Beyond language: An SLP’s perspective on cognitive assessment with RBANS
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How RBANS complemented language assessment and supported clinical decision making in adult rehabilitation
As an SLP, you're often asked to make decisions that go beyond language alone—particularly when working with adults with suspected cognitive changes. Understanding a patient's attention, memory, and overall cognitive status can play an important role in shaping referrals, treatment plans, and expectations for recovery.
Maria Brask, MS, CCC-SLP, spent years in inpatient rehabilitation, regularly using RBANS® with adults recovering from stroke and traumatic brain injury. Now, she shares how cognitive assessment fit into her clinical workflow—and why it matters for your patients.
In this conversation, Maria shares how RBANS fit into her clinical workflow, how it complemented the language assessments she was already using, and how the results helped inform treatment planning, referrals, and patient care.
Q: How did you first start using RBANS in your clinical practice, and what need were you trying to address?
I first started using RBANS while working on an inpatient rehabilitation unit that primarily served patients recovering from stroke or traumatic brain injury (TBI). In that setting, cognitive assessment and treatment were a regular part of my role as an SLP.
One of the reasons RBANS was so valuable was that it offered multiple forms. That allowed us to evaluate a patient's cognitive status upon admission and then reassess during their rehabilitation stay to measure progress. Having a standardized way to track cognitive changes over time was helpful for both treatment planning and measuring outcomes.
Cognitive-communication assessment is absolutely within your scope as an SLP—and in inpatient rehab settings, it's often essential. We needed tools that gave us the full clinical picture, not just pieces of it
Q: In what situations did you choose to use RBANS, and when did you rely on other tools or approaches?
I often chose RBANS when I suspected cognitive-linguistic impairment but needed more information than I could get from a brief cognitive screening.
For example, in acute care settings, patients frequently completed the MoCA®. Sometimes those screening results appeared to be within functional limits, but clinical observations suggested that something was still going on. The patient might demonstrate difficulty recalling information, maintaining attention, or managing complex tasks. In those situations, RBANS allowed me to take a more in-depth look at cognitive functioning.
I also frequently used RBANS with patients recovering from stroke, particularly right hemisphere stroke, when their language abilities were strong enough to participate in the assessment. The results often helped identify cognitive deficits that could affect communication, safety, and independence.
That said, RBANS wasn't always the best fit. If a patient had severe aphasia, the language demands of the assessment could make it difficult to obtain an accurate picture of cognitive functioning.
For patients with more severe cognitive impairment, I often relied on the CLQT+®. The instructions and tasks are generally simpler than those in RBANS, which can make it a better option for patients who may struggle with more complex assessment demands. I also found the CLQT+ useful for individuals with suspected dementia because it provided information about baseline cognitive-linguistic skills and helped identify strategies that could support everyday functioning.
Q: How did RBANS complement the language assessments you were already using?
Cognition and language go hand in hand. Even when a patient has a classic language impairment following a left hemisphere stroke, cognitive skills still need to be assessed.
To participate in conversation, follow directions, learn new information, and use communication strategies effectively, patients need adequate attention, memory, planning, and organization skills. Those cognitive abilities can have a significant impact on communication performance.
What I appreciated about RBANS was that it assessed areas such as memory, attention, and language in a way that helped me better understand a patient's overall presentation. It allowed me to determine whether communication difficulties were primarily related to cognitive deficits, language impairment, or a combination of both.
While RBANS does include a language component, I still completed formal language assessments to identify the specific language skills that should be targeted in treatment.
For me, RBANS wasn't a replacement for language testing—it was a complementary tool that helped provide a more complete clinical picture.
Q: How did RBANS influence your clinical decisions, such as treatment planning, referrals, or tracking progress?
RBANS provided valuable information that directly influenced treatment planning.
A primary goal of inpatient rehabilitation is helping patients maximize independence and return to meaningful daily activities. To do that, clinicians need a clear understanding of the cognitive-linguistic skills that support functional tasks such as medication management, problem-solving, scheduling, and following safety precautions.
RBANS provided a baseline measure of those skills and helped me identify areas that needed intervention. The results supported individualized goal writing and helped guide decisions about which strategies would be most beneficial for each patient.
The assessment also informed referral decisions. In many inpatient settings, neuropsychological evaluations are not readily available, and SLPs often play an important role in identifying patients who may benefit from further assessment. The information gathered through RBANS helped support referrals for outpatient neuropsychological evaluation when needed, ensuring patients received additional follow-up after discharge.
Finally, because RBANS offers multiple forms, it allowed us to measure changes over time. That was especially valuable when tracking progress during rehabilitation and evaluating treatment outcomes.
Key takeaways for SLPs
Maria's experience shows what's possible when you look beyond language alone. Here's how cognitive assessment with RBANS can transform your clinical decision-making:
- Build a complete clinical picture of your patient
- Track real progress throughout rehabilitation
- Identify when language challenges are cognitive
- Make confident referral and discharge decisions
- Guide individualized goals that lead to independence
When you look beyond language alone, you unlock a fuller understanding of what your patients need to succeed—and you become a more confident clinician. For Maria, that broader picture changed how she approached every patient decision.