"Natural" conversation: A treatment for severe aphasia

Background: Many treatment approaches based on different concepts of aphasia have been proposed. Nowadays two main approaches face each other: the impairment- and the consequences-based approaches. The impairment-based approach draws directly from cognitive neuropsychology and is aimed at improving the linguistic deficit. The consequences-based approach (or functional or psychosocial approach) has its roots in the pragmatic approach and endeavours to reduce the consequences of aphasia in daily living. Aims: The aim of this study is to present a treatment for severe aphasia that partially reconciles the two approaches. It incorporates some principles of the impairment-based approach and utilises them in a onaturalo situation that has a direct impact on the daily life of patients with aphasia. Methods Procedures: The description of the characteristic of a conversation between two normal interlocutors serves to illustrate how a theory of conversation can help guide the clinician's behaviour during onaturalo conversation/rehabilitation with a severely aphasic patient. Application of the conversation/rehabilitation treatment is illustrated by the case of Mr I, a global aphasic patient 18 months post-onset who underwent 9 months of treatment. Outcomes Results: Positive outcome was obtained. Mr I was initially unable to keep in contact with anybody or even understand that others were trying to interact with him. After treatment, his approach to others had substantially changed. He showed interest in what happened around him and was capable of sustaining a conversation if his interlocutors took some simple measures to facilitate his comprehension. Conclusions: The conversation/rehabilitation treatment partly reconciles the impairment- and consequences-based approaches and this study demonstrates that at least for one man with aphasia, Mr I, the treatment was successful.