Brain Injury

ISSN: 0269-9052 (Print) 1362-301X (Online) Journal homepage: https://www.tandfonline.com/loi/ibij20

Assessment practices of speech-language

pathologists for cognitive communication
disorders following traumatic brain injury in
adults: An international survey

Matthew Frith, Leanne Togher, Alison Ferguson, Wayne Levick & Kimberley
Docking

To cite this article: Matthew Frith, Leanne Togher, Alison Ferguson, Wayne Levick &
Kimberley Docking (2014) Assessment practices of speech-language pathologists for cognitive
communication disorders following traumatic brain injury in adults: An international survey, Brain
Injury, 28:13-14, 1657-1666, DOI: 10.3109/02699052.2014.947619

To link to this article: https://doi.org/10.3109/02699052.2014.947619

Published online: 26 Aug 2014.

Submit your article to this journal

Article views: 4283

View related articles

View Crossmark data

Citing articles: 32 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=ibij20
 http://informahealthcare.com/bij
ISSN: 0269-9052 (print), 1362-301X (electronic)

Brain Inj, 2014; 28(13–14): 1657–1666

! 2014 Informa UK Ltd. DOI: 10.3109/02699052.2014.947619

ORIGINAL ARTICLE

Assessment practices of speech-language pathologists for cognitive

communication disorders following traumatic brain injury in adults:
An international survey
Matthew Frith1,2,3, Leanne Togher2,3, Alison Ferguson4, Wayne Levick5, & Kimberley Docking2,3
1
Kaleidoscope: Children, Young People & Families, Hunter New England Local Health District, NSW, Australia, 2Speech Pathology, Faculty of Health
Sciences, University of Sydney, Sydney, Australia, 3NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia, 4School of Humanities
& Social Sciences, and 5School of Psychology University of Newcastle, Newcastle, Australia

Abstract Keywords
Primary objective: This study’s objective was to examine the current assessment practices of Assessment, cognitive, language, survey
SLPs working with adults with acquired cognitive communication impairments following a TBI.
Methods and procedures: Two hundred and sixty-five SLPs from the UK, the US, Canada, History
Australia and New Zealand responded to the online survey stating the areas of communication
frequently assessed and the assessment tools they use. Received 25 August 2013
Main outcomes and results: SLPs reported that they routinely assessed functional communi- Revised 16 May 2014
cation (78.8%), whereas domains such as discourse were routinely assessed by less than half of Accepted 20 July 2014
the group (44.3%). Clinicians used aphasia and cognitive communication/high level language Published online 26 August 2014
tools and tools assessing functional performance, discourse, pragmatic skills or informal
assessments were used by less than 10% of the group. The country and setting of service
delivery influenced choice of assessment tools used in clinical practice.
Conclusions: These findings have implications for training of SLPs in a more diverse range of
assessment tools for this clinical group. The findings raise questions regarding the statistical
validity and reliability of assessments currently used in clinical practice. It highlights the need
for further research into how SLPs can be supported in translating current evidence about the
use of assessment tools into clinical practice.

Introduction methodology and complimentary assessment choices in this

rehabilitation setting. One approach is to use locally regulated
Speech Language Pathologists (SLPs) play an integral role in
SLP practice guidelines, but internationally there are incon-
the rehabilitation of a person after a traumatic brain injury
sistencies amongst speech language pathology associations
(TBI). SLP assessment and intervention commences in the
on practice guidelines for the assessment and management
acute setting with a focus primarily on dysphagia manage-
of cognitive communication disorders. In countries such as
ment [1], observation and monitoring of communication
Australia and New Zealand there are no practice guidelines or
abilities during post-traumatic amnesia [2] and further on
position papers regarding the selection of relevant assess-
in the rehabilitation process SLPs have an important contri-
ments in this specialized field of practice and in the UK,
bution in cognitive rehabilitation, with assessment and
while the Royal College of Speech & Language Therapists
management of cognitive communication disorders [3].
(RCSLT) have produced guidelines [5] for the assessment and
Rehabilitation after a TBI is a specialized field and requires
management of aphasia, as yet there is no reference to
expert clinical decision-making skills where there is an
cognitive communication disorders. However, more detailed
understanding of the person’s impairments in communication
guidelines are available through the US and Canada. The
and how this relates to their ability to participate in real life
American Speech-Language-Hearing Association [6, 7] have
activities [4].
produced a number of general guidelines and position papers
Considering this is a complex specialized field, there is
on the assessment of cognitive communication disorders,
limited consensus in the literature to assist the SLP to
while The College of Audiologists and Speech Language
make appropriate clinical decisions regarding the type of
Pathologists of Ontario [8] have produced detailed preferred
practice guidelines for both the assessment and management
of cognitive communication disorders. Both papers make
Correspondence: Matthew Frith, Speech Pathologist, Kaleidoscope, reference to assessment of cognitive functions such as
HNE LHD PO BOX 2563 Dangar, NSW, Australia 2309, Australia.
Tel: +61(0)249 257963. Fax: +61(0)249257955. E-mail: attention, concentration, executive function, memory/new
[email protected] learning as well as linguistic components such as auditory
1658 M. Frith et al. Brain Inj, 2014; 28(13–14): 1657–1666

comprehension, oral expression, discourse, word finding, assessment choices [19–21]. Years of clinical experience has
reading rate and comprehension and written expression. also been highlighted as another factor that may impact on
The Academy of Neurologic Communication Disorders clinical decision-making skills [4], as well as the benefits
and Sciences (ANCDS) has similarly published guidelines on of a mentor or experienced clinician to assist with decision-
standardized testing [9] and non-standardized testing [10]. making.
Surprisingly, these guidelines have received very little While some guidelines exist in some countries around the
citation, but they do provide valuable information for the world, with very little else to guide an SLP’s decision
SLP to guide clinical decision-making. The ANCDS surveyed regarding assessment selection, there has been some research
clinicians and test distributors about assessments that are into the assessment practices of Speech Language
recommended to be used in TBI and cognitive communica- Pathologists working in TBI. The difficulties inherent with
tion disorders [9]. These were reviewed by the ANCDS this population include the heterogeneous nature of the TBI
committee for reliability and validity and of 85 tests, only six population and the varying severity. SLPs have been reported
were recommended for adult patients that met the majority of to use more standardized assessment practices in the acute
criteria for reliability and validity. The tests which were setting with the minimally conscious patient [22], such as the
recommended by the ANCDS committee included Wessex Head Injury Matrix (WHIM [23]); and recent research
the Functional Independence Measure FIM [11]; American has also shown that, when a patient is in PTA (post-traumatic
Speech Language Hearing Association Functional amnesia), the SLP is more likely to monitor and observe any
Assessment of Communication Skills in Adults ASHA changes than conduct a formal assessment [24].
FACS [12]; Communication Activities of Daily Living More recently, there has been a stronger focus on
Second Edition CADL-2 [13]; Repeatable Battery for the assessments for cognitive communication disorders after a
Assessment of Neuropsychological Status RBANS [14]; and mild TBI in studies coming from the US and Australia [25].
the Western Aphasia Battery WAB [15]. Some of the SLPs in the US reported using the Ross Information
described [10] non-standardized assessment procedures used Processing Assessment [26], Boston Diagnostic Aphasia
by Speech Language Pathologists focused mainly on dis- Battery [27] and Boston Naming Test [28]. These results
course procedures including monologic and conversational were similar to the work by Frank and Barrineau [19], who
discourse. The authors discussed some of the inherent conducted a large scale study where severity of injury was not
weaknesses with non-standardized approaches, such as lack defined. The initial data on assessment protocols for combat-
of normative data to distinguish impaired and normal injured servicemen with a mild TBI highlighted selection of
discourse abilities within the context of the person and the assessments that were different again as part of clinical
influences context has on discourse. It was also recommended practice. These included the Functional Assessment of Verbal
that rating scales and checklists used in discourse and Reasoning Strategies (FAVRES) [29] and the Attention
pragmatic assessments about the person and communication Processing Test. Informal measures were included to examine
partner should be used with caution due to weak psychometric word finding and pragmatic deficits. Some Australian studies
properties and the level of training required to reliably use have used case studies to highlight particular assessments
them. to use with TBI including sub-tests such as the inference/
Not much has been documented on the influence of listening comprehension sub-test from adolescent language
assessment choices for SLPs working with people with TBI. tests such as the Test of Language Competence [30] and The
Surveys of SLPs working in TBI in the US have highlighted Word Test 2 [31] vocabulary sub-test [32]. Test selection has
that undergraduate training does not provide adequate training also been examined in the acute setting and it was found that
in TBI [16, 17]. The questions that a clinician should ask the Cognitive Linguistic Quick Test [33] was useful in
themselves when deciding on an assessment have been identifying deficits in an acute setting of 83 patients with
described in detail [18]. These four questions consisted of: varying severity of TBI injury [34].
(1) Does the test identify a cognitive communication To the authors’ knowledge, there is no study which has
disorder?; (2) Does it characterize the components contribut- compared communication assessment practices in the field
ing to the performance?; (3) Are the test results appropriate of TBI between countries, although there has been some
for the real life situations?; and (4) Does it assist with comparison of aphasia assessment practice [35]. For aphasia,
decisions about intervention? The statistical aspects of test there have been similarities between countries with the use of
construction and its importance in test selection has been the Western Aphasia Battery [15], Boston Diagnostic Aphasia
discussed [9], however a survey conducted in the US Examination [27] and Boston Naming Test [28] primarily
suggested that, despite poor validity and reliability, the used by SLPs in Australia, Canada, the UK and the US. The
choice of assessment by SLPs was most commonly based PALPA [36] and Mount Wilga [37] were reported to be
on whether it identified deficits and assisted with goal-setting popular assessments in the UK and Australia compared with
and therapeutic planning [19]. The same survey demonstrated Canada and the US. However, there was no difference in the
that test choice was also more likely to be based on advice type of assessment tools used when comparing the practice
from fellow colleagues, workshops and conferences rather of speech pathologists working in acute settings compared to
than evidence-based literature [19]. Ylvisaker et al. [4] community outpatient services. Assessment practices were
identified that evidence statements (for example guidelines) consistent across Australia in regard to the Mount Wilga High
can also impact on clinical decision-making. Time factors, Level Language assessment [37] predominately used by over
such as the available clinical time and the time required 70% of clinicians in acute and community setting for CVA/
to administer a test, have been described as impacting on aphasia [20, 35, 38].
DOI: 10.3109/02699052.2014.947619 Cognitive communication following TBI in adults 1659

Few aphasia and TBI studies have focused on assessment Speech Language Pathologists (CASLPA) and the American
choices across settings, mainly focusing on one setting [38] Speech-Language-Hearing Association (ASHA). These pro-
and not comparing choice of assessment tools across an fessionals were invited to complete an online survey through
inpatient and community setting. Studies which have email invitation or web link using survey monkey (www.sur-
reviewed assessment choice across settings have shown no veymonkey.com). Email invitation allowed the SLPs to have
difference in the choice of tools [19, 20]. Studies have also multiple opportunities to complete the survey without losing
attempted to guide the clinician to move away from impair- information to which they had already responded. Three
ment type tests such as aphasia assessments [39, 40] and reminders were automatically sent over a period of 8 weeks.
apply the ICF (International Classification of Functioning, SLPs were also identified through Speech Pathology
Disability and Health) model to assessment choice, with Interest Groups in Brain Injury via the UK, Australia, New
assessments such as the FAVRES [29] and ASHA FACS [12] Zealand, Canada and the US, as well as managers of Speech
for tools to assess activities and participation. Pathology departments throughout a number of hospitals and
There has also been a focus on informal assessment in TBI, community health centres. The dissemination of the survey
primarily concentrating on discourse. Togher [41] reviewed was modified using a general Web Link using the online
the theoretical approaches to discourse analysis and Coelho survey tool Survey Monkey (www.surveymonkey.com). This
[42] discussed the limitations which continue to be a barrier link was not personalized to any one participant and an email
to implementing this procedure. Previous research has outlining the study and survey was sent to moderators of the
reported responses from clinicians who were asked about interest groups and managers of health services asking them
informal assessment procedures. In literature pertaining to to disseminate to staff and/or colleagues. Ethics approval was
both aphasia and TBI, SLPs reported using informal proced- granted by the Hunter New England Human Research Ethics
ures which primarily focused on observations, interviews with Committee of Hunter New England Health reference 10/04/
the family and client and developing tools for other assess- 21/5/10.
ments for their own use [19, 35, 38]. In the studies discussed It was estimated that for both Australia and New Zealand
previously surveying SLPs about assessment practices, dis- and the UK there was a greater than 50% response rate with a
course analysis or discourse sampling was very rarely lower response rate (525%) from the US/Canada group. There
reported. was also a high rate of undeliverable emails for the US/
Most of the research in assessment practices has focused Canada group, which may have been an indication that the
on the tools used and not on SLP’s perception about what they database email addresses that were extracted were not
feel are the areas of communication they assess. There is only accurate. Overall, of those who responded, 63.4% of partici-
one paper to date which has documented this from the pants were recruited through email invitation and 36.6%
perspective of SLPs [43]. This study documented SLPs were recruited via web link. A higher number of partici-
working in the US and documented that the aspects of pants were recruited through a web link in the UK
communication that were reported by the SLPs to be assessed (62.3%) compared to Australia/New Zealand (13.6%) and
included receptive and expressive language, pragmatics, the US/Canada (37.2%).
reading, writing and cognition.
The present study was designed to identify the current
Survey design
clinical assessment tools used by speech language patholo-
gists working with adults who have sustained a cognitive A 12 item questionnaire was developed to evaluate the
communication disorder after a traumatic brain injury. The assessment practice of SLPs working in traumatic brain
aims of the study were to survey SLPs working in TBI and: injury. It formed part of a larger study, with the first seven
(1) Identify differences in the reported use of assessment questions included in the analysis presented in this paper. The
tools/protocols by SLPs in different countries. seven questions asked included geographical location, clinical
(2) Identify whether setting of care influences the reported setting and years of experience. A 5-point category rating
use of assessment protocols/tools used by SLPs scale using fixed anchor points was used to identify SLPs’
(3) Identify whether years of experience influences the perceptions of how often they assessed aspects of language
reported use of assessment tools/protocols used by SLPs. and communication (receptive language, expressive language,
(4) Identify whether there was a link between all three pragmatic skills, discourse, word-finding ability, vocabulary,
variables: country, setting of care and years of high level language, problem-solving, reading decoding,
experience. reading comprehension, written language and functional
communication). Fixed anchor points were used as they
Method have been recommended as more reliable when making
quantitative comparisons [44].
Participants
Descriptors were provided for each point on the rating
Speech Language Pathologists (SLPs) who reported having scale and, given the difficulties of interpreting responses
specific clinical expertise in the rehabilitation of adults with when ambiguous adverbs are used as descriptors [45], a
traumatic brain injury (TBI) were identified through publicly percentage of clinical time was provided as an additional
available databases including; Speech Pathology Australia qualifier with the anchor points to guide the clinician in
(SPA), New Zealand Speech-Language Therapists’ making an accurate judgement of their assessment practices.
Association (NZSTA), Royal College of Speech and The quantifiers used for clinical time included; Never ¼ 0%,
Language Therapists (RCSLT), Canadian Association of Infrequent 525% of clinical time, Somewhat frequent ¼ 25–
1660 M. Frith et al. Brain Inj, 2014; 28(13–14): 1657–1666

550% of clinical time, Frequently 450–585% of clinical time Table I. Speech language pathologists (n ¼ 265) demographic
information.
and the Majority of the time 485% of clinical time.
SLPs were also provided with four open response text SLPs’ Percentage of
boxes and asked to list four assessments that they use responses (n) SLPs (%)
frequently and find useful in identifying the strengths and
Geographical setting
weaknesses of a client and assists with goal-setting and Metropolitan 210 78.9
intervention practices. These descriptors were based on Rural & Remote 56 21.1
general clinical questions and principles a SLP is likely to Country
Australia/New Zealand 81 30.6
use when using an assessment [18].
US/Canada 113 42.6
UK 69 26
Terminology Unknown 2 0.8
The generic term ‘language-based communication disorders’ Employment setting
Inpatient acute/rehabilitation 134 50.6
was used to ensure SLPs did not respond about assessment Community rehabilitation 131 49.4
practices relating to dysarthria, dyspraxia and dysphagia. The Years of experience
term ‘cognitive communication’ was deliberately not used in 510 years 121 45.7
410 years 144 54.3
order to prevent any response-bias by SLPs, which may return
a false positive to assessing areas of cognitive communica-
tion. The chosen terminology was utilized to promote
respondents to think broadly about what aspects of language
and communication they assess in clinical practice, with areas
relating to cognitive communication derived from responses Table II. Relative risk for country influencing years of experience and
employment setting.
collected.
Country group Relative risk Level of significance
Analysis
2
AUS/NZ 1.37  (1, n ¼ 81) ¼ 1.22, p ¼ 0.27
Responses from Survey Monkey software were downloaded UK 1.31 2 (1, n ¼ 69) ¼ 1.42, p ¼ 0.23
into IBM SPSS (Statistical Package for the Social Sciences US/CA 2.03 2 (1, n ¼ 113) ¼ 12.84, p ¼ 0.00
version 21). Countries were characterized into three groups
(Australia and New Zealand; UK; US and Canada). Years of
experience were characterized into 10 years and less and
greater than 10 years and setting was characterized into metropolitan centres, while the remaining group reported
Inpatient acute/rehabilitation and Community rehabilitation. working in rural and/or remote areas. The community
Due to the high number of assessments reported by the rehabilitation setting predominately consisted of clinicians
respondents, a classification system was developed based on a working in outpatient and community rehabilitation facilities
Simmons-Mackie et al. [21] study which categorized assess- (56.5%), private practice (17.6%) and university clinics
ments into linguistic/cognitive, functional, subjective/qualita- (14.5%).
tive and vague/other. In the current study, these categories Pearson Chi-Square analysis was conducted to confirm
were broadened to include aphasia assessments, cognitive whether geographical location impacted on group differences
communication/high level language assessments, cognitive/ for the key variables, experience, country and setting. There
neuropsychology assessments, assessment of functional per- was a significant difference between geographical location
formance (including literacy), informal language and cogni- and years of experience. SLPs with greater than 10 years
tive assessments, naming and word-finding assessments, of experience were less likely to work in rural and remote
discourse and/or pragmatic skills assessments and other. areas than SLPs with less than 10 years’ experience, 2
Assessments were categorized based on expert opinion from (1, n ¼ 265) ¼ 7.30, p ¼ 0.007.
five SLPs working in the area of traumatic brain injury and A three-way table with Pearson Chi-Square analysis was
aphasia. Chi-Square analysis was conducted as recommended conducted for employment setting and clinical experience in
for categorical and ordinal data [46] to make comparison each country group. Results indicated a significant relation-
between country, years of experience and setting of care. ship between clinical experience and employment setting 2
(1, n ¼ 263) ¼ 15.31, p ¼ 0.00. A relative risk ratio was
Results obtained to determine the likelihood of country influencing
employment setting. This is described in Table II.
Responses received from 265 Speech Language Pathologists In all country categories there was a higher likelihood
(SLPs) are reported. Of these, 2.6% did not respond to the of experienced SLPs (greater than 10 years) working in
rating scale question which asked how often the individual community rehabilitation settings compared with inpatient
assessed different areas language and communication; 7.6% settings. This was only significant for the US/Canada
did not provide a list of assessments commonly used in category.
clinical practice in the open response text box. A logistic regression was conducted to determine the
presence of significant relationships between the three
Demographic information
variables of clinical experience, employment setting and
Demographic information is represented in Table I. As shown, country. However, this was not significant according to the
the majority of SLPs reported that they worked in Wald test, 2 (2, n ¼ 263) ¼ 2.78, p ¼ 0.25.
DOI: 10.3109/02699052.2014.947619 Cognitive communication following TBI in adults 1661

Areas of communication assessed after traumatic and the UK (38.7%); however, this was not significant (2
brain injury (8, n ¼ 243) ¼ 14.41, p ¼ 0.072).
SLPs reported functional communication skills (78.8%) to
Setting of care
be the most routinely assessed communication skill when
assessing a person after TBI. Table III highlights the There were no significant differences when using a Pearson
percentage of SLPs who routinely assessed each component Chi-Square between areas of communication assessed and
of communication. setting of care worldwide. In inpatient acute/rehabilitation
settings there was a higher percentage of SLPs who routinely
Country assessed each area of communication compared with SLPs
working in a community setting.
There were significant differences between the country where
the SLP resides and certain areas of communication. SLPs
Years of experience
in US/Canada (CA) reported routinely assessing problem-
solving more frequently than the UK and Australia (AUS)/ A Pearson Chi-Square revealed significant differences
New Zealand (NZ) (2 (8, n ¼ 251) ¼ 33.88, p ¼ 0.00); and between certain areas of communication assessed when
frequently assessing written language (2 (8, n ¼ 243) compared with years of experience of the SLP. SLPs with
¼ 20.89, p ¼ 0.007) and reading decoding (2 (8, n ¼ 249) more experience (410 years of experience) reported routinely
¼ 17.01, p ¼ 0.030), more than SLPs in the UK and AUS/NZ. assessing more key areas of cognitive communication than
A higher number of SLPs in the US/CA reported routinely SLPs with less than 10 years of experience. These included;
assessing discourse (55.7%) compared with AUS/NZ (32.0%) pragmatic skills (2 (4, n ¼ 286) ¼ 25.28, p ¼ 0.00), discourse
(2 (4, n ¼ 277) ¼ 25.28, p ¼ 0.02), high level language (2
(4, n ¼ 287) ¼ 11.99, p ¼ 0.01), problem-solving (2 (4,
Table III. Areas of communication routinely assessed by SLPs. n ¼ 253) ¼ 29.56, p ¼ 0.00), word-finding (2 (4, n ¼ 288)
¼ 10.58, p ¼ 0.03) and written language (2 (4, n ¼ 286)
Area of communication Average %
¼ 17.17, p ¼ 0.002). In addition, reading (decoding) (2 (4,
Functional communication 78.8% n ¼ 288) ¼ 10.58, p ¼ 0.003), reading comprehension (2 (4,
Receptive language 70.7%
n ¼ 286) ¼ 13.42, p ¼ 0.009) and receptive language (2 (4,
Expressive language 70.3%
Word-finding skills 62.9% n ¼ 288) ¼ 10.26, p ¼ 0.04) were reported as routinely
High level language 62.6% assessed more often in the more experienced clinician.
Pragmatic skills 58.9%
Problem-solving skills 57.5% Assessment tools used in clinical practice
Reading comprehension 48.4%
Discourse 44.3% Overall, aphasia assessments (27.7% of SLPs) and cognitive
Written language 40%
Reading (decoding) 34.8%
communication/high level language assessments (31.7% of
Vocabulary 31.5% SLPs) were the most frequently used category of tools, as
depicted in Figure 1.

Assessments Tools Used by SLPs by Category

Other (4.2%)

Discourse & / or Pragmatic Skills (6.2%)

Assessment

Naming & / or Word-Finding Assessment (5.4%)

Number of Responses (n)
Total = 779
Informal Language & Cognitive Assessments (5.6%)
(derived by clinicians &/or SP Dep’t)

Assessment of Functional Performance (incl: (9.9%)

literacy)

Cognitive Neuropsychology Assessments (9.2%)

Cognitive Communication / High Level (31.7%)

Language Assessment

Aphasia Assessment (27.7%)

0 50 100 150 200 250

Figure 1. Distribution of assessment categories as reported by SLPs by all country groups.

1662 M. Frith et al. Brain Inj, 2014; 28(13–14): 1657–1666

Each assessment category contained assessment tools cognitive assessments and slightly higher use of naming/word
which were reported to be utilized more commonly than finding assessments and discourse and pragmatic skills
others. The aphasia assessment category consisted of a large assessments. SLPs in the US/CA reported lower use of
number of assessments led by the Boston Diagnostic Aphasia assessment tools for discourse and pragmatic skills.
Examination (BDAE) [27], which was reportedly used by Particular assessment tools were also reported as more
23% of SLPs, closely followed by the Western Aphasia popular by country. In AUS/NZ and the UK there was less
Battery (WAB) [15] at 21.7%. Fewer assessment tools were variability in assessment tools reported compared with the US
reported in the cognitive communication/high level language and Canada, which mostly consisted of cognitive/neuropsych-
assessment category. The Mount Wilga High Level Language ology assessments. AUS/NZ and the UK also had very similar
assessment (MWHLL) [37] was used by 35.2% of clinicians, popularity with assessment tools. In AUS/NZ the most
followed by the Measure of Cognitive Linguistic Ability reported assessment tools used included the MWHLL [37]
(MCLA) [47] on 35.2%. In the Assessment of Functional with 77.2%, MCLA [47] with 45.6%, informal assessment
Performance (incl: literacy) category, The Functional practices with 32.9% and Psycholinguistic Assessment of
Assessment of Verbal Reasoning and Executive Strategies Language Processing in Adult Acquired Aphasia (PALPA)
(FAVRES) [29] was the most popular tool at 36.4% and in the [36] with 30.4%.
Cognitive/Neuropsychology Assessment category, the Ross In the UK the most reported assessment tool was the
Information Processing Assessment (RIPA) [26] was the most MCLA [47] at 55.4%, followed by CAT [50] at 46%,
popular with 27.8%. A variety of other standardized cognitive MWHLL [37] at 43% and the PALPA [36] at 40%. In the
assessments were also included in this category. The Boston US/CA, the WAB [15] and BDAE [27] were most popular at
Naming Test (BNT) [28] was the most frequently used 30.5% and the Scales of Cognitive Ability for Traumatic
assessment in the Naming and/or Word Finding Assessment Brain Injury (SCATBI) [51] at 29.5%, CLQT [33] and
category, with 66.7% of SLPs reporting their use of that informal assessment practices both at 24% and the RIPA [26]
particular tool. The La Trobe Communication Questionnaire on 23% were the most frequently used assessments. See Table
(LCQ) [48] was the most popular tool in the Discourse/ V for the popular assessment tools in each country.
Pragmatic Skills Assessment category, with 35.4% reporting
use of the assessment, followed by The Awareness of Social Setting of care
Inference Test (TASIT) [49], with less than 20%. Various A Pearson chi-square was conducted to determine if there was
outcome measures and paediatric language assessments a difference in assessments tools used within inpatient and
comprised the other category. community settings. Results indicated a significant difference
between setting of care (2 (14, n ¼ 779) ¼ 18.60, p ¼ 0.01).
Country Table VI shows the comparison of assessment tools by setting.
Discourse was the only assessment category which was
A Pearson chi-square was conducted to determine if there was
significantly different amongst settings with discourse and
a difference in assessment tools used between countries.
pragmatic skills assessment more likely to be completed in a
Results indicated a significant difference between countries
community setting. Most assessment categories were report-
2 (14, n ¼ 779) ¼ 97.31, p ¼ 0.00. Table IV shows the
edly used more often in an inpatient setting, except for
comparison of assessment tools by SLPs from each country.
SLPs in the US/CA reported a lower use of Cognitive discourse (which was significant), cognitive assessments,
word-finding assessments and other assessments.
Communication/High Level Language Assessment tools
while SLPs in AUS/NZ reported significantly higher use.
Years of experience
In contrast, SLPs in the US/CA reported higher use of
Cognitive/Neuropsychology Assessment tools when com- There were no significant differences with reported level
pared with SLPs in the UK and AUS/NZ. However, SLPs experience and assessment tools used by SLPs 2 (7,
in AUS/NZ reported higher use of informal language and n ¼ 779) ¼ 4.17, p ¼ 0.760. There was also very little variance

Table IV. Comparison of assessment tools by country.

Country (% of use)
Assessment tool Average % AUS/NZ UK US/CA
Aphasia Assessment 27.7 25.9 32.7 25.9
Cognitive Communication/High Level Language 31.7 39.9* (+) 33.2 23.6* ()
Cognitive/Neuropsychology Assessments 9.2 0.8* () 6.6 18.4* (+)
Assessment of Functional Performance (incl: Literacy) 9.9 8.0 6.6 13.8* (+)
Informal Language/Cognitive Assessment 5.6 9.5* (+) 2.4* () 4.6
Naming and/or Word Finding Assessment 5.4 3.0* () 6.2 6.9
Discourse and/or Pragmatic Skills Assessment 6.2 9.1* (+) 6.2 3.6* ()
Other Assessment 4.2 3.8 6.2 3.3

An adjusted standardized residuals test was carried out to determine if there were differences amongst countries on particular assessment tools.
Residuals which exceeded ± 2 are presented, with a + indicating significantly higher use of assessment tool compared to average of all SLPs.
A  indicates significantly less use of that assessment tool compared to average of SLPs who participated in survey. *indicates p50.001.
DOI: 10.3109/02699052.2014.947619 Cognitive communication following TBI in adults 1663
Table V. Popular assessment tools by country. skills the most frequently in clinical practice followed by
receptive and expressive language skills. Areas of communi-
Australia/
Overall New Zealand UK US/Canada
cation considered to be sensitive to TBI [52, 53], such as
pragmatic skills, word finding skills, higher level language
1 MWHLL MWHLL MCLA WAB/BDAE abilities, discourse, literacy and problem-solving skills, were
2 MCLA MCLA CAT SCATBI
3 BDAE PALPA MWHLL CLQT/Informal not routinely assessed by SLPs, regardless of country, setting
4 WAB Informal PALPA RIPA or years of experience. In particular, discourse/pragmatic
skills assessment tools were used by less than 10% of the
MWHLL, Mt Wilga High Level Language [37]; MCLA, Measure of
Cognitive Linguistic Ability [47]; BDAE, Boston Diagnostic Aphasia SLPs surveyed and findings showed that discourse assess-
Examination [27]; WAB, Western Aphasia Battery [15]; PALPA, ments currently used included checklists such as the LCQ [48]
Psycholinguistic Assessment of Language Processing in Adult or the social communication assessment TASIT [52]. These
Acquired Aphasia [36]; CAT, Comprehensive Aphasia Test [50]; assessments have already had research conducted to evaluate
CLQT, Cognitive Linguistic Quick Test [33]; Informal, Informal tests
made up by the clinician; SCATBI, Scales of Cognitive Ability for their validity and reliability which have been positive [52, 54].
Traumatic Brain Injury [51]; RIPA, Ross Information Processing These results about the assessment of discourse may contrib-
Assessment [26]. ute to a possible trend in the literature, suggesting that
perceived time taken and ease of transcription, training, the
decision process regarding the type of assessment/tool and
Table VI. Comparisons of assessment tools by setting. translating the findings into clinical practice may still be
possible deterrents for a SLP to implement discourse analysis
Average Inpatient Community
(%) (%) (%)
into clinical practice [42].
Interestingly, while Functional Communication was rated
Aphasia Assessment 27.7 29.8 25.6 as the most routinely assessed area of communication,
Cognitive Communication/ 31.7 33.9 29.5
High Level Language impairment-based assessments designed for aphasia and
Cognitive/Neuropsychology 9.2 7.9 10.6 high level language were noted to be the most prevalently
Assessments used by SLPs internationally. To date, only one assessment in
Assessment of Functional 9.9 10.5 9.3
this category has been recommended for use in this popula-
Performance (incl: Literacy)
Informal Language/Cognitive 5.6 6.4 4.9 tion of adults with TBI [9]: the WAB [15]. Further research
Assessments needs to evaluate why other assessments in the category of
Naming and/or Word Finding 5.4 4.8 5.9 aphasia assessments that were revealed by the survey, such as
Assessments
Discourse and/or Pragmatic Skills 6.2 3.1* () 9.3* (+)
the PALPA [36], CAT [50] and BDAE [27], are used in
Assessments clinical practice if impairment-based aphasia tools are
Other 4.2 3.6 4.9 generally not reported in the literature to be sensitive to TBI
nor considered appropriate to the targeted function in
An adjusted standardized residuals test was carried out to determine if
there were differences setting on particular assessment tools. Residuals everyday life [39]. Most of the assessments commonly used
which exceeded ± 2 are presented with a +, indicating significantly in studies examining cognitive communication impairments
higher use of assessment tool compared to average of all SLPs. A  in TBI were not identified as preferred assessment tools in
indicates significantly less use of that assessment tool compared to
clinical practice in this study, except for the SCATBI [51],
average of SLPs who participated in survey. *indicates p ¼ 0.01.
which again has not consistently proved sensitive to milder
deficits after TBI [32, 55].
between assessments used between clinicians with greater
Differences were also noted between the countries repre-
experience and, while it was not significant, more experi-
sented in the survey in regards to the assessment of specific
enced clinicians (410 years) were more likely to complete a
areas of communication as well as the assessment tools used.
cognitive/neuropsychology and discourse/pragmatic skills
In the US and Canada (US/CA), SLPs more frequently
assessment and less likely to conduct an informal language/
assessed areas of communication such as problem-solving,
cognitive assessment with a client after a traumatic brain written language and reading compared to their colleagues in
injury.
Australia/New Zealand (AUS/NZ) and the UK. As high-
lighted by past research [43], SLPs in the US are using a high
Discussion
number of cognitive assessments compared to linguistic
This study’s primary objective was to examine the current assessments and this may be a reflection of the guidelines
assessment practices of SLPs working with adults with distributed in the US and Canada [6–8], which highlights
acquired cognitive communication impairments following a cognition as an area of assessment for the SLP. Studies which
TBI. It aimed to identify potential differences in the use of have reviewed the role of the SLP in regards to assessment of
assessment tools and protocols by SLPs across prominent cognition have demonstrated the overlapping role between
English speaking countries worldwide and whether setting of SLPs and Neuropsychologists [56]. A large majority of
care and years of clinical experience influenced these choices. Neuropsychologists saw the role of the SLPs was to assess
The results of the worldwide survey of clinicians in this field cognition as part of an assessment of communication, but
informed each of these areas and highlighted a number of there was very little collaboration with pre-assessment
clinical and research implications. planning which had implications for integrity of psychomet-
Overall, when assessing adults communication skills after ric assessments and the reporting of results as each discip-
a TBI, SLPs reported assessing functional communication line had its own interpretation and perspective view [56].
1664 M. Frith et al. Brain Inj, 2014; 28(13–14): 1657–1666

This has implications for clinical practice about the clinical of communication styles and context-specific nature of
decision-making rationale behind choosing cognitive-based communication in different settings [41].
assessments over linguistic-based assessments. The survey conducted as part of the present investigation
Conversely, the results of the present study demonstrated highlighted that overall SLPs do not report assessing a
that cognitive communication and high level language particular area of communication more frequently depending
assessments (CC/HLL) were used significantly less by SLPs on clinical setting; whether it was an inpatient or community
in the US/CA compared to SLPs in AUS/NZ. The most setting. The majority of assessments were used equally
widely used CC/HL assessments in AUS/NZ and the UK across inpatient and community setting, similar to findings in
were the MWHLL [37] and the CLAMCLA [47]. The use of previous research examining clinical assessment practices in
the MWHLL has been documented as a preferred assessment both TBI and aphasia populations [19, 35]. However, at a
in Australia in adults with aphasia [35, 38], a finding which category level, discourse and pragmatic skill assessment tools
was also evident in the current study in demonstrating were noted to be significantly more likely to be used in a
its popularity amongst clinicians for use with adult TBI community setting. As discourse and social skills are con-
patients as well. This is an interesting finding considering sidered by clinicians to play a significant role in re-establishing
there is no known empirical research or normative data peer relationships and re-integrating back to work [58], it is
supporting its use in clinical practice to date. The MWHLL possible that SLPs specifically target social communication in
assessment is available online free (for example their assessment and rehabilitation practices in order to support
www.Libguides.city.ac.uk) and may influence SLP choice re-integration of their patients back into the community.
based on availability rather than on psychometric robustness. Methodological issues such as practice effects on repeated
However, further research is warranted to establish appropri- measures needs to be highlighted given the lack of change in
ateness for individual assessments with this population in assessment tools between inpatient and community settings.
order to guide the SLP in making the best tool selections to The possible use of re-testing using the same assessment
assess cognitive communication abilities in adults after TBI. within short time frames as the person with a TBI follows
It also may serve to further highlight previous research their rehabilitation from inpatient to community and possibly
indicating that SLPs do not place great emphasis on statistical a number of different clinicians. Given previous research
properties of an assessment when choosing an assessment highlighting that SLPs have focused less on statistical
tool [19]. properties [19], further investigation is warranted in deter-
Although discourse/pragmatic assessment tools repre- mining how often assessments are re-administered in clinical
sented a smaller proportion of assessment tools reported to practice and whether this impacts not only on the validity and
be used by SLPs surveyed in this study, this category was reliability, but also regarding appropriateness for goal setting,
noted to be more prevalent in AUS/NZ settings. This may intervention planning and as an outcome measure.
reflect that the stated assessments of choice were more Those areas of communication demonstrated to be more
commonly developed locally, with the potential for AUS/NZ specifically impacted or sensitive to TBI [53], such as
based SLPs to have had more exposure to these tools via pragmatic skills, discourse word finding ability and literacy,
workshops or conferences; reported to be an effective method were more likely to be more frequently assessed by
of promoting assessment choice [19]. Similarly, use of the experienced clinicians. However, the tools selected in the
FAVRES [29] in the assessment of functional performance assessment of these areas of communication were not signifi-
category was noted to be more popular in the US/CA from cantly different in regard to years of experience. Previous
where it also originated. These findings suggest that the research has highlighted that clinicians did not feel adequately
location where the assessment is developed may influence trained at an undergraduate level and that experience of TBI
SLPs local to that area in their choice of assessment tool. is learnt through exposure, mentoring from experienced
Naming assessments were used significantly less in AUS/ staff and workshops [19]. Additionally, findings of the present
NZ, as were cognitive assessments which may reflect role study suggest that less experienced staff in AUS/NZ are
delineation between Neuropsychologists and SLPs in those working in regional and rural areas, often times employed as a
countries. The BNT which was the most popular tool in the sole or generalist clinician, where they may not have access
naming group has also been reported as a tool used by to the appropriate assessment tools or support in deciding on
Neuropsychologists when examining their clinical assessment which appropriate tools to use. Such reports of inconsistent
practices [57]. use of assessments targeting areas of communication known
Use of informal language/cognitive measures were not to be most commonly impacted by a TBI [3, 52, 59], regardless
considered as a preferred method of assessment by SLPs in of level of experience, further supports the importance of
the UK and US/CA, with less than 3% and 5% using them, further education and training. The development of prescrip-
respectively, whereas closer to 10% reported use of these tive guidelines worldwide may also prove useful, suggesting
assessments in the AUS/NZ group. Of those used, tools what areas of communication should be assessed and the tools
selected from this category focused mainly on observations of that could be used as part of an assessment protocol to address
non-specific functional activities or assessments developed by not only impairment but also tools that reflect functional
the clinician. Observation is one form of informal assessment activities and participation in the community [40]. Training
that has been previously reported to be a preferred choice for programmes linking rural clinicians with metropolitan clin-
both TBI and aphasia patients [19, 21, 38]. However, further icians are also recommend and have been shown to be an
research is required about the validity of this category of effective method in mentoring and supporting allied health
assessment given there is no normative data and individuality professionals in these settings [60].
DOI: 10.3109/02699052.2014.947619 Cognitive communication following TBI in adults 1665

A potential limitation of this study is the potential sample 2. Steel J, Ferguson A, Spencer E, Togher L. Speech pathologists’
current practice with cognitive-communication assessment during
bias, in that SLP survey participants were recruited based on post-traumatic amnesia: A survey. Brain Injury 2013;27:819–830.
their own perception of identification using previous experi- 3. Turkstra KM. Evidence-based practice for cognitive-communica-
ence with populations/patients with TBI. SLPs were asked if tion disorders after traumatic brain injury. Seminars in Speech &
they had specialist experience working with adults with TBI. Language 2005;26:213–214.
4. Ylvisaker M, Coelho C, Kennedy M, Sohlberg MM, Turkstra L,
The extent of specific TBI experience or the frequency they Avery J, Yorkston K. Reflections on evidence-based practice and
may assess a client with TBI was not explicitly asked. It is, rational clinical decision making. Journal of Medical Speech-
therefore, possible that SLPs with minimal or extremely Language Pathology 2002;10:xxv–xxxiii.
limited experience in TBI may have participated in the survey, 5. Royal College of Speech & Language Therapists. RCSLT Clinical
Guidelines. Oxon, UK: Speechmark Publishing Ltd; 2005.
although this was minimized by recruiting through special 6. American Speech-Language Hearing Association. Evaluating and
interest groups in brain injury throughout each country. An treating communication and cognitive disorders: Approaches to
additional limitation is that there are also potential weaknesses referral and collaboration for speech language pathology and
in using Likert scales due to their subjective nature of evalu- clinical neuropsychology [Technical Reprt]. Rockville, MD, 2003.
Available from www.asha.org/policy, accessed 30/3/2013.
ation and evidence that suggests that people from different 7. American Speech-Language-Hearing Association. Roles of
cultures and countries may answer a question on a Likert scale speech language pathologists in the identification, diagnosis, and
more or less positively [61]. To manage this possible treatment of individuals with cognitive-communication disorders:
weakness, the use of Likert scales was supplemented with Position statement [Position Statement]. Rockville, MD. 2005.
Available online at: www.asha.org/policy2005, Accessed 24/8/
open-ended questions, which offered participants the oppor- 2012.
tunity to provide detail about their current clinical practice. 8. College of Audiologists and Speech-Language Pathologists of
In addition, categorizing assessments into groups is not Ontario. Preferred practice guidelines for cognitive-communication
always straight forward as an assessment can have multiple disorders. Ontario, Canada, 2002. Available online at: www.caslpo.
com/Portals/0/ppg/ppg_ccd, accessed 1/4/2013.
sub-tests which may overlap into other categories or there 9. Turkstra L, Ylvisaker M, Coelho C, Kennedy M, Sohlberg MM,
might be different perspectives of where an assessment might Avery J, Yorkston K. Practice guidelines for standardized assess-
be best categorized and this has been highlighted in previous ment for persons with traumatic brain injury. Journal of Medical
research which has attempted to map assessments to the ICF Speech-Language Pathology 2005;13:ix–xxxviii.
10. Coelho C, Ylvisaker M, Turkstra LS. Nonstandardized assessment
model [40]. Nonetheless, this was addressed by obtaining approaches for individuals with traumatic brain injuries. Seminars
agreement from a panel of five experienced researchers in the in Speech & Language 2005;26:223–241.
field of TBI on the assignment of tests to categories. Further 11. Uniform Data System for Medical Rehabilitation. Functional
study is warranted to ascertain whether an assessment that is Independence Measure (FIM). Buffalo, NY: University of
Buffalo; 1996.
used, is used in its entirety or parts of the assessment are used. 12. Frattali C, Thompson C, Holland A, Wohl C, Ferketic M. American
In conclusion, this study is the first to document Speech Language Hearing Association Functional Assessment of
international assessment practices of SLPs working with Communication Skills for Adults (ASHA FACS). Rockville, MD:
adults who have a cognitive communication disorder after a American Speech Language Hearing Association; 1995.
13. Holland A, Frattali C, Fromm D. Communication Activities of
TBI. Similarities between countries highlights that traditional Daily Living. 2nd ed. Austin, TX: PRO-ED; 1999.
impairment-based aphasia tools continue to be favoured, with 14. Randolph C. Repeatable Battery for the Assessment of
less focus on specific functional assessment tools, yet Neuropsychological Status. 1st ed. San Antonio, TX:
reported routinely assessing functional communication Psychological Corporation; 2001.
15. Kertesz A. Western Aphasia Battery- Revised. Harcourt
skills. Guidelines regarding the role of SLPs’ assessment of Assessment, San Antonio, TX: Inc; 2006.
cognitive communication disorders were noted to have 16. Frank EM, Williams AR, Butler JG. Current socio-cognitive
influenced change in assessment practices in some countries, communication assessment protocols for children with traumatic
such as the US, with cognitive assessment tools forming an brain injury. Journal of Medical Speech-Language Pathology 1997;
5:97–111.
important part of a clinical assessment protocol. Countries 17. McGrane S, Cascella P. TBI knowledge and pragmatic assessment
without guidelines such as Australia, New Zealand and the among Connecticut school speech language pathologists. Brain
UK focus on assessment protocols from the field of aphasia Injury 2000;14:975–986.
and use aphasia and or cognitive communication/high level 18. Turkstra L, Coelho C, Ylvisaker M. The use of standardized tests
for individuals with cognitive-communication disorders. Seminars
language assessments. The use of discourse analysis in clinical in Speech and Language 2005;26:215–222.
practice is still not used readily as part of an assessment 19. Frank EM, Barrineau S. Current speech-language assessment
protocol. The study supports the need for clearer recommen- protocols for adults with traumatic brain injury. Journal of
dations and guidelines about assessment protocols for assess- Medical Speech-Language Pathology 1996;4:81–101.
20. Verna A, Davidson B, Rose T. Speech-language pathology services
ment of cognitive communication disorders after a TBI. for people with aphasia: A survey of current practice in Australia.
International Journal of Speech-Language Pathology 2009;11:
Declaration of interest 191–205.
21. Simmons-Mackie N, Threats TT, Kagan A. Outcome assessment in
The authors report no conflicts of interest. The authors alone aphasia: A survey. Journal of Communication Disorders 2005;38:
are responsible for the content and writing of the paper. 1–27.
22. Wilson FC, Harpur J, McConnell N. Vegetative and minimally
References conscious state(s) survey: Attitudes of clinical neuropsychologists
and speech and language therapists. Disability and Rehabilitation
1. Morgan AT, Skeat J. Evaluating service delivery for speech and 2007;29:1751–1756.
swallowing problems following paediatric brain injury: An 23. Shiel A, Wilson B, McLellan L. The Wessex Headn Injury Matrix
International survey. Journal of Evaluation in Clinical Practice (WHIM). Bury St Edmunds, UK: Thames Valley Test Company;
2011;17:275–281. 2000.
1666 M. Frith et al. Brain Inj, 2014; 28(13–14): 1657–1666

24. Steel J, Ferguson A, Spencer E, Togher LSpeech pathologists’ 44. Hofmans J, Theuns P, van Acker F. Combining quality and quantity.
current practice with cognitive communication assessment during A psychometric evaluation of the self-anchoring scale. Quality and
post-traumatic amnesia: A survey. Brain Injury 2013;27:819–830. Quantity 2009;43:703–716.
25. Duff MC, Proctor A, Haley K. Mild traumatic brain injury (MTBI): 45. Blais JG, Grondin J. The influence of labels associated with anchor
Assessment and treatment procedures used by speech-language points of likert-type response scales in survey questionnaires.
pathologists (SLPs). Brain Injury 2002;16:773–787. Journal of Applied Measurement 2011;12:370–386.
26. Ross-Swain D. Ross Information Processing Assessment. 2nd ed. 46. Howell D. Fundamental Statistics for the Behavioral Sciences.
(RIPA-2). Austin, TX: PRO-ED; 1996. Belmont, CA: Duxbury Press; 1995.
27. Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination. 47. Ellmo W, Graser J, Krchnavek B, Hauk K, Calabrese D. Measure of
3rd ed. (BDAE). Austin, TX: PRO-ED; 2000. Cognitive Linguistic Abilities (MCLA). Norcross, GA: The Speech
28. Kaplan E, Goodglass H, Weintraub S. The Boston Naming Test. Bin; 1995.
2nd ed. (BNT-2). Austin, TX: Pro-Ed; 2001. 48. Douglas J, Bracy C, Snow P. La Trobe Communication
29. MacDonald S. Functional Assessment of Verbal Reasoning and Questionnaire. Bundoora, Victoria: Victoria School of Human
Executive Strategies. Ontario, Canada: CCD Publishing; 2003. Communication Sciences, La Trobe University; 2000.
30. Wiig EH, Secord W. Test of Language Competence – Expanded 49. McDonald S, Flanagan S, Rollins J. Awareness of Social Inference
Edition (TLC -Expanded). San Antonio, TX: Pearson; 1989. Test, (TASIT). Sydney, Australia: Pearson; 2002.
31. Bowers L, Huisingh R, LoGiudice C, Orman J. The Word Test 2. 50. Howard D, Swinburn K, Porter G. Comprehensive Aphasia Test.
Austin, TX: Pro-Ed; 2005. Routledge: Psychology Press; 2004.
32. Wong MN, Murdoch B, Whelan B-M. Language disorders subse- 51. Adamovich B, Henderson J. Scales of Cognitive Ability for
quent to mild traumatic brain injury (MTBI): Evidence from four Traumatic Brain Injury (SCATBI). Austin, TX: PRO-ED; 1992.
cases. Aphasiology 2010;24:1155–1169. 52. McDonald S, Flanagan S, Rollins J, Kinch J. TASIT: A new clinical
33. Helm-Estabrooks N. Cognitive Linguistic Quick Test (CLQT). San tool for assessing social perception after traumatic brain injury.
Antonio, TX: Pearson; 2001. Journal of Head Trauma Rehabilitation 2003;3:219–238.
34. Blyth T, Scott A, Bond A, Paul E. A comparison of two 53. King KA, Hough MS, Walker MM, Rastatter M, Holbert D. Mild
assessments of high level cognitive communication disorders in traumatic brain injury: Effects on naming in word retrieval and
mild traumatic brain injury. Brain Injury 2012;26:234–240. discourse. Brain Injury 2006;20:725–732.
35. Katz RC, Hallowell B, Code C, Armstrong E, Roberts P, Pound C, 54. Douglas JM, Bracy CA, Snow PC. Measuring perceived commu-
Katz L. A multinational comparison of aphasia management nicative ability after traumatic brain injury: Reliability and validity
of the La Trobe Communication Questionnaire. Journal of Head
practices. International Journal of Language & Communication
Trauma Rehabilitation 2007;22:31–38.
Disorders 2000;35:303–314.
55. Parrish C, Roth C, Roberts B, Davie G. Assessment of cognitive-
36. Kay J, Coltheart M, Lesser R. Pscholinguistic Assessments
communicative disorders of mild traumatic brain injury sustained in
of Language Processing in Aphasia (PALPA). Oxford, UK:
combat. Perspectives on Neurophysiology and Neurogenic Speech
Psychology Press; 1992.
and Language Disorders 2009;19:47–57.
37. Christie J, Clark C, Mortensen L. Mount Wilga High Level
56. Wertheimer JC, Roebuck-Spencer TM, Constantinidou F,
Language Test. Unpublished Test: Speech Pathology Department
Turkstra L, Pavol M, Paul D. Collaboration between neuropsych-
Mount Wilga Rehabilitation Centre; 1986. ologists and speech-language pathologists in rehabilitation settings.
38. Vogel AP, Maruff P, Morgan AT. Evaluation of communication Journal of Head Trauma Rehabilitation 2008;23:273–285.
assessment practices during the acute stages post stroke. Journal of 57. Rabin LA, Barr WB, Burton LA. Assessment practices of clinical
Evaluation in Clinical Practice 2010;16:1183–1188. neuropsychologists in the United States and Canada: A survey of
39. Larkins B. The Application of the ICF in Cognitive- INS, NAN, and APA Division 40 members. Archives of Clinical
Communication Disorders following Traumatic Brain Injury. Neuropsychology 2005;20:33–65.
Seminars in Speech & Language 2007;28:334–342. 58. Isaki E, Turkstra L. Communication abilities and work re-entry
40. Hughes J, Orange JB. Mapping functional communication measure- following traumatic brain injury. Brain Injury 2000;14:441–453.
ments for traumatic brain injury to the WHO-ICF. Canadian Journal 59. Bernicot J, Dardier V. Communication deficits: Assessment of
of Speech-Language Pathology & Audiology 2007;31:134–143. subjects with frontal lobe damage in an interview setting.
41. Togher L. Discourse sampling in the 21st century. Journal of International Journal of Language & Communication Disorders
Communication Disorders 2001;34:131–150. 2001;36:245–263.
42. Coelho CA. Management of discourse deficits following traumatic 60. Parkin AE, McMahon S, Upfield N, Copley J, Hollands K. Work
brain injury: Progress, caveats, and needs. Seminars in Speech & experience program at a metropolitan paediatric hospital: Assisting
Language 2007;28:122–135. rurual and metropolitan allied health professionals exchange
43. Ellmo W, Graser J, Calabrese D. Methods of assessment utilized by clinical skills. Australian Journal of Rural Health 2001;9:297–303.
speech-language pathologists with traumatically brain injured 61. Lee JW, Jones PS, Mineyama Y, Zhang XE. Cultural differences in
adults. A national survey. Journal of New Jersey Speech and responses to a Likert scale. Research in Nursing and Health 2002;
Hearing Association 1997;6:17–23. 25:295–306.