5 /15
AUDITORY COMPREHENSION
7. Yes No Questions /12
8. Following Verbal Commands /8
9. Identifying pictures by description /6
10. Identifying objects by function /2
11. Odd-one-out /2
12. Complex Question /6 (13) Self-reported difficulty? (Yes/No)
14. Synonyms /2 /38
*VERBAL EXPRESSION
15. Automatic Speech /1
16. Sentence Completion /2
17. Personal / Orientation Questions /6
18. Repetition /4
19. Object Naming /2
20. Naming Actions /2
21. Picture Naming /4
22. *Naming objects from the room /4
23. Naming gestures /2
24. Verbal Fluency – Animals /45
24. Verbal Fluency – Words starting with F /35
25. Picture Description /16 (26) Self-reported difficulty? (Yes/No)
27. Word Definitions /4
28. Similarities and Differences /2
29. Proverbs /3 /132
READING
30. Object to Word Matching /2
31. Single Word Reading /2
32. Written Word to Picture Matching /6
33. Following Written Commands /4
34. Sums /2
35. Reading Aloud /1
36. Medicine Label /3
37. High Level Sentence Comprehension /2
39. *Delayed Recall /21 (38) Self-reported difficulty? (Yes/No)
40. Inference /1 /44
WRITING
41. Drawing Completion /1
42. Simple Copying /2
43. Functional Writing – Name /2
44. Functional Writing – Address /3
45. Writing to Dictation /6
46. Written Naming – Object /1
47. Written Naming – Gesture /1
48. Sentence Construction /13 (49) Self-reported difficulty? (Yes/No) /29

Total Brisbane EBLT Score /258

Adapted Brisbane EBLT Total Scores
Adapted score: excluding hospital ward items
If test is not administered at hospital bedside omit *Subtest 22 (which requires the naming of hospital ward objects) (note total
possible test score is now 254) /254
Adapted score: excluding verbal expression subtests
If patient performance is proportionally more affected in Verbal Expression, query the presence of other expressive conditions (such
as apraxia of speech) which may impact test score. If significant other expressive co-morbidities exist, exclude the *Verbal
Expression section Q 15 - 29 and *Delayed Recall Q 39 and calculate total test score from the remaining items in the four following
/105
areas (Perceptual, Auditory Comprehension, Reading and Writing) (note total possible test score is now 105)
2
 Two of EACH of the following objects are required:
cup, pen, spoon and knife

Perceptual

Presence of cognitive impairment? Nature of impairment:

Yes No ___________________________________________________
Premorbid Cognitive impairment: New Cognitive impairment: Impacting on test performance?
Yes No Yes No Yes No Sometimes

1 COPYING GESTURES
‘Copy what I’m doing.’ [Wave at patient] ‘Copy me.’ [If required gently assist patient to lift arm and wave] ‘Let’s try the
next one.’ [Point to nose] ‘Copy me.’
Pointing to nose Patient copies – points to nose __/1
Opening mouth Patient copies – opens mouth __/1 __/2
PLACE ONE CUP, PEN, SPOON and KNIFE IN FRONT OF PATIENT
(Second set of objects is kept out of patient’s sight)
2 OBJECT TO OBJECT MATCHING
[Take out second KNIFE] ‘Which object matches with this? I’ll do the first one.’ [Hold second KNIFE next to first knife].
‘This one matches.’ [Remove second knife].
[Now, take out the second CUP and give to patient] ‘Which one matches with this?’
CUP Matches it with first CUP __/1
PEN Matches it with first PEN __/1 __/2
ALL OBJECTS TAKEN OUT OF SIGHT - NOW GIVE ONE AT A TIME
3 DEMONSTRATING OBJECT USE
‘Show me how you would use these objects. I’ll do the first one.’ [Pick up KNIFE and pretend to saw/cut].
‘Now your turn’ [Give patient → PEN]
PEN Pretends to write __/1
CUP Pretends to drink __/1 __/2

4 GIVE STIMULUS SLIDE 1 DEMONSTRATING GESTURES (Object Use) FROM PICTURES

‘Show me the action that goes with each picture. I’ll do the first one.’
[Point to ‘Hammer’ and pretend to use a hammer] ‘Now your turn.’ [Point to KEY]
If needed, physically assist patient to copy your action in practice task (hammer) to demonstrate task aim
Key Pretends to turn key in lock __/1
Toothbrush Pretends to clean teeth __/1 __/2

5 GIVE STIMULUS SLIDE 2 OBJECT TO PICTURE MATCHING

‘Match the object with the right picture. I’ll do the first one.’ [Get out KNIFE → point to the picture of the KNIFE or
place the KNIFE on picture of the KNIFE]. ‘It goes there.’ [Take the KNIFE away].
‘Now your turn.’ [Give patient the PEN]
PEN Match PEN with picture of PEN __/1
SPOON Match SPOON with picture of SPOON __/1 __/2
PUT OBJECTS AWAY (required again later)
6 GIVE STIMULUS SLIDE 3 PICTURE to PICTURE MATCHING (Semantic Links)
‘Which of these bottom two pictures goes best with the middle one? [Point to pictures]
‘I’ll do the first one.’ [Point to GLOVES and HANDS]. ‘These go together.’ ‘Now your turn.’
Scoring: patient can either point or say name of target picture name in response
Apple Banana (left) Fruit (noun) __/1
Saw Scissors (left) Cutting tools (adjective) __/1
Mop Tissue (right) Cleaning (verb) __/1 __/3
‘Now let’s try pictures of actions.’ [Verbs]
Eating Drinking (left) Consuming/imbibing (verb) __/1
Fencing Boxing (right) Combat sports (noun) __/1 __/2
__/5
3
 Presence of Impairment
Hearing impairment (mild / moderate / profound)
Presence of hearing aids Left Right
Impacting on test performance? Yes No
Sometimes
7 YES/NO QUESTIONS
‘Answer these questions.’ Patient can respond verbally via gesture or provide written response and still achieve correct score.
Is your name ‘MARK’/ ‘JAMES’? (male patients) (or) ‘NO’ __/1
Is your name ‘EMMA’/ ‘KATE’? (female patients)
[CHOOSE INCORRECT PATIENT NAME]
Is your name...? [INSERT CORRECT FIRST NAME] ‘YES’ __/1
Are you a woman? ‘YES’ or ‘NO’ __/1
Are you a man? ‘YES’ or ‘NO’ __/1
Are we in Moscow? [INCORRECT] ‘NO’ __/1
Are we in…….? [INSERT CORRECT CITY/TOWN] ‘YES’ __/1 __/6
Is it night time? ‘YES’ or ‘NO’ __/1
Is this a hospital? ‘YES’ or ‘NO’ __/1
Are you in bed? ‘YES’ or ‘NO’ __/1 __/3
Do fish swim? ‘YES’ __/1
Is sugar salty? ‘NO’ __/1
Does 6 come before 3? ‘NO’ __/1 __/3
TOTAL: ___/12
8 FOLLOWING VERBAL COMMANDS
‘I’d like you to do what I say. If I say ‘wave’ you then...’ [WAVE to demonstrate]. If required gently assist patient to lift arm
and wave. ‘Now your turn. I want you to…Smile.’ (All components must be correct to achieve score)
CAN REPEAT COMMAND AGAIN ONCE. However ask patient to RE-START their response from beginning.
1 Stage
Close your eyes
__/1
Point to the ceiling (point = indication with finger/ arm/ hand)
__/1 __/2
‘These commands now get longer. Please wait until I’ve finished before you respond.’
NOTE - Score patient normally even if patient starts responding before you finish speaking (do not penalise)
2 Stage
Touch your nose then point to the floor (can use the same or different hands, though must complete in this order)
__/1
Point to me while shaking your head (both actions must be completed together)
__/1 __/2
3 Stage
Point to your eyes, your nose and then your mouth (pointing to single eye for ‘eyes’ acceptable)
__/1
Scratch your head and then point to the ceiling with your eyes closed (eyes closed during whole task = mark correct)
__/1 __/2
4 Stage
Touch your ear, your shoulder, your nose and then point to your chin with your thumb (must be in this order)
__/1
Before you scratch your head, touch your ear, your shoulder and then your nose
Touch ear shoulder then nose then scratch head (must be in this order)
__/1 __/2
NOTE: ‘touch’ only refers to first item ‘ear’, patient may point/indicate shoulder or nose = correct. SCORING: Score target
modality only (ignore unrelated vocalisations). However, inclusion of unrelated gestural responses (purposeful actions) =
mark incorrect. (e.g. ‘Point to the ceiling’ = patient pointed to ceiling and floor = incorrect). TOTAL ___/8
4
9 GIVE STIMULUS SLIDE 4 IDENTIFYING PICTURES BY DESCRIPTION
‘Point to the…’
Toilet Sign/Washroom Sign (N) Points to Toilet Sign __/1
Boat (N) Points to Boat __/1
‘Now point to the one that...’
Slithers (V) Points to Snake __/1
Sails (V) Points to Boat __/1
‘Now point to the one which...’
Is Poisonous (A) Points to Snake __/1
Is Thorny (A) Points to Rose __/1 __/6
10 IDENTIFYING OBJECTS BY FUNCTION
‘I would like you to point to some different body parts.’
Point to where you would wear a hat Head __/1
Point to a place where someone would usually wear a ring Finger __/1 __/2
SCORING: Patient can indicate body part by showing it to you, waving it or pointing to it.

11 ODD ONE OUT

‘Tell me which of these words is the odd one out or doesn’t belong.’ [Wait for response, then ask]
‘Why?’ [Ask ‘why’ even for incorrect answers] (patient can verbally respond or write response = correct)
GIGGLE, BLUSH, LAUGH, CHUCKLE Blush __/1
‘Why?’  Happy/ laughter vs. shy/
If patient is unable to verbally respond hold up embarrassment (or)
4 fingers and point to each finger as you say the  Noise vs. noiseless (or)
4 stimulus words. Patient can then point to
appropriate finger as response  Mouth vs. not mouth (or)
nd
(2 finger = correct).  Involves movement vs. no movement __/1 __/2
NOTE: Giving one component e.g. ‘the rest are happy’ = correct response. If patient says “others are all the same” say “Why?”

12 COMPLEX QUESTIONS
‘Answer these questions.’ (patient can verbally respond or write response = correct)
I had a coffee and then washed my hair AFTER I  Had a coffee (or) __/1
spoke to Michael. What did I do second? Patient  [Had a coffee and washed my hair]
can think out aloud. Score final response. (‘washed my hair’ = incorrect)
Repeat these words in alphabetical order: ASTRONAUT BUTTER GLOBE RED TIGER __/5
TIGER, RED, BUTTER, ASTRONAUT, GLOBE
(Speak slowly and clearly - no repetitions allowed) ___/6
SCORING: recalling 1 word only = 0 score. Score 1 for each word recalled in alphabetical order e.g. ‘Globe, Butter, Astronaut, Red’ = 2 (1 x ‘Butter’
and 1 x ‘Red’). Don’t penalise for word omissions/ substitutions/additional words.

13 SELF REPORT
‘Do you think these last few questions are harder for you now since you have had your stroke?’
Tick response: (patient can nod/shake head/gesture/write in response)
Self-Report ‘YES’ I found them harder now than would have previously
‘NO’, no change ‘UNSURE’, ‘I don’t know’
14 SYNONYM GENERATION
‘What is ONE WORD that means the same as...surprised or shocked?’ (give BOTH words as example)
Patient is able to reason and think out loud. Only score their final response. Patient can write or say response = correct.
‘Surprised or startled staggered floored astounded
shocked’ amazed dumbfounded flabbergasted dazed __/1
astonished stupefied stunned aghast
‘Wealthy comfortable prosperous moneyed flush
or rich’ affluent loaded opulent well-off __/1 __/2
Answer MUST be a single word ADJECTIVE (e.g. ‘millionaire’/‘in the money’ = incorrect). Only one synonym answer required per question. Scoring -
Surprised or Shocked: Words containing a strong negative element (e.g. frightened, alarmed = incorrect)

5
 Presence of Expressive Impairment Impacting on performance:
Dysarthria (mild / mod / severe) Yes No Sometimes
Verbal dyspraxia (mild / mod / severe) Yes No Sometimes
Subtest requires stethoscope and Other condition (e.g. dysphonia) _________ Yes No Sometimes
items found at hospital bedside
15 AUTOMATIC SPEECH
‘Count from 1 to 10.’ ‘I’ll start ... one, two, three...’
4 5 6 7 8 9 10
__/1

16 SENTENCE COMPLETION
‘Finish what I say. Boys and ... [Pause] GIRLS.’ ‘Now your turn.’ ‘Up and ...’
Up and...  ‘DOWN’ (or)  ‘AT ‘EM’ (or)
 ‘AWAY’ (or)  ‘COMING’ (or)
 ‘GO’ (or)  ‘RUNNING’ __/1
Knife and... ‘FORK’ __/1 __/2

17 PERSONAL/ ORIENTATION QUESTIONS

Tell me, what is your name? As listed in medical chart __/1
First name scored only. Accept
appropriate alternative e.g. ‘Bob’
What is your address? As listed in medical chart __/1
(if patient has recently moved accept either Must include all basic elements of
new or old address) address as included in medical chart.
Does not need: city or post/ZIP code.
What is your date of birth? D, M, Y (any order) __/1
What month is it now? Current month __/1
Who is your next of kin, or your As listed in medical chart/as __/1
closest relative? per family report
If you needed to call an ambulance Emergency number __/1
(or paramedic) what number would
you call? __/6

18 REPETITION
‘Repeat what I say…’ (Score LANGUAGE component, not motor speech/other deficits)
Book Impossible Uncharacteristically
__/3
The ship shone the light on the shore (repetition must be perfect e.g. ‘lights’ = incorrect)
__/1 __/4

OBJECTS REQUIRED
19 OBJECT NAMING
[Get out a KNIFE] ‘What is this called? I’ll do the first one. This is a knife.’
[Next, get out a CUP] ‘What’s this called?’
CUP Patient says ‘CUP’ or ‘MUG’ __/1
SPOON Patient says ‘SPOON’ or ‘TEASPOON’ __/1 __/2

20 NAMING ACTIONS (VERBS)

‘What do you call this action?’ [Pick up KNIFE and pretend to saw/cut] ‘I am CUTTING.’
[Next, pick up a CUP and pretend to drink] ‘Tell me, what am I doing?’
CUP – DRINKING ‘Drinking’/ ‘Sipping’/ ‘Having a drink’ (‘drink’ = incorrect) __/1
PEN – WRITING ‘Writing’ (‘write’ = incorrect) __/1 __/2
SCORING: Score verb response only (e.g. patient answers with grammatically incorrect phrase ‘Writing a pen’ = correct, as task aim = naming the
verb (‘writing’). Further example: ’Writing a feather’ = correct (as verb is named correctly)

6
21 GIVE STIMULUS SLIDE 5 PICTURE NAMING
‘Look at these pictures.’ [Point to Car] ‘What is this?’
Car Car/Motorcar/Automobile/Sedan (if patient responds __/1
with ‘vehicle’ or ‘motor-vehicle’ say ‘Can you be more specific?’)
Toilet Toilet/Lavatory/WC (if patient responds with __/1
‘Loo/Dunny/Toot’ say ‘Can you give me another word for it?’)
Helicopter Helicopter (if patient responds with ‘chopper’ say ‘Can you __/1
give me another word for it?’)
Skeleton Skeleton __/1 __/4
SCORING: Semantically correct description given in addition to target word – do not penalise (e.g.’ Hospital bed’ for bed) = correct.
Semantically incorrect description given in addition to target word (e.g. ‘double bed’ for single bed) = incorrect.

TAKE PICTURES AWAY NOTE: STETHOSCOPE NOW REQUIRED

22 NAMING OBJECTS FROM ROOM
‘Let’s name some items in the room.’ [Point to item in room → BED] ‘What’s this called?’
Bed ‘Bed’ (if patient responds with ‘mattress/sheet’ indicate more __/1
generally to the entire bed)
Chair ‘Chair’ __/1
Pillow ‘Pillow’ (‘cushion’ = incorrect) __/1
Stethoscope ‘Stethoscope’ __/1 __/4

23 NAMING GESTURES
‘Tell me what action I’m doing?’ [Pretend to Wave] ‘I am waving.’
‘Now your turn.’ [Perform next action→ Salute] ‘What am I doing?’
Salute (hand to forehead) Saluting/ a salute __/1
Pretend to sneeze. Say: ‘achoo’ Sneezing/ a sneeze __/1 __/2

24 VERBAL FLUENCY
‘I want you to think of items that are similar.’ Score 1 point for each correct response.

Name as many
different animals as
you can in 1 minute

___/45
‘Animal’ definition: Any multicellular organism including vertebrates (mammals, birds, reptiles, fish), molluscs (clams, oysters, snails) arthropods
(insects) annelids (leeches), sponges and jellyfish (excl: bacteria, plants, algae, fungi, viruses). SCORING: Must be different animal species e.g. ‘brown
cow’ and ‘white cow’ = 1 score. However, ‘brown snake’ and ‘tree snake’ = 2 different species = 2 scores. Award score for most specific category only
e.g. ‘dogs’, ‘spaniel’, ‘cocker spaniel’ and ‘springer spaniel’ score most specific responses only: ‘cocker spaniel’ and ‘springer spaniel’ = 2 scores.

Name as many
words starting with
the letter ‘F’ as you
can in 1 minute

___/35
SCORING F WORDS: Must be real English words. ‘Fast’, ‘faster’ and ‘fastest’ = 3 scores. Proper nouns acceptable. Hyphenated words or multiple-
word responses e.g. ‘fire engine’ = score first word only. E.g. ‘fire engine’ and ‘fire hydrant’ score ‘fire’ only = 1 score.
7
25 GIVE STIMULUS SLIDE 6 PICTURE DESCRIPTION: COOKIE THEFT PICTURE (Goodglass, Kaplan & Barresi, 2001)
[NOTE – COOKIE THEFT PICTURE IS NOT INCLUDED IN TEST FORM. CLINICIANS TO OBTAIN OWN COPY]
‘Look at this picture, it tells a story. Tell me what you see. Use full sentences. Please speak slowly and clearly.’
 BOY/brother (he)  GIRL/sister (she)  WOMAN/mother/lady  KITCHEN
(TWO CHILDREN) (she)
 TRYING TO GET/  WANTS COOKIE  WASHING UP/ drying  WATER/ SINK
stealing OVERFLOWING/ spilling
water
 COOKIES FROM JAR/  REACHING UP/getting  DAYDREAMING/  TAP LEFT ON
cookie ignoring
 ON STOOL  SAYING ‘shh’/ smiling  WINDOW
TOTAL ___/16
 ABOUT TO FALL
SCORING: Tick the appropriate boxes the patient refers to. There is no need to transcribe the response. Scoring = single word responses = 1 score for
each correct word. NOTE: He/ she must be used in a phrase/ sentence to obtain a score. (e.g. He’s on the stool = score 2 (‘he’ = 1 and ‘stool’ = 1)
(scoring system adapted from Yorkston & Beukelman, 1980)

26 SELF REPORT
‘Did you find that task difficult? Did you feel you had any If ‘YES’, ask: ‘Is that difficulty new since your stroke?’
difficulty thinking of the right words to describe the ‘YES’ If ‘YES’, specify nature of
picture?’ ‘YES, some difficulty’
‘NO’ difficulty:
‘NO, no problem’ ‘UNSURE’
‘UNSURE’
27 WORD DEFINITIONS
‘Tell me what these words mean. Explain the word as fully as you can. Tell me, what is a SCHOOL?’
Score 1 for each point mentioned. If response relates to collective noun (e.g. ‘school’ of fish) clarify for the singular noun
 Institution/place/somewhere/where/building/organisation (AND)
 Learning/teaching/education/study (AND)
 Children/young people/students/people/kids /(gives ages) __/3
‘Now, explain to me, what does the word UNUSUAL mean?’
 Not habitually/typically/commonly occurring or done
(e.g. out of the ordinary) (OR) __/1
 Different/rare or atypical (OR)
 Strange/odd/abnormal (OR)
 Remarkable for being better than others __/4
(e.g. extraordinary, unique)
28 SIMILARITIES AND DIFFERENCES
‘Tell me what is similar and what is different about these things.’ Only 1 answer required for each section
What is similar between an ELECTION BALLOT PAPER and a MENU?
 Both involve reviewing options/ information
 Both involve making a choice/choosing
 Both viewed/have words/ numbers/can have pictures/ written/printed/on paper __/1
 Both are produced in multiple copies
How are they different?
 One is choosing politicians/who you vote for/elect vs. foods/prices
 One is sometimes compulsory vs. voluntary
 One is in polling booth/ can go in box vs. restaurant/café
 One you mark/write on vs. verbally choose/point
 Voting is secret vs. choosing on a menu is not
 Outcome is short in duration (food/drink consumed) vs. longer outcome (duration of power)
 One outcome depends on others vs. dependant on you (will get what you want) __/1
SCORING: score based on meaning (not grammatical content). Explaining one component of item e.g. ‘You choose food from a menu’
(inferring you do not choose food from a ballot paper) = correct. Do not penalise if patient answers in different order i.e. second question
first e.g. patient first describes differences between items = mark the second part of the question and then go back and ask the ‘What is __/2
similar…” test item.

8
29 PROVERBS
‘Tell me, what does this saying mean?’ Patient is able to reason and think out loud. Only score final response.
‘Beauty is only skin deep.’
 Pleasing/nice appearance is not a good guide/indication of overall worth (OR)
 It’s what is inside that counts (OR)
 Can be pleasing on the outside but not on the inside __/1

‘You can lead a horse to water, but you can’t make him drink.’
 You can give advice/show an opportunity/way to do something/tell someone something (AND)
 But you can’t make people act/do it/ act the way that you think they should/it may not be what they
want/are stubborn (Answer MUST relate to human behaviour) __/2

__/3

Reading SCORING INSTRUCTIONS: Score READING language performance. Do not penalise for any visual or
perceptual deficits (e.g. hemianopia). If required provide patient with an enlarged version of test items.

Presence of Impairment Impacting on Test Performance?

Presence of hemianopia? (mild / mod / severe) Yes No Sometimes
Presence of other visual impairment? _________________________ Yes No Sometimes

OBJECTS REQUIRED
30 GIVE STIMULUS SLIDE 7 OBJECT TO WORD MATCHING
‘Match the object with the right WORD. I’ll do the first one.’ [Take out KNIFE and match it with the word ‘KNIFE’]
‘Now your turn.’ [Give patient the SPOON]
SPOON Match with word SPOON __/1
CUP Matches with word CUP __/1 __/2

31 GIVE STIMULUS SLIDE 8 SINGLE WORD READING

‘Read these words and then point to the body part. I’ll do the first one. Watch me. If I point to this’ [Point to word
‘HAND’], ‘You do this’ [Point to your own HAND] ‘Now your turn.’ [Point to word ‘EAR’]
EAR Patient points to their ear __/1
NOSE Patient points to their nose __/1 __/2

32 GIVE STIMULUS SLIDE 9 WRITTEN WORD TO PICTURE MATCHING

‘Read each of these words aloud and then point to the right picture.’ [Point to the first word ‘CAT’]
1 Cat (N) Cat __/1
2 Hospital (N) Hospital Sign (cross) __/1
Verbs
3 Burns (V) Fire __/1
4 Sparkling (V) Diamond __/1
Adjectives
5 Hot (A) Fire __/1
6 Furry (A) Cat __/1 __/6
SCORING: NOUNS: patients MUST point to picture to answer. VERBS/ADJECTIVES: patients may verbally respond (e.g. ‘fire’). Do NOT penalise for any
errors reading aloud (simply make note of the response). Task assesses reading comprehension only.

9
33 GIVE STIMULUS SLIDE 10 FOLLOWING WRITTEN COMMANDS
‘Read this and do what it says’ ‘I’ll do the first one.’ [Point to word ‘Wave’ and wave to demonstrate].
[If required gently assist patient to lift arm and wave] ‘Now your turn.’ [Point to ‘Point to the floor’].
Patient is able to complete task as they read along the text. Can read silently or aloud. Score target modality only.
1 stage
Point to the floor
__/1
2 stage
Raise your arm while you close your eyes (raising both arms = mark as correct)
__/3 __/4
SCORING Incorrect responses: Omissions = 0; Substitutions = 0; Additional actions = penalise - 1 per additional action. (e.g. ‘Point to the floor’ =
patient points to ceiling and floor. Total score = 0 (point to floor =1; additional action = -1. Total = 0). Min = 0.

34 KEEP STIMULUS SLIDE 10 SUMS

‘Solve these.’ [Point to the calculations]
Patient can reason out loud. Do not score this incorrect as self-correction. Only mark final response. Pen and paper allowed.
4+2= 6 __/1
146 – 17 = 129 __/1 __/2

35 KEEP STIMULUS SLIDE 10 READING ALOUD

[Point to the sentence ‘My father had...’] ‘Read this aloud.’ (Score language performance, not other deficits e.g. speech)
My father had only one shoe
__/1
Mark patient’s first response. Response must be perfect to achieve score. Score incorrect if any additional/incorrect sounds or words.

36 GIVE STIMULUS SLIDE 11 FUNCTIONAL READING: MEDICINE LABEL

‘Here is a medicine label.’ [Point to LABEL]. ‘I am going to ask you some questions about it.’
[Point to each question and READ ALOUD to patient] ‘How many tablets per day?’
NOTE - Questions are provided in BOTH written and verbal form. Patient may use pen/paper and write response OR verbally answer.
‘How many tablets per day?’  ‘3’ (or) ‘Three’ __/1
‘Do you take this tablet on an  No /No, with food __/1
empty stomach?’
‘It is 3pm in the afternoon. When Any of the following:
should the next tablet be taken?’  Dinner/tea time/next meal __/1
 In the evening
 Gives appropriate time (e.g. 5, 6, 7 or 8 pm) __/3

37 GIVE STIMULUS SLIDE 12 HIGH LEVEL SENTENCE COMPREHENSION

‘Read these instructions and answer the questions.’ [Point to final Q’s DO NOT READ THESE ALOUD to patient]
‘Is someone’s aunt their mother’s Their mother’s sister __/1
sister or their sister’s mother?’
‘The best ground produces weeds as b. Even with preparation bad things __/1
well as flowers.’ always accompany good things __/2

38 GIVE STIMULUS SLIDE 13 WRITTEN PARAGRAPH COMPREHENSION and SELF REPORT

‘Read this story.’ [Daylight Robbery]. ‘I will then ask you some questions about it.’
Patient can choose to read silently or aloud. NOW REMOVE THE STORY FROM PATIENT’S SIGHT
‘Did you feel you had any difficulty reading and understanding the words as you read?’
‘YES, some difficulty’ NO UNSURE
If YES, ask: ‘Is that difficulty new since your stroke?’
‘YES, it’s new’ (Specify nature of difficulty): NO, not new UNSURE
SCORING: Score YES if ANY difficulty is reported, regardless of how minor; Score NO only if there is NO difficulty whatsoever (For example: If a patient
reports ‘YES’ they had difficulty reading, but this is due to their longstanding poor sight. Score ‘YES, some difficulty’ and then can report ‘NO, not
new’ indicating that this visual deficit is not new since the stroke).

10
39 DELAYED RECALL and READING COMPREHENSION
‘Now, tell the EXACT story back to me. Tell me as much as you can remember.’
Order does not matter. Tick/circle relevant boxes as patient recalls the story items and then total the overall score.

 SALLY  OPENED DOOR  GASPED in  THOUGHT SHE HAD BEEN ROBBED/

woman/lady/ came home/ astonishment/ burgled/items stolen
SALLY girl/she walked in/ shocked/surprised
returned home
 LAMP/ light  PHOTOGRAPHS/  THINGS FALLEN  CURTAINS IN TATTERS/ wrecked/
ROOM pictures/picture OFF/ SMASHED/ destroyed/ ruined
frames state of mess
BIRD/  BIRDCAGE/  KNOCKED FROM  DOOR OPEN  CHIRPY/  MISSING/
CAGE cage STAND/ on floor AFRICAN gone/ stolen
GREY
PARROT/ bird
 RAN TO  CALLED POLICE/  FELT/LOOKED  SYLVESTER/  RUBBED
PHONE/ called for help DOWN at/ saw/ RUSSIAN against her/
PHONE/ went to phone noticed BLUE/ cat legs/came up
CAT  PURRING  LUMP IN  HUNG UP
STOMACH/ PHONE/ put TOTAL: ___/21
bulging belly down phone
SCORING: Patient can their use own words to recall points but semantic content must remain fundamentally the same. No additional points for recall
of the ‘actual’ story including inference. Items recalled in different but logical order = still mark correct.

40 INFERENCE
‘Why did sally put down the phone?’ or ‘What do you think really happened?’
Inference Tick box that semantically matches patient response: SCORING: Only one of the
points is required to
 She realised she hadn’t been robbed (or)
achieve the score. Patient
 The cat had eaten the bird (or) can use own words to __/1
 Cat caused the mess (not a burglar) (or) indicate understanding of
 Patient explicitly said correct response previously story inference.

Dominant writing hand: Left Right

Writing Presence of hemiparesis impacting on writing ability?
No Yes (mild / mod / severe)
SCORING: Score WRITTEN LANGUAGE Hand used for writing tasks: Left Right
performance not upper limb motor Unaffected dominant Hemparetic dominant Non-dominant
performance. Patients may need to use their
non-dominant hand. Legibility of writing: Legible Partially Legible Illegible Unable

41 GIVE WRITTEN RESPONSE FORM 1 DRAWING COMPLETION

’Look at this picture. Draw in the part that is missing.’
Face (mouth) Draws in mouth __/1
SCORING: Response should indicate a general horizontal/curved shape located in general region under nose. Single line is acceptable. Do not
penalise for motor weakness. Score based on understanding of concept only (awareness the mouth is missing).

42 KEEP WRITTEN RESPONSE FORM 1 SIMPLE COPYING

‘Look at these.’ [Point to ‘87’ and ‘man’]. ‘Copy them below.’ SCORING: must be legible and spelt correctly = correct score.
Give patient time to respond, however if patient clearly does not comprehend task, score 87 as incorrect and provide patient with answer (write in
‘87 ’for patient). Then point to the second copying task (copying ‘man’) to initiate patient response.
87 87 __/1
man man (lower case or capitals = correct) __/1 __/2
43 KEEP WRITTEN RESPONSE FORM 1 FUNCTIONAL WRITING
‘Write your full name here.’ [Point to line below]
Full name  First Name __/1
 Second Name (surname) __/1 __/2

11
44 GIVE WRITTEN RESPONSE FORM 2 FUNCTIONAL WRITING
‘Please fill in the form.’ (patient required to select correct gender box and fill out their address)
Gender Selects correct box __/1
Address As listed in medical chart: (items as appropriate, address may not have both number and street)
Post code/ZIP  House/flat/apartment number
code not __/1
required  Street
City/Town:  Suburb/district/area/region __/1 __/3
Note: If patient has recently moved house, accept either the new or old address. SCORING: Total score of ‘Address’ item = 1 for single or both
components as applicable (house/flat/apartment no. and/or street) (some people may not have a house number).
45 KEEP WRITTEN RESPONSE FORM 2 WRITING TO DICTATION
‘Write down what I say…’
Write the number ‘4’ 4 __/1
Write the word ‘young’ Young (or) young __/1
Write the sentence ‘The dog is brown’ The (or) the __/1
Scoring: Response must be written correctly and dog __/1
in correct position e.g. ‘The brown is dog’ = 2 is __/1 __/4
scores (1 score = ‘The’, 1 score = ‘is’) brown __/1
__/6
46 KEEP WRITTEN RESPONSE FORM 2 WRITTEN OBJECT NAMING
‘I am going to point to something. Write down what it’s called.’ [Point to your own index finger]
‘What is this? Write it down.’ If patient verbally replies, say: ‘Write it down.’
Index finger finger/index finger/forefinger __/1
(Index finger = first finger next to thumb)

47 KEEP WRITTEN RESPONSE FORM 2 WRITTEN GESTURE NAMING

‘Watch what I am doing, and then write it down.’
Clapping (clap multiple times) Clapping /clapping/clapped/clap your hands __/1
(clap = incorrect)

48 GIVE WRITTEN RESPONSE FORM 3 SENTENCE CONSTRUCTION

‘Read the instruction and do what it says.’ [Patient completes task quietly – no further instruction provided. Response must include at
least one other word other than stimulus words (e.g. must be an attempt at phrase or sentence response) – if nil other words included = score 0.
cat  Contains all target words (e.g. ‘scare’ = incorrect) __/1
scared  Makes sense (semantically) __/1
bed  Grammatically correct (morphology and syntax) __/1
 Correct spelling (all words, not just target words) __/1
 No self-correction evident __/1
___/6
 Contains full stop, capital letter, correct spacing __/1
accidentally  Contains all target words (e.g. ‘run’ ‘rained’=incorrect) __/1
ran  In correct order (of target words included) __/1
after  Makes sense (semantically) (note: Accidentally = __/1
rain inadvertently, by mistake, or fluke)
 Grammatically correct (morphology and syntax) __/1
 Correct spelling (all words, not just target words) __/1
 No self-correction evident __/1
 Contains full stop, capital letter, correct spacing __/1 __/7
Total __/13
SCORING: Self-correction: Is the attempt at correction (can be successful or unsuccessful) of language-related mistakes (e.g. fixing letters facing
wrong way/ correcting spelling errors) = mark as incorrect. If patient is neatening their response due to poor hand dexterity = do not penalise.
Scoring of ‘Makes Sense (semantically)’: correct score = sentences that would have meaning in context of a paragraph (e.g. ‘I accidentally ran after
the cat in the rain’ = correct, as sentence could be part of a paragraph describing why a person was not supposed to run/ go in the rain).
49 SELF REPORT
‘How did you feel about your ability to make up these sentences and write them down? Do you think you found it
harder than you would have before your stroke?’
‘YES’ I found them harder now ‘NO’ ‘UNSURE’
12
 Written Response Form 1

Copy these:

87 man

Write your full name: .

13
 Written Response Form 2

Fill in the form:

Gender: Male Female

Address:

City/Town:
 Written Response Form 3
Please write the following sentences:

Write ONE sentence which contains ALL of these

words (in any order): cat, scared, bed

Write ONE sentence which contains ALL of these

words in THIS order: accidentally, ran, after, rain

15
Stimulus Forms
Complete Test
Perceptual - Stimulus Slide 1
Perceptual - Stimulus Slide 2
Perceptual - Stimulus Slide 3
Auditory Comprehension – Stimulus Slide 4
Verbal Expression - Stimulus Slide 5
 Verbal Expression - Stimulus Slide 6

[COOKIE THEFT STIMULUS ITEM REQUIRED]

 Reading - Stimulus Slide 7

Knife Pen
Cup Spoon
 Reading - Stimulus Slide 8

Hand

Ear Nose
 Reading - Stimulus Slide 9

Cat Hospital Burns

Sparkling Hot Furry

 Reading - Stimulus Slide 10

Wave

Point to the floor

Raise your arm while you close

your eyes

Solve these:

4+2= 146 - 17 =

Read this aloud:

My father had only one shoe.

 Reading - Stimulus Slide 11

Read this medicine label:

• How many tablets per day?

• Do you take the tablet on an empty

stomach?

• It is 3pm in the afternoon. When should

the next tablet be taken?
 Reading - Stimulus Slide 12

Read this and then tell me the answer:

Is someone’s aunt their mother’s sister or
their sister’s mother?

Point to the answer that best reflects the

meaning of this statement:

‘The best ground produces weeds as well

as flowers.’

a. Weeds always grow among the flowers.

b. Even with preparation bad things

always accompany good things.

c. Fertile ground must always be well

prepared in order to grow flowers.
 Reading - Stimulus Slide 13

Daylight Robbery

Sally opened the door to her house and

gasped in astonishment. Her lamp and
photographs had fallen off the table and lay
smashed on the floor. One of the curtains was in
tatters and in the corner of the room the
birdcage had been knocked from its stand and
the cage door was open. There was no sign of
Chirpy her gorgeous African grey parrot. She had
been robbed!

Shocked, Sally ran to the phone to call the

police. Distractedly she felt Sylvester, her
Russian Blue rub himself against her legs, purring
loudly. She looked down and noticed he seemed
to have a large lump in his stomach. Sally put
down the phone.