Test item priorities for a screening tool to identify cognitive-communication disorder after right hemisphere stroke

Background: Early recognition of stroke signs and symptoms is critical to ensure people receive the right treatment at the right time. Communication impairment associated with left-hemisphere stroke is easily identifiable due to the recognisable signs of aphasia, whereas signs of cognitive-communication disorder (CCD) after right hemisphere (RH) stroke are often subtler. In contrast to aphasia, no sensitive screening tools exist to allow for early identification of CCD after RH stroke. Aims: To prioritise test items required for a screening tool to identify CCD after RH stroke from the perspective of expert speech-language pathologists. Methods & Procedures: The nominal group technique (NGT) was used with expert speech-language pathologists to determine the most important test items required for a screening tool to identify RH CCD. Results were analysed using a quantitative measure of item ranking and inductive content analysis. Outcomes & Results: Five expert speech pathologists located across Australia and the USA, representing a mix of clinicians and researchers participated in the nominal group. The highest ranked test items across the four cognitive-communication domains (lexical semantics, discourse, pragmatics and prosody) were interpretation of sarcasm or humour, rating conversational discourse, a conversational skills checklist, and expressive prosody. Content analysis revealed three themes: Assessment Domains, Considerations in Item Design and Knowledge Gap. Conclusions: The NGT revealed that multiple considerations exist in developing a screening tool for CCD after RH stroke.