Bilingual Aphasia Screening Test Template Page 4
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1
Every
d ay
2
Every
w eek
In
y our
d aily
l ife
b efore
y our
i llness,
d id
y ou
s peak
9
English:
3
Every
m onth
4
Every
y ear
5
Less
t han
o nce
a
y ear
10
Did
y ou
e ver
l earn
t o
r ead
E nglish?
+
–
0
•••
I f the answer is “no” then go to (Spontaneous speech) (20).
11
How
o ld
w ere
y ou
w hen
y ou
l earned
t o
r ead
E nglish?
0
Before
y our
i llness,
y our
E nglish
r eading
w as:
12
From
n ot
g ood
( 1)
t o
v ery
g ood
( 5)
0
1
Every
d ay
2
Every
w eek
In
y our
d aily
l ife
b efore
y our
i llness,
d id
y ou
r ead
13
English
3
Every
m onth
4
Every
y ear
5
Less
t han
o nce
a
y ear
14
Did
y ou
e ver
l earn
t o
w rite
E nglish?
+
–
0
•••
I f the answer is “no” then go to (Spontaneous speech) (20).
15
How
o ld
w ere
y ou
w hen
y ou
l earned
t o
w rite
E nglish?
0
Before
y our
i llness,
w as
y our
E nglish
w riting
:
16
From
n ot
g ood
( 1)
t o
v ery
g ood
( 5)
0
1
Every
d ay
2
Every
w eek
In
y our
d aily
l ife
b efore
y our
i llness,
d id
y ou
w rite
17
English
3
Every
m onth
4
Every
y ear
5
Less
t han
o nce
a
y ear
SPONTANEOUS
S PEECH
•••
R ecord FIVE MINUTES of the patient’s spontaneous speech. The function of this section
of the test is to obtain a sample of the patient’s spontaneous speech, and to allow the test
4
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