MAST Frequently Asked Questions

1. If a patient is nonverbal, how do you administer the expressive index subscales?
2. What if a patient begins to describe the photograph (Verbal Fluency Subscale) during the 10 second orientation interval prior to the start of the test?
3. What if a patient perseverates (repeats the same thing over and over) during administration of the expressive subtests (e.g., Naming, Repetition, Yes/No)?
4. During the administration of the Yes/No Subscale, what if the patient responds verbally with one answer and gestures with a different answer. For example, they verbalize a “yes” but nod their head “no”?
5. During the administration of items with visual demands (e.g., Following Written Instructions and Object Recognition From a Field of Five), what if the person is inattentive to items on the left side due to visual-spatial problems rather than comprehension problems?
6. What if a patient is unable to complete a command due to hemi-paresis?
7. What accommodations are made if a person is illiterate and unable to read the written command cards or spell words to dictation?

1. If a patient is nonverbal, how do you administer the expressive index subscales?
If a patient is non-verbal due to intubation, aphonia, or other physical disorder, then do not administer these subscales. However, spelling to dictation may be administered in addition to the receptive index subscales. If a patient begins to verbalize, then all of the expressive subscales may be administered.

2. What if a patient begins to describe the photograph (Verbal Fluency Subscale) during the 10 second orientation interval prior to the start of the test?
If a patient begins to verbalize too early, cue them to wait until you say to begin describing the picture.

3. What if a patient perseverates (repeats the same thing over and over) during administration of the expressive subtests (e.g., Naming, Repetition, Yes/No)?
Record the patient’s response following administration of an instruction. If the patient’s response is anything other than the correct answer, record the response and score it as incorrect. At the bottom of the test protocol, there is a place to mark that perseveration was present during the examination; this item is a qualitative descriptor in that it only records the presence or absence of this particular phenomenon.

4. During the administration of the Yes/No Subscale, what if the patient responds verbally with one answer and gestures with a different answer. For example, they verbalize a “yes” but nod their head “no”?
In the event that a patient provides two different answers via different modalities, stop the administration and clarify which modality the patient wants to respond and then resume testing.

5. During the administration of items with visual demands (e.g., Following Written Instructions and Object Recognition From a Field of Five), what if the person is inattentive to items on the left side due to visual-spatial problems rather than comprehension problems?
If a patient responds incorrectly to an item due to any type of impairment (visual neglect, apraxia, etc), then the item is scored incorrect. Interpretation of the patient’s responses remains a clinical decision. During the development of the MAST, errors were observed with individuals with apraxia and visual neglect. Common observations included inability to read the left half of the written instruction cards in addition to being inattentive to objects placed in the left visual field. Some methods utilized to tease apart these problems included placing objects in the right visual field if the patient is suspected of having left visual neglect during administration of Objects From a Field of Five. Place written commands from the Following Written Instructions Subscale in the patient’s right visual field. Also, if the patient does not respond to the item, you may ask them to read the card aloud so that you can determine what it is that they are attempting to comprehend. During development of the Following Written Instructions Subscale, individuals with left visual neglect were observed to only read portions of the command such as “make a fist” was read as “a fist” when asked to read the card aloud.

6. What if a patient is unable to complete a command due to hemi-paresis?
During administration of command following subtests, you can alter the command to utilize the other extremity. The written command cards have an optional card that allows for this.

7. What accommodations are made if a person is illiterate and unable to read the written command cards or spell words to dictation?
During the development of MAST items, we eliminated many items that were influenced by education. The MAST items were developed so that a person with a fifth grade reading level would be able to complete the test. However, if a person is illiterate or has a lower level of education, then items are scored as incorrect for incorrect responses and the clinician administering the MAST should interpret scores accordingly.