The fluency dimension in aphasia

A survey of 24 speech-language pathologists was conducted to investigate the reliability of rating expressive language parameters in aphasia. Ratings of the expressive language dimensions from the patient profile of the BDAE were made from spontaneous speech and sentence repetition samples and were compared to fluency judgements for 10 different aphasic subjects. Agreement on a fluent/non-fluent diagnosis reached a criterion of two-thirds for only half of the subjects, despite the reports of most clinicians that they used fluency classifications almost all the time. A wide range of terms were used to describe each patient's language deficits. The distributions of ratings were also highly variable for individual subjects, especially on the dimensions of articulation and paraphasia rating. The results are explored for underlying contributors to the variability of ratings observed. Implications for clinical practice and research studies are discussed.