Summary        Sommaire        Text in French
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Orthophonistes Paris - France

INTRODUCTION (by P. Ferrand)

In 1980, at the request of students and young professionals in the field of speech and language therapy, A.M. Tréanton and I, then lecturers and responsible for training in the Schools of Speech and language Therapy in Lille and Toulouse respectively, wrote a teaching manual titled "Speech and Language Evaluation" and published in 1983 by L’Orthophoniste Edition.

Suzanne Borel-Maisonny wrote the preface for this book which remained faithful to her intuition and her clinical orientation. The book had three major goals in mind: CLARIFICATION, RIGOUR, MODEL DEVELOPMENT.

• CLARIFICATION was particularly needed at a time when methodological approaches, reflecting scientific and sometimes ideological schools of thought, were quite diverse and contradictory.

The practice of speech and language therapy was accordingly submitted to successive sociological, behavioural or psychoanalytical movements, rapidly switching from being " totally instrumental " to being " totally socio-cultural ", to being " totally relational ". [2]

It was becoming urgent to reduce the size of the pendulum’s swings.

• RIGOUR was needed to improve our professional credibility. It was therefore important to:

- specify and harmonize the terminology which our discipline used;

- define the framework of a Standard Evaluation;

Briefly stated, it was important to give priority to a scientific rather than an intuitive approach, thus defining a flexible yet rigorous framework of evaluation.

• MODEL DEVELOPMENT was crucial at a time when Classification Systems were being revised, when competency criteria were in the process of being defined, and when relationships with supporting economic and political agencies were becoming increasingly technocratic.

More specifically, it was becoming very urgent to develop a system for the evaluation of oral and/or written language pathology, allowing not only for the assessment of learning-related disturbances, but also of oral and written language as a symptom of " underlying " pathology and of authentic suffering.

We therefore expected that the development of a clear and didactic methodological model would help us step away from what Suzanne Borel-Maisonny so nicely called " the customary form " of speech and language evaluation, and encourage us to use a more organized form of evaluation [1].

So, here we are 20 years later!

Those requirements which led to a more rigorous definition of the speech and language evaluation protocol, also understandably generated new requirements:

- theoretical updating

- quantitative and qualitative evaluation

- the modernizing of tools.

• Theoretical updating has become possible due to major advances in areas related to language and communication.

More specifically, progress in Neurology, Linguistics and Cognitive Psychology has encouraged a " homo communicans " perspective which takes into account all the variables involved in human language, as opposed to the more fragmentary, sometimes sectarian approach which characterized the theoretical debates of the 80s.

This perspective allows us to have a more global therapeutic approach to language pathology today, as well as a stronger focus on the patient as a ‘developing’ PERSON who lives in an evolving, complex but rich environment, rather than as a simple carrier of symptoms!

• Quantitative and qualitative evaluation is imposed upon us by two contradictory forces:

How will we manage to reconcile technical progress and control of expenses, the latter being automatically challenged by the former?

These two types of pressure certainly raise major problems which this Congress intends to address...

• The modernizing of tools is an obvious necessity!

Without renouncing the pleasure associated with handling a book, it is necessary to find a new presentation for our Manual! Computer techniques are available to help us in this direction...

On behalf of our team, Gilles LELOUP will now suggest some possible changes, based on a presentation of the preliminary results of our work.

I want to thank those speech and language therapists who participated in this transformation and whose skills, experience, rigour and... imagination contributed to progress in this research area of the speech and language field:

The starting point of our working group on the development of a speech and language evaluation battery was to create a scientific and structured evaluation which would eventually include standardized and reliable tests based on models compatible with computer processing techniques.

We will first summarize the objectives of this type of evaluation and the theoretical models upon which it is based, then describe the evaluation model we selected which has three levels:

- input

- information processing

- output.

For each level, we will suggest evaluation tools with referenced batteries. Results obtained from these tests may serve to develop hypotheses regarding the subject’s functioning, which will in turn contribute to establishing a diagnosis and selecting optimal remediation strategies.

We also included a dictionary and constructed a " screening " procedure to be administered prior to the three levels, designed to help us take into account the socio-psychological-emotional dimension of the evaluation process.

• Objectives of the evaluation model

The main objective was to build an evaluation template which could be applied to all pathologies treated in speech and language therapy, thus defining shared " hubs ", such as a more precise theoretical model of relationships between oral and written language or between voice and oral language.

This template also had to be applicable to such diverse diagnostic situations as cases where the presenting problem is clear, for instance aphasia or dysphonia, and cases where a specific diagnosis has not yet been established, for instance learning delays in school children.

It also had to provide a coding system and an information processing system. We considered it was important to " embody " information processing for such diverse patients as those with memory impairment or those with vocal dysphonia.

This evaluation model had to take into account relationships between cognitive and emotional aspects of functioning, and social-psychological-emotional data.

Finally, the evaluation battery had to be a simple and easy to use tool, and it also had to be both a diagnostic and educational tool so as to allow for both an evaluation and research approach through the use of standardized tasks, and a clinical approach through the formulation of treatment hypotheses.

• Model selection

Our evaluation model is anchored in cognitive sciences and draws from both J. Fodor’s " modular " theory and cognitive neuropsychology on the one hand, and from " information processing " techniques on the other hand.

J. Fodor hypothesized the existence of a set of independent systems called modules. According to him, human cognition is composed of a finite set of more or less autonomous subsystems (language, memory, visual perception, reasoning, attention, etc.). Research in cognitive neuropsychology has reported results which are compatible with the " modular theory ", as indicated for instance by the use of a cognitive approach in the treatment of reading or mathematics disorders.

In addition, the " information processing " school of thought in the field of psychology has provided us with the useful concept of mental representations.

• A proposed model of speech and language evaluation

Let us note that Table 1 is primarily a working basis for developing a speech and language computer program. It is organized around three levels:

- input

The Table should be read from left to right and from bottom to top. This modular representation should not exclude the notion that input, information processing and output function in parallel fashion.

The glossary is the database which functions like a dictionary.

The social-psychological-emotional dimension is the relational dimension which cannot be dissociated from our activities. It underlines the paramount importance of the social environment and of interactions between the emotional and cognitive spheres.

The presenting problem gives the opportunity to collect information on the patient and establish rapport with him (her).

Input was arbitrarily divided into auditory input, visual input, kinesthetic input and motor input. This input includes information processed at a primary or sensorimotor level ® sensory functions, then processed at a secondary level where gnostic integration takes place ® gnostic skills.

Information processing takes place at a tertiary level of associative functions, which can be divided into:

And the site of ‘cognitive architecture’:

Output is regrouped in the same manner as input: information goes through a secondary level of praxic construction ® praxic skills, then through a primary sensorimotor level ® sensory functions.

Each module is matched with specific tests. For each level, we will list those tests which make up the evaluation protocol, for instance the oral language evaluation protocol.

Results obtained in this manner are submitted to a qualitative and quantitative semiological analysis which can lead to a diagnosis, generate hypotheses and contribute to the selection of remediation strategies.

Concretely speaking, all one has to do is to type in the name of a pathology, or that of a specific treatment such as the treatment of swallowing difficulties, and an evaluation model evoking the set of modules will appear on the screen. Results from the tests may generate a diagnosis and suggest intervention strategies, but they may also point out diagnostic difficulties or discrepancies.

• Discussion

This type of evaluation model tends to be reductionist and arbitrary. It was important for us to go beyond a simple enumeration of tests for specific pathologies. We wanted to introduce the future user of this speech and language evaluation computer program to its coding and information processing systems, and to its social-psychological-emotional dimension as well, so that each task could be paired with a specific level in the system.

We wanted to develop an evaluation template common to all pathologies while remaining simple and flexible enough to be used in both clinical and educational settings. We are aware that this choice of a modular model, inspired from cognitive neuropsychology, is being questioned by current theories, but it is nevertheless a valuable starting point for conceptualizing speech and language evaluation, treatment and treatment evaluation processes.

1- Ferrand P., Tréanton A. M., (1983) -Manuel pour le Bilan Orthophonique, Isbergues (France), Ortho Edition.

2 - Ferrand P. , (1987) - La dyscommunie, maladie du XXI" siècle, Rééducation Orthophonique, (France ) Vol. 25, Septembre 1987,No 151,331-333.

3 - Ferrand P. (1989) - Le Bilan Orthophonique : inventaire, évaluation, stratégies ? Glossa, (France ) n° 15, 1989, 36-37 . (France ) n° 15, 1989, 36-37 .

4 - Bideaud J., Houdé O., Pedinielli J-L., (1993) L’homme en développement ; PUF.

5 - Chevrie-Muller Cl ., Narbonna J., (1996), Le langage de l’enfant ; Masson.

6 - Mazeau M., Déficits visuo-spatiaux et dyspraxies de l’enfant ; Masson.

7 - Seron X., (1993), in L’homme psychopathologique et psychologie clinique, Huber W. ; PUF.