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Aphasia is a language disturbance caused by brain damage, with two types: expressive and receptive. Screening tests like the Halstead and Token tests can detect the type of aphasia, while more comprehensive assessments like the Minnesota and Boston tests require extensive training. The Portico index measures linguistic impairment, and the Communication Skills in Daily Life test simulates normal activities to evaluate communication ability. A speech therapist tailors therapy to optimize speech for the best outcome.
The term “aphasia” describes a disturbance, often caused by damage to the brain, in the ability to understand or produce speech. Aphasia can be divided into two specific types: expressive aphasia and receptive aphasia. A speech therapist (SLP) is trained to identify the types of aphasia the patient presents with and to evaluate the condition using one of several techniques. Among the different types of assessment of aphasia are the Halstead Screening Test, the Token Test, the Porch Index of Communicative Ability (PICA), and the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA). Other types of aphasia assessments are the Boston Diagnostic Aphasia Examination and the Communication Skills in Daily Living (CADL) screening test.
Initial testing for aphasia is usually a screen to detect the type of aphasia present and to call attention to specific features. Screening tests do not require specialized training on the part of the assessor. They should, however, be conducted by a competent healthcare professional. Using available aphasia assessment tools, a speech therapist will tailor therapy to the patient, designing a program to optimize speech for the best achievable outcome.
The two most common screening tests for evaluating aphasia are the Halstead Screening Test and the Token Test. The Halstead Screening Test, developed in 1984, requires the subject to perform a variety of tasks such as spelling words common things, the naming of common objects, and the identification of numbers and letters. The patient may also be asked to read, write, and understand spoken language to identify the severity of both receptive and expressive aphasia. The Token Test, revised in 1978, is an easy-to-administer test that requires 20 tokens of different shapes, sizes, and colors. The patient will be asked to identify more than 60 combinations, such as “touch the red square” or “place the green rectangle over the blue circle”.
More comprehensive aphasia assessments require the assessor to have extensive training in conducting aphasia assessments. The Minnesota Test for Differential Diagnosis of Aphasia provides an assessment of a patient’s strengths and weaknesses across all language modalities. It is the most comprehensive test, taking two to six hours to administer. The MTDDA consists of more than 40 subtests divided into five sections, such as hearing impairments, visual impairments, and speech/language impairments.
The Boston Diagnostic Aphasia Examination, developed in 1972, contains more than two dozen subtests that diagnose the presence of aphasia, measure performance over a wide range, and assess the severity of deficits in all areas of speech. The patient is assigned a score that objectively describes the level of aphasia displayed.
The Portico index of communication skills is used primarily as an objective measure of the degree of linguistic impairment. It is also an indicator of the patient’s prognosis for recovery. Subtests require the patient to participate in object manipulation, visual matching, and copying of abstract shapes.
Communication skills in daily life is a more recently developed assessment of aphasia. The patient is engaged in a role-play exercise that simulates normal activities such as being in a doctor’s office or the supermarket. Patients are asked to answer more than 60 specific questions, and each response is rated on a three-point scale based on how well the patient communicated her thoughts.
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