13 Verbal Functions and Language Skills

The most prominent disorders of verbal functions are the aphasias and associated difficulties
in verbal production such as dysarthria (defective articulation) and apraxia of speech. Other
aspects of verbal functions that are usually affected when there is an aphasic disorder, such as
fluency and reading and writing abilities, may be impaired without aphasia being present.
Assessment of the latter functions is therefore discussed separately from aphasia testing.

APHASIA
It is always important to look for evidence of aphasia in patients displaying right-sided weakness
or complaining of sensory changes on the right half of the body (see pp. 60, 62, 82, 89). Aphasia
must also be considered whenever the patient’s difficulty in speaking or comprehending speech
appears to be clearly unrelated to hearing loss, attention or concentration defects, a foreign
language background, or a thought disorder associated with a psychiatric condition. The patient’s
performance on tests involving verbal functions should help the examiner determine whether a
more thorough study of the patient’s language functions is indicated.
Aphasic disorders can be mistakenly diagnosed when the problem actually results from a
global confusional state, a dysarthric condition, or elective mutism. The reverse can also occur
when mild deficits in language comprehension and production are attributed to generalized
cognitive impairment or to a memory or attentional disorder. Defective auditory comprehension,
whether due to a hearing disorder or to impaired language comprehension, can result in
unresponsive or socially inappropriate behavior that is mistaken for negativism, dementia, or a
psychiatric condition. Aphasia occurs as part of the behavioral picture in many brain pathologies
such that often the question is not whether the patient has aphasia, but rather how (much) the
aphasia contributes to the patient’s behavioral deficits disorders (Mendez and Clark, 2008).
Questions concerning the presence of aphasia can usually be answered by careful observation in
the course of an informal but systematic review of the patient’s capacity to perceive, comprehend,
remember, and respond with both spoken and written material, or by using an aphasia screening
test. A review of language and speech functions that will indicate whether communication
problems are present will include examination of the following aspects of verbal behavior:

1. Spontaneous speech.
2. Repetition of words, phrases, sentences. “Methodist Episcopal” and similar tongue-twisters
elicit disorders of articulation and sound sequencing. “No ifs, ands, or buts” tests for the integrity
of connections between the center for expressive speech (Broca’s area) and the receptive speech
center (Wernicke’s area).
3. Speech comprehension. a. Give the subject simple commands (e.g., “Show me your chin.”
“Put your left hand on your right ear.”). b. Ask “yes-no” questions (e.g., “Is a ball square?”). c.
Ask the subject to point to specific objects.
The wife of a patient diagnosed as a global aphasic (expression and comprehension severely impaired in all modalities)
insisted that her husband understood what she told him and that he communicated appropriate responses to her by
gestures. I examined him in front of her, asking him—in the tone of voice she used when anticipating a “yes” response
—“Is your name
 John?” “Is your name Bill?” etc. Only when she saw him eagerly nod assent to each question could she begin to
appreciate the severity of his comprehension deficit [mdl].
An inpatient with new onset global aphasia nodded enthusiastically and said “yes” to all questions, causing his
physicians to believe that he had consented to a surgical procedure because they had not asked him a question in
which “no” was the appropriate answer [dbh].

4. Naming. The examiner points to various objects and their parts asking, “What is this?” (e.g.,
glasses, frame, nose piece, lens; thus asking for object names in the general order of their
frequency of occurrence in normal conversation). Ease and accuracy of naming in other
categories, such as colors, letters, numbers, and actions, should also be examined (Goodglass,
1980; Strub and Black,
2000).
5. Reading. To examine for accuracy, have the subject read aloud. For comprehension, have the
subject follow written directions (e.g., “Tap three times on the table”), explain a passage just read.
6. Writing. Have the subject copy a printed sentence, write to dictation, and compose a sentence
or two.

When evaluating speech, Goodglass (1986) pointed out the importance of attending to such
aspects as the ease and quantity of production (fluency), articulatory error, speech rhythms and
intonation (prosody), grammar and syntax, and the presence of paraphasias (see p. 77). Although
lapses in some of these aspects of speech are almost always associated with aphasia, others—
such as articulatory disorders—may occur as speech problems unrelated to aphasia. The examiner
should also be aware that familiar and, particularly, personally relevant stimuli will elicit the
patient’s best responses (Van Lancker and Nicklay, 1992). Thus, a patient examined only on
standardized tests may actually communicate better at home and with friends than test scores
suggest, especially when patients augment their communication at home with gestures.
Formal aphasia testing should be undertaken when aphasia is known to be present or is
strongly suspected. It may be done for any of the following purposes:
(1) diagnosis of presence and type of aphasic syndrome, leading to inferences concerning cerebral localization; (2)
measurement of the level of performance over a wide range, for both initial determination and detection of change over
time; (3) comprehensive assessment of the assets and liabilities of the patient in all language areas as a guide to therapy
(Goodglass and Kaplan, 1983, p. 1).

The purpose of the examination should determine the kind of examination (screening,
symptom focused, or comprehensive?) and the kinds of tests required (Spreen and Risser, 2003).
Aphasia tests differ from other verbal tests in that they focus on disorders of symbol
formulation and associated apraxias and agnosias. They are usually designed to elicit samples of
behavior in each communication modality—listening, speaking, reading, writing, and gesturing.
The examination of the central “linguistic processing of verbal symbols” is their common
denominator (Wepman and Jones,
1967). Aphasia tests also differ in that many involve tasks that most adults would complete with
few, if any, errors.

Aphasia Tests and

Batteries
The most widely used aphasia tests are actually test batteries comprising numerous tests of many
discrete verbal functions. Their product may be a score or index for diagnostic purposes or
an orderly description of the patient’s communication disabilities. Most aphasia tests involve
lengthy, precise, and well-controlled procedures. They are best administered by persons, such
as speech
pathologists, who have more than a passing acquaintance with aphasiology and are trained in the
specialized techniques of aphasia examinations. Many speech pathologists, like
neuropsychologists, choose a flexible approach in selecting what tests to administer.
Aphasia test batteries always include a wide range of tasks so that the nature and severity of
the language problem and associated deficits may be determined. Because aphasia tests
concern disordered language functions in themselves and not their cognitive ramifications, test
items typically present very simple and concrete tasks on which most children in the lower grades
can succeed. Common aphasia test items ask the patient (1) to name simple objects (“What is
this?” asks the examiner, pointing to a cup, a pen, or the picture of a boy or a clock); (2) to
recognize simple spoken words (“Put the spoon in the cup”); (3) to perform serial commands; (4) to
repeat words and phrases; (5) to recognize simple printed letters, numbers, words, primary level
arithmetic problems, and common symbols; (6) to give verbal and gestural answers to simple
printed questions; and (7) to print or write letters, words, numbers, etc. In addition, some aphasia
tests and examination protocols include story telling or drawing items. Some also examine
articulatory disorders and apraxias.
Aphasia test batteries differ primarily in their terminology, internal organization, the number
of modality combinations they test, and the levels of difficulty and complexity to which the
examination is carried. The tests discussed here are both representative of the different kinds of
aphasia tests and among the best known. Some clinicians devise their own batteries, taking parts
from other tests and adding their own. Detailed reviews of many batteries and tests for
aphasia can be found in Assessment of Aphasia (Spreen and Risser, 2003); and A Compendium
of Neuropsychological Tests (E. Strauss, Sherman, and Spreen, 2006).

Assessment of aphasia and related disorders (Goodglass and Kaplan, 1983), Boston Diagnostic Aphasia Examination (BDAE-
3) (Goodglass, Kaplan, and Barresi, 2000)

This test battery was devised to examine the “components of language” that would aid in
diagnosis and treatment and in the advancement of knowledge about the neuroanatomic correlates
of aphasia. It has evolved since its original 1972 publication and the 1983 version. Research and
evaluation data based on these two earlier editions are still relevant for the BDAE-3 as many items
and scales remain unchanged.
The BDAE provides for a systematic assessment of communication and communication-related
functions in 12 areas defined by factor analysis, with a total of 34 subtests. Time is the price paid
for such thorough coverage, for a complete examination takes from one to four hours. As a result
many examiners use portions of this test selectively, often in combination with other tests of
neuropsychological functions. The BDAE-3 has a short form that takes only an hour or less. A
number of “supplementary language tests” are also provided, to enable discrimination of such
aspects of psycholinguistic behavior as grammar and syntax and to examine for disconnection
syndromes (see below). The extended version of the BDAE-3 contains instructions for examining
the praxis problems which may accompany aphasia.
Evaluation of the patient is based on three kinds of observations. The score for the Aphasia
Severity Rating Scale has a 5-point range based on examiner ratings of patient responses to a
semistructured interview and free conversation. Subtests are scored for number correct and
converted into percentiles derived from a normative study of aphasic patients, many presenting
with relatively selective deficits and also including the most severely impaired. These scores are
registered on the Subtest Summary Profile sheet, permitting the examiner to see at a glance the
patient’s deficit pattern. In addition, this battery yields a “Rating Scale Profile” for qualitative
speech characteristics that, the
authors point out, “are not satisfactorily measured by objective scores” but can be judged on seven
7- point scales, each referring to a particular feature of speech production.
Data from a 1980 (Borod, Goodglass, and Kaplan) normative study of the original BDAE and
the
supplementary spatial-quantitative tests (see below) contributed to the 1983 norms. The
1999 standardization sample includes 85 adults with aphasia and 15 normal elderly persons.
Subjects with low education have lower scores (Borod, Goodglass, and Kaplan, 1980; Pineda et al.,
2000).
For some scales requiring examiner judgment, relatively low interrater reliability
coefficients have been reported (Kertesz, 1989). Yet interrater agreement correlations typically
run above .75, and percent agreement measures also indicate generally satisfactory agreement
levels (A.G. Davis,
1993). The BDAE-3 introduced a standardized procedure for coding the Cookie Theft
picture. However, one study found that a 43% agreement between novice and expert coders
improved to 66% when a scoring aid was provided (T.W. Powell, 2006). Based on his review of
BDAE research, Davis suggested that BDAE scores predict performance on other aphasia tests
better than patient functioning in “natural circumstances.”
A Spatial Quantitative Battery (called the Parietal Lobe Battery [PLB] in the 1983 edition)
supplements the verbal BDAE as part of the comprehensive examination for aphasics. This set
of tests includes constructional and drawing tasks, finger identification, directional orientation,
arithmetic, and clock drawing tasks. While sensitive to parietal lobe lesions, patients with
both frontal and parietal damage are most likely to be impaired on this battery (Borod, Carper,
Goodglass, and Naeser, 1984).
The range and sensitivity of the “Boston” battery makes it an excellent tool for the description
of aphasic disorders and for treatment planning. However, an examiner must be experienced to use
it diagnostically. Normative data for the individual tests allow examiners to give them as needed,
which may account for some of this battery’s popularity. Of course, not least of its advantages are
the attractiveness and evident face validity of many of the subtests (e.g., the Cookie Theft picture
for telling a story; a sentence repetition format that distinguishes between phrases with high or
low probability of occurrence in natural speech). This popular aphasia battery has been used to
evaluate many aspects of aphasia disorders, including outcome from aphasia (Seniow et al.,
2009), the contributions of the left and right hemispheres to language performance (Jodzio et al.,
2005), and the effect of white matter alterations and dementia on language (Giovannetti et al.,
2008).
Two translations of this battery are available. Rosselli, Ardila and their coworkers
(1990) provide norms for a Spanish language version (Goodglass and Kaplan, 1986). A French
version developed by Mazaux and Orgogozo (1985) has retained the z-score profiling of the
BDAE first edition.

Communication Abilities in Daily Living (2nd ed.) (CADL-2) (Holland et al.,

1999)

The disparity between scores that patients obtain on the usual formal tests of language
competency and their communicative competency in real life led to the development of an
instrument that might reduce this disparity by presenting patients with language tasks in familiar,
practical contexts. The original—1980—CADL examined how patients might handle daily life
activities by engaging them in role-playing in a series of simulated situations such as “the
doctor ’s office,” encouraging the examiner to carry out a dual role as examiner/play-acting
participant with such props as a toy stethoscope.
The CADL-2 revision eliminated items that require role playing and most props. This reduced
the number of items from 68 to 50 but retained the focus on naturalistic everyday communications
(e.g.,
with a telephone, with real money). The number of communication categories was reduced from ten
to seven in the CADL-2: (1) reading, writing, and using numbers; (2) communication sequences;
(3) social interactions; (4) response to misinformation or proverbs; (5) nonverbal communication;
(6) contextual communication; (7) recognition of humor, metaphor. Examination
informality is encouraged.
The CADL-2 normative sample includes 175 adults with communication disorders, primarily
from
stroke or TBI. Test–retest reliability for CADL-2 was .85, and interrater reliability for stanine
scores was .99. Evaluations of the original CADL based on 130 aphasic patients demonstrated that
this test was sensitive to aphasia, age, and institutionalization (unspecified) but not sex or social
background (Holland, 1980). The CADL differentiated patients with the major types of aphasia
on the single dimension of severity of communicative disability based on the summation score.
The ten category scores also identified aphasia subtypes. The test has been used to measure the
effectiveness of types of therapy (Carlomagno et al., 2001).
Because responses need not be vocalized to earn credits, this test tends to be more sensitive to
the communication strengths of many speech impaired (e.g., Broca’s aphasia) patients than are
traditional testing instruments. Spreen and Risser (2003) recommend the CADL to provide the
descriptive information about functional communication that is lacking in all the larger,
comprehensive, batteries: “it allows an estimate of the patient’s communication ability rather than
… accuracy of language” (Spreen and Strauss, 1998). Yet, A.G. Davis (1993) warned, CADL
findings cannot be interpreted as representing naturalistic behavior as it “is still a test” and, as
such, “does not provide for observing natural interactions.”

Comprehensive Aphasia Test (CAT) (Swinburn et al.,

2004)

This aphasia battery has three main components: Cognitive Screen, Language Battery, and
Disability Questionnaire. The Cognitive Screen is designed to assess nonlanguage functions that
often are affected in association with aphasia. The screen includes tests of semantic memory,
recognition memory, arithmetic, word fluency, line bisection, and gesture object use. The
Language Battery’s comprehension subtest assesses both spoken and written input in tasks ranging
in difficulty from single words to paragraphs. Factors known to influence language use such as
word imageability, frequency, and length are assessed. The expressive language section assesses
repetition, spoken language production, reading, and writing. Again, items vary from simple to
complex: single words to a picture description. Uniquely, the CAT includes a Disability
Questionnaire that examines the effects of language impairment on the patient’s lifestyle and
emotional well-being. The battery takes approximately 90 to 120 minutes. Most items are scored
on a 0–2 scale. This relatively new test has been described as a valid and reliable test of
language-processing abilities in adults with aphasia (Bruce and Edmundson, 2010).

Multilingual Aphasia Examination (MAE) (3rd ed.) (Benton, Hamsher, Rey, and Sivan,
1994)

A seven-part battery was developed from its parent battery, the Neurosensory Center
Comprehensive Examination of Aphasia (Spreen and Benton, 1977; Spreen and Strauss, 1991) to
provide for a systematic graded examination of receptive, expressive, and immediate memory
components of speech and language functions. Three tests assess oral expression—naming,
sentence repetition, and verbal associative capacity; three tests assess oral verbal understanding;
one test assesses reading comprehension; and three tests assess oral, written, and block
spelling. Speech articulation and degree of fluency are rated but not systematically sampled.
Writing is evaluated from performance on
the test of written spelling. The Token Test (pp. 557–559) and Controlled Oral Word Association
(pp.
694–695) are probably the most used of the
tests.
Almost all of the tests have two or three forms, thus reducing practice effects. The adult
normative sample in the manual was composed of 360 subjects ranging in age from 16 to 69. For
each test, age and education effects are dealt with by means of a Correction Score which, when
added to the raw score, gives an Adjusted Score (see E. Strauss, Sherman, and Spreen, 2006), p.
935. Percentile conversions for each adjusted score and their corresponding classification have
been worked out so that scores on each test are psychometrically comparable. This means of
scoring and evaluating subtest performances has the additional virtue of allowing each test to be
used separately as, for instance, when an examiner wishes to study verbal fluency or verbal
memory in a patient who is not aphasic and for whom administration of many of the other
subtests would be a waste of time. A Spanish version of this test (MAE-S) is available (G.J. Rey
and Benton, 1991).
Most of these tests are both age and education sensitive; the effects of age and education have
been reported for many of them (Ivnik, Malec, Smith, et al., 1996; Mitrushina, Boone, and
D’Elia, 1999; Ruff, Light, and Parker, 1996). Normative data also are available from the
Framingham Heart Study (M.F. Elias, Elias, et al., 1997).

Neuropsychological Assessment Battery (NAB) Language Module (R.A. Stern and White,
2003)

The Language Module is of one five modules of the NAB (see pp. 766–767). This comprehensive
battery assesses discourse for picture description, auditory comprehension, naming, reading,
writing, and an everyday practical item involving paying a bill. For the latter, the patient answers
question about a bill, fills out a check to pay the bill, records the information in the check
ledger, and addresses an envelope for payment. Other than the manual, published articles on the
performance of aphasic patients on the Language Module are lacking.

Protocol Montréal d’Évaluation de la Communication [Montreal Protocol for the Evaluation of Communication] (Protocol MEC)
(Joanette, Goulet, et al., 2004)

Most tests for examining verbal communication have been based on the assumption that
communication deficits arise predominantly from left hemisphere lesions and appear as the
blocked or impoverished verbal production and/or comprehension of aphasia. However, as many
as 80% of patients with right hemisphere lesions may also have communication disorders (Côté,
Payer, et al.,
2007). Their impairments differ from those commonly associated with left hemisphere dysfunction
in that these patients typically understand and speak single words and simple statements
accurately and at a normal pace. Yet their communication deficits interfere with social interactions
and the ability to comprehend and deal with everyday situations (see pp. 63, 66–67).
The Protocol MEC was developed to document the frequency and the nature of the
communication problems associated with right hemisphere disorders, and to identify remediation
strategies (Moix and Côté, 2004). The original protocol is in French and was standardized and
validated on French- Canadian patients and control subjects (Côté, Moix, and Giroux, 2004). It
has been standardized in Portuguese with Brazilian subjects (Fonseco et al., 2008). Spanish and
Italian adaptations have been published; an English adaptation is undergoing standardization.
The complete test protocol takes about two hours but can be given a few sections at a time.
Each section focuses on a different aspect of verbal communication. Deficit awareness is
examined in questionnaire format; conversation is evaluated by a trained observer; metaphor
interpretation asks for spoken and multiple-choice interpretation of a spoken metaphor (e.g.,
John is in the doghouse);
verbal fluency comes in three formats: without constraints, semantic, phonetic; semantic judgment
questions whether word pairs are similar (e.g., silk-linen, horse-veal); indirect speech
comprehension asks for interpretation of implied statements (e.g., “do you have plans for
this evening?”); prosody includes evaluation and imitation of speech that is emotionally intoned
(sad, happy, angry) and linguistically intoned (question, statement, order); and narrative
discourse calls for repeating each paragraph of a story—each read separately, then telling the
whole story.
A scoring system assigns different weights to each section. Both age and education effects
showed up on some, but not all, sections (Côté, Moix, and Giroux, 2004). A cluster analysis of
performances of 28 patients with right hemisphere damage resulted in two distinct impairment
patterns: one group was impaired in all categories, one retained discourse abilities with reduced
fluency and prosody; a third group had minimal if any deficits; two subjects had deficits fitting no
pattern (Côté, Payer, et al.,
2007).

Psycholinguistic Assessments of Language Processing in Aphasia (PALPA) (J. Kay, Lesser, et al.,
1992)

The PALPA is a language assessment battery developed in the United Kingdom. It consists of 60
tests grouped into four sections: Auditory Processing, Reading and Spelling, Word and
Picture Semantics, and Sentence Processing. As it was originally conceived to evaluate acquired
reading and spelling disorders, nearly half of the tests are in the Reading and Spelling
section. Least represented is Sentence Processing (six tests). The authors recommend a flexible
administration tailored to the individual, using one or more sections as appropriate. Based on
models of normal language processing, it is a resource for research as well as clinical use. Stimuli
were chosen according to linguistic parameters such as frequency of use, length, and regularity (A.
Basso, 1996). Limitations include no measures of conversation to assess sentence production and
writing items are few. Reviewing the PALPA for clinical and research purposes, the authors note
that although the battery has been well received, it could benefit from some improvements
in its content and presentation, including the addition of a general screening test (Bate, Kay, et
al., 2010).

Western Aphasia Battery Revised (WAB-R) (Kertesz,

2007)

This battery, first published in 1982, grew out of efforts to develop an instrument based on the
Boston Diagnostic Aphasia Examination that would generate diagnostic classifications and be
suitable for both treatment and research purposes. Thus, many of the items were taken from the
BDAE. The Western Aphasia Battery consists of four oral subtests—spontaneous speech,
auditory comprehension, repetition, and naming—yielding five scores using either a rating scale
(for Fluency and Information content of speech) or conversion of summed item-correct scores—
that make up an Aphasia Quotient (AQ). The AQ gives a measure of discrepancy from normal
language performance, but like any summed score in neuropsychology, it tells nothing of the
nature of the problem. The profile of performance and the AQ can be used together to determine
the patient’s diagnostic subtype according to pattern descriptions for eight aphasia subtypes.
Types of aphasia are classified according to Global, Broca’s, Isolation, Transcortical Motor,
Wernicke’s, Transcortical Sensory, Conduction, and Anomic, but this does not address the many
patients whose symptoms are of a “mixed” nature (i.e., have components of more than one type)
(Spreen and Risser, 2003).
The WAB-R includes two new supplementary tasks—reading and writing irregular and non-
words
—to evaluate types of dyslexia. Reading and writing scores are used to calculate a Language
Quotient (LQ). Tests of apraxia, drawing, block design construction, calculation, and
Raven’s Progressive Matrices are included in a Cortical Quotient (CQ) as impairments in these
areas are
often associated with aphasia. The pattern of deficits is more important than the
quotient.
The manual reports high interrater reliabilities across all tasks. Reliability and validity
evaluations meet reasonable criteria. Its statistical structure, based on the original version,
is satisfactory (Spreen and Risser, 2003). The WAB has been used to measure rate of improvement
from stroke over time (Bakheit et al., 2007). Language abilities of patients with a variety of
neurological diseases have also been assessed with the WAB. Patients with right hemisphere
strokes performed as well as control subjects on all five scales in contrast to those with strokes on
the left who were significantly impaired across all of the basic subtests (K.L. Bryan and Hale,
2001). The WAB-R manual includes a review of performance on the battery by patients with
Alzheimer disease, primary progressive aphasia, and vascular dementia. Early language
impairment in patients with primary progressive aphasia involves fluency and naming, while
comprehension and nonverbal cognition are retained (Karbe et al., 1993). The nonfluent type of
progressive aphasia has impaired fluency and apraxia of speech in contrast to patients with
semantic dementia who have impaired word recognition and naming (Amici et al., 2007).
A comparison of dementia groups on the WAB showed different profiles for patients
with Alzheimer ’s disease, primary progressive aphasia, semantic dementia, and the behavioral
variant of frontotemporal dementia (Kertesz, Jesso, et al., 2010). Patients with semantic dementia
had significantly lower single noun recognition and sequential command scores than Alzheimer
patients and lower naming of objects than all other groups. They also had lower animal fluency
output than those with Alzheimer ’s disease and fron-totemporal dementia. Qualitative features
of speech of patients with semantic dementia included semantic jargon and substitutions.
Phonological paraphasias were frequent in progressive nonfluent aphasia. Patients with vascular
dementia performed worse than Alzheimer patients on the writing scale while the latter scored
lower on the repetition scale (Kertesz and Clydesdale, 1994). The WAB has also been used
to study language impairment associated with corticobasal degeneration (McMonagle, Blair, et
al., 2006) and HIV infection (P. McCabe et al., 2002).

Aphasia Screening
Aphasia screening tests do not replace the careful examination of language functions afforded by
the test batteries. Rather, they are best used as supplements to a neuropsychological examination
battery when patients are unable to tolerate longer testing procedures. They may signal the
presence of an aphasic disorder and even call attention to its specific characteristics, but they do
not provide enough information for either a reliable diagnosis or the fine discriminations required
for understanding the manifestations of an aphasic disorder. These tests do not require technical
knowledge of speech pathology for satisfactory administration or determination of whether a
significant aphasic disorder is present. However, conversations with the patient coupled with a
mental status examination should, in most cases, make an aphasia screening test unnecessary. “All
we need is a concept of what needs to be assessed, a few common objects, a pen, and some
paper” (A.G. Davis, 1993, p. 215). Davis considered screening tests to be useful to the extent that
“a standardized administration maximizes consistency in diagnosis, supports a diagnosis, and
facilitates convenient measurement of progress” (p. 215).
The Aphasia Screening Test (Halstead and Wepman, 1959) has been one of the most widely
used of all aphasia tests since it or one of its variants has been incorporated into many formally
organized neuropsychological test batteries. As originally devised, the Aphasia Screening Test
has 51 items
which cover all the elements of aphasic disabilities as well as
the most common associated communication problems. The
Halstead-Reitan Battery reduced the items to 32. Wepman (personal
communication, 1975 [mdl]) rejected this test about 30 years after he
had developed it, as he found that it contributed more confusion than
clarity to both diagnosis and description of aphasic disorders. The
strong association between the Aphasia Screening Test scores and
education or intelligence as measured on the WAIS-R could result in
some individuals being misclassified (Salter et al., 2006).
The Western Aphasia Battery-R has a short bedside screening
examination that consists of one half of the items contained in the
basic aphasia section (Aphasia Quotient). It takes about 15 minutes to
administer. Salter and her colleagues (2006) review six other aphasia
screening tests.