Influence of pragmatic performance on functional communication in aphasic adults

The purpose of this study was to determine the relationship between pragmatic performance and functional communication. Twenty-seven aphasic subjects, fourteen fluent and thirteen non-fluent, who had suffered a single left hemisphere stroke participated in the study. Subjects were divided into groups according to aphasia type (fluent and non-fluent), as well as, severity level (mild, moderate, or severe). Language impairment was determined with the Western Aphasia Battery. Pragmatic performance was assessed during conversation with the Pragmatic Protocol. Information gathered from two additional observation sessions was used to determine functional communicative ability as defined by overall independence and qualitative scores from the ASHA FACS. In addition, this study examined the relationship between objective measures (WAB, Pragmatic Protocol, & ASHA FACS), unfamiliar listeners' judgements, and caregivers' perception (CETI) of functional communication. Results from this investigation indicate pragmatic performance is a better predictor of functional communication than linguistic competence. No significant differences between type of aphasia (fluent and non-fluent) with respect to pragmatic performance and functional communication were found. The results did indicate severity of aphasia, regardless of type, was an important indicator of pragmatic performance and functional communication. Significant differences were found between the mild and severe groups, however, no significant differences were found between the moderate group when compare with the mild and severe groups. Strong correlations were found between the CETI, the Pragmatic Protocol and the ASHA FACS. This finding indicates pragmatic and functional communication assessments correlate better with caregivers' perception of communication abilities than traditional language assessments. In addition, the unfamiliar listeners' judgements were found to correlate better with the WAB, Pragmatic Protocol, and the ASHA FACS quantitative communication independence score than the CETI and ASHA FACS qualitative score. No significant correlations were found between the unfamiliar listeners' ratings and the CETI or the qualitative scores from the ASHA FACS. While available measures may help quantify impairment, even in a "functional" context, there are no substitutes for familiarity with the subject and interactions with family and friends.