SpeechPathology.com Phone: 800-242-5183

ATX Learning - Difference

Discourse in Aphasia Rehabilitation

Tricia Olea Santos, PhD, CCC-SLP

October 29, 2018



Why should discourse be considered in aphasia rehabilitation?


Discourse is language that is beyond the boundaries of isolated sentences. It is the manner through which sentences are combined to form meaningful wholes. We can look at discourse as connected language. This concept developed from the field of sociolinguistics when Labov, in the 1960s, looked at speech styles in New York. It was also used in interactional sociolinguistics and was studied by several fields, including anthropology, history, sociology, linguistics, psychology, education, and, in the 1990s, speech-language pathology.

There are different discourse genres. The most popular one used in speech-language pathology is narrative discourse. Simply put, narratives are stories. We use these when we ask our patients to describe picture sequences, or have them read a paragraph and then recall the story later. We can also look at this by asking them to tell the story of their stroke, or a memorable experience, or a frightening experience. Another type of discourse is procedural discourse. One of the more popular elicitation methods used in research is, "Tell me how to make a peanut butter sandwich"; and the patient is asked to give the steps.  Conversational discourse is when the person with aphasia is conversing with another person. There is also expository discourse, wherein there is one subject, with details that are logically related to that subject and that may not necessarily be in chronological order. For example, we ask a patient to talk about their stroke. They can discuss the symptoms of the stroke, the causes of the stroke, and the risk factors behind the stroke. These are not chronologically related - unlike a story - but they all revolve around one topic.

Why is it important that we consider discourse in aphasia rehab? From the patient's perspective, patients with aphasia choose to speak about their life experiences. They want to reconnect with their families and focus on communication that helps them with activities of daily living. If you were to put yourself in your patients' shoes and you only had very limited language, where would you want to put all your effort? This idea was underscored in the 1970s by the work of Holland and Sarno, wherein they would emphasize functional communication rather than linguistic accuracy for persons with aphasia. Persons with aphasia “communicate better than they talk,” in that there is very little relationship between the severity of the language impairment and the ability to communicate in daily life.

Also, from a clinical perspective, we want to get a comprehensive analysis of what our patients can and cannot do by examining how they perform in social contexts. Another important reason to consider discourse is that discourse allows us to examine the cognitive and linguistic aspects of expressive language via natural forms of communication. 

Consider the following question.  What are the various cognitive tasks that are required for engaging in our patients in discourse? Discourse is a complex task that involves executive skills, working memory, and long-term memory. For example, if you asked a patient to talk about his wedding day, he would need to recall information from his memory. He would need to select what to include and what not to include. He would need to remember what has been said and try to organize what he is about to say while accounting for what the listener may or may not know and also while maintaining that same topic.

Finally, it is important to consider discourse because it can be used to identify meaningful changes in communication that may not be detected on standardized battery tests. 

Please refer to the SpeechPathology.com course, Discourse Intervention in Aphasia: The Clinical Value of Stories and Conversation, for more in-depth information on the importance of discourse in patient-centered care and various approaches to incorporating discourse in aphasia rehabilitation.


tricia olea santos

Tricia Olea Santos, PhD, CCC-SLP

Tricia Olea Santos is an adjunct assistant professor at the School for Behavioral and Brain Sciences, University of Texas at Dallas. She has over 20 years of clinical experience and 5 years of teaching and supervision at the undergraduate and graduate level. Her primary research interests include discourse in healthy aging and adult neurogenic populations (aphasia, right hemisphere, dementia), adult dysphagia, health literacy and health education of the elderly, and therapy considerations when working with bilingual/bicultural adult populations. She also works in various medical settings as a per diem SLP. She has co-authored journal articles and a book chapter on topics pertinent to discourse in healthy aging and aphasia. She has also presented on these topics in national conventions.

Related Courses

Discourse Intervention in Aphasia: Renegotiating Identity Post-Stroke
Presented by Tricia Olea Santos, PhD, CCC-SLP


Tricia Olea Santos, PhD, CCC-SLP
Course: #8925Level: Intermediate1 Hour
  'I like that it focused on the identity and sense of self for PWA instead of highlighting deficits'   Read Reviews
This course examines the loss of identity in aphasia and essential factors in renegotiating identity post-stroke. The role of discourse and strategies to facilitate positive social identity are discussed.

Acceptance and Commitment Therapy: An Introduction for SLPs
Presented by William S. Evans, PhD, CCC-SLP


William S. Evans, PhD, CCC-SLP
Course: #10771Level: Intermediate1 Hour
  'Very applicable and immediately actionable - great course!'   Read Reviews
An introduction to Acceptance and Commitment Therapy (ACT), a modern evidence-based counseling approach, is provided in this course. Research support for ACT is discussed, and case studies to illustrate how ACT techniques can help patients and their families with the psychosocial consequences of living with communication disorders are presented.

Best Practice for Assessment and Treatment of Bilingual Aphasia
Presented by Maria Muñoz, PhD, CCC-SLP


Maria Muñoz, PhD, CCC-SLP
Course: #9759Level: Intermediate1.5 Hours
  'The quality of information and the presentation of it in a very organized and easy to understand matter'   Read Reviews
This course focuses on best practice in the assessment and treatment of bilingual aphasia by speech-language pathologists. Recommended practices are contrasted against common mistakes made by clinicians working with bilingual patients with aphasia. Implementation of best practices are modeled through case studies.

20Q: Goal and Treatment Selection in Aphasia in 20 Sessions or Less
Presented by Jackie Hinckley, PhD, CCC-SLP


Jackie Hinckley, PhD, CCC-SLP
Course: #9281Level: Intermediate1 Hour
  'encouraging client desires/social needs in selecting goals'   Read Reviews
Have you ever wondered how to focus aphasia therapy and set reasonable goals when treatment time is limited? This course will provide evidence-based guidance on goal-setting and treatment selection for aphasia with examples from time-limited situations.

20Q: Mental Health, Aphasia, and the SLP’s Role
Presented by Rebecca Hunting Pompon, PhD


Rebecca Hunting Pompon, PhD
Course: #10306Level: Intermediate1 Hour
  'This topic is not discussed or taught as much as it should be in graduate programs'   Read Reviews
Depression and other mental health challenges are prevalent in individuals with aphasia. Recent research on the mental health status of individuals with aphasia, along with mental health and well-being screening options and basic counseling approaches that can be used by SLPs, are discussed in this 20Q.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.