The PICA revisited

Abstract

A little over ten years ago, I wrote a critique of the Porch Index of Communicative Ability (Martin 1977). My purpose was two-fold: first, I wanted to raise objections to use of the test itself since I believe it to be seriously flawed conceptually and therefore of limited, if any, clinical or research use; second, I hoped to stimulate discussion of the entire issue of testing in aphasia. Unfortunately, because of space concerns, a key section of my paper was edited (with my permission I must hasten to add) and the focus of the paper became more of an attack on the PICA than a discussion trigger as I had hoped. While my first purpose was achieved, there has been little discussion of what I still think to be the important issues raised in the paper. Dr Lincoln’s thoughtful piece, ‘Using the PICA in clinical practice: are we flogging a dead horse?’ raises many of these issues. I should say at the start that except for minor reservations of emphasis and priority, I have objections to only two comments she makes in her paper, those on the use of the PICA to monitor recovery and the desirability of a multidimensional scoring system. I hope therefore, I will be excused for discussing from my own points of reference, some of the same points she makes so well.