Strategy of the Month AAC Assessment for People with Aphasia

Published on June 1st, 2013 | by Carole Zangari

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AAC Assessment for People with Aphasia

Many people with aphasia fail to regain sufficient speech and language skills to meet their communication needs. With more than one million people with aphasia in the US alone, chances are most people reading this know at least one person affected by the disorder. While many go on to regain functional speech and language skills, some remain unable to communicate well enough catch up with a neighbor, talk about bills with a spouse, ask a question in a store, play with a grandchild, or tell their healthcare providers about side effects or symptoms. It’s hard to really imagine how devastating and isolating this experience may be.

Aphasia Awareness Month seemed like the perfect time to reach out to SLPs with information on AAC for people with aphasia. In this post, we’ll share some thoughts and resources on assessment.

Assessment activities are, of course, driven by the purpose for which the evaluation is taking place. In this case, we’re assuming that the assessment is being conducted in order to determine what AAC tools and technologies might be helpful, what strategies show the most promise, and where to start in terms of goals and objectives.

Many times, a standard aphasia test battery doesn’t yield the kind of practical information that SLPs need to develop appropriate AAC tools and/or an intervention program. From where we sit, the ‘gold standard’ for AAC assessment in people with aphasia is the approach developed by Drs. Kathy Garrett (Alternative Communication Therapies) and Joanne Lasker (Emerson College). What we love about their approach is that it is functional. It focuses on what the client CAN do and what they might be able to do with supports. It helps us figure out where they are now, where they can go, and what it might take to get them there. It should be taught in every SLP aphasia class because the truth is that many people with aphasia leave traditional therapies still unable to communicate effectively. We can do better. We may not be able to reverse brain lesions but we can teach communication skills that improve quality of life.

If you work with or know someone with aphasia, you may want to explore some of the assessment materials developed by Drs. Garrett and Lasker. In the instrument they developed, The Multimodal Communication Screening Tool for Aphasia (MCAST-A) (2005, revised 2007), a sample communication book is used to determine how well the client can do things such as:

  • identify picture symbols and determine which categories they belong to
  • use pictures, gestures, writing, and drawing to communicate a message,
  • turn the pages of the book to find relevant messages,
  • combine two or more symbols to convey a message,
  • spell out words to communicate, and
  • use the initial letter cueing to help listeners better understand their natural speech.

Dr. Lasker discusses the tool in a brief video that you can see here.

Once you administer the MCST-A, SLP’s can determine the category of communication into which the aphasic communicator falls. The transition to intervention is a smooth one, given the goal areas and strategies appropriate for each type of communicator. You can learn more about this in their 2012 book chapter referenced below.

AAC Assessment for People with Aphasia

You can access the MCST-A stimulus book, instructions, score sheet, and other materials for AAC aphasia assessment online.AAC Assessment for People with Aphasia

If you work with individuals with aphasia, or have a colleague who does, we hope you consider learning more about these AAC assessment tools.


Additional Resources and References

  • Alberta Health Services I CAN Centre for Assistive Technology: Adult Communication Skills, Aphasia Communicator Types
  • Garrett, K., & Lasker, J. (2012). Adults with severe aphasia and apraxia of speech. In Beukelman & Mirenda (Eds.) Augmentative Alternative Communication: Supporting Children and Adults with Complex Communication Needs, 4th Edition, Chapter 15. Baltimore, MD: Paul Brookes Publishing Co.
  • Garrett, K. & Lasker, J. (2005). AAC Aphasia Categories of Communicators Checklist.
  • Garrett, K. & Lasker, J. (2007). Multimodal Communication Screening Task for Persons with Aphasia (MCST-A): Stimulus Booklet and Score Sheet.

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About the Author

Carole Zangari

Carole Zangari has been involved in the practice and teaching of AAC for over 20 years. She is a professor of speech-language pathology and has been fortunate to have been able to introduce many children and adults to the world of AAC. "Far and away the best prize that life has to offer is the chance to work hard at work worth doing." Theodore Roosevelt

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