See the Assessment section of the aphasia evidence map for pertinent scientific evidence, expert opinion and client/caregiver perspective.
Screening does not provide a detailed description of the severity and characteristics of aphasia, but rather is a procedure for identifying the need for further assessment. Screening is an invaluable tool in the appropriate referral of persons with aphasia to speech-language pathology services and is an important first step in determining the need for treatment. It is conducted in the language(s) used by the person, and with sensitivity to cultural and linguistic diversity.
Screenings are completed by the SLP or other professional. Standardized and nonstandardized methods are used to screen oral motor functions, speech production skills, comprehension and production of spoken and written language, and cognitive aspects of communication. Screening typically focuses on body structures/functions, but may also address activities/participation and contextual factors affecting communication (see International Classification of Functioning, Disability and Health [ICF] framework proposed by the World Health Organization [WHO], 2001).
Screening may result in recommendations for rescreening; comprehensive speech, language, swallowing, or cognitive-communication assessments; or referral for other examinations or services.
See the Screening section of the aphasia evidence map for pertinent scientific evidence, expert opinion and client/caregiver perspective.
Individuals identified with aphasia through screening are referred to an SLP for a more comprehensive assessment of language and communication.
Assessment is conducted to identify and describe
- underlying strengths and deficits related to spoken and written language that affect communication performance
- effects of the language disorder on the individual's activities and participation in ideal settings, everyday contexts, and employment settings
- contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with spoken and written language disorders
- the impact on quality of life for the individual and the impact on his or her family.
Assessment may result in
- diagnosis of a language disorder
- description of the characteristics and severity of the language disorder
- prognosis for change (in the individual or relevant contexts)
- recommendations for intervention and support
- identification of the effectiveness of intervention and supports
- referral for other assessments or services.
Prior to assessment, consider the influence of cultural and linguistic factors on the individual's communication style and discuss the potential impact of the impairment on quality of life and participation in daily activities with the person with aphasia, their family, and the treatment team in order to customize the assessment. In addition, evaluate sensory functions to identify deficits (e.g., auditory and visual acuity deficits, auditory and visual agnosia, and visual field cuts) that can potentially impede assessment and treatment procedures (Murray & Chapey, 2001). Also consider cognitive functions (e.g., executive function) prior to assessment.
A comprehensive assessment is sensitive to cultural and linguistic diversity and addresses the components within the WHO framework (see ASHA's Scope of Practice in Speech-Language Pathology), including body structures/functions, activities/participation, and contextual factors. Assessment should occur in the language(s) used by the person with aphasia.
Assessment can be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) and/or dynamic (i.e., ongoing process using hypothesis-testing procedures to identify potentially successful intervention and support procedures). Assessment typically includes
- relevant case history, including medical status, education, occupation, and socioeconomic, cultural, and linguistic backgrounds
- review of auditory, visual, motor, cognitive, and emotional status
- standardized and nonstandardized methods, selected with consideration of ecological validity:
- client's report of areas of concern (listening, speaking, reading, writing), contexts of concern (e.g., social interactions, work activities) and language(s) used in those contexts, and goals and preferences;
- administration of standardized assessment tools and/or nonstandardized sampling or observational methods to assess and describe the individual's knowledge and skills in the areas of language form (phonology and alphabetic symbols, morphology and orthographic patterns, and syntax), content (lexicon and semantics), and use (pragmatics) across spoken and written modalities;
- analysis of natural communication samples gathered in modalities (listening, speaking, reading, or writing) and specific contexts (social, educational, or vocational) identified as problematic;
- assessment of oral, speech, and motor (e.g., hemiparesis, limb apraxia, apraxia of speech) function;
- identification of contextual barriers and facilitators and potential for effective compensatory techniques and strategies, including the use of augmentative and alternative communication (AAC)
- follow-up services to monitor spoken and written language status and ensure appropriate intervention and support in individuals with identified language disorders.
- Individuals with aphasia should receive a comprehensive assessment by a specialized clinician with expertise in aphasia (National Stroke Foundation, 2010; Intercollegiate Stroke Working Party, 2008; Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010).
- The nature and extent of aphasia should be documented and discussed with the person with aphasia and his or her family, and individual goals and a treatment plan should be developed and reassessed at appropriate intervals (National Stroke Foundation, 2010; Intercollegiate Stroke Working Party, 2008; Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010; Taylor-Goh, 2005).
- Alternate means of communication such as gestures, drawing, writing, and use of communication aids should be evaluated in individuals who exhibit aphasia persisting for more than 2 weeks (Intercollegiate Stroke Working Party, 2008).
- Assessment areas should consider the individual's cultural background, their ability to use strategies to compensate for communication impairments in real-life environments, and the communication partner's ability to facilitate strategies (Taylor-Goh, 2005).
- Assessment should consider an individual's speech production abilities in various conditions, including narrative, conversation, and constrained conditions (e.g., picture description) (Taylor-Goh, 2005).
See the Comprehensive Assessment section of the aphasia evidence map for pertinent scientific evidence, expert opinion and client/caregiver perspective.
A number of valid and reliable aphasia screening tools and comprehensive assessment batteries are available to assist SLPs (see the Directory of Speech-Language Pathology Assessment Instruments). These measures may be helpful in assessing basic communication difficulties or may provide a more detailed description of the type and severity of aphasia.
Comprehensive Standardized Test Battery Versus Nonstandardized Testing
Assessment of individuals with aphasia is completed in a number of ways and incorporates a range of assessment measures. In some cases, an entire standardized test battery is administered. In other cases, the clinician may give selected subtests from standardized test batteries, recognizing the impact on the psychometric properties when using subtests in this manner. This impact includes understanding that when tools are not administered according to standardized procedures, scores cannot be reported; only subjective descriptions of a person's functioning can be made. In other cases, nonstandardized tools developed by the clinician are used to probe aspects of speech, language, and cognition. The decision to use standardized or nonstandardized assessment procedures is determined by the clinician based upon a variety of factors, including the needs of the person with aphasia, the complexity of impairment, payer rules, facility policy, and other considerations.
- The speech and language evaluation may incorporate a range of assessment measures including the use of formal and informal measures (Taylor-Goh, 2005).
- Conversation analysis should be considered to assess the conversation/interaction patterns of the individual with aphasia with their caregiver (Taylor-Goh, 2005).
See the Assessment Measures section of the aphasia evidence map for pertinent scientific evidence, expert opinion and client/caregiver perspective.