Approaches to assessment and treatment for people with aphasia have traditionally taken a syndrome or deficit-based view. It’s only in the last few decades that a more functional approach to aphasia has been recognised, namely the need to couch both assessment and treatment in the context of the person with aphasia participating in life. This included observations of discourse-level functional communication, using observers’ ratings to judge the success of communication. This study describes a ‘traditional literature review’, searching databases from 1982 to March 2024 for published studies of people with aphasia’s discourse (conversational or narrative) that utilised ratings from observers on aspects of communicative success. The authors identified a total of 26 studies describing data from 349 people with aphasia. Four studies rated the success of people with aphasia in conversation, considered the most highly situated discourse genre. However, these studies are limited, because activities, topics and contexts are highly varied across people. Other studies used personal narratives, picture descriptions sequences, story retell procedural discourse or word description, which can control for many factors not controllable in conversation. These discourse samples were judged in terms of success, either from video or audio samples. Where only audio samples were available, judgements consistently indicated people with aphasia performed worse. Judgements of communicative success are always limited by the judger’s biases, and ultimately it is the person’s communication partner who may be the best judge of success. Whilst we constantly aim to make assessment objective, when it comes to communication it may not be possible to ensure this. It is possible that embracing the context of the person’s life may ultimately be most valuable.
In the context of the person with aphasia participating in life
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