Communication disability of aphasic persons in daily living.
Jean-Michel Mazaux (University of Bordeaux)
Impairment of communicative ability is one of the most devastating affects of aphasia on an individual's life. From a qualitative point of view, aphasia impairs both verbal and non verbal pragmatic competencies. Verbal skills are poor, and fluency is usually decreased. Lexical items are often inadequate in regard to the aphasic speaker's intention. Syntactic complexity, humour, implicit and inferences are critically reduced or impaired. Modern conversation analysis provides evidence of impairments in partner roles, for instance turn-taking during conversations, deciding conversation topics, switching from one theme to another, and processing verbal repairs during speech. Although non verbal competencies are said to be less impaired, it is far from clear that they are, and in which clinical forms of aphasia such impairments occur. Non verbal tongue and lips noises, looks, smiles and facial gestures are frequently increased, especially in the case of severe fluency and/or phonetic impairment, as an attempt to overcome the verbal impairment. Gesture changes are also observed, with great variability from one patient to another. Taking together, all of these symptome result in a dramatic decrease in communication ability in daily living.
We studied 127 aphasic patients with a new, well-validated assessment tool, the Bordeaux Verbal Communication Disability Rating scale, and found that in daily living, these patients were mostly impaired in reading (68% impaired) and writing (79%) complex and/or administrative documents, performing conversation activity about complex material (59%), using checks and credit cards (57%), calling unknown persons on phone (54%), and talking the first with unknowns (50%). These should be priority goals of speech therapy in aphasia.