SpeechPathology.com Phone: 800-242-5183

New master brand. Same great company. Introducing continued! Read Our Story

Signature Healthcare

Modifying the Communicative Abilities of Daily Living (CADL-2) for Use with Illiterate Persons with Aphasia: Preliminary Results

Modifying the Communicative Abilities of Daily Living (CADL-2) for Use with Illiterate Persons with Aphasia: Preliminary Results
Nidhi Mahendra, PhD, CCC-SLP
November 22, 2004

Postdoctoral Fellow
Department of Speech Language and Hearing Sciences
University of Arizona


Illiterate individuals with aphasia comprise a unique and little studied population. Researchers have demonstrated substantial differences in performance of literate and illiterate individuals on linguistic tests (Lecours, Mehler, Parente, & Caldeira, 1987, 1988) and have suggested that diagnostic tools need to be modified for this population. However, there remains a dearth of appropriate language assessment tools for use with these people.

The primary focus of this study was to translate the CADL-2 (Holland, Frattali, & Fromm, 1998) into Hindi and modify it for use with illiterate aphasic persons residing in India. Preliminary data are presented from fifteen individuals, highlighting the effects of cultural and linguistic variables on test performance. Clinical implications of these data are discussed.


Appropriate assessment and management of language deficits in illiterate individuals with aphasia has long posed a challenge to speech-language pathologists. This challenge is especially significant in developing countries like Mexico and India where large percentages of the population live in rural areas and illiteracy is common. In India, 80% of the country's population lives in rural areas and there is a high prevalence of illiteracy, with approximately 27% of adults being illiterate. However, illiteracy is not a problem confined only to developing countries. For instance, in the 1991 report of the United States Census Bureau, some 22 million illiterate American adults (Kahn & Kelly, 1991) were reported.

There are few appropriate language tests to assess the performance of illiterate aphasic individuals (Castro-Caldas, Reis, & Guerreiro, 1997). Researchers have found substantial differences in performance of literate and illiterate individuals on linguistic tests and psychometric measures (Lecours et al., 1987; Lecours et al., 1988). Therefore, assessment measures and tests should be modified for illiterate people with cognitive and communicative deficits.

However, when developing measures of functional communication, or modifying existing tools for use with illiterate persons with communication disorders, an important issue is the perception of what is considered 'functional communication' by literate versus illiterate persons.

Functional communication has been defined as communication skills used in everyday living situations. This paper represents the first attempt to characterize functional communication in individuals with aphasia, who were premorbidly unable to read or write.

The first goal of this study was to conduct a literal translation of the CADL-2 (Holland et al., 1998) to change the language from English to Hindi, and modify it for use with a population of illiterate individuals with aphasia. The second goal was to explore the need for a cultural translation i.e., changing or modifying test stimuli or response scoring guidelines, to evaluate aphasia among illiterate persons residing in India. This application is significantly different from that for which the CADL-2 was originally developed.

nidhi mahendra

Nidhi Mahendra, PhD, CCC-SLP

Related Courses

Medicare Muscle: Creating Defensible Documentation
Presented by Lorelei O'Hara, M.A., CCC-SLP
Course: #6346 1 Hour
As claim scrutiny increases, it becomes critical that rehab professionals understand Centers for Medicare & Medicaid Services (CMS) requirements, and how to craft content that shows how our services met those requirements. This course will teach the requirements for services to be reimbursable by Medicare, as well as how to present SLP services through quality documentation.

Treatment to Improve Timing & Synchronization of Critical Neural Networks for Speech, Language, and Cognitive-Communicative Abilities; presented in partnership with Interactive Metronome
Presented by Amy Vega, MS, CCC-SLP
Course: #6508 1 Hour
Synchronous timing of neural networks is critical for the core skills of attention, working memory, processing accuracy/speed, and executive functions that underlie speech, language and cognitive-communicative function in people of all ages. Researchers have identified that many of the individuals we see for SLP services exhibit impaired neural timing & synchronization, including those diagnosed with Dyslexia and other reading disorders, Autism, Sensory Processing Disorder, Attention Deficit Hyperactivity Disorder, Aphasia associated with stroke and acquired brain injury, cognitive-communicative impairments associated with acquired brain injury, and cognitive and motor planning/sequencing impairments seen in Parkinson’s disease. This course will introduce you to a patented, non-invasive biometric technology, called the Interactive Metronome, that is specifically designed to help you objectively evaluate and treat this underlying impairment in timing & rhythm in order to achieve better SLP treatment outcomes.

Principles of Aphasia Group Treatment: Structure and Cohesion
Presented by Darlene S. Williamson, MA, CCC-SLP, Suzanne Redmond, M.A., CCC-SLP, Melissa Richman, M.S., CCC-SLP
Course: #6602 1 Hour
This course will describe a group treatment model used with individuals with aphasia that uses empirically supported principles to develop and maintain group cohesion. Videos and discussion will demonstrate this methodology in functional use.

Exploiting Neuroplasticity in Aphasia Rehabilitation
Presented by William A. Connors, MA, CCC-SLP
Course: #6632 1 Hour
This course will discuss effective clinical exploitation of neuroplasticity to maximize the recovery of aphasia and related disorders. It will present 18 tenets, techniques and tools that enhance clinical skills and assist in the integration of evidence into aphasia rehabilitation that focuses on the client’s values and perspective.

Vanderbilt SLP Journal Club - Patient-Reported Outcome Measures in Medical Speech-Language Pathology
Presented by Barbara Jacobson, PhD, CCC-SLP
Course: #6853 1 Hour
This course is designed to introduce the clinician to the range of patient self-report measures for a variety of communication and swallowing disorders. Participants will understand the basic development of these measures and their application to clinical practice.