Assessment Approaches for Aphasia
Combining Formal Tools with Functional Observations
Presented by Iqra Tariq & Fatima Tariq
Introduction
Aphasia is an acquired language disorder resulting from brain damage, typically due
to stroke, traumatic brain injury, or neurodegenerative disease. It affects various
modalities of communication, including speaking, understanding, reading, and
writing.
Accurate and comprehensive assessment is critical to diagnose aphasia, determine
severity, plan intervention, and monitor progress. Modern assessment approaches
combine formal standardized tools with functional observational methods, ensuring a
holistic understanding of the individual’s communicative abilities in clinical and real-life
contexts.
Formal Assessment Tools
Formal assessments are standardized tests that provide objective, quantifiable data on
language abilities. These tools are essential for diagnosing the type and severity of
aphasia, documenting baseline performance, and measuring therapeutic outcomes.
Key Formal Tools
1. Western Aphasia Battery-Revised (WAB-R)
- Assesses fluency, comprehension, repetition, and naming.
- Produces an Aphasia Quotient (AQ) and classifies aphasia type (Kertesz, 2006).
2. Boston Diagnostic Aphasia Examination (BDAE)
- Provides a comprehensive profile of language functions including naming, fluency,
reading, and writing.
- Helps differentiate among aphasia syndromes (Goodglass, Kaplan, & Barresi, 2001).
3. Boston Naming Test (BNT)
- Focuses on confrontational naming abilities.
- Useful for identifying anomic aphasia or subtle naming deficits (Kaplan, Goodglass, &
Weintraub, 2001).
4. Comprehensive Aphasia Test (CAT)
- A modern tool assessing cognitive and linguistic skills and the impact of aphasia on
quality of life (Swinburn, Porter, & Howard, 2004).
5. Aphasia Diagnostic Profiles (ADP)
- Offers diagnostic information with a functional orientation.
- Includes social and communicative behavior assessments (Helm-Estabrooks, 1992).
Advantages and Limitations of Formal Tools
Advantages:
- Standardized scoring and interpretation
- Normative data for comparison
- Reliable documentation for medical and legal purposes
Limitations:
- May not fully reflect communicative effectiveness in real-life settings
- Time-consuming and potentially fatiguing for the client
- Culturally or linguistically biased in some populations
Functional Observation Approaches
• Functional observations assess how aphasia affects a person’s communication in naturalistic
settings. This approach complements formal testing by focusing on real-world performance,
compensatory strategies, and the communicative environment.
Methods of Functional Observation
1. Discourse Analysis
- Evaluates narrative, conversational, or expository speech for cohesion,
coherence, and pragmatics (Armstrong, 2000).
2. Communication Effectiveness Index (CETI)
- Caregiver-rated scale measuring effectiveness of daily communication across
various situations (Lomas et al., 1989).
3. Functional Communication Profile (FCP)
- Assesses communication behaviors such as gestures, facial expressions,
and comprehension during daily tasks (Sarno, 1969).
4. ASHA Functional Assessment of Communication Skills for Adults
(ASHA FACS)
- Focuses on social communication, basic needs, reading/writing/number
concepts, and daily planning (Frattali et al., 1995).
5. Ecologically Valid Observations
- Involves direct observation of interactions in home, work, or community
settings.
Advantages and Limitations of Functional
Assessment
Advantages:
- Captures the impact of aphasia in daily life
- Includes input from caregivers and family
- Identifies meaningful therapy goals aligned with real-life needs
Limitations:
- Subjective and context-dependent
- Lacks standardization and normative data
- May require more time and interdisciplinary input
Integrative Approach: Best Practices
Combining formal tools with functional observations ensures a comprehensive,
person-centered assessment. This approach acknowledges both impairment-level
deficits and real-life participation challenges.
Recommendations:
- Use a tiered approach: Begin with formal tools to identify language deficits, followed
by functional assessments to guide intervention.
- Involve multiple stakeholders: Include family members and caregivers for a broader
perspective.
- Consider cultural and linguistic factors: Adapt tools or interpret results in light of
cultural context and language background.
- Dynamic assessment: Evaluate learning potential and response to prompts rather
than static performance alone.
- Document functional outcomes: Use Goal Attainment Scaling (GAS) or individualized
outcome measures to track progress.
Conclusion
Assessment of aphasia should not rely solely on formal testing or functional
observation, but rather a synergistic combination of both. This blended approach
offers a multidimensional view of the individual’s communicative competence, guiding
effective and personalized intervention. As the field of speech-language pathology
advances, the emphasis on ecologically valid, culturally appropriate, and functionally
meaningful assessments continues to grow, enhancing the quality of care for
individuals with aphasia.
References
• Armstrong, E. (2000). Aphasic discourse analysis: The story so far. Aphasiology, 14(9), 875-
892.
• Frattali, C., Thompson, C. K., Holland, A. L., Wohl, C. B., & Ferketic, M. M. (1995). Functional
Assessment of Communication Skills for Adults (ASHA FACS). ASHA.
• Goodglass, H., Kaplan, E., & Barresi, B. (2001). Boston Diagnostic Aphasia Examination (3rd
ed.). Lippincott Williams & Wilkins.
• Helm-Estabrooks, N. (1992). Aphasia Diagnostic Profiles. Pro-Ed.
• Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test (2nd ed.). Pro-Ed.
• Kertesz, A. (2006). Western Aphasia Battery-Revised (WAB-R). Pearson.
• Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C. (1989). The
communication effectiveness index: Development and psychometric evaluation of a
functional communication measure for adult aphasia. Journal of Speech and Hearing
Disorders, 54(1), 113-124.
• Sarno, M. T. (1969). Functional Communication Profile. University Park Press.
• Swinburn, K., Porter, G., & Howard, D. (2004). The Comprehensive Aphasia Test. Psychology
Press.
