Functional Communication Assessment

Comprehensive language tests designed to assess aphasia are usually structured around specific domains

In addition to measuring specific linguistic performance, a comprehensive aphasia assessment also

Table II

Differential Diagnosis of the Main Types of Aphasia0

Type of aphasia Speech Comprehension Capacity for repetition Other signs Region affected





Transcortical motor


Atypical "Basal ganglia''


Nonfluent; effortful

Fluent; abundant; well-articulated; melodic

Fluent with some articulatory deficits

Scant; nonfluent

Nonfluent; explosive

Fluent; scant

Dysarthric, but often fluent

Fluent; may be logorrheic

Intact or largely preserved


Intact or largely preserved


Intact or largely preserved








Intact or largely preserved

Intact or largely preserved

May be intact or Impaired

Intact or largely preserved

Right hemiparesis (arm and leg); patient aware of defect and may be depressed

No motor signs; patient may be anxious, agitated, euphoric, or paranoid

Often none; patient may have cortical sensory loss or weakness in right arm; right-sided facial weakness may be seen

Right hemiplegia may be present without hemiplegia

Right hemiparesis (arm and leg)

Attentional and memory defects in acute phase

Left frontal (lower, posterior)

Left temporal (posterior and superior)

Left supramarginal gyrus or left auditory cortex and insula

With hemiplegia: massive left perisyl-vian lesion Without hemiplegia: separate frontal and temperoparietal damage

Anterior or superior to Broca's area; may involve part of Broca's area

Area surrounding Wernicke's area, posteriorly or interiorly

Head of caudate nucleus; anterior limb of capsule

Anterolateral thalamus

"Reproduced with permission from Damasio (1992). Copyright © 1992 Massachusetts Medical Society. All rights reserved.

includes supplementary measures of''functional communication."

This category of measures provides information about the individual's actual use of residual communication skills in everyday life, in contrast to performance, which is a response to the presentation of specific tasks in a structured testing situation. Ordinary everyday behaviors, such as making telephone calls, using everyday greetings, and reading the newspaper, have been noted to reflect another dimension of communication behavior that is often not elicited in the performance of a specific, structured task. The notion of a "functional" dimension of communication behavior emerged from the rehabilitation medicine setting in the late 1950s when it was observed that many patients with aphasia communicated with different degrees of skill depending on whether they were communicating in a natural, interactive speaking situation or in structured, task-oriented conditions.

Since then, many rating scales designed to assess the functional communication dimension of aphasia have been published, including the Functional

Table III

Aphasia Assessment Instruments"

Full title



Aphasia Screening Test

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