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Abstract

Background
Assessing spoken discourse during aphasia clinical examination is crucial for diagnostic and rehabilitation purposes. Recent approaches have been developed to quantify content word fluency (CWF) and informativeness of spoken discourse without the need to perform time‐consuming transcription and coding. However, the accuracy of these approaches has not been examined in real‐time clinical settings, and they have been developed and validated mainly in English and thus cannot be applied to other languages.

Aims
For the first time: (i) to create and validate CWF checklists and main concept (MC) lists in Arabic; (ii) to examine the application of these two approaches in real‐time clinical settings with people with aphasia (PWA) while they are performing the task; and (iii) to investigate whether these two approaches can differentiate discourse responses produced by PWA versus neurotypical adults.

Methods
The Arabic Discourse Assessment Tool (ADAT) was used to collect discourse responses on three tasks (composite picture description, storytelling narrative, and procedural discourse) from 70 neurotypical control adults and 50 PWA matched to the control group in age and education. The discourse samples were transcribed, and analysed. For each task, CWF checklists and MC lists were developed and validated using discourse reponses from the control group. Afterwards, the application of these two approaches in real‐time clinical settings was examined with the aphasia groups. The psychometric properties of CWF and MC approches were examined.

Results
Novel Arabic CWF checklists and MC lists were successfully developed, validated, and applied clinically for three discourse tasks. The analysis showed significant high accuracy between CWF scores obtained in real‐time clinical settings and those identified using the traditional approach of transcribing and analysing discourse samples across all three discourse tasks (ICC = 0.88 to 0.94). Furthermore, significant excellent reliability (ICC = 0.917 to 0.994) were found for the three tasks in both groups. Most of the MCs were produced accurately and completely by neurotypical control adults, whereas they were mostly absent in PWA. CWF checklists and MC lists showed significant high validity in distinguishing spoken discourse produced by PWA from those produced by neurotypical adults at p < 0.001.

Conclusions
This is the first study to develop and validate novel Arabic CWF checklists and MC lists. Furthermore, this study demonstrated that the CWF approach and main concept analysis (MCA) can be applied clinically in real‐time with PWA. These transcription‐less approaches can be used as part of the routine aphasia clinical examination to provide quick but accurate assessments of CWF (microlinguistics) and informativeness (macrolinguistics) of spoken discourse in PWA. These approaches also provide a significant resource for Arabic speakers with aphasia, that will lead to accurate aphasia assessments and better clinical management.

Publication Type:	Article
Additional Information:	© 2025 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	aphasia, Arabic, assessment, checklists, content word fluency, discourse, fluency, main concepts
Subjects:	P Language and Literature > PI Oriental languages and literatures R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Language & Communication Science
SWORD Depositor:	Symplectic Administrator

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