Choosing Discourse Types That Align With Person-Centered Goals in Aphasia Rehabilitation: A Clinical Tutorial

Purpose: People with aphasia and their families want rehabilitation services that improve real-world communication. Thus, clinicians and researchers have increased focus on discourse-level interventions and outcome measures, most often using monologue tasks to assess discourse production and guide treatment planning. However, communication in everyday life usually involves participating in conversational discourse. This mismatch raises concern because the literature indicates that different types of discourse possess different linguistic and interactional characteristics and that the communication skills of people with aphasia vary across different types of discourse. In order to provide appropriate, client-centered services, speech-language pathologists (SLPs) need resources that outline the linguistic and interactional characteristics of each type of discourse. Few user-friendly materials of this sort exist. This tutorial aims to equip clinicians with essential foundational knowledge regarding features of narrative, procedural, and expository monologue, as well as conversation, to aid in the design of discourse-level interventions specific to each individual's discourse needs. Method: This tutorial provides an overview of the research regarding the structure and function of commonly assessed and treated forms of discourse, along with findings regarding the varied and unpredictable communicative performance of people with aphasia across the different types of discourse. We then provide practical applied clinical examples to illustrate the literature findings. Conclusion: Given the differences between types of discourse, when SLPs include discourse in a client's treatment program, the types of discourse activities the client wants to address should align very closely with the types of discourse assessed and treated in the clinic room.