One of the ways speech therapists or families talk about a client’s comprehension is by asking yes/no questions. I often hear “she gets ‘yes’ and ‘no’ confused” or “he just says ‘yes’ to everything”. Most aphasia tests have yes/no questions, so when a therapist talks about comprehension, it may largely depend on this testing. 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 (ironic, right?).
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 “Yes”. It’s a hard, abstract question.
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.
The important part of comprehension is everyday contextual (functional) communication. This means asking 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 someone responds, most likely it’s the correct response. “Do you want my tomatoes?” while holding the tomatoes out to someone is another example of contextual comprehension.
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.
Comprehension, like all language skills, is a spectrum. 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?” is a test question. These types of questions are how therapists generally talk about comprehension in my clients. This isn’t helpful as I expect poor responses on most abstract questions. However, if I ask, “are you tired today?” —this is a functional, concrete question. If someone can answer almost 100% of concrete and functional questions, do I really care about the others?
