Paul Broca's famous case reports of language impairment following left hemisphere lesions were issued in the 1860s. Since that time, much has been written about the assessment, typology, and neural underpinnings of aphasia. The two books we had the pleasure of reading and reviewing, Assessment of Aphasia and Aphasia and its Therapy, present well thought out and thorough reviews of aphasia literature, the first focusing on assessment issues, the latter focusing more on issues of and theoretical approaches to treatment. The books are united in their insistence that the field of aphasia research, from assessment to rehabilitation, be grounded in theory and a defensible conceptual model. This overarching theme presents itself throughout the entire corpus of both texts. Just as the clinician conducts a thorough assessment before initiating treatment, so too will this review begin with the book focused predominantly on aphasia assessment, before moving on to aphasia therapy.

Assessment of Aphasia consists of short, easily digested chapters that cover the basics of both test construction and assessment principles in general, with descriptions of an admirably thorough list of tests for use in children, adults, and populations with unique considerations. The authors note that the book is intended for practicing speech pathologists and neuropsychologists, as well as for graduate students seeking to understand the assessment of speech and language disorders. The book is well organized into four sections, each of which could stand alone as a complete entity. Section I provides the general introduction to the topic of aphasia by highlighting global issues of assessment, history of aphasia assessment, and principles of aphasia test construction. Sections II and III contain descriptors of test format and layout, including the purpose and methods of many specific tests; Section II focuses on tests for adults while Section III reviews tests for children. Within these chapters, the authors have taken the extra step of detailing ordering information and cost of each instrument they describe. Finally, Section IV reviews special considerations relevant to various issues encountered in clinical practice including premorbid functioning, brain injured populations, patients with right hemisphere lesions, elderly, demented, and non-English speaking/bilingual patients.

This book has many applications, and most likely will be utilized slightly differently by scientists and practitioners at different stages of training and experience. Section I, the Introduction, contains several chapters with a broader scope than the topic of aphasia. As such, graduate students and beginning clinicians would find this a useful resource for a general review of fundamental principles of assessment, including test selection, diagnostic formulation, and effective delivery of consultation feedback to healthcare professionals. The book begins with an excellent review of clinical–neuroanatomic and psycholinguistic models of aphasia, which highlights the importance of using a conceptual model to guide assessment. Chapter 2 summarizes the history of aphasia assessment; chapter 3 discusses the purposes of an assessment. Again, this topic is broader than aphasia assessment alone and provides an excellent frame of reference for clinicians across disciplines. The authors differentiate screening exams from those designed to provide descriptive evaluations, to evaluate progress, and for functional/pragmatic assessments, reminding the clinician to frame the assessment around the nature of the referral question and to think globally in terms of the rationale and purpose of the assessment. After this first step in the assess\.ment process specific test selection can occur. Finally, chapter 4 is a brief review of “Test Construction 101,” summarizing issues of standardization, reliability, and validity. The presentation of this material is straight-forward and easy to understand, and is made more useful by the inclusion of relevant examples from tests of language functioning. This integrative presentation will aid the clinician in test selection and the budding researcher and test author in test construction. A detailed review of existing measures of language function follows.

Sections II and III are reminiscent of Spreen and Strauss (1998). Section II, which focuses on assessment of language function in adults, contains distinct chapters dedicated various goals of as well as constraints on assessment (e.g., bedside exam, comprehensive exam, tests of specific language behaviors, measures of functional communication). For each test, its history is provided, as are details about various normative samples and correlations with other measures and description of the method of test administration. For those tests not reviewed in detail, the authors provide references for the interested reader (e.g., the Action Naming Test). However, Spreen and Risser did not review tests that “have found little use in published studies” and no objective criteria were offered regarding how the authors determined “little use.” For example, despite more than 100 citations in peer reviewed research studies of language in children and adults, the Lindamood Auditory Conceptualization Test (LAC) was not given a full review. The reader may not agree with the authors' perspective on which tests have significantly contributed to research on aphasia and language disorders.

Within the section of tests for adults, the authors devote chapter 8 to functional communication. They acknowledge and address the fact that social communication demands skills that are more complex and broad-based than those measured on tests of core language skills (e.g., naming, syntax, etc.). A patient could perform almost within normal limits during formal testing, but experience significant deficits in the real world; another may show tremendous gains on a given dependent variable over the course of treatment, but show no change in functional communicative capacity. These facts underscore the need for measures of functional communication and functional outcome to be included in language rehabilitation or remediation research.

Section III describes tests of language functioning appropriate for children, adolescents and teenagers. It begins with a general review of issues specific to testing of children with an emphasis on the complexities of developmentally appropriate tests and the importance of normative data. The authors note the differences between acquired versus developmental language disorders, but consider that most tests are appropriate for both etiologies: because of the interrelated development of substrates for higher-level language abilities, there may be more similarities between developmental and acquired language disorders than differences (Heilman & Alexander, 2003; Nadeau, 2001).

Finally, section IV reviews issues related to clinical assessment. Such considerations as premorbid functioning, attentional and motivational factors, and affective states/comorbid mood disorders, are addressed. Following this more global discussion, issues specific to the assessment of populations with unique features such as traumatic brain injury, right hemisphere damage, dementia, and bilingual or non-English language patients are addressed. Yet the authors fail to mention the importance of obtaining a thorough developmental history of language abilities for adults and children who acquire language disorders. As some aphasic adults may have had an undiagnosed language disorder in childhood, their developmental history could affect the interpretation of a language assessment and treatment plan for a mild or moderate aphasia. In this closing chapter on unique considerations for an aphasia assessment, the book comes full circle by closing with the reminder that selection of tests must be guided by the purpose of the assessment, and with the summary statement that clinicians must attend to current research on assessment instruments employed in practice.

Following Spreen and Risser's elegant review of aphasia assessment, we turn to aphasia therapy. Basso's goal is to connect aphasia research, practice, and therapy, a relationship she describes as “very loose.” She exhorts those in the scientific and clinical communities to work to bridge this gap and notes that while the book is intended mainly for clinicians, she also hopes to inform researchers about the process of therapy. However, because many researchers in aphasia are clinicians by training and practice, it would have been informative to know what aspects of the therapy process that Basso believed researchers have been neglecting.

The second goal of the book is to highlight past knowledge, as current knowledge is only as useful as our understanding of, and appreciation for, knowledge that has formed the foundation of today's insights. In fact, the entire text is imbued with a sense of history from Ernest Auburtin's 1861 address at the Société d'Anthropologie de Paris to the birth of cognitive psychology at the 1956 Symposium on Information Technology held at the Massachusetts Institute of Technology and through the works of Geschwind, Goodglass, and Kaplan in the 1970s.

The book is divided into three parts. Part 1 (chapters 1–4) reviews the first 100 years of aphasiology (e.g., history of aphasia, classification systems, aphasia rehabilitation, and aphasia therapy effectiveness), from World War II through the 1970's. These chapters of the book provide valuable summary of theories of language rehabilitation which also considers limits to the aphasia literature from assessment and classification to rehabilitation. For example, Basso discusses implications of handedness, age and sex of the patient, etiology of the disorder, and time since onset, reviewing these issues in historical context and summaries of relevant reports. Chapter 3 provides an excellent discussion of techniques of aphasia therapy, organized by \.underlying theoretical approach. Finally, in chapter 4, Basso tackles treatment efficacy but does not directly address treatment outcome measures, a topic that is relevant to studies of language rehabilitation and is particularly salient for establishing treatment efficacy. Nonetheless, this chapter goes a long way toward highlighting the importance of efficacy research in aphasia.

Part 2 (chapters 5–7) centers on cognitive neuropsychology. Throughout this section of the book, Basso addresses complex and fundamental theoretical issues that are intimately linked to the study of language including the role of data from brain-injured persons for understanding normal language, modularity vs. universality assumptions of cognition, and the value of single case vs. group studies. This section of the book explains the cognitive neuropsychology of language, moving from basic components of language (e.g., phonemes–lexicons–semantics) to the implications of a cognitive perspective for language rehabilitation. These chapters are rich in providing models of language and aphasia and the more global concepts of cognitive neuropsychology, well illustrated with examples from disorders of speech and language.

Part 3 (chapters 8–10) addresses aphasia therapy including specific interventions at the word and sentence levels, and specific treatments for severe aphasias. At the outset of this section Basso proposes and discusses details of a theory of aphasia such as models of impairment, hypotheses about neural mechanisms of recovery, and theories of learning in brain damage. A few comments on factors influencing recovery are included. One notable omission is a discussion of premorbid/developmental language disorders. Also, Basso essentially dismisses the role of age as a factor in rehabilitation with the comment that few studies have examined this issue and those that have suggest issues such as age, handedness, and education do not play a significant role. However, there is reason to believe that age affects plasticity and patterns of recovery, as well as the possibility that lack of a differential outcome for various age groups reflects the shortcomings of the aphasia therapy and not the factor of age. It is from this platform of theories on aphasia that she moves, in chapter 9, to specifics of language treatments, that is, “what to do in therapy.” In chapter 10, concerning severely impaired aphasia patients, Basso asserts that pragmatic approaches (i.e., teaching compensatory strategies to augment language use) are more appropriate than cognitive strategies (i.e., restoration of impaired language). This chapter provides an insightful of differences between a pragmatic and a cognitive approach to rehabilitation.

In her conclusion, Basso addresses neuroimaging studies, connectionist modeling, and issues related to the process of therapy. Altogether, this impressive work provides a much needed foundation for integrating clinical and research knowledge. It is a thought-provoking and timely work, especially as our understanding of neural plasticity expands.

Together, these two books make a tremendous contribution to the field of aphasiology, as they directly aid in the quest to achieve better diagnosis and treatment for patients with aphasia. Although successfully teaching patients how to compensate for language deficits can improve the quality of life, the ultimate goal of rehabilitation is to find ways to restore impaired language abilities. Spreen, Risser, and Basso have clearly dedicated their significant energies and passion toward achievement of this goal in producing texts that will inform, and hopefully inspire the field.