Synonyms

Aphasia assessment; Aphasia diagnosis; Aphasia evaluation

Description

Tests of aphasia are used to diagnose the type and severity of aphasia and related disorders and to plan intervention for the speech, language, and communication deficits demonstrated by persons who have aphasia following brain injury (PWA). Three types of aphasia tests are commonly used to assess language and communication abilities in PWA: screening tests, comprehensive aphasia batteries, and tests of specific linguistic or communicative function (Patterson 2008, 2015). In addition, assessment of aphasia and its impact on a person’s life includes testing cognitive abilities and related disorders (e.g., memory), testing executive functioning (e.g., attention and planning), observing a person in activities of daily communication (e.g., social functional communication or work-related communication), interviewing the person with aphasia and family members, assessing quality of communication life and communication participation, and determining an individual’s candidacy for use of alternative and augmentative communicative systems (e.g., an alphabet board to spell words, drawing, or a commercially available device).

Historical Background

Aphasia has been assessed more or less systematically for many years. Clinical observation was the earliest method of assessment, and the first standardized test was published in 1926 by Henry Head. In the ensuing years, several comprehensive aphasia tests and specific linguistic tests appeared. Each comprehensive test is based upon a theoretical model of aphasia, and although the tests contain common subtests (e.g., sentence repetition), the test results and aphasia diagnoses vary. For example, the Minnesota Test for Differential Diagnosis of Aphasia (Schuell 1965) assesses language performance across several modalities and rests upon Schuell’s theory of aphasia as a unitary reduction in language across modalities with or without accompanying perceptual or motor deficits. In contrast, the Boston Diagnostic Aphasia Examination (Goodglass et al. 2001) relates speech and language behavioral deficits to neurological lesions. With yet a different perspective, Luria (1966) proposed a comprehensive examination for aphasia through nonstandardized observation of language performance in several modalities, but without specific subtests.

In recent years, several tests have emerged to assess specific language or communication functions in PWA, or to complete testing in a shorter period of time. For example, the ASHA-FACS (Frattali et al. 1995) assesses functional communication skills such as participating in conversation, while the Reading Comprehension Battery for Aphasia – 2 (LaPointe and Horner 1998) evaluates reading performance in several contexts, such as single words and paragraphs. The Aphasia Rapid Test (Azur et al. 2013) is a bedside scale developed for administration in acute stroke settings.

Psychometric Data

The availability of psychometric data for aphasia tests ranges from prolific and well documented for some tests to minimal or nonexistent for others, and the data appear in scholarly journals as well as in the test manuals. Spreen and Risser (2003) and Strauss et al. (2006) provide overviews of psychometric data for many general aphasia tests and supplemental language tests. Few studies, and none recently, compare psychometric data across tests. In evaluating a general or supplemental test for aphasia, several factors should be considered, including size and definition of the standardization sample; reports of item, concurrent and predictive validity; test-retest, interrater and intrarater reliability; report of raw score means, standard deviations, ranges, and standard error of measurement; information about test development, examiner qualifications, administration instructions, scoring, and interpretation; and normative data.

Although it is difficult to judge which of the many aphasia tests best meets all the factors mentioned above, five tests are frequently used in clinical settings and have the most psychometric data published about them: Boston Diagnostic Aphasia Examination, Boston Naming Test, Token Test (and Revised Token Test), the Comprehensive Aphasia Test, and Western Aphasia Battery.

Clinical Uses

Screening Tests for Aphasia

Screening tests for aphasia are brief and may be administered at bedside. Their purpose is to rapidly determine the presence of aphasia or the need for further assessment. A screening test may be independent (e.g., Quick Assessment for Aphasia; Tanner and Culbertson 1999) or a shortened form of a comprehensive aphasia battery, such as the Western Aphasia Battery (WAB; Kertesz 2006).

Comprehensive Aphasia Batteries

A comprehensive aphasia battery is based on a theoretical model of aphasia and contains several subtests. For example, the Boston Diagnostic Aphasia Examination (Goodglass et al. 2001a, b) has 34 subtests, and the performance pattern is used to classify an individual with an aphasia type (e.g., Broca’s aphasia). Although some subtests of comprehensive aphasia batteries may appear similar, the data obtained from each of the subtests and the resulting aphasia diagnosis will vary according to the theoretical model of aphasia which underlies the test. Other comprehensive aphasia batteries are the Comprehensive Aphasia Test (Swinburn et al. 2004; the Western Aphasia Battery (Kertesz 2006), the Multilingual Aphasia Examination (Benton et al. 1994), and the Neurosensory Center Comprehensive Examination for Aphasia (Spreen and Benton 1977).

Tests of Specific Linguistic or Communication Function

Tests of specific functions provide detailed information about a person’s abilities in one area of linguistic or communication ability and are particularly useful for persons who have severe or minimal aphasia and for whom comprehensive aphasia batteries would understate communication strengths and weaknesses. Three examples are the Revised Token Test (McNeil and Prescott 1978) for auditory comprehension, the Boston Naming Test (Goodglass et al. 2001b) for oral naming, and the Psycholinguistic Assessments of Language Processing in Aphasia (Kay et al. 1992) The PALPA uses a cognitive neuropsychological model of language to understand the deficit at the various stages of language processing.

Tests of Cognitive-Communication Abilities and Related Functions

Tests of cognitive-communicative abilities related to language functions have been included as part of comprehensive aphasia batteries (e.g., the Raven’s Progressive Matrices (Raven et al. 1995) as part of the Cortical Quotient in the WAB) or administered independently (e.g., Wechsler Memory Scale; Wechsler 2009).

Tests of Functional Communication

Functional communication abilities in PWA are assessed through observation or the use of specific tests. Functional communication includes verbal and nonverbal methods of conveying information in activities of daily living, such as reading signs, greeting individuals, and participating in conversation. Functional communication assessed through observation can be contextually bound, such as assessing conversation with familiar or unfamiliar partners. Tests of functional communication are intended to simulate activities of daily living but typically are acontextual. Two examples of tests of functional communication are the Communicative Activities of Daily Living – 2 (Holland et al. 1999) and the Assessment of Language-Related Functional Activities (Baines et al. 1999).

Functional communication can also be assessed in a contextually sensitive manner through checklists or scales, as observed by clinicians or reported by persons with aphasia or their family members. Prutting and Kirchner (1987) published the pragmatic protocol which is a list of communicative acts that are rated as appropriate, inappropriate, or no opportunity to observe. The third rating type is important in assessing functional communication because not all communicative acts can be observed within an interaction. Other examples of checklists or scales are the Functional Assessment of Communication Skills for Adults (ASHA FACS; Frattali et al. 1995), the Functional Communication Profile (FCP; Sarno 1969), the Communicative Confidence Rating Scale for Aphasia (CCRSA; Babbitt and Cherney 2010), and the Communicative Effectiveness Index (CETI; Lomas et al. 1989).

Related to but non-synonymous with functional communication is quality of life, or more specific to aphasia, quality of communication life (QCL). QCL examines the impact of a communication disorder on life aspects of a person with aphasia, for example, participation in social, vocational, or educational activities, communication with friends and family, and development of satisfying relationships. Examples of tools to measure QCL are the Quality of Communication Life Scale (ASHA QCL; Paul et al. 2004), the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39; Hilari et al. 2003), and the Assessment for Living with Aphasia (ALA; Simmons-Mackie et al. 2014).

Patient-Reported Outcomes

Patient-reported outcomes (PRO) as a status report on a health condition have gained importance in understanding assessment and treatment. In addition to measuring patient reports of communication, a PRO in aphasia testing also measures the physical, cognitive, and psychological burdens of stroke on the person with aphasia and family members. Two examples of aphasia assessment PRO tools are the Aphasia Communication Outcome Measure (ACOM; Hula et al. 2015) and the Burden of Stroke Scale (BOSS; Doyle et al. 2004).

Cross-References