BNVR: The Butt Non-Verbal Reasoning Test

The Butt Non-Verbal Reasoning Test

Pamela Butt, Romola Bucks

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351687058
• Edition: 1
• Topic: Pedagogía
• Subtopic: Educación general

The BNVR Test is a unique non-linguistic approach for identifying whether a cognitive (problem-solving) deficit as well as a linguistic deficit exists in individuals with acquired aphasia. Recognising cognitive deficits in terms of problem-solving may be a key factor in understanding why some individuals overcome their communication difficulties better than others. Failure to recognise problem-solving difficulties may lead to unrealistic expectations of therapeutic intervention and thus inappropriate management and goal setting. The BNVR requires the client to solve 10 everyday problems, presented in full-colour photographic format. It is short, requires minimal linguistic input, contains real-life situations and is likely to be suitable for non-English speaking individuals. It will be useful to speech language therapists, occupational therapists and psychologists who need to ascertain whether problem-solving skills are affected and to assist in multi-disciplinary team decision-making in acute and rehabilitation settings.

1
Chapter 1
Background

Relationship between problem-solving and aphasia

Aphasia is an acquired impairment of language, which may or may not be complicated by other deficits. That other cognitive processes may be affected in aphasia has been recognised by some authors, eg, Chapey (1994) and Capman & Ulatowska (1994). Being able to problem-solve, that is having the capacity to find solutions to problems that arise in one's environment, may be required to meet even very basic human needs. Indication of a need does not have to be in the form of the written or spoken word; attracting attention by gesture or pointing may be all that is necessary to alert the carer. However, it is insight and intent that appear to be crucial in problem-solving, for those with impaired communication this may depend more on intact cognition and comprehension than the ability to express themselves by speech or writing.

Clinical experience of assessing people with aphasia has demonstrated that there can be a discrepancy between an aphasic individual's linguistic skills, as measured in formal tests, and their behaviour, as observed on wards or at home. For example, a person able to identify a named object or picture of a cup or box of tissues may not be able to indicate that item to fulfil a need, suggesting that he or she is unable to generate the idea of a solution. Although Holland (1979) introduced the idea that 'aphasics probably communicate better than they talk', that is, they are able to transmit messages in spite of a failure to do so through verbal channels, there are many individuals who do not initiate communication by non-verbal means.

Relationship to rehabilitation

Problem-solving is an important aspect of being able to function effectively in one's environment. Indeed, we would define rehabilitation as enabling a person to re-establish control of their environment. Controlling what happens to you means not only making choices but also knowing what action to take to bring about those choices. Hux, Beukleman & Garrett (1994) have defined the concept of 'communication need' in their Augmentative and Alternative Communication (AAC) process for aphasia. In their view, A communication need is simply a thought, feeling, or concept that an individual wishes to express to others'. Speech & Language Therapists are all too familiar with individuals who are unable to make use of picture charts or communication boards, despite being able to recognise pictures. Being able to signal yes or no to questions from carers does not necessarily mean that the individual has intact problem-solving skills. Indeed, deficits in language and cognition have been implicated as the reason for failure to use AAC with patients with aphasia (Kraat, 1990; Light, 1988).

Being able to identify that problem-solving skills are impaired in individuals with aphasia is crucial in determining appropriate goal setting. For example, working on auditory memory, or comprehension and naming of common items, will not necessarily result in the individual using these labels to meet their needs if the individual does not know how having and using these labels will be beneficial to him or her: 'Only after an individual with aphasia recognises a communicative need and wants to interact communicatively with others will he/she be ready to initiate the formulation of messages' (Hux et al, 1994).

Existing tests of language function

Existing standardised tests designed to assess the linguistic skills of patients with aphasia may be insensitive to deficits in problem-solving either because they were designed to assess linguistic skills in a controlled environment (eg, automatic speech or repetition of words or phrases), or because responses are directed to a specific auditory or visual stimulus as, for example, in subsections of the Weston Aphasia Battery (Kertesz, 1980), the Minnesota Test of Differential Diagnosis of Aphasia (Schuell, 1965) and the Boston Naming Test (Goodglass & Kaplan, 1983). Such tests do not reflect how well individuals are able to use their residual communication skills to organise themselves in their environment (Butt, 1992).

During the 1970s clinicians focussed on communicative analysis and rehabilitation; that is, restoring an individual's linguistic function. In the 1980s, the focus shifted to communication competence; that is, being able to use all forms of communication not only those based on the spoken word. This shift was reflected in the number of functional profiles developed in this field. For example Holland (1980), Communication Activities in Daily Living; Lomas et al (1989), the Communicative Effectiveness Index; the revised Edinburgh Functional Communication Profile (EFCP: Skinner et al, 1990); and the Functional Assessment Communication skills for Adults (FACA: American Speech and Hearing Association, 1995).

The EFCP and the FACA do contain small sections to identify an individual's ability to attract attention or express a need, but all the profiles are predominantly observation systems based on getting the message across rather than assessing the individual's capacity.

The more recent emergence of cognitive neuropsychology has provided a framework for the assessment and interpretation of each person's language processing skills and deficits. The Psycholinguistic Assessments of Language Processing in Aphasia (PALPA: Kay et al, 1992) is based on cognitive neuropsychological theory. However, some authors have described limitations to the PALPA. For example, Lesser (1996) has argued that the PALPA does not adequately address language as a communication medium or as social construct. Additionally, Edmondson and ...