Aphasia

See the Assessment section of the Aphasia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

The clinician considers the following factors that may have an impact on screening and comprehensive assessment:

  • Concurrent motor speech impairment (dysarthria, apraxia)
  • Hearing loss and auditory agnosia (inability to process sound meaning)
  • Language(s) spoken
  • Concurrent cognitive impairment (e.g., executive function, memory)
  • Visual acuity deficits, visual agnosia, and visual field cuts
  • Upper extremity hemiparesis (may affect ability to write)
  • Presence of chronic pain from either preexisting or new conditions
  • Poststroke depression
  • Endurance and fatigue (testing may need to be broken into shorter sessions)

See Murray and Chapey, 2001; ASHA’s Practice Portal pages on Adult Hearing Screening and Acquired Apraxia of Speech; and ASHA’s resources on cognitive-communication.

If the individual with aphasia wears prescription glasses or hearing aids, and prescriptions are still appropriate, the glasses or aids should be worn during assessment.

If additional hearing and/or visual deficits resulted from the neurological event—and physical or environmental modifications (e.g., large-print material, modified lighting, amplification devices) are not sufficient to compensate for these changes—then the individual should be referred for complete audiologic and/or vision assessments prior to testing.

When selecting the language of assessment for individuals who speak more than one language, it is important to consider the languages spoken, age of acquisition of each language, premorbid use of each language, and language(s) needed for return to daily activities.

There are times when one language remains intact or mildly impaired, whereas the second language is significantly impaired. Clinicians should gather data in all languages used in order to determine degree of impact. Assessment in only one language may be misleading.

Screening

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. Screening is conducted in the language(s) used by the person, 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, cognitive aspects of communication, and hearing.

Screening may result in

  • recommendation for rescreening;
  • recommendation for comprehensive speech, language, swallowing, or cognitive-communication assessments; and/or
  • referral for other examinations or services.

Comprehensive Assessment

Individuals identified with aphasia through screening are referred to an SLP for a comprehensive assessment of language and communication.

Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016b; WHO, 2001), comprehensive assessment is conducted to identify and describe

  • impairments in body structure and function, including underlying weaknesses in spoken and written language that might affect communication performance;
  • co-morbid deficits such as other health conditions and medications that can affect communication performance;
  • the individual’s limitations in activity and participation, including changes in, and impact on, functional status in communication and interpersonal interactions;
  • contextual (environmental and personal) factors that serve as barriers to, or facilitators of, successful communication and life participation; and
  • the impact of communication impairments on quality of life and functional limitations relative to premorbid social roles and abilities for the individual and the impact on his or her community.

See the ASHA resource titled Person-Centered Focus on Function: Aphasia  [PDF] for an example of assessment data consistent with ICF.

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 protocols can include both standardized and nonstandardized tools and data sources. See ASHA’s resource on assessment tools, techniques, and data sources, and ASHA’s Preferred Practice Patterns for the Profession of Speech-Language Pathology: Spoken and Written Language Assessment—Adults.  

Appropriate accommodations and modifications can be made to the testing process to reconcile cultural and linguistic variations. Documentation should include descriptions of these accommodations and modifications. Scores from standardized tests should be interpreted and reported with caution in these cases. See ASHA’s Practice Portal pages, Bilingual Service Delivery; Collaborating With Interpreters, Transliterators, and Translators; and Cultural Competence.

Typical Components of Aphasia Assessment

Case History
  • Medical status and medical history
  • Education
  • Occupation
  • Cultural and linguistic backgrounds
Self-Report
  • Functional communication struggles and successes
  • Communication difficulties and impact on individual and family/caregivers
  • Contexts of concern (e.g., social interactions, work activities)
  • Language(s) used in contexts of concern
  • Goals and preferences of the individual
Oral–Motor Examination
  • Differentiate between language-based and motor-based deficits by assessing
  • Strength, speed, and range of motion of components of the oral–motor system
  • Sequential/alternating movement repetitions (diadochokinesis; Thoonen, Maassen, Wit, Gabreëls, & Schreuder, 1996)
  • Steadiness, tone, and accuracy of movements for speech and nonspeech tasks (Darley, Aronson, & Brown, 1969)

See ASHA’s Practice Portal page on Acquired Apraxia of Speech.

Language
  • Assess expressive and receptive skills in spoken and written language across a variety of contexts (e.g., social, educational, vocational)

See ASHA’s resource, Language in Brief, for language domains to consider when testing. See also ASHA’s resource, Assessment Tools, Techniques, and Data Sources.

Identification of Environmental and Personal Factors
  • Facilitators (e.g., family support, availability of communication partners able to provide communication support to persons with aphasia in daily interactions; personal motivation to return to prior level of function; desire for greater communication independence; ability and willingness to use compensatory techniques and strategies, including AAC)
  • Barriers (e.g., lack of regular and willing communication partners who are able to provide communication support to the person with aphasia in daily interactions; reduced confidence in one’s ability to communicate with familiar and unfamiliar speakers; cognitive deficits; visual and motor impairments; other comorbid chronic health conditions)

See ASHA’s Practice Portal page on Augmentative and Alternative Communication.

Assessment Results

Assessment may result in one or more of the following:

  • Diagnosis of a language disorder
  • Description of the characteristics, severity, and functional impact of the language disorder
  • Prognosis for change (in the individual or in relevant contexts)
  • Recommendations for intervention, support, and community resources
  • Referral for other assessments or services

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.