The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury

ABSTRACT

Primary objective: The assessment of language in patients post-comatose patients is limited by their reduced behavioral repertoire. We developed the Brief Evaluation of Receptive Aphasia (BERA) tool for assessing phonological, semantic and morphosyntactic abilities in patients with severe brain injury based on visual fixation responses.

Research design: Prospective cross-sectional study and case reports.

Methods and procedure: The BERA and Language Screening Test were first administered to 52 conscious patients with aphasia on two consecutive days in order to determine the validity and reliability of the BERA. Four post-comatose patients were further examined with the BERA, the Coma Recovery Scale-Revised (CRS-R), positron emission tomography and structural magnetic resonance imaging.

Main outcome and results: The BERA showed satisfactory intra- and inter-rater reliability, as well as internal and concurrent validity in patients with aphasia. The BERA scores indicated selective receptive difficulties for phonological, semantic and particularly morphosyntactic abilities in post-comatose patients. These results were in line with the cortical distribution of brain lesions.

Conclusions: The BERA may complement the widely used CRS-R for assessing and diagnosing patients with disorders of consciousness by providing a systematic and detailed characterization of residual language abilities.

KEYWORDS:

• Coma
• aphasia
• minimally conscious state
• behavioral assessment
• language

Acknowledgments

We thank Dr H. Jedidi, Dr Z. Jedidi, Dr L. Pirnay and all the speech therapists from the four rehabilitation centers (Centre Neurologique William Lennox, Service de Neurologie de l’Hôpital du Valdor, Centre Neurologique et de Réadaptation Fonctionnelle de Fraiture et Centre de Réadaptation Neuro-locomotrice du CHU d’Esneux). We are highly grateful to the members of the Liège Coma Science Group for their assistance in clinical evaluations. We also thank the whole staff from the Neurology, Radiodiagnostic and Nuclear Medicine departments, University Hospital of Liege, as well as all the aphasic conscious or less conscious patients and their families.

Declaration of interest

The authors declare that there is no conflict of interests regarding the publication of this paper. The study was supported by the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union’s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 785907 (Human Brain Project SGA2), the Luminous project (EU-H2020-fetopenga686764), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, the Center-TBI project (FP7-HEALTH- 602150), the Public Utility Foundation ‘Université Européenne du Travail’, “Fondazione Europea di Ricerca Biomedica”, the Bial Foundation, the Mind Science Foundation and the European Commission. CA and NL are research fellows and SL and SM are research directors at FRS-FNRS.

Author contribution

C.A., S.M. and S.L. conceived and planned the presented research. C.A., S.G., N.H. and M.T. assessed the aphasic conscious patients using the BERA. C.A., N.H., M.T., C.C., N.L. and H.C. contributed to clinical and neuroimaging data acquirement and analyses in post-comatose patients. C.A., S.M., S.L., S.G., N.H. and M.T. worked on data interpretation. C.A. drafted the manuscript under S.M.’s supervision and all authors provided critical feedback and helped shape the manuscript.

Additional information

Funding

This work was supported by the University and University Hospital of Liège, the French Speaking Community Concerted Research Action (ARC 12-17/01), the Belgian National Funds for Scientific Research (F.R.S-FNRS), the Generet funds and King Baudouin Foundation, the Marie Sklodowska-Curie Actions (H2020-MSCA-IF-2016-ADOC-752686), the European Union’s Horizon 2020 Framework Program for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the James McDonnell Foundation, the Mind Science Foundation, IAP research network P7/06 of the Belgian Government (Belgian Science Policy), the European Commission, the Public Utility Foundation “Université Européenne du Travail”, the “Fondazione Europea di Ricerca Biomedica”, the BIAL Foundation, the AstraZeneca Foundation, and the Belgian National Plan Cancer (139).