Notes for Language Disorders (Acquired) - Assessment Framework and Methods (Lecture 4, Week 2)

Assessment Framework and Methods for Acquired Language Disorders (Lecture 4, Week 2)

  • Context and scope

    • Lecture contrasts with L3: L3 covered the why and what of assessment; L4 focuses on how to conduct assessment and apply frameworks/tools in practice.

    • The aphasia pathway emphasizes a holistic process involving the PwA (person with aphasia) and their carer/family, recognizing that language and motor-speech disorders frequently co-occur.

    • Pathway components (from Page 5): Personal Factors, Care Transitions, Intervention, Environmental Factors, Goal Setting, Assessment, Referral. Initial contact is the starting point. Link provided: https://www.aphasiapathway.com.au/?name=Home.

    • Core aim: identify assessment components and tailor a person-centred assessment plan for PwA and family.

    • Important caveat: this series does not address CALD populations now; plans to discuss aphasia assessment/intervention for Australian Aboriginals and multilingual populations later.

  • Key concepts in assessment philosophy

    • Assessment should reveal intact abilities and functioning across the ICF domains, not only impairment.

    • Assessment is iterative and ongoing, used to inform education, support, and goal setting with PwA and partners.

    • Emphasis on participation and quality of life alongside linguistic/neuronal measures.

    • Ethical/practical implications: culturally safe practices, involvement of family, consideration of caregiver burden, and consent/participation in ongoing assessment.

  • Components of assessment for a PwA and their carer/family

    • Language and motor speech disorders frequently co-occur; assess interaction of linguistics (form, content), cognition, and pragmatics (Chapey, 2008).

    • Assessments should cover: language strengths/difficulties, communication strategies, and daily interaction effectiveness.

    • Inter-subjective aspects: dyadic interaction (PwA and partner) and how repair strategies function in real contexts.

    • The role of discourse, turn-taking, and pragmatic skills, which may require specific analysis beyond standard batteries.

  • Types of assessment and their purposes

    • Formal assessments

    • Informal assessments

    • Screening assessments

    • Language batteries

    • Assessments of specific linguistic skills

    • Cognitive assessments

    • Discourse sampling and analysis

    • Quality of life measures

    • Caregiver perspectives

    • Qualitative observation

  • Formal assessments

    • Purpose

    • Component of the assessment process; includes screening and assessment batteries for communicative and cognitive function.

    • Determine current level of function, strengths/weaknesses; identify aphasia type and severity; establish baseline; predict recovery; monitor therapy outcomes; prioritize goals.

    • Context sensitivity: acute vs rehabilitation unit; may also yield qualitative information.

    • Characteristics

    • Use specific formal constructs/procedures; tests vary in length, scope, target population.

    • Norm-referenced vs standardised; reliability and validity considerations; psychometric properties are important.

    • Provides numerical data but limited direct translation to intervention goals.

    • Examples of considerations

    • Reference to validity and reliability of common aphasia assessments via the Australian Aphasia Rehabilitation Pathway.

  • Screening assessments

    • Purpose

    • Early identification/diagnosis, indication for further assessment, planning.

    • Context-influenced by time, medical stability, and referral background; may be administered by speech-language pathologists (SPs) or non-SPs.

    • Psychometric properties (validity, reliability, standardisation) should be considered.

    • Examples of screening tools

    • Western Aphasia Battery – Revised Bedside Screener (WAB-R; Kertesz,<br>2006Kertesz,<br>2006)

    • Australian Mississippi Aphasia Screening Test (AusMAST; RoyalHobartHospital,<br>Royal Hobart Hospital,<br>Launceston General Hospital, the North West Regional Hospital, 2009)\n- Information Language Processing Screen (ILPS; Prince of Wales Hospital,
      1999)\n- Brisbane Evidence-Base Language Test (online resource)\n

  • Language batteries

    • Purpose

    • Comprehensive appraisal of current language abilities; diagnosis of aphasia subtype; identify areas of impairment; measure treatment outcomes.

    • Examples

    • Western Aphasia Battery – Revised (WAB-R; Kertesz,<br>2006Kertesz,<br>2006)

    • Boston Diagnostic Aphasia Examination (BDAE; GoodglassGoodglass et al., 20012001)

    • The Comprehensive Aphasia Test (CAT; SwinburnSwinburn et al., 20052005)

    • Mt Wilga High Level Language Test (Mt Wilga; Christie, Clark & Mortensen, 1986; Simpson, 2006)

    • Psycholinguistic Assessments of Language Processing in Aphasia (PALPA; Kay, Coltheart & Lesser, 1992)

  • Assessments focusing on specific linguistic skills

    • Rationale

    • Used when batteries or screenings are not sensitive enough to detect subtle linguistic/cognitive difficulties; important for planning precise goals and monitoring subtle changes.

    • Examples

    • Boston Naming Test (BNT; Kaplanetal.,2001Kaplan et al., 2001)

    • Pyramids & Palm Trees (Howard & Patterson, 1992)

    • PALPA (Kay, Coltheart & Lesser, 1992)

    • Note

    • Many such tests tax multiple perceptual and cognitive abilities; careful interpretation needed to isolate specific skills. See Papathanasiou et al. 2022 Table 5.2 for more examples.

  • Cognitive assessments

    • Rationale

    • People with aphasia may have cognitive deficits; cognitive skills are not determined solely by aphasia severity.

    • Cognitive assessment supports prognosis and informs treatment length/type; assists planning attention, memory, executive function, processing, task switching.

    • Collaboration

    • Involve OT and neuropsychologist considerations; ensure language demands of the assessment are valid for CALD/NESB PwA when applicable.

    • Examples

    • The Comprehensive Aphasia Test (CAT; Swinburn et al., 2005) with cognitive screener subtests: visual perception, semantic memory, word fluency, memory, gesture, arithmetic.

    • Cognitive Linguistic Quick Test-Plus (CLQT+; Helm-Estabrooks, 2017).

  • Discourse sampling and analysis

    • Limitation of standard batteries

    • Minimal assessment of connected speech/discourse in standard batteries.

    • Rationale

    • Connective discourse offers insights into activity limitations and participation restrictions; pragmatics (turn-taking, topic maintenance) are best assessed via discourse analysis.

    • Protocols

    • Use multiple genres and aim for 300–400 words per sample: e.g., picture description, narrative, conversation.

    • Analysis protocols should be defined (not specified here in detail).

  • Informal assessment

    • Purpose and use

    • Helps determine therapy goals; can be an intermediate step before battery assessment; supports dynamic hypothesis testing.

    • Focus questions

    • What is the extent of the problem? Where does communicative behavior break down? What helps the behavior? What are the underlying mechanisms?

    • Methods

    • Observations in relevant contexts; inform goal setting and plan development.

  • Quality of life assessment for PwA

    • Rationale

    • Measures how aphasia affects self-perception, wellbeing, and life participation; informs goal setting and intervention evaluation.

    • Aligns with the Life Participation Approach to Aphasia and the ICF framework (participation domain).

    • Factors to assess

    • Feelings, experiences, attitudes, beliefs; contextual factors that promote or hinder recovery (personal and environmental ICF domains).

    • Tools

    • Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) ext(SAQOL−39)ext{(SAQOL-39)}

    • Assessment for Living with Aphasia (ALA) https://www.aphasia.ca/home−page/health−care−professionals/resources−and−tools/ala/https://www.aphasia.ca/home-page/health-care-professionals/resources-and-tools/ala/

    • Additional references

    • See Papathanasiou et al. 2022 Table 5.2 for other examples.

  • Caregivers’ perspectives

    • Rationale

    • Essential to understand participation restrictions and contextual factors; informs goal setting and perceived impact on daily interactions.

    • Assessment focus

    • Carer views of PwA’s impact, communication/cognitive strengths and weaknesses, burden, and needs.

    • Tools and methods

    • Perception scales (e.g., VAS), conversational sampling, and ratings of carers' understanding and support.

  • The power of observation: qualitative assessment

    • Observational domains

    • Lability and emotional responses, fatigue, interest/motivation, frustration, signs of depression, response rate/speed, error responses and self-correction, attention and task switching, turn-taking, eye contact, initiation, responses to others, learning new information, repetition, response to repetition, pausing, stimulus reduction, and context (conversational vs testing).

    • Purpose

    • Informs treatment approach (rate, intensity, fatigue), strategies to support communication in clinic/at home, education/support for family/carer, feedback to PwA and partners, and individualized task focus.

  • Iterative and ongoing nature of assessment

    • Why iterative

    • To evaluate progress and stability; monitor fatigue before starting treatment; track positive therapy responses; identify when plateau occurs and change is needed; plan maintenance post-discharge.

    • Practical aspects

    • Provide feedback to PwA and family; use formal tools with caution for practice effects; use informal probes to track target behaviors (avoid using treatment stimuli as probes); monitor for generalization to untrained items or contexts; establish baseline and conduct follow-ups and review schedules.

  • Take-home messages for assessment planning

    • Focus on the person with aphasia (PwA) with a person-centred approach; include family/carer, children, and friends as appropriate.

    • Use assessments to reveal intact abilities and functional capacity across all ICF domains (not only impairment).

    • Use results to educate, inform, and support PwA and communication partners; align goals with real-life participation and life satisfaction.

    • Be mindful of cultural safety and CALD considerations; plan for future discussion of aphasia assessment/intervention in diverse populations (Australian Aboriginals and multilingual populations).

  • Practical references and context

    • Core sources cited include (among others):

    • WAB-R (Kertesz, 2006)ext,ext{, }Bedside Screener</p></li><li><p>AusMAST(RoyalHobartHospitaletal.,2009)</p></li><li><p>AusMAST (Royal Hobart Hospital et al., 2009)

    • PALPA (Kay, Coltheart & Lesser, 1992)

    • CAT (Swinburn, Howard & Porter, 2004/2005)

    • Foundational works for aphasia assessment and intervention discussed (Papathanasiou et al., 2022; Chapey, 2008; Howard & Patterson, 1992; Kaplan et al., 2001; Goodglass et al., 2001).

  • Quick glossary and reminders

    • PwA: Person with Aphasia

    • ICF: International Classification of Functioning, Disability and Health

    • CALD: Culturally and Linguistically Diverse

    • SP: Speech-Language Pathologist

    • SAQOL-39: Stroke and Aphasia Quality of Life Scale-39

    • ALA: Assessment for Living with Aphasia

    • PALPA: Psycholinguistic Assessments of Language Processing in Aphasia

  • Notes on formatting and analysis in practice

    • Always consider psychometric properties (validity, reliability, standardisation) when selecting formal tools.

    • When using screenings, be aware of context-driven limitations and the need for follow-up batteries.

    • Discourse analysis should be incorporated to capture pragmatic and social-communication aspects of language.

    • Documentation should include context, participant background, and environmental factors to inform interpretation and planning.