CB
BSL Cognitive Battery
What is it?
The BSL CB is a battery for assessing cognition and memory in older deaf signers. It takes 45–60 minutes to administer. It is a wholly clinician-operated battery, with standardised items and video instructions presented via video to the respondent in BSL. The clinician operates the test and enters response data. Once data is entered, a test report will be generated.
This battery should only be used by qualified clinicians, who are fluent in BSL, with the supervision of a qualified clinical psychologist who is skilled in test interpretation.
The battery has three tests:
What normative data is available?
Older deaf adults aged 50–89 years for four age-bands: 50–59, 60–69, 70–79, 80–89.
1. BSL Cognitive Screening Test
The CST is designed wholly in British Sign Language, to help detect dementia and acquired cognitive impairment in older deaf adults. It is designed to screen all areas of cognition, with items relating to memory, language, executive function, visuospatial ability, orientation, and attention. It can be used to detect neurodegeneration, or as a clinical baseline for future comparison.
Who is the CST suitable for?
2. BSL Verbal Learning and Memory Test
This is a test of verbal memory and learning for a list of BSL signs. There are immediate and delayed recall trials and a recognition task. This test provides information about learning, memory retrieval, and recognition.
3. Modified Digit Span
MDS is a visual administration of traditional digit span tasks. The respondent watches as numerals flash up on screen and recalls them using BSL number signs.
Sample Report
This is an example of the report generated after completing any of the tests within the BSL Cognitive Battery. The report includes test scores, age-related percentiles, and interpretive guidance for clinicians.
Test citation
Atkinson, J., Denmark, T., Marshall, J., Mummery, C., & Woll, B. (2015). Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test. Archives of Clinical Neuropsychology.
Download PaperDenmark, T., Marshall, J., Mummery, C., Roy, P., Woll, B., & Atkinson, J. (2016). Detecting Memory Impairment in Deaf People: A New Test of Verbal Learning and Memory in British Sign Language. Archives of Clinical Neuropsychology, 31(8), 855–867. https://doi.org/10.1093/arclin/acw032
Download PaperInstructions
Respondents watch video instructions and questions in BSL on the screen. There are no English language requirements.
Please note that this test is not suitable for users of signed languages other than British sign language.
Controlling the tests
The test administrator should control the computer. Do not let the respondent operate the video control panel.
Download the scoresheet and response sheet
You will need to download, print and complete a scoresheet for each test respondent.
Download and print the response sheet for the Cognitive Screening Test drawing items.
Download the scoring guide
You will need to refer to this during scoring.
Equipment required
Recording the responses
The administrator must print the scoresheet and record responses using a pen. The scoresheet includes additional information relevant for clinical interpretation and should be completed carefully.
You may wish to video record the responses for these BSL CST items, so you can double-check your scoring afterwards:
Videoing is recommended but may not be essential once you are familiar with the test scoring. If you are working with an interpreter, we always recommend video recording the session so you can check scoring is accurate.
Providing additional prompts
The test administrator may need to provide additional prompts in BSL. Please refer to the scoresheet.
Using the response sheets
The following items require the respondent to draw on the response sheets:
You will use the blank sheet of paper for:
You can also use the same sheet for folding during the:
Be ready to hand over the appropriate response sheet at the right times during the assessment. The scoresheet and video provide visual reminders for these items.
Only give the respondent one sheet at a time. Once completed, remove each response sheet and hide it from view to avoid distraction.
Entering scores
At the end of the session, scores should be entered by the administrator to generate the report, which includes the test scores and age-related percentiles.
Administering the test using a BSL–English interpreter
The test is normed only for administration by fluent BSL users, and the norms may not be valid when an interpreter translates BSL responses to English.
If an interpreter is used, include caveats in the clinical write-up.
If you cannot sign fluently, consider whether the person should be referred for a specialist assessment conducted directly in BSL. There is a cognitive disorders clinic for deaf BSL users at the National Hospital for Neurology and Neurosurgery in London.
Ensuring you are qualified to administer
A clinical psychology qualification or supervision from a qualified clinical psychologist is essential.
When to use each test
BSL Cognitive Screening Test
Use the BSL Cognitive Screening Test to assess change in memory or cognition where there is concern about change in a deaf signer.
It is recommended to use the BSL Verbal Learning and Memory Test and the Modified Digit Span Tests with the BSL CST.
Do not use the BSL CST test to assess learning disability or general cognition.
The BSL CST provides a basic screen of:
Harder tests will be required to assess signers with high cognitive reserve.
Additional tests will be required to assess more complex executive functions, visual/visuospatial memory, processing speed and posterior brain functions.
During administration of the 3-stage command task always hand the blank sheet of paper with both of your hands.
BSL Verbal Learning and Memory Test
This is a harder list learning test for BSL signs.
Administer this except where respondent performed very poorly with the verbal memory items on the BSL CST.
Complete delayed recall 25 minutes after the immediate recall learning trials. We recommend completing the Modified Digit Span in between. You will also need to do other tests in the interim to fill the time. We recommend WAIS Matrix Reasoning as a good filler test. Matrix Reasoning is a good hold test for assessing premorbid nonverbal intellectual ability in most signers except where there is neurodegeneration affecting visuospatial cognition or poor attention.
During the VLMT learning trials, you may need to remind respondents that they should recall signs in any order, and that they need to repeat all the signs again for each trial.
For delayed recall, if they are struggling to remember the task, you can cue with ‘MOUSE’ but do not score cued responses or generate a percentile. Cueing provides clinical information about whether a cue facilitates retrieval. If the cue helps facilitate recall, this suggests encoding. If a cue is ineffective, it suggests poor encoding.
Modified Digit Span
It is important to always use the video for administration to ensure that the norms are valid.
Altering the administration (i.e. administrator signing the numbers in BSL) will make the norms invalid.
Forward digit span score measures short term memory and visual attention.
Backward digit span score measures working memory.
It is recommended to report these processes and scores separately in clinical reports.
During administration you may need to remind respondents to pay attention to the screen by pointing to the numbers and holding until the number string is finished.
Downloads
Please download the following materials before administering the BSL Cognitive Battery.
Use this to record respondent responses and clinical observations. Scores will be entered at the end of testing to generate the test score and normative age-band percentile.
Use this for the CST. Have these sheets to hand to pass to the respondent at the relevant time during the assessment.
Read these before administration.
Use this to assist with scoring.
Publications
Atkinson, J., Denmark, T., Marshall, J., Mummery, C., & Woll, B. (2015). Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test. Archives of Clinical Neuropsychology.
Download PaperDenmark, T., Marshall, J., Mummery, C., Roy, P., Woll, B., & Atkinson, J. (2016). Detecting Memory Impairment in Deaf People: A New Test of Verbal Learning and Memory in British Sign Language. Archives of Clinical Neuropsychology, 31(8), 855–867. https://doi.org/10.1093/arclin/acw032
Download PaperFormat
Data is generated in CSV format for easy import into your preferred data management software
Task data
A separate CSV file is generated for each participant.
