Pragmatic Performance and Functional Communication in Adults with Aphasia

Abstract This study used linear regression to define the relationship between pragmatic performance and functional communication by 27 individuals with aphasia, including 14 with fluent aphasia and 13 with non-fluent aphasia. Pragmatic performance was measured with the Pragmatic Protocol. Functional communication was measured using the ASHA Functional Assessment of Communication Skills (ASHA FACS). Results provide support for the relationship between these variables and for their underlying link to linguistic competence. Nonetheless, standard language assessment (Western Aphasia Battery) appears insufficient for describing overall communicative competencies and for explaining differences between some participants' functional communication abilities. Implications for assessment and treatment of communicative effectiveness are discussed. Keywords: Aphasia Pragmatics Functional Communication. Introduction With any type of disorder, different assessment measures can be, and have been, constructed to assess different aspects of behavior. For example, numerous assessments for aphasia currently exist. Some assessments, such as the Western Aphasia Battery (WAB) (Kertesz, 1982) or the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983) purport to assess type and severity of aphasia. Other assessment tools focus on different aspects of communication. The Pragmatic Protocol (Prutting & Kirchner, 1983), for example, examines communication from an entirely different perspective. Pragmatics is the study of the relationship between language behavior and the contexts in which language is used (Prutting & Kirchner, 1983). It involves the acquisition and use of conversational knowledge and the semantic rules necessary to communicate intent. In addition, pragmatics involves the interactional aspects of communication, including sensitivity to social contexts (Chapey, 1992). Specific pragmatic aspects investigated in adults with aphasia include communication acts (Gurland, Chwat, & Wollner, 1982; Wambaugh, Thompson, Doyle, & Camarata, 1991), speech acts (Doyle, Thompson, Oleyar, Wambaugh, & Jackson, 1994; Prinz, 1980; Wilcox & Davis, 1977), discourse analysis (Armstrong, 1987, 1991; Bottenberg & Lemme, 1991; Guilford & O'Connor, 1982; Mentis & Prutting, 1987) and use of nonverbal communication (Behrmann & Penn, 1984; Cicone, Wapner, Foldi, Zurif, & Gardner, 1979; Glosser, Weiner, & Kaplan, 1986; May, David, & Thomas, 1988). Researchers have investigated pragmatic performance in individuals with aphasia (Avent & Wertz, 1996; Holland, 1982; Prutting & Kirchner, 1987; Wilcox & Davis, 1977), and data suggest that individuals with aphasia maintain a high level of pragmatic appropriateness despite their linguistic impairments (Avent & Wertz, 1996; Prutting & Kirchner, 1987). Another area of assessment for aphasia has been referred to as "functional communication." Functional communication is defined as "the ability to receive or convey a message, regardless of the mode, to communicate effectively and independently in a given [natural] environment" (p.2)(ASHA, 1990). While profiling specific pragmatic strengths and weaknesses may assist in identifying the nature and processes involved in "communication," a functional communication assessment should help to outline the consequences of the communication deficit in an individuals' daily interactions. For example, when assessing pragmatic ability with an instrument such as the Pragmatic Protocol (Prutting & Kirchner, 1987), speech act usage, turn-taking ability, and lexical selection categories may be rated as appropriate or inappropriate. Using a functional communication measure, such as the American Speech Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) (Frattali, Thompson, Holland, Wohl, & Ferketic, 1995), rather than profiling specific deficits, the overall quality of communication in "real-life" activities can be established, as well as the amount of assistance needed during these activities. …