When I review records of potential clients, I read reports from their speech therapists. One of the measures speech therapists use to talk about a client’s comprehension is how well they respond to yes/no questions. Yes/no questions are contained in most tests of aphasia, so reporting comprehension may largely depend on this task. But is this a good measure of someone’s comprehension? Does it really tell me anything about that person’s abilities? The answer is yes and no.
Comprehension questions on tests or in workbooks are often abstract. One of my favorite examples is something like: “Is a horse bigger than a dog?” The expected response is “No”. My response is “who cares?” To answer this question, the client must understand that “bigger” refers to size and what a horse and a dog look like. If I just sit and ask yes/no questions that have no relation to real life communication, what does that tell me about someone’s comprehension? Is comprehension an all-or-nothing skill? A score of 56% on an abstract yes/no set of questions only tells me that this person has difficulty with high-level, abstract yes/no questions. This is something I would expect with any type or severity of aphasia.
On the other side of comprehension is everyday contextual communication. This means that we ask questions such as “how are you?” when we see someone and they answer “good”, or “fine” or sometimes even “yes”. Did they understand what you were asking? Most likely. If we are having lunch and I ask “Would you like something to drink?” and I get a response, most likely it’s the correct response. “Do you want my tomatoes?” while holding the tomatoes out to someone…if they like tomatoes they’ll say “yes”. You talk about what you are doing at the time.
Most people with aphasia have a hard time, especially in the beginning of recovery, saying yes and no when they want to. The default response may be “yes”. Over time, as their comprehension improves they may correct themselves and say “Ugh, no!” immediately after they’ve just said “yes”. Sometimes it’s confusing to both communication partners getting caught in a web of yes/no questions.
When I think of someone’s comprehension, there’s a whole spectrum of it. Most people with aphasia, even very high-level aphasia, do poorly on abstract yes/no questions “Do you peel a banana after you eat it?”. These types of questions are how therapists report comprehension in my clients. This doesn’t give me much good information. I expect poor responses on most abstract questions. However, if I ask, “are you tired today?”—this is a functional, concrete, contextual question. If someone can answer almost 100% of concrete and functional questions, do I really care about the others? Not if they have no meaning in real life.