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Language Problems and Assessment: The Aphasic Patient

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Abstract

The singularly most uniquely human attribute is language. Such a bold statement is difficult to make, but profoundly true. Many species possess communication skill and communication among some species is elaborate and facilitates complex social relationships and interactions; however, the extent and sophistication of human use of representational language is truly unique. Language is so intertwined into what it is to be human that its complexity is often overlooked as a prerequisite skill in neuropsychological assessment.

At its simplest, language can be conceptualized as expressive and receptive language functions. While typically residing in the left hemisphere (referred to as the dominant hemisphere because of the propensity of language to develop even if damage occurs to normal language centers), bilateral representation and right hemisphere representation of language occurs both naturally and secondarily in response to early cerebral injury that affects the typically dominant left hemisphere (see (Table 7.1) for relative frequencies of hemispheric language dominance). See also Chaps. 3 and 12.

The evaluation of the patient with language deficits first requires a review of the assessment of language and the definition of some terms. We will first review the basic aspects to evaluate speech and define terms describing different types of speech problems. We will then return to evaluating various speech problems commonly encountered in the clinic.

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Correspondence to James G. Scott .

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Appendix A

Appendix A

Acute Assessment of Language and Prosody

Receptive language and prosody

Response

Correct

Simple receptive language

Simple Yes/No question

Is it winter?

_________

_________

Are you in a hospital?

_________

_________

Complex Yes/No question

Are cows carnivorous?

_________

_________

Would a nice person express complements?

_________

_________

Receptive comprehension of commands

Simple

one StepPoint to the door

_________

_________

two StepLook up and then look down

_________

_________

Complex

SequencedTouch your arm and then touch your ear

_________

_________

ReversedPoint to the door after you point to the chair

_________

_________

Reading (Read and/or comply)

I feel good today

_________

_________

Point to each person in the room

_________

_________

Prosody

Simple Prosody (statement or question)

I’m going to town! (spoken as a statement)

_________

_________

I’m going to town? (spoken as a question)

_________

_________

Emotional Prosody (expressed emotion)

That is wrong. (Spoken Angrily)

_________

_________

That is wrong. (Spoken sadly)

_________

_________

That is wrong. (Spoken happily)

_________

_________

Expressive language and prosody

Naming

Simple objects

What is this? (Point to shirt)

_________

_________

What is this? (Point to pen)

_________

_________

Complex naming

What is this? (Point to sleeve or cuff of shirt)

_________

_________

What is this? (Point to point or tip of pen)

_________

_________

Repetition

Single word

Desk, chair, light

_________

_________

Simple Statement

I would like some ice cream

_________

_________

Complex Statement No ifs, ands or buts

_________

_________

Writing

Simple

Write his/her name

_________

_________

Write name of watch

_________

_________

Write a sentence

_________

_________

Verbal Fluency (60 seconds, record number)

Phonemic fluency (ie. words beginning with the letter r)

_________

_________

Semantic fluency (ie. Animals)

_________

_________

Expressive Prosody

Say, “I’m going to work.”

  

Phrase as if sad

_________

_________

Phrase as if angry

_________

_________

Discourse/spontaneous expressive speech

Structured

Show a picture; ask patient to describe what is happening

_________

_________

Unstructured

Ask patient what he/she did/does

  

for work and give the details.

_________

_________

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Scott, J.G., Schoenberg, M.R. (2011). Language Problems and Assessment: The Aphasic Patient. In: Schoenberg, M., Scott, J. (eds) The Little Black Book of Neuropsychology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-76978-3_7

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