Communication impairment and activity limitation in stroke patients with severe aphasia

Purpose. This study investigated how patients with severe aphasia communicated in daily living, which verbal and nonverbal communication skills were spared and which were impaired, and whether activity limitations in communication are related to verbal impairments. Methods. Twenty-seven patients with severe aphasia and 9 with moderate aphasia originating from a sample of 102 aphasic persons followed up in a French regional survey were assessed with a communication test and a communication activity limitation questionnaire 12-18 months after a first stroke. Results. Patients with severe aphasia suffered severe activity limitations in communication, with performance 3-fold lower than that of patients with moderate aphasia, and 4-fold lower than scores attained by normals. Both aphasia severity and communication disability at follow-up were related to the initial severity of aphasia. Using a phone, credit card and a chequebook, reading and filling in administrative documents, and communication behaviours involved in social life were the most severely impaired. Non-verbal communication performance was not related to aphasia severity. Conclusions. We conclude that there is a great need for speech therapy research to develop new compensatory or alternative strategies for patients with severe aphasia.