Challenges in Assessing Aphasia in Congenital Blind Patients: A Case Report

Abstract

This case report focuses on assessing aphasia in a congenitally blind patient with an ischemic lesion using the Aachener Aphasia Test. The method involved adapting existing assessment tools to the patient, integrating Braille as an accessible technology, and incorporating the patient's family for emotional support and for the identification of patient-specific communication strategies. The assessment revealed patient strengths in areas such as articulation, prosody, and repetition skills, but also exposed challenges in semantic and syntactic structures. However, the unavailability to assess and score naming and comprehension limited a full assessment of the patient's language abilities. The findings underscore the need for flexible, tailored assessment strategies and collaborative approaches involving healthcare professionals and families. Moreover, it suggests a considerable research gap and a need for standard tools to assess blind patients with aphasia comprehensively. This case report contributes to the limited knowledge of assessing aphasia in blind individuals and calls for further research in this area to refine and expand the available tools and strategies.

Keywords: blindness; broca aphasia; communication aids for disabled; health communication; sensory aids.

Figure 1

Computerized axial tomography of the patient. Asymmetric ventricular system in the supratentorial area, predominantly on the right and on the midline. General volume increase in the subarachnoid spaces at the top and base. Subtle hypo-density of the left insulo-frontal cortico-subcortical region, partially extending to the corresponding nuclear-capsular region, as if from a recent ischemic lesion.

Figure 2

Scheme of the adaptation process of the AAT test to blind patients. After the first approach to the patients, the speech therapist interacted with the patient’s family to study his communication modality and define the strategy for a possible correct approach to the assessment and AAT administration. The patient’s family collaborated with the speech therapist to translate part of the AAT test regarding written language in Braille. For the naming test, we studied which natural object to use for the item regarding the denomination of the objects. After defining the modification to the patient’s AAT test, the test was administered for the patient’s assessment.

Figure 3

Example of adaptation of AAT. (a,b) Reading and Composition—the family’s patient provided the words and phrases in AAT in Braille, allowing for the administration of part of the written language items. (c) Dictation—The patient used the Braille display tool to write in Braille.

Figure 4

Based on the patient’s score in the different AAT items, the standard score defines the severity level of the deficit for each item (i.e., 1–3: severe deficit; 4–5: moderate deficit; 6–7: slight deficit; 8–10: no deficit). In dark blue is the score that the standard AAT administration would have obtained without the adaptation of AAT; in light blue is the score obtained with the AAT-adapted administration. It is important to note that no adaptation was possible for the token test and comprehension, while the naming item was partially adapted.