Towards combining the cognitive neuropsychological and the pragmatic in aphasia therapy

Given that the aim of aphasia therapy is to improve communication rather than performance on formal tests, cognitive neuropsychologically-based approaches need to provide evidence that successful outcomes generalise to communication in everyday life. One means of doing this is to address everyday communication directly by combining inferences made from a psycholinguistic assessment with analysis of natural conversation. This permits the individualised case-study approach used in cognitive neuropsychology to be applied in pragmatic intervention, since ethno-methodologically driven Conversational Analysis (CA) also uses a fine level of detail from individual language users. This can then be applied in indirect intervention achieved through caregivers. In the study reported here, the word-finding difficulties of two aphasic women were interpreted from a psycholinguistic perspective, and conversations between them and their caregivers at home analysed using CA. Inferences from both were combined in order to establish strategies which the respective caregivers could apply in facilitating communication with their aphasic partners. Individually tailored recommendations were given to the caregivers, both orally and through booklets, which included specific illustrations of these strategies from the conversations. Re-assessment two months later showed subjectively positive changes in communication.