Table 1.

The 27 features of the auditory-perceptual rating of connected speech in aphasia.

Connected speech feature	Definition
Anomia	Overall impression of word-finding difficulties, which may be instantiated in many different ways, e.g., word-finding pauses, abandoned utterances, circumlocution, comments on inability to find words. Some of these behaviors are also captured by other specific features. Nonaphasic speakers sometimes have difficulty finding words, so occasional difficulties may be scored not present (0).
Abandoned utterances	Utterances are left incomplete. The speaker may move on to another idea, stop talking, attempt to use another modality (e.g., gesture), or give a vague conclusion to the utterance (e.g., shrug shoulders and say “you know”).
Empty speech	Speech that conveys little or no meaning. Pronouns and nonspecific words such as thing, stuff, and do are substituted for content words.
Semantic paraphasias	Substitution of content words for related or unrelated content words, e.g., cat for dog.
Phonemic paraphasias	Substitution, insertion, deletion, or transposition of clearly articulated phonemes, e.g., papple for apple.
Neologisms	Word forms that are not real English words. The intended target may or may not be apparent.
Jargon	Mostly fluent and prosodically correct but largely meaningless speech containing paraphasias, neologisms, and unintelligible strings.
Perseverations	Repetition of previously used words or utterances in contexts where they are no longer appropriate.
Stereotypies and automatisms	Commonly used words, phrases, or neologisms produced with relative ease and fluency, e.g., tan, I know it, dammit.
Short and simplified utterances	Utterances are reduced in length or complexity. A mild rating (1) should reflect utterances that are sometimes shorter than expected based on the context (e.g., simple sentence structures, lack of subordinate clauses). A severe rating (4) should be reserved for single-word utterances. Nonsentence responses (e.g., Did you come with your wife? Yes, or Who did you come with? My wife.) should not be considered.
Omission of bound morphemes	Inflectional or derivational morphemes are not used where they should be, e.g., I am go to the store.
Omission of function words	Function words are not used where they should be, e.g., I going to the store.
Paragrammatism	Inappropriate juxtaposition of words and phrases and/or misuse of function words and morphemes (e.g., It's so much wonderful, Makes it hard to speech).
Pauses between utterances	Pauses that occur between utterances may relate to utterance formulation. Pauses between examiner's questions and patient's responses should also be considered. Failure to string together multiple utterances when appropriate can be scored here.
Pauses within utterances	Unfilled or filled (um, uh) pauses within utterances. Both prevalence and length of pauses should be taken into account in assessing severity. Because pauses are a feature of unimpaired connected speech, a score of not present (0) should be assigned if the number of pauses is within the typical range.
Halting and effortful	Speaking is labored and consequently uneven. Intonation, rhythm, or stress patterns may be reduced, absent, or inappropriately placed. Prosody or melodic line may be disrupted.
Reduced speech rate	The number of words per minute within utterances is reduced. Speaking slowly and pauses within utterances count toward reduced rate. Pauses between utterances, potentially reflecting utterance formulation, do not count.
False starts	Partial words are abandoned after one or two phonemes, e.g., It's a ca- cat.
Retracing	Sequences of one or more complete words are made redundant by subsequent repetitions, revisions, amendments or elaborations, e.g., The kite is (.) the boy is flying the kite.
Conduite d'approche	Successive approximations at target forms. The target may or may not be achieved. The patient is aware of their errors. These instances also contribute to scores for Retracing and Phonemic paraphasias or Neologisms.
Target unclear	It is not clear what phonemes the speaker is attempting to produce. This is often due to dysarthria, apraxia of speech, muttering, mumbling, or in some cases severe jargon.
Meaning unclear	It is not clear what the speaker is talking about, or the topic may be clear but what is being said about it is not.
Off-topic	It is not clear how what is being said relates to the context.
Expressive aphasia	Language production is disrupted.
Apraxia of speech	Speech contains distortions, substitutions, or omissions that tend to increase with length or complexity of the word or phrase. Groping behaviors or impaired intonation may be present. See Duffy (2013) for more information.
Dysarthria	Speech is difficult to understand and characterized as slurred, choppy, or mumbled. Errors are consistent and are the result of impaired strength, tone, range of motion, or sequencing. Speech breathing, phonation, resonance, articulation, and prosody may be impaired. See Duffy (2013) for more information.
Overall communication impairment	Overall impression of the extent to which the speaker is impaired in conveying their message. A mild rating (1) should reflect an evident speech-language impairment, but no limitation in discussing all topics. A moderate rating (2) should be used when the speaker can readily communicate about simple, everyday topics, but is imited in discussion of more complex topics. A marked rating (3) should be used when communication about everyday topics is possible with help from the examiner, but the patient shares the burden of communication. A severe rating (4) should be used when all communication is fragmentary, and the examiner carries the burden of communication. These guidelines, including some of the specific wording, are based on the Boston Diagnostic Aphasia Examination Aphasia Severity Rating Scale.