Frenchay Aphasia Screening Test (FAST)
A brief bedside screen for aphasia, typically 3 to 10 minutes.
By Claire White
- Administered by non-specialists as well as clinicians; 3 to 10 minutes.
- Four subtests: comprehension and expression scored out of 10 each, reading and writing out of 5 each.
- Total score from 0 to 30; higher is better. The cut-off is adjusted for age.
Psychometrics
From Al-Khawaja, Wade and Collin (1996), 50 consecutive patients referred with suspected aphasia. Higher is better.
What does the FAST measure?
The FAST has four subtests. Comprehension asks the person to point to things in a river scene and to geometric shapes, and is scored out of 10. Verbal expression asks them to describe the same scene and then to name as many animals as they can in one minute, and is scored out of 10. Reading asks them to follow five written instructions, out of 5. Writing asks them to write about the picture, out of 5. It is designed for the acute hospital setting where time is limited and the person doing the screening may not be a speech therapist.
What does a FAST score mean?
The total runs from 0 to 30 and higher is better. Aphasia is indicated below the cut-off, and the cut-off depends on age, because the score falls with age among people who do not have aphasia.
| Age | Aphasia indicated | Version |
|---|---|---|
| Up to 60 | Below 27 | Full, out of 30 |
| 61 and over | Below 25 | Full, out of 30 |
| Any age | 13 or below | Shortened, out of 20 |
These cut-offs come from 123 people without aphasia aged 21 to 81. That sample held few very old people, so scores near the threshold in the very elderly are read with caution and the threshold is sometimes lowered further to avoid misclassifying them. The FAST is a screen. A result below the cut-off should prompt full aphasia testing, and it is reference information rather than a diagnosis.
How the FAST is administered
- Administered by
- General practitioners, junior medical staff, and other non-specialists
- Time to administer
- 3 to 10 minutes for the full test, about 3 minutes for the shortened version
- Equipment
- A double-sided stimulus card with attached reading cards, pencil and paper, and a stopwatch
- Training required
- None. Designed for use without specialist training.
- Age range
- Adults. Cut-offs are normed on people aged 21 to 81.
- Available languages
- English
Which conditions is the FAST used for?
Related instruments
- Mississippi Aphasia Screening Test (MAST)The other short screen, with separate expressive and receptive indices
- Western Aphasia Battery (WAB-R)The full battery a positive screen leads to
- Frenchay Dysarthria Assessment (FDA-2)Enderby's motor speech assessment, for slurred speech rather than lost words
- NIH Stroke Scale (NIHSS)The wider stroke severity scale, which scores language as one item
FAST questions, answered
What is the cut-off score for the FAST?
It depends on age. On the full test, out of 30, aphasia is indicated below 27 for people up to 60 and below 25 for people aged 61 and over. On the shortened version, which uses only comprehension and expression and is scored out of 20, a score of 13 or below indicates aphasia. The cut-offs come from 123 people without aphasia aged 21 to 81, and because the total falls with age, they are age-adjusted rather than fixed.
How is the FAST scored?
Comprehension and verbal expression are each scored out of 10, and reading and writing are each scored out of 5. Those four sum to a total out of 30. Higher is better.
How long does the FAST take?
3 to 10 minutes for the full test. The shortened version, which drops reading and writing, takes about 3 minutes.
Who can administer the FAST?
It was designed for general practitioners, junior medical staff, and other non-specialists, so a speech-language pathologist is not required. It is a screen that decides who gets referred for a full assessment, not the assessment itself.
When should the FAST not be used?
Its specificity suffers when something other than language is interfering with the task. Visual field loss, visual neglect or inattention, illiteracy, deafness, poor concentration, and confusion all push scores down for reasons that are not aphasia. In those cases a low score needs to be interpreted against the rest of the clinical picture.
Does the FAST diagnose aphasia?
No. It flags who should be referred, and it produces reference information rather than a diagnosis. A positive screen leads to a full battery such as the WAB-R.
Evidence, psychometrics and provenance
Created by Pamela Enderby and colleagues at Frenchay Hospital, Bristol, and published in 1987 as a screen that non-specialists could run at the bedside.
- Inter-rater reliability
- High, Kendall's W 0.97 (Enderby et al., 1987, via the StrokEngine review)
- Test-retest reliability
- Good to excellent in older rehabilitation inpatients (Philp et al., 2002)
- Concurrent validity
- Correlates with the Minnesota Test and the Functional Communication Profile (Enderby and Crow, 1996)
- Internal consistency
- Not reported. No study has examined it.
References
- 1.Enderby PM, Wood VA, Wade DT, Hewer RL. The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists. Int Rehabil Med. 1987;8(4):166-170.
- 2.Al-Khawaja I, Wade DT, Collin CF. Bedside screening for aphasia: a comparison of two methods. J Neurol. 1996;243(2):201-204.
- 3.Enderby P, Crow E. Frenchay Aphasia Screening Test: validity and comparability. Disabil Rehabil. 1996;18(5):238-240.
- 4.Salter K, Jutai J, Foley N, Hellings C, Teasell R. Identification of aphasia post stroke: a review of screening assessment tools. Brain Inj. 2006;20(6):559-568.
- 5.Philp I, Lowles RV, Armstrong GK, Whitehead C. Repeatability of standardized tests of functional impairment and well-being in older people in a rehabilitation setting. Disabil Rehabil. 2002;24(5):243-249.
- 6.Zeltzer L. Frenchay Aphasia Screening Test (FAST). StrokEngine, McGill University. Evidence reviewed 2008. Source of the age-adjusted cut-off table and the scoring breakdown.
This assessment uses a validated instrument and is reference information, not a diagnosis.