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Therapeutic assessment

Assessment should be therapeutic

Reference: Hersh et al., 2013
NHMRC level of Evidence: GPP

The process of assessment should be a learning opportunity, not only for the clinician, but also for the client. The client should find the actual assessment to be therapeutic in that it provides information on which that client can build and progress. This process should be made accessible by explaining clearly what the assessment is for and why it is worth doing. The results can be discussed afterwards, integrated into further discussion and clearly linked to the subsequent choices of therapy tasks. The links between assessment, tasks and goals should be transparent and part of an evolving and dynamic progression through the period of treatment.

Therapeutic assessment

Therapeutic assessment is an assessment approach that aims to enable the person to understand their aphasia, the rehabilitation process and to be actively engaged and supported throughout the assessment process. Described by Deborah Hersh and colleagues in the chapter Assess for Success: Evidence for therapeutic assessment (Hersh et al., 2013) within Supporting Communication for Adults with Acute and Chronic Aphasia (Simmons-Mackie, King & Beukelman, 2013), this approach is broadly informed by three principles:

  1. Assessment as an intervention: A dynamic assessment approach is key to this principle whereby the assessment is not only used to assess language abilities but also as an opportunity to determine learning strengths and weaknesses, the range of strategies that are useful to a person with aphasia and how responsive they are to such strategies (Hasson & Joffe, 2007).  Such an approach results in an interactive assessment process. Within a therapeutic assessment framework, it is fundamental that results from such an assessment be shared with the person with aphasia in an accessible and supportive way. 

  2. Adult learning theory and aphasia assessment. Adult learning theory assumes that "adults have life experiences that can be productively tapped to motivate learning, that adults learn best when they take some responsibility for their learning, that they want to know why they are learning something before they undertake it and that they expect that the learning will be useful and relevant to their lives" (Hersh et al., 2013). Through this principle it is recommended that the assessment process be a learning experience for the person with aphasia. To enable this Hersh and colleagues recommend that that the process should include explaining in an aphasia friendly way why the assessment is happening, why it is useful and relevant to the person and how it can assist a shared goal setting process. 

  3. Assessment in context: the person-environment fit. This principle suggests that assessment of functional communication abilities needs to be considered within the environment in which the person is. For example, if the person lives at home alone, are they able to communicate themselves in the case of an emergency. 


Therapeutic Assessment tools 

In the chapter Assess for Success: Evidence for therapeutic assessment (Hersh et al., 2013), Hersh et al. describe two therapeutic assessment processes: 

  1. Using the IFCI: The IFCI is a semistructured interview that a SLP can conduct in the hospital setting. The IFCI is a good example of dynamic assessment for adults with a communication disability. 

  2. Assessing within a goal directed therapy model: "Goal directed therapy involves collaborative problem solving between the SLP and the client and begins with goal setting" (Hersh et al., 2013, p154). Hersh et al., (2013) suggest that beginning with the person’s goals to direct assessment can assist in provided a more integrated therapeutic assessment process that has the potential to be more informative and supportive for the person with aphasia. The clinician could also make hypotheses regarding particular areas that may  be impacted based on the nature of the impairment (e.g. a writing impairment would impact a person’s ability to text message/use Facebook/ write poetry). In this process, the SLP uses a SMARTER framework for goal setting.  Known aphasia assessments can be incorporated into this framework to help identify therapy goals that are meaningful and relevant to the person with aphasia. 

Table 6 Examples of  assessment tools that can be used within a ‘therapeutic approach’ (Hersh et al., 2013)



ASHA Functional Assessment of Communication Skills for Adults (ASHA FACS) (Frattali et al, 1995)

  • Rates a person’s ability to perform various activities of daily living.
  • Can be used to identify a person’s communicative needs in everyday contexts.

Functional Communication Therapy Planner (Worrall, 1999)

  • Provides a step-by-step process to assess a person’s communicative needs.
  • A questionnaire is conducted which investigates the person's premorbid communicative style and the everyday activities that are important and meaningful to him/her.

Informal approaches:

Compiling a ‘Contextual Inventory

The Communicative Profiling System (Simmons-Mackie & Damico, 1996) for example, uses qualitative interviews, diaries and observation to determine what people do on a regular basis and what they did before aphasia.

Pictographic resources

The Life Interests and Values cards or the folder of Pictographic Resources from the Aphasia Institute could be used to guide a client through a discussion about their communication needs.

 Other assessment areas that may be considered are listed below:

Table 7: Additional areas of assessment that may be considered and possible assessment tools

Area of assessment

Potential assessments

Assessing a client’s satisfaction with their communication abilities.

  • The Communication Disability Profile (Swinburn & Byng, 2006; Swinburn, Porter, Howard, 2005 (in the Comprehensive Aphaisa Test).
  • The Assessment for Living with Aphasia (ALA) (Kagan et al., 2011).

Assessing a client’s ability to communicate via alternative modes.

  • Multimodal Communication Screening Test for Aphasia (MCST-A), part of the AAC Assessment Battery for Aphasia (AAC-ABA) – for people with severe aphasia which aims to assess their ability to communicate via pictorial symbols and whether they can use supports independently or need assistance of another person.

Assessing a client’s social networks.

This enables a greater understanding of the support available to the person with aphasia through communication partners.

  • The social network analysis of the Communicative Profiling System (Simmons-Mackie & Damico, 1996, 2001).
  • Social Networks Package (Blackstone & Hunt Berg, 2012).
  • The Social Network Convoy Model (Antonucci et al., 2006).
  • Conversational analysis.


 1. Hersh, D., Worrall, L., O'Halloran, R., Brown, K., Grohn, B., & Rodriguez, A. (2013). Assess for Success: Evidence for Therapeutic Assessment In N. Simmons-Mackie, J. King & D. Beukelman (Eds.), Supporting communication for adults with acute and chronic aphasia. Baltimore, MD: Paul H. Brookes.



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Professor Linda Worrall
The University of Queensland
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