Abstract/Summary

Aphasia is an acquired language impairment most often caused by stroke. One of the main goals of speech and language therapy is to improve a person’s ability to communicate in everyday life. Research on this level of functioning, often referred to as functional communication, has grown since the 1980s. The lack of a clear conceptualisation of the term functional communication has, however, negatively affected the evidence base for the assessment and treatment of everyday communication in aphasia. This thesis explores the theoretical, practical and empirical operationalisation of functional communication in aphasiology by addressing the following questions: How can we: (1) define real-world communication? (2) measure functional communication in an ecologically valid manner? and (3) investigate communication experimentally? A scoping review was conducted to identify a theoretical framework of real-world communication, followed by a review of existing research on each component of the framework in the aphasia and control literature, to get an overview of the existing evidence base. The framework was used to evaluate the content validity of existing clinical measures of functional communication. Finally, sixteen PWA and sixteen matched NHC participated in an experimental investigation of communication to identify which communication measures uniquely characterised communication for the aphasia group. The construct validity of one measure was established, and the influence of conversation partner familiarity on communication for PWA was explored. Results showed that real-world communication is interactive, multimodal and embedded in context. The Scenario Test (van der Meulen et al., 2010) was selected as the instrument with the highest content validity. The experimental work provided support for the use of a lab�based task to explore communication in aphasia and identified two important characteristics of aphasic communication (the amount of information exchanged and modalities used). PWA were shown to respond differently to an unfamiliar conversation partner compared to controls. Finally, the results suggest some PWA show evidence of learning on the experimental, communicative task. Together, these results provide important insights into functional communication in aphasia. Theoretical and clinical implications of these findings are discussed.