Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Assessment of Aphasia


Assessment of Language and Functional Communication

Collecting Pt. History

Importance of chart review: (important to know all these things because it directs you in therapy)

Personal Data

Etiology: type, date of onset:, differential Dx, lesion Location

Previous diseases/related illnesses

Medications

Physician’s desk Notes

Physical Health Problems

Vision

Hearing

Limb involvement

Progress notes

Written by patient care personnel recording of chronological physical state, behavior and metal status

What information should you gather or collect about the patient?

Ask about heath, how they are feeling, their family, occupation, ask them to tell you if they are having trouble talking ect., and to tell you about it.

What can this information tell you?

Gives you an Idea of who that person is and how to direct therapy with them. You can get a sense of their personality and what communication needs they and their family members need to have met.

How does the patient spend their normal day?

Prepare for a first meeting with a pt, what are the factors you should consider?

Look at chart, know it, so you can see if they match up with it

Establishing a Prognosis

Biographical Considerations

Pt general Characteristics

Age, gender, education, occupation, pre-morbid intelligence, handedness, personality, emotional state

Medical Considerations

Type, and location and extent of the lesion – most support for prognosis

Look at their age and overall health

Associated conditions that could compromise the pt recovery

Sensory and motor impairments

General health

Behavioral Considerations

Are they motivated?

How are they acting?

How do they feel about therapy

Assessment

Before you Assess:

Do your homework from medical records and interview, have in mind a plan

Choose an appropriate place for testing- quiet, well-lit and free of distractions, should be comfortable

Schedule testing to maximize pt performance

Make testing a collaborative effort

Select test(s) that are appropriate for the patient

Test battery should be at different levels of difficulty

Should be standardized

Should sample in a consistent way the input modalities through which test instructions are delivered, metal process for tasks, and output modalities

Multidimensional scoring should be used

Suggest reason for the deficient performance

What is the purpose of speech/Language screenings? Identify pt who have no communication/language impairments

Patients who have complications that will hinder them for being able to be formally tested

Identify patients with severe irreversible impairments

Also helps SLP decide what test to administer and the level of difficulty to begin at

Also can provide enough information for SLP to write-up an initial impression, diagnosis and recommendations to be placed in progress notes

What kind of testing items do they typically include? 

Orientation, memory

Auditory comprehension

Single word

Yes-no questions

Sentence comprehension

Reading comprehension

Word to picture matching

Automated sequencing

Repetition

Confrontational naming

Oral reading

Rating of connected speech

Writing

Naming

Letters to dictation

Words to dictation

What is the purpose of comprehensive standardized testing of language?

They assess four modalities: Auditory comprehension, Speech, Reading, Writing

They are used to classify the disorder

Determine language and communication abilities

Make a prognostic statement

And provide guidance for treatment

What tests are available?

Classification test:

WAB – Western aphasia battery

BDAE – Boston diagnostic Aphasia Examination

Non-classification test:

MTDDA – Minnesota Test for differential diagnosis of aphasia

PICA

Communication and Pragmatics in daily activity

ASHA FACS, Pragmatic Protocol, CADL, Functional Communication Profile

Tests that make a prognostic statement:

MTDDA or PICA

Which of them provide a “classification” for aphasia?

Western

Boston

What are the pros and cons of each?

Western Aphasia Battery (WAB)

Pros

  • Evaluates content, fluency, auditory comp, repetition, naming, reading, writing, and calculation
  • Also evaluates some nonverbal abilities: drawing, block design, praxis and visual thinking
  • Relatively short
  • Aphasia Quotient, number that allows you to make a sensitivity rating
  • 93.8 or greater is considered not aphasic 93.8 or below is considered aphasic
  • Classifies into 1 of 8 categories: Global, Brocca’s, Isolation, Transcortical Sensory,, conduction and Anomic

Cons

Not as comprehensive

No profile just classification

Boston Diagnostic Aphasia Exam (BDAE)

Pros

  • Tests conversational and expository speech via conversation and pictures – like the WAB
  • Auditory comp, verbal expression, oral movement, repetition, oral reading, naming, understanding, written language and writing
  • More comprehensive than WAB
  • 0-5 severity rating scale – profile of speech characteristics (profiles for each aphasia type)

Cons

  • Takes longer than WAB but more comprehensive

The Minnesota Test for the Differential Diagnosis of Aphasia (MTDDA)

  • Assess pt strengths and weaknesses in all language modalities
  • Designed to determine where language performance breaks down in each modality and provides information about deficit
  • Oldest test
  • 6 hours to administer
  • 48 subtests
  • No classification information
  • Not used much any more

Porch Index of Communicative Ability (PICA)

  • Have to have 80 hours of training to administer this test
  • Good thing- multidimensional scoring system
  • Provides accurate and reliable measure of pt performance and a prognostic statement of what changes in performance can be expected

What methods and assessments are available for assessing pragmatics and functional communication? What are the pros and cons of each?

Pragmatic Assessment

Elicit a conversation sample

Analysis – the Pragmatic Protocol

Verbal and paralinguistic and non-verbal aspects

Functional communication

Observation

American Speech and Hearing Association Functional Assessment of Communication Skills (ASHA FACS)

Looks at: social communication, communication of basic need, reading and writing, number concepts, daily planning

Looks at pt getting message across and also the conversation partner understanding and getting their message across

Communication Abilities in Daily Living (CADL)

Picture description and role play

Less conversational interactive

Not as good b/c adults don’t usually pretend they feel stupid doing this

Good for moderate to severely impaired

Caregiver assessment

The Communicative Effectiveness Index (CETI)

Family/caregiver rates person on a variety of areas on a scale from “not at all able” to ‘as able as before stroke”

Visual analog scale

As a clinician you need to:

  1. Assist pt to regain as much communication as their brain damage will allow
  2. Help them learn how to compensate for residual deficits
  3. Help them learn to live in harmony with the differences b/t the way they were before stroke and they way they are now
  4. Let Pt and family guide your treatment , don’t limit treatment to speech and communication
  5. Educate and involve pt family in therapy
  6. Keep humor and hope in the face of adversary
  7. Know when to stop and when to start therapy – EBP therapy collect good data, make sure you are doing tx when its good for the pt, keep them motivated

Areas to Consider When Doing Informal Evaluation in…

Speech

Single world level

Recitation, rhymes, Automatized sequences

Sentence completion

Speech repetition

Naming

Confrontational naming

Responsive naming – what do you tell time with?

Generative naming – name all the animals you can think of

Variables that affect naming accuracy:

Frequency of occurrence

Length and phonological complexity

Context

Sentence level

Word definition test

Make a sentence from a word task

Expressing ideas

Discourse level

Picture description (picnic scene, stealing cookie scene)

Story telling

Interview and conversation

Auditory Comprehension

Single world level

Carrier phrase: Point to the:

Point to objects in environment

Body parts

Variables that affect single word comp:

Frequency of occurrence (do they hear that word, know that word)

Semantic/acoustic similarities b/t target word and foils

Fidelity – can you hear the question

Sentence level

Question, perform a task to spoken command

Yes/no question – easier, easier if they are relevant

Are you a doctor, do you cut grass with and ax?

Variables that affect this:

Predictability

Personal relevance

Discourse level

Read out loud a short story then the patient answers questions

Read magazine that they enjoy, bible study, book, then ask them question, they will do better if its relevant

Variables that affect spoken discourse:

Salience- the way the speaker makes important information stand out

Directness – how directly you say your information compared to having them infer the information

Redundancy – how many times you repeat or reword the same idea- repetition makes it easier

Speech rate and emphatic stress- should use slow speech rate and exaggerated emphasis on the discourse to help pt do better

Reading

Single word level

Visual matching

Oral reading of words

Match word with picture

Match printed word to spoken word

Sentence level

Oral reading of sentences

Comprehension of printed sentence or text

Discourse level

Reading rate – how well they can read and comprehend under normal time constraints

Reading capacity – how well they can read if they have as much time as they need (do better with this)

Want to bring RR and RC closer together

Writing

Single word level

Generating ‘automatic” sequences (sign name, address, date)

Copying

Writing to diction

Writing to self formulated materials

Sentence level

Writing to diction

Discourse level

Writing a story

Most clients depending on occupation might only need to sign name and write lists. After school we don’t do as much writing depending on occupation

9 comments on “Assessment of Aphasia

  1. Hadasah Chapman
    February 10, 2013

    This is GREAT! I definitely plan on referring to this when I have clients in the school clinic!

  2. Charley
    February 17, 2015

    In outpatient settings, what would you consider the best practice for aphasia assessment when you only have 30 minute sessions with the patient to establish baseline?

    • Admin
      February 17, 2015

      Depends on the type and severity. If they are mild, then maybe the Boston Naming test and portions of the Western Aphasia Battery. I like both of those tests for mild-moderate aphasia and the Western for mod-sev.

  3. jacquie buzzard
    September 16, 2015

    What about COGNITION? There is much research regarding attention, memory, and problem solving concerns in those with Aphasia. Assessment should include a brief cognitive assessment.

    • Admin
      September 16, 2015

      Hello Jacquie. Your point about cognition is true. Very few patients have a pure anomia or broca’s aphasia, or any pure aphasia without issues with working memory, problem solving, etc.
      But depending on the severity of aphasia, cognitive testing may be of little clinical benefit. By that I mean, they may score poorly on a test for cognition, but teasing apart what is a cognitive impairment and what is part of their aphasia may be impossible.
      I do, however, frequently use cognitive tests after a patient has made significant gains in language and/or speech.
      Here are a few cognitive tests I use: the MOCA, SLUMS, RIPA-G, CLQT, ABCD, and the SCATBI.

      What assessments do you all use? Does anyone have suggestions for other tests that might be more beneficial with those with aphasia?

      • jacquie buzzard
        September 16, 2015

        Thank you for your response! You’ll have to forgive me, I’m a 2nd year grad student! I have one additional question. If the PWA has significant concerns with attention, would you address this directly, or incorporate into the language intervention?

      • Admin
        September 16, 2015

        Early on, I tend to set up language therapy in a quiet environment and use the LARK kit to focus on both attention and aphasia. If this wasn’t working as well, you could always try a basic coloring task to see if they can focus attention on a task…though that might be tricky for many R handed individuals with aphasia that also likely have some hemiparesis with their dominant hand.
        Ultimately, whatever works to increase attention and basic communication are great activities. What does your patient like? If you can engage in an activity they find stimulating, then their “buy-in” will be much better.

  4. peter
    October 8, 2015

    kindly advice am interested in taking a study in aphasia in my post graduate degree but it is proving heard to get one. kindly advice.

  5. Jinagna Shah
    June 5, 2017

    Great, thanks for the information! Was looking of a brief comparison of the test materials.

    Also, I have a question.
    What is an “Impairment Oriented Test”?
    Are WAB/BDAE considered as the same?
    I’m looking for information regarding this, and haven’t found anything. It’s a question in my exam papers, and I’m just looking for answers as revisions.

    Help from anyone will be much appreciated! :)

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