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Pictographic Assessment Tools – Aphasia Institute

Personal AFROM

The Personal A-FROM is based on Living with Aphasia: Framework for Outcome Measurement (A-FROM). It is a concrete and convenient way for clinicians and clients with aphasia to identify goals that include the domains of impairment, environment, life participation, and personal factors encompassing emotions and feelings. The Personal A-FROM gives people with aphasia an accessible way to take ownership of their goals. It also provides  a simple way to share goals with the interprofessional team so that they also support the person with aphasia in achieving their goals. 


Assessment for Living With Aphasia (ALA)

Developed with funding from the Ontario Ministry of Health, via the Ontario Stroke Network, this comprehensive assessment package provides tools to better assess the impact of aphasia and identify the factors that affect the quality of life and exacerbate or reduce disability.

Benefits of the Assessment

  • Provides quantitative and qualitative data from the perspective of the person living with aphasia
  • Uses pictographic approach which allows for participation across a full range of severity
  • Based on Living with Aphasia: Framework for Outcome Measurement A-FROM
  • In line with World Health Organization’s ICF
  • Psychometrically sound: demonstrated reliability and validity (n=101)
  • Captures real-life issues for planning and evaluating aphasia treatment and making funding decisions

Price: $350 CAD

For additional information on the assessment, contact 


The ALA can certainly be an aid for development of therapy goals as it taps into each domain of the A-FROM framework (Living with Aphasia: Framework for Outcome Measurement) – participation, environment, personal and aphasia domains.  However, it is important to note that the ALA is best described as a self-report measure of participation in life situations and activities (e.g. ADLs, work, recreation, relationships, conversation, psychosocial adjustment and environmental support). The ‘Aphasia’ domain within the tool is based on the person’s perception of their own aphasia.

While one of the motivations for development of the ALA is to assess change/progress over time, please note that to date, only reliability has been formally evaluated. Sensitivity (namely ability to detect change over time) has not yet been formally assessed, although there is anecdotal evidence that the measure is sensitive. We would love to hear from you if you have used the ALA in a pre-post study. 

Overall, results indicate that the ALA is a psychometrically sound assessment tool built on the expressed needs and concerns of key stakeholders including people with aphasia, family members and speech-language pathologists.

Rasch analysis identified 12 questions for removal and four conceptual domains from focus groups which were not unidimensional. Therefore factor analysis was conducted to identify unidimensional sub-domains within conceptual domains, revealing sub-domains including 2 language, 2 participation, 2 environment, 2 personal sub-domains and a final sub-domain represented by a single question.

In addition, evaluation of test-retest reliability resulted in moderate to high intraclass correlations (ICC) for the ALA overall score (0.87) and individual sub-domain scores (0.66 to 0.84). Cronbach’s alpha demonstrated acceptable to high internal consistency of items. And lastly, evaluation of construct or concurrent validity resulted in significant and moderately strong correlation with measures believed to assess similar constructs including the Stroke and Aphasia Quality of Life scale-39 (SAQOL-39) (Pearson’s correlation coefficient = 0.65; p<0.001); the Visual Analogue Self-esteem Scale (VASES) (Pearson’s correlation coefficient = 0.63; p<0.001); the Communication-Associated Psychological Distress Scale of the Burden of Stroke Scale (BOSS CAPD) (Pearson’s correlation coefficient = -0.63 p< 0.001).

The ALA has been designed specifically for aphasia – as people use it, we will be able to collect data on applications for other applications, but at this point, we cannot give an answer based on experience.

This is a very new tool, sensitivity (namely ability to pick up change after an intervention) has not been formally assessed, although anecdotally, we have reports that it has been useful.

Click here to order an ALA, either by credit card or by cheque.

If you’re ordering by cheque, please include in the notes section of your order any pertinent information such as P.O. number if applicable. Once your cheque is received, your order will be dispatched. Cheques may be mailed to the following address, attention Online Store:

Aphasia Institute
73 Scarsdale Road
Toronto, ON  M3B 2R2

Please be advised we are NOT responsible for any additional charges levied from overseas postal services.

Communicatively Accessible Hearing Screening Protocol (CAHSP)

The Aphasia Institute is pleased to offer you the communicatively accessible hearing screening protocol (CAHSP).

CAHSP was developed by Lisa Samson, speech-language pathologist, at the Aphasia Institute and Joanne DeLuzio, audiologist.

What is the CAHSP?

CAHSP is a resource for professionals to use with clients who have communication barriers. The CAHSP consists of pictographic resources to help the hearing screener and client who “knows more than they can say” effectively exchange messages related to a hearing screening. The CAHSP also includes an audiometric protocol for clients who “know more than they can say”. CAHSP is designed to be used with individuals who need help to understand information and to express themselves. However, CAHSP was piloted with people with aphasia and consequently some resources included are specific to that population.

Click below to download each item in the CAHSP package, as follows:

01.1 Communicatively Accessible Hearing Screening Protocol

02.1 Hearing vs. Aphasia

03.1 Hearing Screening

04.1 Hearing Screening Follow-Up Form

05.1 Communicatively Accessible Hearing Handicap Questionnaire

06.1 CAHHQ score sheet

Communication Aid for Capacity Evaluation (CACE)

The Aphasia Institute is pleased to offer you the Communication Aid for Capacity Evaluation – CACE

Alexandra Carling-Rowland, Ph.D., developed and tested CACE, a communicatively accessible capacity evaluation process to help health care professionals determine whether or not people living with communication barriers have the capacity to decide where they shall live. CACE is designed to be used with individuals who need help to understand information and to express themselves.  CACE can be used with people living with aphasia, speech disorders or hearing loss and with those who speak English as an acquired language.

The Aphasia Institute has partnered with Alexandra to publish CACE.  We strongly recommend you read the manual before you first administer CACE.

Individual CACE items available for download:


  • The Basic Outcome Measure Protocol for Aphasia (BOMPA) is a tool to quickly and efficiently assess participation in conversation, quality of life related to living with aphasia, and aphasia severity. BOMPA  is designed to be administered by a speech-language pathologist (S-LP) skilled in Supported Conversation for Adults with Aphasia (SCATM) or similar method. $99.00CAD
  • BOMPA offers several features:   
    • A score representing a person’s perceptions of his/her/their life with aphasia
    • Observational ratings by the speech-language pathologist of aphasia severity and the person with aphasia’s participation in conversation (in the context of communicating without and with conversational support)
    • Psychometrically sound instrument with demonstrated reliability
    • Developed with input from many experienced speech-language pathologists
    • Designed specifically for people with aphasia
    • Appropriate for all aphasia severity levels
    • Aphasia-friendly (includes pictographs, clinician script and administration guidelines)

Price: $99 CAD

"Thank you so much for your accommodation of our presentation and study recruitment efforts! We got much more interest than we ever thought we would, and enough volunteers to keep us busy for a couple of years! ...Thank you for your help with everything! I am really happy to have the Aphasia Institute as a partner in our research. "
- Researcher
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