chapter  6
30 Pages

The Assessment and Rehabilitation of Language Disorders

L anguage assessment constitutes one aspect of virtually any evaluation of individuals with brain dysfunction. The centrality that language has in human functioning and its susceptibility to alteration following many kinds of neurological injuries or illnesses necessitates its inclusion as part of a comprehensive neurocognitive evaluation. Furthermore, since one relies upon language in order to evaluate other cognitive domains such as reasoning, judgment, or attention, the integrity of the language domain itself must be evaluated before making inferences regarding other domains that rely upon language for their expression. These language evaluations are, in most settings, performed by speech-language pathologists who diagnose decits and make recommendations for remediation or compensation. However, as a result of changing responsibilities in rehabilitation, many rehabilitation professionals (and particularly neuropsychologists) who provide gross language evaluations lack a clear understanding of speech-language

pathology and associated rehabilitation strategies. Traditionally, before the advent of contemporary neuroimaging techniques, the emphasis of neuropsychological assessment was on lesion localization. When diagnostic lesion localization was the goal of a cognitive evaluation, neuropsychological assessment could rely upon relatively cursory screening measures to identify pathognomonic language signs that have signicance for localizing dominant hemisphere lesion sites, without a great deal of emphasis on the functional implications of these diagnostic ndings. It was the discipline of speech-language pathology that became best positioned, both with regard to knowledge and practice, to comprehensively evaluate and manage the patient with language impairment from a functional perspective. In part, as a result of this growing inuence of speech-language pathology, as well as historical diagnostic emphasis of neuropsychological assessment, neuropsychology and rehabilitation psychology have adopted a secondary role with regard to language assessment and rehabilitation in many settings.