Research into communication disorders has been undergoing a slow revolution over the past few decades with some fascinating advances and some exciting new directions ahead. The major change in emphasis that has emerged is an interest in assessing communication as this relates to real-life everyday type situations. In particular, three major thrusts can be identified. The first is the application of socially relevant linguistic theory to communication disorders. Thus, theorists such as Halliday have provided useful frameworks for identifying patterns in discourse. In turn, these have revealed the strengths and weakness of speakers with aphasia or other communication disorders (e.g., traumatic brain injuries) and also what their conversational partners do to help or hinder this process. The second is an examination of how cognitive processes, including memory, inferential reasoning and social cognition, contribute to communicative competence in people who have communication disorders but not aphasia, such as those with Alzheimer's disease, with traumatic brain injuries and with right hemisphere lesions. The third is the adoption of a more integrated approach, whereby verbal and nonverbal behaviours are examined in detail for their communicative meaning, for both the purposes of characterising communication breakdown and for developing an integrated treatment approach.

This article discusses the significance of conversation in current clinical practice with individuals with aphasia and their conversation partners. It explores the nature of everyday talk, and provides an overview of how studies to date have examined the conversations of individuals with aphasia and have provided some promising treatment avenues. It also proposes another framework, Speech Function Analysis, that may assist further in incorporating conversational principles into the therapy context. The framework provides a system network for examining speech functions in dialogue, while considering the effects of both lexical and syntactic limitations, and context. Examples of conversations between three individuals with aphasia and their partners are used to illustrate the analysis. The authors suggest that further knowledge of both aphasic speakers' and their partners' interactions as well as clinician–client interactions may increase our insights into this area, and make authentic and meaningful conversation more accessible in the clinical situation and beyond.

This article presents preliminary findings on an investigation into the differences in communicative performance across varying speaking conditions, of an individual with a cognitive–linguistic impairment following traumatic brain injury (TBI). The article compares the communicative exchanges of an individual in a conversation with a therapist, a conversational dyad with a peer with TBI, and in a communication group task where they were interacting with other participants with TBI. The speaking conditions studied included an unstructured chat, the participant requesting information and the participant giving information. Results showed that the person with TBI responded to differences in communication partner and speaker role. He was best able to give information in the unstructured chat with the clinician and the information giving session in the group. Requesting was maximally facilitated in the information request condition with the clinician. Qualitatively, however, the most equal interactions occurred with the peer, with evidence of the person with TBI engaging in typical conversational strategies such as establishing common ground to facilitate topic development and co-constructing the discourse topics. These strategies did not occur in the clinician or group interactions, possibly due to power imbalance in the former and impaired cognitive–linguistic ability in the latter situation. Implications for clinical decision making regarding intervention strategies for patients with cognitive–communication deficits are discussed.

Right hemisphere damage (RHD) following unilateral stroke is often associated with impairment of pragmatic language, specifically, the ability to comprehend inferences that arise from language used in context. Three kinds of cognitive deficits have been proposed to explain the pragmatic deficits in RHD individuals, impaired Theory of Mind (TOM), weak central coherence (CC), and impaired executive function (EF). This study aims to evaluate the explanatory ability of these theories in relation to the comprehension of nonliteral (ironic) jokes versus literal lies. Twenty-one RHD patients and 21 age-matched controls were assessed on tasks tapping TOM, CC processing and general inference ability (EF) and the comprehension of irony. Second-order TOM and EF were found to play a significant role. However, neither construct, either in isolation or combined, completely explained the poor performance of RHD patients on this task compared to control participants.

The term ‘cognitive-linguistic’ has been widely adopted in descriptions of a variety of communication disorders of neurogenic origin. Despite this, clear agreement on the meaning of the term has yet to be reached, with the result that it is used both inconsistently and misleadingly. This lack of terminological clarity also undermines the assessment of complex communicative function. In this article the terminology associated with complex communication disorders is discussed and a simple framework for conceptualising cognitive-linguistic function is outlined. On the basis of this it is proposed that some currently available assessments that purport to measure cognitive-linguistic skills in fact have less explanatory power than other assessments that are often not specifically targeted at communication. Further, it is suggested that the framework offers an ecologically valid basis for the systematic assessment of cognitive-linguistic function.

There is limited understanding of the effects of normal and abnormal aging on gist-based memory in relation to the massive evidence regarding detail-based memory. This void is striking given the widely accepted view that memory is rarely veridical, but most often abstracted. The present study examined the effects of healthy advanced aging and mild Alzheimer's disease (AD) on three distinct forms of gist. Two of these gist forms involved a passage: transformed gist (global generalised meaning of a passage) and main-idea gist (main points of a passage). The third gist form involved a word list: categorical gist (clustering of words according to semantic categories during list recall). These gist forms were assessed in immediate and delayed recall conditions. A total of 36 participants were included: 12 cognitively healthy young seniors (65–79 years), 12 cognitively healthy old seniors (80–95 years), and 12 young seniors with mild AD (65–79 years). The findings revealed that age and dementia did not equally affect all three forms of gist. Specifically, transformed gist was relatively maintained in the cognitively healthy senior groups as compared to the other two gist forms (main-idea gist and categorical gist), whereas all three gist forms were impaired in individuals with AD. The present study suggests that transformed gist operates differently than detail-based memory in the cognitively healthy senior groups. These findings have important theoretical implications in terms of informing existing models on the interrelationship between gist and detail-based memory and clinical implications in diagnosis of AD.

Most studies of conversational discourse in traumatic brain injury (TBI) have used summary measures averaged over time. These measures have yielded useful aggregate data but do not capture the temporal dynamics of interpersonal interactions. To fully characterise the conversational discourse of individuals with TBI, it may be useful to consider individuals and behaviours as systems changing over time. In this article, we review dynamic systems approaches that have been used to study conversational interactions, and present data to illustrate their potential utility in characterising the conversational discourse of individuals with TBI.

Unsuccessful social communication after traumatic brain injury (TBI) is often a consequence of self-regulatory (executive function) impairments. The primary goal of this article is to describe an approach to intervention for individuals with self-regulatory impairments that is individualised, sensitive to context and to the role of everyday communication partners, and supported by personally compelling metaphors. After a brief review of the social communication outcome literature, an innovative approach to improving social competence is presented and illustrated. The article ends with a review of the evidence base for social skills and self-talk interventions.