Language Assessment: SLH 371 Spring 2025

Language Assessment

Learning Objectives

  • Outline purposes of language assessment.
  • Define and describe components within a comprehensive language assessment.
  • Discuss best practices for interacting with someone with aphasia.
  • List factors that impact aphasia prognosis.

Purposes of Language Assessment

  • Mirror purposes of other communication and swallowing assessments:
    • Diagnosis.
    • Prognosis.
    • Document and describe type and severity of deficits.
      • Including impacts on Activities of Daily Living (ADL) and Quality of Life (QOL).
    • Compare with previous performance.
    • Inform:
      • New treatment goals.
      • If previous goals have been met.
      • When the patient is ready for discharge.
      • Referrals to other healthcare providers.
      • Patient and care partner education and counseling (Hollowell, 2023).

Best Practices

  • Acknowledge your own affect on the assessment.
  • Acknowledge peculiarities of testing.
    • Mistakes and wrong answers are okay and help us learn about patient's functioning.
    • Assessment materials are designed so that most people cannot do every task perfectly.
    • Incorrect answers do not reflect on a lack of intelligence.
    • Performance on a test does not capture the whole picture of what is relevant to the patient's communication abilities and challenges.
  • Keep the patient at the center of the process.
  • Speak directly to the person!
  • Note communication difficulties as well as strengths.
  • Create the most optimal assessment environment.
  • Attend to cultural and linguistic differences.
  • Assess language proficiency across all languages spoken.
  • Balance standardized and personalized assessments (Hollowell, 2023).

How to Talk and Listen to People with Aphasia

  • Take it slow.
  • Encourage them to do the same.
  • Unless they have hearing loss, loud speech will not help comprehension!
  • Look at them.
  • Watch for indications of understanding or confusion.
  • Use multiple communication modalities.
    • Gestures, drawing, writing.
    • Encourage them to do the same.
  • Keep your sentences simple.
  • Check your understanding!
  • Don't ignore or move on if you didn't understand something.
  • Treat them like an intelligent adult with valuable information and an interesting life (Donkers, 2016).

Components of Language Assessments

Case History
  • Chart Review
    • Medical/surgical history
    • History of SLP services
    • Etc.
  • Interview
    • Information about communication
    • Involve family/care partners
    • Specific communication needs
  • Patient-Reported Outcome (PRO)
    • Perception of function and quality of life (QOL)
Aphasia PROs
  • Aphasia Impact Questionnaire
  • Stroke Specific Quality of Life Scale (free)
  • Quality of Communication Life Scale
Assess Receptive & Expressive Language
  • RECEPTIVE
    • Auditory comprehension
    • Reading comprehension
  • REPETITION
  • EXPRESSIVE
    • Speech production
    • Written expression
Standardized Tests
  • Aphasia Diagnostic Profiles
  • Boston Diagnostic Aphasia Examination
  • Communication Activities of Daily Living
  • Western Aphasia Battery
  • Quick Aphasia Battery
  • Quick Assessment for Aphasia
  • Comprehensive Aphasia Test
  • Examining for Aphasia
  • Porch Index of Communicative Ability
  • Minnesota Test for Differential Diagnosis of Aphasia
  • Standardized tests evaluate verbal receptive & expressive language, reading, and writing (Manasco (2021), Brookshire (2015)).

Auditory Comprehension

  • Single-word
    • Patient points to body parts, objects, pictures of nouns, verbs, colors, etc.
    • “Point to the _”
    • “Show me the _”
  • Sentence
    • Patient performs gesture or other motor response
    • “Point to the dog, garage, and ladder”
    • “Point to the ceiling & then the floor”
  • Yes/no questions
    • “Is your last name Gutierrez?”
    • “Are the lights on in this room?”
  • Discourse
    • Example:
      • A customer walked into a hotel carrying a coil of rope in one hand and a suitcase in the other. The hotel clerk asked, ‘Pardon me, sir, but would you tell me what the rope is for?’ ‘Yes,’ responded the man. ‘That’s my fire escape!’ ‘I’m sorry, sir,’ said the clerk, ‘but all guests carrying their own fire escapes must pay in advance”
      • Was the customer carrying a suitcase in each hand?
      • Did the clerk trust this guess? (Brookshire, 2015)

Auditory Comprehension – Confounding Factors

  • Word frequency
  • Word familiarity
  • Noun case and gender
  • Imageability
  • Concreteness/abstractness
  • Word, phrase, sentence length
  • Phonemic complexity
  • Grammatical complexity
  • Density of prepositions
  • Audibility, clarity, and rate of spoken language
  • Discourse genre (Hollowell, 2023)
Confounding Factor Examples
  • Word frequency: High-frequency words like "dog" vs. low-frequency words like "onomatopoeia"
  • Word familiarity: Common words like "house" vs. less familiar words like "haberdashery"
  • Noun case and gender: Masculine vs. feminine forms (e.g., "actor" vs. "actress")
  • Imageability: Words like "apple" (easily visualized) vs. "justice" (harder to visualize)
  • Concreteness/abstractness: Concrete words like "book" vs. abstract words like "freedom"
  • Word, phrase, sentence length: Short sentences ("She runs.") vs. long sentences ("The dog that chased the cat runs quickly.")
  • Phonemic complexity: Simple words like "cat" vs. complex ones like "contradiction"
  • Grammatical complexity: Simple sentences ("She runs.") vs. complex sentences ("Although she was tired, she ran.")
  • Density of prepositions: "She ran across the street." vs. "She ran."
  • Audibility, clarity, and rate of spoken language: Clear, slow speech vs. unclear, rapid speech
  • Discourse genre: Narrative vs. expository text

Reading Comprehension

  • Matching:
    • Symbols, letters, words
  • Oral reading
    • Patient reads words or sentences aloud
    • Does not necessarily probe reading comprehension (Brookshire, 2015)
Reading Comprehension Tasks
  • Single-word
    • Word to symbol or symbol to word
  • Sentence
    • Yes/no questions
    • Complete unfinished sentences
      • Example: A cowboy rides a _ (cow, horse, house, candlestick)
  • Written task instructions
    • Example: Pick up the pencil, knock it three times, then put it back (Brookshire, 2015)
  • Paragraph:
    • Example:
      • Goose down
      • The soft and light feathers from the underside of a goose have so many uses. This material is called down, and it is used to fill some pillows. Goose down is used to fill sleeping bags and cold weather clothes, also. That is why you see so many naked geese walking around.
      • Soft goose feathers are called:
        • Down
      • This material is used to fill:
        • Pillows
        • Sleeping bags
      • A down-filled coat would be best in:
        • Winter
      • Goose down equipment can be used for:
        • Camping
      • (From LaPointe, LL., & Horner, J. [1998]. Reading comprehension battery for aphasia (2nd ed.]. Austin, TX: Pro-Ed.)
      • Fig. 5-16. A longer paragraph comprehension item from the Reading Comprehension Battery for Aphasia-Second Edition.
      • Brookshire (2015)

Reading Comprehension – Confounding Factors

  • Script, font
  • Word frequency
  • Word familiarity
  • Noun case and gender
  • Age of acquisition
  • Imageability
  • Concreteness/abstractness
  • Word, phrase, sentence length
  • Phonemic composition and articulatory difficulty
  • Grammatical complexity
  • Density of prepositions
  • Plausibility of content (Hollowell, 2023)
Confounding Factor Examples
  • Script, font: Arial vs. Times New Roman, uppercase vs. lowercase
  • Word frequency: High-frequency words (e.g., "the," "and") vs. low-frequency words (e.g., "zugzwang," "glossolalia")
  • Word familiarity: Common words (e.g., "book") vs. uncommon words (e.g., "kalopsia")
  • Noun case and gender: English (gender-neutral nouns) vs. French (gendered nouns like "le livre" vs. "la table")
  • Age of acquisition: Words learned early in life (e.g., "cat") vs. later in life (e.g., "paradox")
  • Imageability: Concrete words (e.g., "dog," "apple") vs. abstract words (e.g., "freedom," "justice")
  • Concreteness/abstractness: Concrete: "ball," "house"; Abstract: "love," "truth"
  • Word, phrase, sentence length: Short words (e.g., "cat") vs. long words (e.g., "extraordinary") or short vs. long phrases/sentences
  • Phonemic composition and articulatory difficulty: Words with simple sounds (e.g., "cat") vs. complex sounds (e.g., "sphygmomanometer")
  • Grammatical complexity: Simple sentence (e.g., "She runs") vs. complex sentence (e.g., "Although she runs every morning, she is still tired by noon")
  • Density of prepositions: Sentence with few prepositions (e.g., "He walks") vs. many prepositions (e.g., "He walked through the park beside the river near the school")
  • Plausibility of content: Plausible: "The cat sat on the mat" vs. implausible: "The cat flew to the moon"

Speech Production

  • Automatic speech
    • Patient counts, says days of the week, months of the year, alphabet, etc.
  • Sentence completion
    • “I’d like a cup of _”
    • “Roses are red, violets are _”
  • Naming
    • Confrontation naming: picture or object naming
      • “What do you write with?”
    • Generative naming: list as many words in a category in a given amount of time (Brookshire, 2015)
Automatic Speech - Confounding Factors
  • Articulatory difficulty
  • Familiarity of rote sequences (Hollowell, 2023)
Sentence Completion & Naming – Confounding Factors
  • Word frequency
  • Word familiarity
  • Age of acquisition
  • Imageability
  • Concreteness/abstractness
  • Phonemic composition & articulatory difficulty
  • Word length
  • Semantic category
  • Real objects vs. images
  • Degree of control of physical stimulus (Hollowell, 2023)
Speech Production Tasks
  • Sentence production
    • “Tell me what onion means”
    • “Tell me a sentence that includes the word today”
    • “Tell me three things you did today”
  • Discourse
    • Picture description
    • Conversation/discussion (Brookshire, 2015)
Cookie Jar Example
  • Tears Post Onset: *CASE 3 Primary Progressive Aphasia
    • _