Naming: Aphasia Screening Test
Naming: Aphasia Screening Test
Name: _______________________________
Date: ____________DOB:________________
Handedness: __________
Education: ______________
Date of Onset: ____/____/_______ Side 1
Naming (2 points each; present object and ask “What is this called?”)
1) ___ Pen
2) ___ Hand (point to both sides of your hand)
3) ___Thumb
4) ___Watch
5) ___Ceiling (also accept light)
Automatic Speech (2 = correct; 0 incorrect; for items 3-5 say “Finish these sentences for me.”)
1) ___Count to ten (1 = cueing required)
2) ___Tell me the days of the week (1 = cueing required)
3) ___Three strikes and you’re _______.
4) ___I pledge allegiance to the _______.
5) ___The phone is off the _______.
Yes/No Responses (2 pts; “y”=yes; “n” = no; “I’m going to ask some questions; just tell me yes or no”)
1) ___Is your name Johnson (change if last name is Johnson)
2) ___Is your name ______? (insert correct last name)
3) ___Do you live in Rhode Island?
4) ___Do you live in ______? (insert correct state)
5) ___Do you wear a glove on your foot?
6) ___Am I touching my eye (clinician touches his/her nose)?
7) ___Does Monday come before Tuesday?
8) ___Does summer come after spring?
9) ___Is a chicken bigger than a spider?
10) ___Do you put your shoe on before your sock?
Object Recognition in a Field of Five (2 pts each; last 3 objects can use following possible items:
Book, paper, pen, photo, coin, name badge, cup)
___Watch ___( ) “I want to show you some things, point to them as I call them out.”
___Keys ___( )
___ ( )
Verbal Fluency Dictation: [SIDEWALK] write all words that the patient verbalizes and code unintelligible utterances
with a dash ( “!” ); OR TAPE PT RESPONSE AND TRANSCRIBE AFTERWARDS
INSTRUCTION: Show the photo (10 seconds) and say, “Look at this picture for a while (pause) Now tell me everything that you
can about this picture; keep talking until I tell you to stop”, immediately start timing for 10 seconds..
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Writing/Spelling (2 points each) “Now I would like for you to write some words for me, spell ___”
1 ___sit
2 ___twist
3 ___airplane
4 ___ computer
5 ___ under the black bridge
Optional Ratings (indicate presence “+” or absence “-“) For further information, please contact:
Dysarthria: _____ Risa Nakase-Thompson, Ph.D.
Methodist Rehabilitation Center
Paraphasia: _____ 1350 East Woodrow Wilson Drive
Perseveration: _____ Jackson, Mississippi 39216
Phone: (601) 364-3448
Oriented: _____ Email: [email protected]