Aachen aphasia test

The Aachen Aphasia Test (AAT) is a procedure specially developed for the German language to diagnose aphasia as a result of acquired brain damage. It was developed in 1983 by Walter Huber, Klaus Poeck , Dorothea Less and Klaus Willmes in Aachen . The Aachen Aphasia Test (AAT) is used to diagnose and describe aphasic disorders and can be used for aphasia sufferers of all etiologies . With this procedure , all linguistic levels are reliably checked , especially by testing spontaneous speech . An attempt is made to reliably identify linguistic disorders when repeating, reading and writing, naming and understanding language.

Scope and aim

The routine clinical examination of brain tumor patients runs the risk of overlooking aphasic disorders. In order to systematically record the occurrence of such disturbances, the AAT was developed, among other things. According to the AAT, 50% of the patients with left-sided and 36% of the patients with right-sided brain tumors were found to have language problems. The AAT offers several options for diagnosis.

This includes:

• Differential diagnosis: This enables aphasic patients to be selected from a population of patients with neuronal damage without aphasia;
• A differentiation of aphasic patients into the four aphasic standard syndromes. These are named as: global aphasia , Broca aphasia , Wernicke aphasia, and amnesic aphasia ;
• Identification of non-standard aphasias and other language disorders;
• An identification of non-classifiable aphasias;
• Determining the severity of the aphasic disorder based on a performance profile (easy-medium-severe);
• The description of the aphasic disorder on the various linguistic processing levels ( phonology , lexicon , syntax and semantics );

The Aachen aphasia test is suitable both for the one-off diagnosis and description of aphasic syndromes and for repeated use for the controlled observation of the course of the disease and the influence of speech therapy.

The AAT is usually used for young people aged 14 and over and adults. The users of the AAT are speech therapists , clinical psychologists, clinical linguists, and doctors.

The Aachen aphasia test is now used at many university clinics, in the training of speech therapists and at all rehabilitation clinics specializing in aphasia. The test has now also gained international recognition: standardized Italian and Dutch versions have been published, an English and a French version are currently in preparation.

execution

The implementation time is approximately 60-90 minutes. It is important to do the test in one piece, otherwise the test result will not be valid. The tasks of the AAT start with a low level of difficulty and increase from task to task. The evaluation is based on a point scale.

Subtests

The AAT consists of six sub-tests, which examine and check the linguistic competence at all linguistic levels. These are always applied in the same order. Each subtest examines a different linguistic modality.

1. Spontaneous language
   testing of: communication behavior, articulation and prosody , automatisms, semantic / phonematic and syntactic structure.
   A conversation lasting about 10 minutes is recorded between the examiner and the patient.
   The conversation takes the form of a semi-standardized interview, i. H. the examiner asks specific, openly formulated questions, the sequence and approximate wording of which are specified.
   The questions relate to the patient's illness, job, family and leisure activities.
   Among other things, attention is paid to the following language abnormalities:
   Speech automatisms, echolalia , semantic / phonematic paraphasias , repetitions, speaking speed and word finding disorders.
   In addition, general communication behavior is assessed.
2. Token test:
   This sub -test examines and tests language comprehension, attentional performance, and general cognitive performance.
   The token test differentiates between aphasic and non-aphasic brain-damaged people with great certainty, but it does not contribute anything to the classification of the individual aphasic syndromes. The only assessment is whether the task was solved correctly or incorrectly. As a rule, the token test is sufficient to distinguish an aphasic from a non-aphasic disorder.
   Example: In front of the patient there are five different colored squares. The therapist asks him to point to a square with a certain color: "Show me the green square".
3. Repeating
   sounds, monosyllabic words, loan and foreign words, compound words and sentences.
   The test consists of these five parts with ten items each. Each item is auditioned by the examiner and may be repeated a maximum of once. The patient should repeat the items, not repeat them. In addition, each of these items is rated with 0-3 points, with 3 standing for no disturbance and 0 for a strong deviation.
4. Written language:
   Testing of:
   • Reading aloud (for example from blackboards where the words / sentences are printed). The test consists of three parts with ten items each.
   • 
     Assembling according to dictation: With the help of letters or word cards, the patient should assemble the items spoken by the examiner.
     For example: HALL, CAMEL- HAIR- COAT, SHE- SEEMS-SAD- TO BE
   • Writing after dictation:
     The patient should write down the items spoken by the examiner.
     Each item is rated with 0-3 points, which are weighted in the same way as when repeating them.
5. Naming:
   ... of objects, compounds, colors, situations and actions.
   The test consists of ten parts with ten items each. In the first three parts, objects (line drawings) or colors should be named with one word. In the fourth part, drawn situations and actions should be named with one sentence each.
   These items are again rated with 0-3 points.
   The fourth part tests the ability to describe a situation (picture cards, picture stories).
6. Speech comprehension :
   The test is structured in such a way that the test person has to select the line drawings that are presented at the same time from four line drawings that correspond to the word or phrase that was read out before. In this way, the auditory understanding of speech and the sense of reading for words and sentences are checked. The reactions areevaluatedwith 0-3 points according to the following criteria: 3 - no disturbance, 2 - repetition of the stimulus and self-correction, 1 - an image with linguistic similarity to the target image is chosen, 0 - no reaction or an image without linguistic similarity to the Stimulus is selected.

forecast

With the Aachen aphasia test, neurologically well-founded evidence of the presence of aphasia can be provided, and syndrome classification and severity can be carried out.

To diagnose disorders of linguistic abilities, aphasic disorders must first be differentiated from other disorders using a differential diagnosis. Determining the initial severity level plays a major role in estimating the prognosis.
To optimize the approach in therapy, it is recommended to use model-oriented examination methods such as Lemo to analyze the deficits and the skills obtained more precisely.

The objectives of the rehabilitation of aphasic patients are based on the results of a detailed anamnesis and communication- oriented examination procedures.

Further test procedures for aphasia diagnostics

In addition to the Aachen aphasia test, there are other methods for testing post-acute and chronic aphasia. There are also test procedures that have been specially developed and standardized for the acute phase. The AABT enables an initial assessment from day 2 of the disease.

Acute phase:

• AABT (Aachener Aphasia Bedside Test) by Biniek et al. 1993 (German)
  It is used for acute aphasia; Duration: approx. 15-60 minutes.

• ACL ( Aphasia Check List ) by Kalbe et al. 2002
  Duration: approx. 30 minutes
  The aim of this test is on the one hand to detect aphasia at all and not to differentiate between individual aphasias, and on the other hand to determine the performance of the patient through the following tests.
  • Row speaking
  • Follow the instructions
  • Color figure test
  • Word generation tasks
  • Oral naming
  • Reading aloud and comprehension
  • Reading aloud: pseudo-words , numbers
  • Auditory speech understanding
  • Writing after dictation: words, pseudo-words, numbers
  • Repeating: words, pseudo-words, numbers
  • Spontaneous speech

• AST (aphasia rapid test) :
  The rapid test is used to determine linguistic expression and understanding (slow and normal speaking speed).

swell

• Walter Huber, Klaus Poeck, Dorothea Less: Klaus Willmes: Aachener AphasieTest. Hogrefe, Göttingen 1983.