Assessment of Aphasia

2020 -21, SED6019 Part II S2

Lorinda Kwan, PhD
Core Concepts
1. Aphasia is the language impairment that results from brain damage in
the dominant hemisphere.
2. Aphasia can be evaluated by behavioral tasks which are highly selective
with respect to the theoretical framework of medical, cognitive,
psychological, linguistic, and social paradigm.
3. Assessment of aphasia includes evaluations of language impairments in
the areas of comprehension, production, repetition, reading and writing.
4. Assessment of aphasia includes steps to identify core problems, as well
as responses to interventions.
5. Impairments in reading and writing are not usually assessed thoroughly
in assessment procedures of aphasia. However, possible deficits in
reading and writing result from aphasia may mirror the deficits found in
oral language.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 2

Learning Objectives
1. Describe the different theoretical approaches to understand aphasia
2. Describe the main goals in assessments of aphasia, and varied ways to
achieve them.
3. Account for the factors that impinge on the reliability and validity of ax of
aphasia
4. Use assessment results, or scores, to predict the types of aphasia.
5. Use principles of ax to design one 20- minute clinical test of aphasia and
explain its relevance and limitations.
6. Describe steps to use ax results to develop intervention LTG and STG

29/1/2021 SED 6015 2021 Acquired Lang Disorder 3

Classification of Aphasia
Revision
 o

Dichotomous Classification
( Rosenbek et al 1989) aphasia is language impair result in brain impair of dominant hemisphere

• Speech Fluency Wernicke’s aphasia

Broca’s aphasia
• Non-fluent Aphasia vs Fluent Aphasia

• Degree of comprehension deficits

• Receptive Aphasia vs Expressive Aphasia
• Example of Expressive Aphasia
• http://auditoryneuroscience.com/?q=brocas_aphasia

• Example of Receptive Aphasia

• http://auditoryneuroscience.com/?q=wernicke_aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 5

Dichotomous Classification
( Rosenbek et al 1989)

• Based on observable behaviors

• Mapped grossly with site of lesions

Broca’s area (frontal lobe)
• Anterior lesion ( non-fluent, expressive)
Wernicke’s area (temporal lobe)

• Posterior lesion ( fluent, receptive)

• A number of exceptions ( Binder et al, 1997; Mazzocchi & Vignolo, 1979;

Metter et al, 1989; Naeser, Palumbo, Hel-Estabrooks, Stirassny-Eder &
Albert 1989)

• Behaviors change over time of recovery ( Rosenbek et al 1989)

dementia, and other brain disease

29/1/2021 SED 6015 2021 Acquired Lang Disorder 6

 Connectionist Classification of aphasia
• Used in aphasia diagnostic batters:
• Boston diagnostic aphasia Battery
Examination-3 (Goodglass, Kaplan &
Barresi, 2001);

• Western apahsia Battery (WAB) (Kertesz,

1982);

• Cantonese Aphasia Battery (CAB) (Yiu,

1992)
29/1/2021 SED 6015 2021 Acquired Lang Disorder 7
 Connectionist Classification of aphasia
Behavioral characteristics + neuroanatomical correlates ( Aphasia Syndromes)
stroke

• Global Aphasia
• Broca’s Aphasia Transcortical Motor + Transcortical Sensory

• Transcortical Mixed ( Isolation)

• Wernicke’s Aphasia
• Conduction arcuate fasciculus
Broca’s area
Broca’s area 同附近啲area
area 有事

• Transcortical Motor
4 stroke

Wernicke’s area area

• Anomic
• Transcortical Sensory

29/1/2021 SED 6015 2021 Acquired Lang Disorder 8

Areas of the Left Cortical Hemisphere related
to sub-types of Aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 9

stroke day1 global
self recovery
- e.g. anomic…

29/1/2021 SED 6015 2021 Acquired Lang Disorder 10

29/1/2021 SED 6015 2021 Acquired Lang Disorder 11
29/1/2021 SED 6015 2021 Acquired Lang Disorder 12
29/1/2021 SED 6015 2021 Acquired Lang Disorder 13
Challenges to the Localization/ Connectionists
Model of Aphasia
• Brain imaging technology has called into questions the classic
concepts of the relationships between brain damage and aphasia
syndromes:
qchronic Broca’s or Werneicke’s aphasia includes brain damage
beyond those cortical areas
qAphasia can be caused by damage deep in the brain below the
perisylvian cortex and its associated areas.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 14

Different Approaches to Assess Aphasia
Textbook
• Chapter 5, Chapter 6 of Brookshire, R. H., & McNeil, M. R.
(2014). Introduction to neurogenic communication disorders. Elsevier
Health Sciences.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 16

Different Approaches to Ax Aphasia
• Medical, connectionist model
• Cognitive neuro-psychological (CNP)
• Linguistic Model
• Functional Model
• Social Model

29/1/2021 SED 6015 2021 Acquired Lang Disorder 17

Medical Model
• Localization Model
• Connectionist Model
• Syndrome Approach

western aphasia battery (WAB)

CAB

29/1/2021 SED 6015 2021 Acquired Lang Disorder 18

 Cognitive
Neuropsychological
model

Source: Kay, J., Lesser, R.,

& Coltheart, M. (1992).
Psycholinguistic
Assessments of Language
Processing in Aphasia
(PALPA). Hove: Erlbaum.
29/1/2021 SED 6015 2021 Acquired Lang Disorder 19
 (Kay, Lesser &
Coltheart
(1996) Model)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 20

 Linguistic Elements

• Components of language
• Phonology
• Morphology
• Syntax
• Lexical - Semantics
• Prosody
• Discourse
Courtesy: Prof S. Kiran

29/1/2021 SED 6015 2021 Acquired Lang Disorder 21

Functional Approach

• Person-centred vs clinician-centred
• Communication versus language
• Communication within a daily event
• Communication with different spheres of communication partners
• Communication with larger, functional outcomes

29/1/2021 SED 6015 2021 Acquired Lang Disorder 22

Functional –Social Model (ICIDH-2)
(International Classification of Functioning Disability and Health -2, WHO 1993)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 23

Assessment of Aphasia
Assessment of stroke history
case history

• Personal info: name, age, • CVA history

sex. HKID
• CVA history
• Medical History
• Presence of comorbid
disease, sensory deficits
• CVA type : ischemic / hemorrhagic
• Date of CVA ( acute )
• Neuroimagingà CT, MRI, MRA
• Site of CVA ( left/ right, MCA/ACA, ICH, others )
• Immediate med care ( hospital, surgical
hearing level, hearing aid
management), medication, others covid 19 ? aids?

• Med Hx: hypertension, cardiac problem,

• Education, language, smoker, previous history of stroke, others
social history • Medication, Rehab services
social role: want to work?

29/1/2021 SED 6015 2021 Acquired Lang Disorder 25

Interviewing your patient with stroke
Communication Observation
Broca’s area

• Introduction of your self • Paralysis / paresis

• Prepare your patient for case • Verbal behaviours
history interview • Non verbal behaviours
• Use simple way seek • Insight of the problem
information
• Problem solving skills
• Always provide a non-verbal
text communication

communication aid such as pen • Care-taker communication skills

and paper
• Respectful, and supportive
29/1/2021 SED 6015 2021 Acquired Lang Disorder 26
Tools to assess aphasia
• Screening Test of Language • Goal of ax of aphasia if they have low education level , or dementia

• Quick Test • Dx of Aphasia - therefore case history is very important!

• Determine eligibility of tx
• Comprehensive Language Tests • Profile speech and language
• Auditory Comprehension capacities for treatment
programmes and management
• Reading plan
• Speech Production • Measure outcomes of phases of tx
• Writing • Determine long term plan
• Language Pragmatics
• Standardized Aphasia Tests

29/1/2021 SED 6015 2021 Acquired Lang Disorder 27

 Screening of
Aphasia
in patients with neurological impact

29/1/2021 SED 6015 2021 Acquired Lang Disorder 28

Screening for HA setting, screening is the only assessment

• A protocol done in 10-20 min, bed-side

• Provide a general sense in these areas
• Orientation
• Memory
• Auditory comprehension
• Reading comprehension
• Production of automatized sequences,
• Repetition
• Naming
• Oral reading
• Writing
• Conversational speech • Sample of Screening Ax Form, 167-
168,Brookeshire, 7th Ed., 2007)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 29

Screening
• A protocol done in 10-20 min, bed-side
• Provide a general sense in these areas
• Orientation
• Memory
• Auditory comprehension
• Reading comprehension RED : ST
• Production of automatized sequences, immediate tasks
• Repetition
• Naming
• Oral reading
• Writing
• Conversational speech • Sample of Screening Ax Form, 167-
168,Brookeshire, 7th Ed., 2007)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 30

Screening
• A protocol done in 10-20 min, bed-side
• Provide a general sense in these areas
• Orientation
• Memory
• Auditory comprehension
• Reading comprehension
• Production of automatized sequences, 1 10
GREEN: ST’s
Secondary tasks
• Repetition
• Naming
• Oral reading
• Writing
• Conversational speech • Sample of Screening Ax Form, 167-
168,Brookeshire, 7th Ed., 2007)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 31

 Example

Screening for • Presence of

neuropathology**
• Case history ( Left CVA,
TBI, Dementia, etc)
aphasia – • Auditory Comprehension • 你叫咩名？ 呢到係邊到？

verbal • Conversation
• Object Naming
• 點解會來呢到？發生咩
事？你有咩病？
behaviours • Repetition
• 呢個係咩? 你用佢來做咩?
• 跟我講一次：牛，牛頭，
• Production of autonomic
牛頭角，牛頭角村
speech
• 由1數到10
• Reading
• Writing • 讀下呢個係咩字？
• 寫低你個名

SED 6015 2021 Acquired Lang Disorder 32

What will be in your tool box to screen for
Aphasia? (annotate)
case history
score sheet / note pad eyeglasses
pen and paper cup
(recorder) pen
reading card blanket
pillow
face mask
body parts
for naming
clothes

29/1/2021 SED 6015 2021 Acquired Lang Disorder 33

Screening
• A protocol done in 10-20 min, bed-side
• Provide a general sense in these areas
• Orientation
• Memory
• Auditory comprehension
• Reading comprehension BLUE: Infer only from
• Production of automatized sequences, screening. Suggest
• Repetition MoCA, or MMSE
• Naming
• Oral reading
• Writing
• Conversational speech • Sample of Screening Ax Form, 167-
168,Brookeshire, 7th Ed., 2007)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 34

 Screening Probes are better if they …1/2

•Can be carried out within 10-15

minutes, limit the number of
probes

•Can make use of daily objects that

are available in hospital wards or
clinics. Real objects, good quality
photos ( presented by iPad), and
line drawings
29/1/2021 SED 6015 2021 Acquired Lang Disorder 35
Screening Probes are better if they …2/2
• Ensure reasonable Validity ( comparison to Gold Standards,
results of standardized language tests for people with
aphasia) [ Receiver operation characteristics, ROC]
• Ensure reasonable Reliability ( consensus of test procedures
among users and contexts test
8.9

• Ensure reasonable Diagnostic Accuracy: Sensitivity,

Specificity, test

no severity rate 10

• Outcome: Pass / Fail àchoose a cut-off line

• Fail = Positive=Presence of Aphasia <8.9
• Pass = Negative= Absence of Aphasia >8.9
29/1/2021 SED 6015 2021 Acquired Lang Disorder 36
SED 6015 2021 Acquired Lang Disorder

Quick Aphasia
Battery (QAB)
(Wilson’s et al, PLosONE)

37
29/1/2021
QAB 30min
in between screening and full assessment

• Level of Consciousness
• Connected Speech talk about a topic for 3 min
- find the speech rate(syb/s) and MLUm(m/sentence)

• Word Comprehension
• Sentence Comprehension
• Picture Naming
• Repetition
• Reading Aloud
• Motor Speech papapa
pataka

29/1/2021 SED 6015 2021 Acquired Lang Disorder 38

Comprehensive Test of Aphasia
- expressive
- receptive
- reading
- writing
Assessment of
Comprehension / setting

in
People with Aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 40

Auditory • Single Word : Nouns, verbs
• [attributes](“aphasics
• Presentation of targets: real
objects, drawings , photos
Comprehension: comprehend nouns and
verbs better than colours,
(especially verbs)( presentation
mode affect those with
Single Word numbers,…Goodglass, 1966) damage at visual cortex,
dementia) ( presentation mode
does not affect performance of
• High Frequency words /Low aphasic patients, Helm-
Frequency words Estabrooks, 1981)

• Words acquired earlier /Words • Array size (6) , distribution

acquired later space ( within visual span)

• High imaginable words /Low • Reduce rehearsal or practice

imaginable words effect: Random arrangement of
listen-and-point-to: targets after each trial
example:
taget: noun
distractor 1: visual (cupcake )
distractor 2: semantic
distractor 3: phonological
SED 6015 2021 Acquired Lang Disorder 41
What matters in an Auditory comprehension test of
single words?
• Personal relevance
• Frequency of occurrence
/familiary
• Age of acquisition of the word

• Linguistic features
• Imaginability/ abstractness/
ambiguity of the word
• Word configuration ( #syllables;
etc) vs

• Nouns, verbs,
superordinate/subordinate
29/1/2021 SED 6015 2021 Acquired Lang Disorder 42
Auditory Comprehension: Sentences
• Commands (Imperatives)
• Gesture
• Manipulation of objects
• One-step, two steps, three steps
• Request of objects
• Names
• Functions
• Questions ( Interrogatives)
• Yes-no questions
• Wh-questions
• Personal information
• Knowledge learned in school
• General Knowledge ( temporal relationship, comparative relationships)
• Declaratives???

29/1/2021 SED 6015 2021 Acquired Lang Disorder 43

What matters in Auditory Comprehension of
Sentences
• Length of Sentences • Presentation speech rate
• 120 syllables per min

• Syntactic complexity • Redundancy

prepare the patient to answer the question:

• Semantic variables/ complexity • Response mode: number of

choices, similarity of choices,
• Cognitive Load ( reasoning, inference, verbal/gestural/ reading mode
summarize, conclusion) o

• Personal relevance

29/1/2021 SED 6015 2021 Acquired Lang Disorder 44

 What about comprehension of discourse
On-line comprehension in conversation like that in daily life
Examples of Discourse Comprehension in CAB

Comprehensive Language Tests

• Boston Diagnostic Aphasia Examination (Goodglass, Kaplan,
Narresi, 2001) narrative

• A customer walked into a hotel carrying a coil of rope in one

hand and a suitcase in the other…
• Was the customer carrying a suitcase in each hand?
• Questions for main information

• Minnesota Test for Differential Diagnosis of Aphasia

(Schuell, 1972)
• Gold was first discovered in California by a millwright
named James Marshall…
• In this story, did Marshall discover gold on the Rio Grande?
• Questions for details

29/1/2021 SED 6015 2021 Acquired Lang Disorder 46

Examples of Discourse Comprehension Test
• Discourse Comprehension Test ( Brookshire & Nicholas, 1993)
• One day last fall, several women on Willow Street decided
to have a garage sale.
• Did several women have a party? (No) [Stated main idea]

• Were there a large number of things at the garage sale? [Implied

main idea]

• 10 tape-recoded narrative stories controlled for number of words,

sentences, mean sentence length, speech rate, number of
unfamiliar words, listening difficulty and grammatical complexity

• Questions for main ideas and details; direct questions and implied
questions

29/1/2021 SED 6015 2021 Acquired Lang Disorder 47

 for

What matters in Requires Heuristic Processes • Directness

Discourse
World knowledge, previous • Redundancy
Comprehension experience, cohesion,
coherence…)
• Spoken at a combination
of slower rate and
Salience exaggerated stress (Pashek
and Brookeshire, 1982;
Kimelman and McNeil,
1987)

SED 6015 2021 Acquired Lang Disorder 48

Assessment of
Reading in
people with
aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 49

Assessment of Reading
• Matching Visual elements • 邊個字同 【凍 】 一樣（ 凍，
棟， 冬， 動）
• Printed words
• Spoken Word-picture, picture- spoken • 邊個係 冰凍個 凍 字（凍，動，
word matching 冬，洞）
• Spoken word-print word, print word -
spoken word matching
• Print word-picture, picture-print word • 邊張圖 同個【凍】字有關？
matching

• Printed sentences • 請填充：冬天天氣好 ____ (凍，

冬，熱，棟）
• Print sentence completion
• Act on print sentence

29/1/2021 SED 6015 2021 Acquired Lang Disorder 50

Comprehension of Printed Text
• Boston Diagnostic Aphasia Examination (Goodglass, Kaplan, Narresi, 2001)
• “In the early days of this country…”
• Minnesota Test for Differential Diagnosis of Aphasia (Schuell, 1972)
• “Lawrence Griswold, a writer and scientist…”

29/1/2021 SED 6015 2021 Acquired Lang Disorder 51

 Reading Comprehension Battery for Aphasia
2nd Ed(LaPointe & Horner, 1998)
• Single word Reading test ( at pre-sch – Grade 3)
• Functional Reading
Signs
for eng
•
• Labels
• Menus
• Calendars
• recipes

• Reading of synonyms, nouns, verbs, abstract and concrete words

• Matching of print sentences to pictures
• Matching second sentence of a two-sentences print to pictures
• Sentence completion tasks
• Reading sentences with implied information
• E.g. some people save money by using utensils that do not use any
electricity. Point to the picture showing the one that is cheapest to use.
(picture choices: electric egg beater, electric toaster, spoon)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 52

What matters in reading comprehension tests
• Reading rate
• Reading capacity
• Measures of component reading skills
• Following directions
• Using context
• Getting main ideas
• Drawing conclusions
• Making inferences
• Text and Knowledge components

29/1/2021 SED 6015 2021 Acquired Lang Disorder 53

 Assessment of
Expressive language
in people with aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 54

Assessment of Expressive Language
• Naming
• Sentence Repetition
• Sentence Completion
• Recitation, Rhymes, and Automated Sequences

29/1/2021 SED 6015 2021 Acquired Lang Disorder 55

Assessment of Expressive Language
• Naming Picture naming
• 呢個係咩？
• 佢做緊咩？
• Sentence Repetition • 你見到啲咩？
• Sentence Repetiton
• 請你跟我講
• 落雨之後空氣好清新
• 游過書本放大馬拉松
• 霧妥易個排知人央寄

29/1/2021 SED 6015 2021 Acquired Lang Disorder 56

Assessment of Expressive Language
• Sentence Completion • 請你完成以下句子：
• 一年四季分為 ____________
• Recitation, Rhymes, and
Automated Sequences
• 由1數到10

• 請你完成以下句子：
• 新年______

29/1/2021 SED 6015 2021 Acquired Lang Disorder 57

SED 6015 2021 Acquired Lang Disorder

What matters
• Frequency of occurrence
in an
Expressive • Length and phonological complexity (composition)

Language Test • Semantic Category

of Naming?
• Personal Relevance

• Context, Culture

29/1/2021 58
 Word Fluency Measure
(Borkowski, Benton, and Spreen, 1967)

• A Generative Naming Test

• Contribute to subtest of Neurosensory Centre Comprehensive Examination for Aphasia
(Spreen & Benton, 1977)

• One minute naming of words being with F,A,S for eng

• Modify for Cantonese speakers CAB

• Norms are available in English speakers

• Sensitive indicator of brain injury, but does not discriminate among aphasia
syndromes

• Functional generative naming can be used for Cantonese speakers

• Name the stores near your home
• Name the person who lives with you
• Name the things you would see in a birthday party

29/1/2021 SED 6015 2021 Acquired Lang Disorder 59

Assessment of Verbal Sentence Production
• Word definition task
• Personally related vs distant
• Concrete vs abstract

• Make a sentence from a word given

• High/low frequency
• Noun/verb/attribute

• Expressing specific idea

• Personally related vs distant
• Concrete vs abstract

29/1/2021 SED 6015 2021 Acquired Lang Disorder 60

Assessment of Verbal Sentence Production:
Add you own ideas!
• Word definition task • 請你解釋一下咩叫「放工」？
咩叫「工具」？
• Make a sentence from a word
given • 請你用「幫忙」來作一句句子。

• Expressing specific idea • 請你講出今日做過的三件事情。

29/1/2021 SED 6015 2021 Acquired Lang Disorder 61

Assessment of Discourse Production
• Picture Descriptions

• Story Retelling

• Picture description is more preferred as it required less cognitive and

linguistic load as in story-retelling.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 62

 Boston Diagnostic Aphasia Examination
(Goodglass, Kaplan, Narresi, 2001)

• Rating Scale Profile of Speech Characteristics 0-5 clinical experience

• Melodic line, Phrase length, Articulatory agility, Grammatical form,

Paraphasia, Repetition, Word-Finding difficulty

• Overall Aphasia Severity rating scale ( 0 -5)

• 0 - No usable speech or auditory comprehension
• 5 – Minimal discernible speech handicaps; the patient may have subjective
difficulties that are not apparent to the listener
• ( page 201-202, Brookeshire, 2007)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 63

Cantonese Linguistic Communication Measure
( CLCM) ( Kong, 2006)
• Kong (2006), Kong and Law (2009) In Law, Weekes & Wong (Eds). Language Disorders in Speakers of Chinese. UK:
Multilingual Matters

29/1/2021 SED 6015 2021 Acquired Lang Disorder 64

Cantonese Linguistic Communication Measure
( CLCM) ( Kong, 2006)
• Using Picture descriptions to elicit connective language samples from
people with aphasia.

• Language samples are analyzed using these indices: for

• Total number of words, Number of Informative words, Index of Lexical

Efficiency, Index of Communication Efficiency, Index of Grammatical Support,
Index of Elaboration, Index of Error, Index of Lexical Richness
• Based on LCM ( Menn et al, 1994)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 65

 Assessment of Writing
in People with Aphasia

66 29/1/2021 SED 6015 2021 Acquired Lang Disorder

Tasks for testing Writing
• Discourse • Generative writing
• Sentences • Response Writing
• Words • Cued/supportive writing
• Characters • Dictation
• Radicals • Partial/supportive writing
• Strokes • Delayed copying
• Direct copying
• Copying with grids
• Stroke sequences

29/1/2021 SED 6015 2021 Acquired Lang Disorder 67

 Other Tests

• Calculation
• Communication of Daily
living
• Interactions between Care-
takers

SED 6015 2021 Acquired Lang Disorder 29/1/2021 68

ASHA – FACS functioning model

(Frattali, Holland, Thompson, Wohl, & Ferketic, 1995).

• The ASHA-FACS is a measure of

functional communication. It
does not aim to measure
impairment. Rather, the
assessment aims to measure
how specific speech, language,
hearing and/or cognitive deficits
affect the performance of daily
life activities

29/1/2021 SED 6015 2021 Acquired Lang Disorder 69

 ASHA-FACS
• The ASHA-FACS consists of 43 items. The items within the
ASHA-FACS address four domains: social communication;
communication of basic needs; reading, writing and
number concepts; and daily planning.
• It covers different activities of daily living (ADLs) such as
understanding television and radio, responding in an
emergency, and using a calendar (Frattali et al., 1995).
• The ASHA-FACS is also subdivided into 2 scales:
Communicative Independence and Qualitative
Dimensions of Communication. These scales measure the
level of independence, and the nature of the functional
deficit, respectively (Frattali et al., 1995).

29/1/2021 SED 6015 2021 Acquired Lang Disorder 70

ASHA-FACS
• The Communicative Independence Scale is rated on a 7-point scale ranging from
1) "does not perform the behavior" to 7) "does perform the behavior". It reflects
the extent of assistance the individual requires to perform routine verbal and
nonverbal transactions.
• The Qualitative Dimensions of Communication Scale is rated on a 5-point scale
reflecting adequacy, appropriateness, and promptness of communication and
communication sharing.
(1+2)/2

• The total score is obtained by summing the scores on each item and then dividing
by the number of items (means). It is also possible to calculate both
abovementioned scale scores by calculating the means of interest (Frattali et al.,
1995).

• Lower scores are indicative of greater impairment.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 71
Life Participation model
• Start by seeing the end
• Kagan, Simmons-Mackie (2007) “Beginning with the End”
• Lyon
• Living with Aphasia
• A-FROM ( Kagan et al 2009)

29/1/2021 SED 6015 2021 Acquired Lang Disorder 72

AFROM

• Living with Aphasia: Framework for Outcome

Measurement (A-FROM; Kagan et al., 2008,
Aphasiology )
• conceptual guide to outcome assessment in aphasia
• enhancing the potential for meaningful
communication
• integrating Quality of Life and including domains
related to environment, participation, and personal
identity in the same framework as impairment, the
importance of outcomes in all these areas is
acknowledged for aphasia in particular and disability
in general.

29/1/2021 SED 6015 2021 Acquired Lang Disorder 73

AFROM
(A-FROM; Kagan et al., 2008, Aphasiology )
• Severity of Aphasia
• Communication and
language environment
• Personal Identity, Attitudes
and Feelings
• Participation in life situations
• Living with Aphasia

29/1/2021 SED 6015 2021 Acquired Lang Disorder 74

29/1/2021 SED 6015 2021 Acquired Lang Disorder 75
Documenting your assessment results
• Reason of referral
• Case History
• Clinical Impression
• Assessment
• Method, outcomes, tentative diagnosis
• Diagnosis
• Prognostic factors
• Recommendation
• Management plan

29/1/2021 SED 6015 2021 Acquired Lang Disorder 76

 End of this session

29/1/2021 SED 6015 2021 Acquired Lang Disorder 77