Using the Multimodal Communication Screening Test for Persons with Aphasia (MCST‐A) to guide the selection of alternative communication strategies for people with aphasia

Abstract

Background: People with severe communication problems associated with aphasia and concomitant apraxia of speech are often unable to meet their daily communication needs through speech alone. For these people, augmentative and alternative communication (AAC) strategies may offer opportunities for improved communication effectiveness. However, it can be challenging to determine if individuals can learn to use alternative communication strategies independently or if they will require assistance from conversational partners to participate in meaningful communication interactions.

Aims: The authors developed an assessment tool, the Multimodal Communication Screening Task for Persons with Aphasia (MCST‐A; Garrett & Lasker, 2005b), to help clinicians differentiate those individuals who would benefit most from partner‐dependent communication strategies (e.g., written choice conversation, partner‐presented symbol choices, tagged yes/no questions) and those who could learn to use AAC systems (e.g., digitised speech devices that store complete messages; multi‐level devices with stored messages and spelling capabilities) to communicate independently. This article describes the tool and its administration protocol. We also compare MCST‐A scores to profiles of actual communication strategy use for four individuals across a range of aphasia severity.

Methods & Procedures: Four individuals with communication disabilities associated with aphasia were asked to locate pictorial, textual, or graphic symbols from an eight‐page stimulus manual to communicate simple needs and complex concepts, complete simple categories, tell and retell stories, or use partial spelling to convey novel information. Accuracy of responses and the amount and type of cueing required to complete each simulated communication task were tallied for each individual. MCST‐A test results are discussed in light of each individual's observed pattern of AAC strategy and system use both during and following functional communication treatment.

Results: Descriptive analyses of the four cases revealed a correspondence between MCST‐A test scores, level of impairment as measured by the Western Aphasia Battery (Kertesz, 1982), and patterns of communication strategy use. The two individuals who received the lowest response accuracy scores and the highest cueing scores on the MCST‐A were primarily dependent on partner‐supported communication strategies in their daily lives. The two individuals with the lowest cueing scores and highest response accuracy scores had learned to use complex AAC communication devices to communicate independently and generatively in community settings.

Conclusions: The hierarchy of scores seen on the MCST‐A corresponded with individuals' abilities to communicate using AAC strategies after participating in functional therapy. The MCST‐A may guide clinicians in identifying the most appropriate AAC strategies for individuals with aphasia. Further validation is warranted.