Development and validation of Thought, Language, and Communication Assessment Scale for Persons with Aphasia
Keywords:
TLCAS-PWA, Language and Thought Impairment, Aphasia, TLC interrelatedAbstract
Introduction: Aphasia impacts language and thought organization, disrupting effective communication. Thought, Language, and Communication (TLC) are interrelated, and breakdowns in one domain often affect the others. A comprehensive assessment tool is essential to understand and address these interlinks. This study aimed to develop and validate the Thought, Language, and Communication Assessment Scale for Persons with Aphasia (TLCAS-PWA) for Persons with Aphasia (PWA) and Neurotypical Individuals (NTI).
Method: The tool was developed through literature review and expert validation, comprising 14 parameters across communication, language, and thought domains, rated on a 5-point scale. It was administered to 20 PWA and 20 NTI.
Results: Among PWA, PCS showed the highest mean scores, while Self-reference was least frequent. At the domain level, both PWA and NTI had higher scores in Communication Disorder and lower in Language Disorder. Mann-Whitney U tests revealed significant differences between groups across all the domains. Psychometric analysis showed good internal consistency (α = 0.88), excellent inter-rater reliability (ICC = 0.98), and stable test–retest reliability.
Conclusion: TLCAS-PWA is a valid tool that aids clinicians in assessing TLC in aphasia, supporting diagnosis, intervention, and progress monitoring.
Downloads
Metrics
References
Albert, M. L., & Sandson, J. (1986). Perseveration in Aphasia. Cortex, 22(1), 103–115. https://doi.org/10.1016/S0010-9452(86)80035-1
Andreasen, N. C. (1986). Scale for the Assessment of Thought, Language, and Communication (TLC). Schizophrenia Bulletin, 12(3), 473–482. https://doi.org/10.1093/schbul/12.3.473
Andreasen, N. C., & Grove, W. M. (1986). Thought, Language, and Communication in Schizophrenia: Diagnosis and Prognosis. Schizophrenia Bulletin, 12(3), 348–359. https://doi.org/10.1093/schbul/12.3.348
Balaram, K., & Marwaha, R. (2024). Circumstantiality. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532945/
Bearden, C. E., Wu, K. N., Caplan, R., & Cannon, T. D. (2011). Thought Disorder and Communication Deviance as Predictors of Outcome in Youth at Clinical High Risk for Psychosis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(7), 669–680. https://doi.org/10.1016/j.jaac.2011.03.021
Benson, D. F. (1973). Psychiatric Aspects of Aphasia. The British Journal of Psychiatry, 123(576), 555–566. https://doi.org/10.1192/bjp.123.5.555
Blanken, G. (1993). The production of stereotyped neologisms in aphasia: A case study. Aphasiology, 7(6), 551–568. https://doi.org/10.1080/02687039308248630
Fineberg, S. K., Leavitt, J., Deutsch-Link, S., Dealy, S., Landry, C. D., Pirruccio, K., Shea, S., Trent, S., Cecchi, G., & Corlett, P. R. (2016). Self-reference in psychosis and depression: A language marker of illness. Psychological Medicine, 46(12), 2605–2615. https://doi.org/10.1017/S0033291716001215
Gotts, S. J., Della Rocchetta, A. I., & Cipolotti, L. (2002). Mechanisms underlying perseveration in aphasia: Evidence from a single case study. Neuropsychologia, 40(12), 1930–1947. https://doi.org/10.1016/S0028-3932(02)00067-2
Helm-Estabrooks, N. (2002). Cognition and aphasia: A discussion and a study. Journal of Communication Disorders, 35(2), 171–186. https://doi.org/10.1016/S0021-9924(02)00063-1
Hoffman, P., Loginova, E., & Russell, A. (2018). Poor coherence in older people’s speech is explained by impaired semantic and executive processes. eLife, 7, e38907. https://doi.org/10.7554/eLife.38907
Jackendoff, R. (2002). Foundations of Language: Brain, Meaning, Grammar, Evolution. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198270126.001.0001
Jilani, A. Q., Agarwal, A., Bharti, S., & Srivastava, S. (2019). PSYCHOSIS OR WERNICKE’S APHASIA, AND RESPONSE OF SPEECH THERAPY IN WERNICKE’S APHASIA: A CASE REPORT. Era’s Journal of Medical Research, 6(2), 177–179. https://doi.org/10.24041/ejmr2019.151
Landre, N. A., Taylor, M. A., & Kearns, K. P. (1992). Language functioning in schizophrenic and aphasic patients. Brain and Language 5(1), 7–14.
Lee, J. W. Y. (2004). Chronic ‘speech catatonia’ with constant logorrhea, verbigeration, and echolalia successfully treated with lorazepam: A case report. Psychiatry and Clinical Neurosciences, 58(6), 666–668. https://doi.org/10.1111/j.1440-1819.2004.01318.x
Linnik, A., Bastiaanse, R., & Höhle, B. (2016). Discourse production in aphasia: A current review of theoretical and methodological challenges. Aphasiology, 30(7), 765–800. https://doi.org/10.1080/02687038.2015.1113489
Lupyan, G. (2012). Linguistically Modulated Perception and Cognition: The Label-Feedback Hypothesis. Frontiers in Psychology, 3, 54. https://doi.org/10.3389/fpsyg.2012.00054
Moravcsik, J. M. (1981). Frege and Chomsky on Thought and Language. Midwest Studies in Philosophy, 6(1), 105–123. https://doi.org/10.1111/j.1475-4975.1981.tb00431.x
Mpert, M., Kotsaftis, A., & Pouget, R. (1997). At Issue: Speech Fluency and Schizophrenic Negative Signs. Schizophrenia Bulletin, 23(2).
Oh, T. M., McCarthy, R. A., & McKenna, P. J. (2002). Is There a Schizophasia? A Study Applying the Single Case Approach to Formal Thought Disorder in Schizophrenia. Neurocase, 8(3), 233–244. https://doi.org/10.1093/neucas/8.3.233
Pallickal, M., & N. H. (2020). Discourse in Wernicke’s aphasia. Aphasiology, 34(9), 1138–1163. https://doi.org/10.1080/02687038.2020.1739616
Potagas, C., Kasselimis, D., & Evdokimidis, I. (2011). Short-term and working memory impairments in aphasia. Neuropsychologia, 49(10), 2874–2878. https://doi.org/10.1016/j.neuropsychologia.2011.06.013
Puttanna, D., Swamy, A., Puri Goswami, S., & Budiguppe Panchakshari, A. (2022). Treatment Approaches for Word Retrieval Deficits in Persons with Aphasia: Recent Advances. In D. Cătălin Jianu & D. Fior Mureșanu (Eds.), Aphasia Compendium. IntechOpen. https://doi.org/10.5772/intechopen.100828
Radanovic, M., Sousa, R. T. de, Valiengo, L., Gattaz, W. F., & Forlenza, O. V. (2012). Formal Thought Disorder and language impairment in schizophrenia. Arquivos de Neuro-Psiquiatria, 71(1), 55–60. https://doi.org/10.1590/S0004-282X2012005000015
Rhodes, A. (2024). Exploring Neologism in Psychology: Understanding Language and Cognitive Processing. https://listen-hard.com/cognitive-and-experimental-psychology/neologism-psychology-language-cognitive-processing/
Sass, L. A. (2003). “Negative Symptoms”, Schizophrenia, and the Self.
Shenton, M. E., Kikinis, R., Jolesz, F. A., Pollak, S. D., LeMay, M., Wible, C. G., Hokama, H., Martin, J., Metcalf, D., Coleman, M., & McCarley, R. W. (1992). Abnormalities of the Left Temporal Lobe and Thought Disorder in Schizophrenia: A Quantitative Magnetic Resonance Imaging Study. New England Journal of Medicine, 327(9), 604–612. https://doi.org/10.1056/NEJM199208273270905
Turk, M. J. (2007). Self-referential gestures in conversation. Discourse Studies, 9(4), 558–566. https://doi.org/10.1177/1461445607079166
Wallesch, C.-W. (1990). Repetitive verbal behaviour: Functional and neurological considerations. Aphasiology, 4(2), 133–154. https://doi.org/10.1080/02687039008249066
Wensing, T., Cieslik, E. C., Müller, V. I., Hoffstaedter, F., Eickhoff, S. B., & Nickl‐Jockschat, T. (2017). Neural correlates of formal thought disorder: An activation likelihood estimation meta‐analysis. Human Brain Mapping, 38(10), 4946–4965. https://doi.org/10.1002/hbm.23706
Zlatev, J. (2012). Cognitive Semiotics: An emerging field for the transdisciplinary study of meaning. Public Journal of Semiotics, 4(1), Article 1. https://doi.org/10.37693/pjos.2012.4.8837
Published
Versions
- 20.12.2025 (2)
- 07.10.2025 (1)
How to Cite
Issue
Section
License
Copyright (c) 2025 Sampath Muthu Lakshmipriya, Nagaraj Hema

This work is licensed under a Creative Commons Attribution 4.0 International License.
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles published in the Journal of Health and Rehabilitation Sciences are licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
This license permits use, distribution, reproduction, adaptation, and commercial use in any medium or format, provided the original work is properly cited, the authors are credited, and the source is acknowledged.










