MAST Syllabus

Individuals with significant brain injury due to trauma, stroke (including subarachnoid hemorrhage), tumor, or anoxia may demonstrate communication impairment, particularly during early recovery. Patients with focal left hemisphere lesions will have marked language impairment acutely and may demonstrate persistent aphasia (Kertesz & McCabe, 1977; Uzzell et al., 1979). These impairments complicate early medical and rehabilitation treatment and have implications for long-term outcome (Tate et al., 1989). Clinicians are frequently called upon to serially assess communication skills and language function, provide information to guide medical and rehabilitation interventions, detect improvement or decline in clinical status, provide feedback to family, and assist with post-discharge planning. For patients with severe language impairments, lengthy language assessment batteries may not be cost-effective for serial evaluation. A brief instrument that surveys a broad array of language and communication abilities is more suited to tracking patients’ progress through their early clinical course.

Individuals with severe language impairment are challenging to evaluate given the lengthy nature of comprehensive language batteries and the limited number of abilities assessed by some brief language tests. In addition, patients with severe language difficulties may make small improvements over time that may not be reflected in language battery summary scores. Common practice involves administering language batteries or many different tests across multiple sessions to assess patients’ evolving abilities (Brooks et al., 1984; Kertesz, 1982). Performance differences from one part of the battery to another may reflect evolution of symptoms between 2 testing sessions. A brief screening instrument that can be completed within a single therapy session, bedside evaluation, or clinic appointment would address some of these possible problems with the use of comprehensive language batteries.

The MAST was developed in response to the lack of a standardized brief assessment instrument that could be used with severely neurologically impaired individuals who were expected to demonstrate impairments in communication and language functioning. The intent of the MAST was to briefly and objectively evaluate changes over time for individuals who could not undergo formal, lengthy language assessments. The MAST was developed by a team of neuropsychologists, brain injury physicians, and speech-language pathologists over a two year time period. Each specialty generated items relevant to the domains important in the assessment of an acquired language disorder. Items assessing both expressive and receptive language abilities were created. Items for 9 language domains were subsequently tested and revised on patients during acute care hospitalization and inpatient rehabilitation. The MAST Form I was subsequently evaluated in research; however, two other alternate forms were created for future research purposes.

The current MAST Form I has nine subtests: a) Naming, b) Automatic Speech, c) Repetition, d) Yes/No Accuracy, e) Object Recognition from a Field of Five, f) Following Verbal Instructions, g) Reading Instructions, h) Verbal Fluency, and i) Writing/Spelling to Dictation. Forty six items comprise the MAST. The test takes approximately 5 to 15 minutes to administer and yields nine subtests and two index scores (Receptive & Expressive Language Index). Each subscale sums to 10 points with the exception of the Yes/No Accuracy subscale which sums to 20. The Index scores sum to 50 points each and are added for the MAST Total Score (0 -100 points).

Figure 1. Description of MAST Form I
The MAST (see Figure 1) items were initially generated, pilot-tested, and revised to its current form. The MAST-I has nine subscales measuring the following language domains and yield the following scoring schema.

	Number of Items	Score Range
MAST Total Score	46	0-100
Expressive Language Index	21	0-50
Naming	5	0-10
Automatic Speech	5	0-10
Repetition	5	0-10
Verbal Fluency	1	0-10
Writing to Dictation	5	0-10
Receptive Language Index	25	0-50
Following Verbal Instructions	5	0-10
Following Written Instructions	5	0-10
Object Recognition from a Field of Five	5	0-10
Yes/No Responding	10	0-20

MAST Instructions for Administration

Administration instructions are in bold for each subscale.

Now I am going to ask you to do a few things for me.

Subscale Test Instructions

Naming
Tell me what this is called ________(present 1st stimuli). And this _____ (present 2nd stimuli)…..etc.

Automatic Speech
Can you count to ten for me?

Recite the days of the week.

Now I am going to say something and I want you to finish it. (present last 3 items)

Repetition
Now say, ______ (present the first word, record response and proceed with subsequent words).

Yes/No Responses
Now I am going to ask you some questions and I want you to answer yes or no. (present 10 items).
If patient restates the phrase, repeat the statement and say “Tell me just yes or no.”
If patient gives a verbal and nonverbal response, score the verbal response.
If the patient is nonverbal, establish a yes and no gesture and administer the subtest.

Object Recognition From Field of Five
Place stimuli in scrambled order in front of the patient. The first two items should be a watch and some keys. The last three items can include the following: paper, pen, photo (can use the Verbal Fluency stimulus photos), coin, name badge, or cup. Say, Point to the _____(present stimuli in order on list).

Following Instructions
Now I am going to ask you to do some things. (issue verbal instructions).

Reading Instructions
Now I want you to read this card to yourself and do what it says. (present 1st card)
Again, read this one to yourself and do what it says (present 2nd card; keep going until all cards presented).
** An alternative instruction is given for item 3 if the person is unable to use their right upper extremity to complete the instruction. An alternative item 3 using the person’s left upper extremity is available.

Verbal Fluency
I want you to look at this photo for 10 seconds. (after exactly 10 seconds has elapsed say) Now tell me everything you can about this picture; keep talking until I tell you to stop. (Immediately begin timing responses for next 10 seconds. Write all that the subject says during the 10 second interval onto the recording sheet. Use a dash for unintelligible utterances.). The 10 second duration that you record verbalizations begins immediately after you have finished stating the instructions. Any delay in patient response is included in the 10 seconds.

Writing
(present a blank piece of paper and pen to the subject)
Now I want you to write some words for me. Write ______(present 1st word), Now write _____(present 2nd word and continue with last three items)

MAST Instructions for Scoring

Naming Subscale
Two points are given for each item named correctly. If patient provides incorrect response such as a paraphasic error (word substitution), 0 points are given for that item.

Automatic Speech
Two points are given for all items completed correctly. Items 1 and 2 must be completed without error in order to receive credit. If patient provides incorrect response or partially complete response, 0 points are given for that item.

Repetition
Two points are given for correct restatement of words and phrases. If the patient provides a word substitution or unintelligible response, 0 points are given for that item.

Yes/No Accuracy
Two points are given for correct answers and 0 points are given for incorrect responses.

Object Recognition in a Field of Five
Two points are given for each correct identification of an object named by the examiner.

Following Instructions
Two points are given for each correct execution of a verbal instruction presented. If any part of the instruction is not completed accurately, 0 points are given for that item.

Reading Instructions
Two points are given for each correct execution of a written instruction presented. If any part of the instruction is not completed accurately, 0 points are given for that item.

Verbal Fluency
Sum all intelligible words (relevant or irrelevant to the photo stimulus) given by the patient during the 10 second recording interval. If the intelligible words sum less than 5, the subscale score is 0. If the intelligible words sum range from 5 to 10, the subscale score is 5. If the intelligible words sum to greater than 10, the subscale score is 10. See conversion formula below.

 

Verbal Fluency Sum	Verbal Fluency Converted Score
0-4 words	0
5-10 words	5
11 or more words	10

Writing/Spelling
Two points are given for each word correctly written. If there is an incorrect spelling of any word, a score of 0 is given for that item.

Optional Ratings
Examiners may indicate presence or absence of several features observed during the MAST administration including dysarthria, paraphasic errors, perseveration, and orientation.