English 20-2 Reading Comprehension Practice Test
Orencio Suhag
The scope of this page is acquired aphasia in adults (18+). See the Aphasia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives. For research about neurodegenerative aphasia, see the Primary Progressive Aphasia Evidence Map.
Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, typically the left hemisphere, that affects the functioning of core elements of the language network. Aphasia involves varying degrees of impairment in four primary areas:
Aphasia symptoms vary in severity of impairment and impact on functional communication, depending on factors such as the location and extent of damage and the demands of the communication environment. Aphasia may include deficits in verbal expression and auditory comprehension deficits as well as reading and writing deficits. Anomia, or difficulty retrieving words, is essentially universal across all individuals with aphasia (Laine & Martin, 2006). Alexia is the term for reading comprehension difficulties, and agraphia is the term used for written expression difficulties. Alexia and agraphia can occur together or in isolation.
Aphasia is caused by damage to the language network of the brain. Aphasia typically results from left-hemisphere damage. However, in rare instances, aphasia can occur with a right-hemisphere lesion. This happens most often in people who are left-handed because left-handed individuals are more likely to have language networks that are bilateral or that are located in the right hemisphere (Szaflarski et al., 2002). When a right-hemisphere lesion causes aphasia in someone who is right-handed, this is referred to as crossed aphasia.
As indicated in the Code of Ethics (ASHA, 2016a), individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.
Assessment can be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) and/or dynamic (i.e., an ongoing process using hypothesis testing procedures to identify potentially successful intervention and support procedures).
These factors may have an impact on screening and assessment and are considered during the evaluation. For example, if the individual with aphasia wears glasses (prescription or nonprescription), hearing aids, or dentures, then these devices should be worn during assessment if applicable prescriptions are still appropriate. Hearing and/or visual deficits may exist prior to the onset of aphasia or may be present as a result of the neurological event that caused aphasia. Physical or environmental modifications (e.g., large-print material, modified lighting, amplification devices) may assist SLPs with diagnosing language deficits in the presence of such co-occurring factors.
Documentation should include a description of any modifications and/or accommodations made to the testing process to reconcile cultural and linguistic variations, hearing and/or visual deficits, or other factors that may impact screening or comprehensive assessment. Any modifications and/or accommodations should also be considered when reporting assessment results (e.g., standardized scores may be impacted by modifications to assessment materials).
Screening is a procedure for identifying the need for further assessment and does not provide a detailed description of the diagnosis, severity, and characteristics of aphasia. Screening is a valuable tool that helps health care providers make appropriate referrals to speech-language pathology services. Screening is conducted in the language(s) used by the person, with sensitivity to cultural and linguistic diversity.
Screenings are completed by the SLP, the speech-language pathology assistant, or other trained professionals. Standardized and nonstandardized methods are used to screen oral motor functions, speech production, expressive and receptive language, cognitive communication, and hearing.
See Person-Centered Focus on Function: Aphasia [PDF] for an example of assessment data consistent with the ICF. See also Counting What Counts: A Framework for Capturing Real-Life Outcomes of Aphasia Intervention [PDF] for a model of how to capture real-life outcomes in assessment and intervention.
Assess expressive and receptive skills in spoken/signed and written language of increasing complexity across a variety of contexts (e.g., social, educational, vocational). Language assessment supports aphasia classification and identifies facilitating strategies.
The Life Participation Approach to Aphasia (LPAA) considers an intervention that emphasizes achieving or reengaging in life (Chapey et al., 2000; Lyon, 1992). This is done by focusing on the specific life concerns of the person with aphasia, with the overall goal of strengthening daily participation in activities of choice. The LPAA often focuses on long-term management of aphasia. Although LPAA approaches have traditionally taken place at home and in the community, the principles can be applied in any setting and at any stage of recovery from aphasia. Clinicians may choose to incorporate LPAA principles alongside other restorative or compensatory treatments.
See the following ASHA Practice Portal pages: Multilingual Service Delivery in Audiology and Speech-Language Pathology; Collaborating With Interpreters, Transliterators, and Translators; and Cultural Responsiveness.
Brief descriptions of both general and specific treatment options for individuals with aphasia are provided below. This information is not exhaustive, nor does inclusion of any specific treatment approach imply endorsement from ASHA. Treatment can be restorative (i.e., aimed at improving or restoring impaired function) and/or compensatory (i.e., aimed at compensating for deficits not amenable to retraining).
If the individual is not able to complete one of the components above, then they are given a choice from a list of up to three. After the individual completes all the above elements, the clinician asks them to state the target word (Leonard et al., 2008, 2014; van Hees et al., 2013).
In addition to determining the optimal treatment approach for individuals with aphasia, other factors include the availability of specific types of services in a particular region, insurance coverage, pattern of recovery, and service delivery options, including the following:
Treatment typically begins in the acute or rehabilitation inpatient setting and may continue in post-acute care. Treatment can occur in various formats or settings with the frequency, intensity, and duration of services based on the individualized treatment plan and progress. For example, in addition to one-on-one treatment, group treatment is often used to apply learned strategies in a more natural conversational context. Community-based programs (e.g., LPAA; Chapey et al., 2000) can be used to foster community integration and to provide peer support from other individuals with chronic aphasia. Intensive treatment/programs (e.g., intensive aphasia day treatment) may be used for a time-limited period.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Commission on Social Determinants of Health Final Report. World Health Organization.
Holland, A., Milman, L., Munoz, M., & Bays, G. (2002, June). Scripts in the management of aphasia [Paper presentation]. World Federation of Neurology, Aphasia and Cognitive Disorders Section Meeting, Villefranche, France.
The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 234,000 members, certificate holders, and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology assistants; and students.
Educators can move from the understanding gained through Panorama data to taking action by filtering Playbook strategies by domain, tier, topic, rating, developmental stage, framework, and several other categories to quickly find best practices to meet their students' needs. They can save relevant strategies, to easily access them again.
This strategy helps motivate students to view their abilities as a work-in-progress through reflection and improvement. Through several classroom practices and appropriate use of language, it encourages students to strive to meet their fullest potential and to create a positive attitude toward the learning process.
Story Mapping is a strategy where students create a graphic organizer to visualize the elements and structure of a story. It helps students understand the text on a structural level, which builds literary analysis and writing skills. It is applicable as an individual or group exercise, and is equally effective as a learning strategy, as well as an assessment tool.
Story maps can have a variety of looks and layouts, depending on the level of your students. At higher grades, maps might include the story exposition, conflict, rising action, climax, falling action, and resolution. Lower grades might simply include the setting, characters, and events in the beginning, middle, and end of the story.
This strategy can be used as early as first grade and is applicable at all levels of education. It builds the crucial academic skill of visually organizing information, which is used in nearly all fields of study. It engages with visual learners (and possibly tactile learners, depending on implementation) and develops independent metacognitive engagement with the story. It encourages collaboration and creativity and gives students a sense of ownership in their learning.
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