Aphasia check list

The Aphasia Check List (ACL) , also: Aphasia Check List, is a procedure for diagnosing aphasia developed in 2002 by Elke Kalbe, Nadine Reinhold, Matthias Brand and Josef Kessler .

Scope and objectives

The aphasia checklist focuses less on the division into syndromes , but tries to describe the patient's linguistic performance and failures and is intended for the acute area. The implementation and the evaluation can thus be realized in a short time. The ACL checks all four linguistic modalities (reading, writing, speaking, understanding). It is used both in rehabilitation clinics specializing in aphasia and in the training of linguists and speech therapists .

The goals of the ACL are

• identify aphasia
• map linguistic performance as a profile (degrees of severity)
• to be applicable to a broad group of patients (with regard to etiology and disease stage)
• to be economical in terms of time and cost
• also to be able to grasp important neuropsychological factors that are important for language functions

execution

Performing the ACL on a patient takes approximately 30–40 minutes. The aphasia check list is divided into two sub-tests. It consists of a longer language part (part A) and a shorter cognition part (part B):

Part A

The “Language” part consists of a total of 7 subtests. Both the linguistic levels and the processing of important language units, pseudo-words and numbers are examined.

1. Series speaking: In this sub-test, the patients have to say days of the week and numbers.
2. Compliance with instructions: The language understanding for instructions is therefore checked. The patient is asked to perform simple, concrete actions. Example: "Please knock on the table."
3. Color Figure Test: This sub -test tests the auditory understanding of abstract verbal material and also tests short-term verbal memory . The patients are verbally asked to point to different colored or differently sized circles or triangles on a color template. This test is similar to the token test from the AAT .
4. Word generation: In these tasks, patients are asked to name as many terms as possible within one minute that either begin with the same initial letter or come from a semantic category (example: fruit). These tasks are used to check lexical retrieval, processing speed, cognitive flexibility and “imagery”.
5. Individual linguistic achievements: There are 6 tasks with 6 items each at different levels of difficulty. These include naming, reading aloud, reading comprehension, auditory language comprehension, writing after dictation and repeating. The receptive language performance is checked with clear, colored picture material, whereby two distractors ( phonological and semantic or morphosyntactic ) are presented in addition to the target words . For the tasks reading, dictating and repeating, 3 pseudo-words each have to be worked on.
6. Rating of verbal communication skills : This ability of the patient is rated on a four-point scale. The rating is simply structured and formulated in an understandable way and is therefore also suitable for non-experts . The quick assessment of whether there are communication disorders or only residual symptoms leads to a simplification of communication between hospital staff and patient or relatives.
7. Number processing: Here 3 different-digit numbers are checked in the task areas of reading aloud, writing after dictation and repeating.

Four-point rating scale (according to Tesak 2002, p. 25)

Rating value	Degree of disruption
3	No disorder, no objective or patient-mentioned speech disorders
2	Minor or residual disorder Minor , predominantly expressive speech disorder, verbal communication only insignificantly impaired
1	Moderate disorder Significant receptive and expressive speech disorders, communication mainly on simple topics with the help of the interlocutor possible
0	Severe disorder, severely impaired speech production and reception, communication predominantly non-verbal

part B

In this cognitive part, essential brain functions are checked, which can be impaired and thus possibly influence the speech performance and everyday activities of the patient. This part consists of three test procedures, all of which are non-verbal in order to avoid overlapping with the speech impairments. The respective tasks cannot be replaced by a neuropsychological examination, because they are intended to provide the speech therapist with information on possible cognitive deficits.

1. Nonverbal memory test: This task examines short-term and medium-term memory performance. The person concerned has to remember six geometric figures for ten seconds and then recognize them immediately or after a delay (after approx. Ten minutes) from a series of characters.
2. Attention test: Here, the patient's selective attention is determined. In a given time, certain characters have to be picked out of a column of distractors and crossed out. This test consists of a total of six columns, each of which should be processed in ten seconds.
3. Logical series: This sub-test checks the logical thinking and recognition of regularities. For this, increasingly difficult rows of consecutive symbols have to be processed. Each row contains a character that does not follow the rule. The patient's task is to recognize this symbol and cross it out.

criticism

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• only a very small number of items
• Differentiation of the point values ​​insufficient (evaluation)
• Assessment of spontaneous speech only in a test situation

Conclusion

According to Kalbe (2002), the aphasia check list is a standardized test procedure with which a detailed linguistic performance profile can be drawn up. The ACL is characterized primarily by its ease of implementation and the short test duration. The transparency of the test results makes planning the first therapy sessions much easier, as the symptoms can be read off relatively quickly.

Alternative test procedures

• AAT Aachen aphasia test by Huber et al. 1983
• AABT - Aachen aphasia bedside test by Biniek et al. 1993
• FAST - Frenchay Aphasia Screening Test by Enderby et al. 1987
• BAT - Bilingual Aphasia Test from Paradis 1987
• BDAE - Boston Diagnostic Aphasia Examination by Goodglass and Kaplan 1972
• KAP - Brief Aphasia Examination by Lang et al. 1999
• BOSU - Bogenhausen semantics study by Glindemann et al. 2002
• AST - Rapid Aphasia Test by Kroker 2000
• WAB - Western Aphasia Battery by Kertesz 1982
• MTDDA - Minnesota Test for Differential Diagnosis of Aphasia by Schuell 1965

swell

• M. Thiel (Ed.): Aphasia. Ways out of the language jungle. 2nd Edition. Springer, Berlin / Heidelberg 2004, ISBN 3-540-20469-5 .
• E. Kalbe et al.: The Aphasia Check List (ACL): A new instrument for aphasia diagnosis. In: J. Tesak (Ed.): Work on aphasia. 2006, pp. 21-31.
• J. Tesak (Ed.): Work on aphasia. 1st edition. Schulz-Kirchner, Scheßlitz 2006, ISBN 3-8248-0330-5 .