Elaboration and validation of R-LAST (Right Language Screening Test), a rapid and reliable screening tool to detect cognitive communication disorders in acute right hemisphere stroke
Bibliographic record
Abstract
Abstract Background The role of the right hemisphere in language use and interpretive abilities has become clearer through studies describing sequelae in patients with right hemisphere stroke (RHS). Between 50% and 78% of stroke survivors with RHS experience communication disorders, a condition recently termed “apragmatism” by a group of experts. Apragmatism can negatively impact individuals’ personal lives and overall quality of life. Objective To develop and validate a bedside cognitive and communication screening tool for features of apragmatism in prospective patients with right stroke, called the Right Language Screening Test (R-LAST), which is simple, rapid, and suitable for emergency settings. Patients and methods R-LAST consists of seven subtests and twelve items. We report its internal and external validity and inter-rater reliability. We validated the scale by prospectively administering it to 300 patients admitted to two stroke units with confirmed right stroke, as well as to 94 stabilized patients with and without cognitive-communication disorders, using the MEC B as a reference. Results Internal validity demonstrated no redundancy with a Pearson coefficient less than 0.8. The internal consistency of the 12 items was questionable, indicated by a Cronbach’s alpha of 0.62. External validation against MEC B revealed a sensitivity of 0.84 and a specificity of 0.82. Inter-rater agreement was nearly perfect (ICC 0.993). The average time needed to complete R-LAST was 3 minutes and 52 seconds. Conclusion R-LAST could enable rapid and reliable detection of apragmatism in the acute phase of stroke, which could lead to timely referrals to speech-language therapists and ensure timely rehabilitation. This comprehensively validated cognitive-communication disorders rating scale is simple and rapid, making it a useful tool for bedside evaluation of acute stroke patients in routine clinical practice. Clinical Trial Registration Unique Identifier: NCT03622606 URL: https://clinicaltrials.gov/study/NCT03622606?term=R-LAST&rank=1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".