APHASIOLOGY,

2000, VOL. 14,

NO.

9, 875892

Review
Aphasic discourse analysis: The story so
far
ELIZABETH ARMSTRONG
School of Communication Sciences and Disorders, University of Sydney,
Australia

Abstract
This paper provides a critical review of the literature currently available relating
to aphasic discourse. It outlines the major approaches which have been taken to
analysis, differentiating the structuralist and functionalist frameworks in particular and discusses the resultant gap existing in aphasiology research between
microstructural linguistic aspects of discourse and macrostructural/pragmatic
aspects. Studies addressing lexical, syntactic, semantic, pragmatic and conversational aspects of discourse, as well as those focusing on specific aspects such as
cohesion and text macrostructure are discussed and placed in a theoretical perspective. The different methodologies involved in the various studies are critically
examined, with implications for using different elicitation techniques in particular
discussed.

Introduction
The aphasiologist analysing discourse directly addresses the question of how aphasic
speakers talk in connected speech in everyday situations. In such an endeavour, the
following kinds of questions are of importance: what kinds of meanings can aphasic
speakers convey? What lexical and grammatical resources do they use in order to convey
these meanings? Given the lexical and grammatical problems inherent in aphasia, at
what point do these become so pervasive that meanings are impossible to construe? And
from another perspective, given these well-documented problems, how is it that listeners
actually understand many aphasic attempts at communication as well as they do in so
many cases?
In attempts to answer some of these questions, a variety of frameworks have been
used to gather data which document lexical and syntactic patterns occurring in aphasic
discourse as well as patterns of overall text structure and cohesion. Some studies have
utilized principles based on previously used lexical and sentence-level syntactic analyses
(e.g. Wagenaar et al. 1975, Miceli et al. 1989) while others have used broader discourse
notionssome based on cognitive/linguistic text theories (e.g. Ulatowska et al. 1981,
Ulatowska et al. 1983, Glosser and Deser 1990) and some less theoretical but functionally based (e.g. Yorkston and Beukelman 1980, Shewan 1988).
Address correspondence to: Elizabeth Armstrong, School of Communication Sciences and Disorders,
University of Sydney, Lidcombe Campus, P.O. Box 170, Lidcombe, N.S.W. 1825, Australia.
Email: b.armstrong@cchs.usyd.edu.au
2000 Psychology Press Ltd
http://www.tandf.co.uk/journals/pp/02687038.html

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Elizabeth Armstrong

While these different perspectives have all contributed to our understanding of

aphasic discourse, the different views on what discourse is often appear to lead to a
variety of results/characterizations which may not be compatible and which may be
confusing with respect to clinical implications. The formalist or structuralist approaches
view discourse as a level of language above the sentence (Harris 1963, 1988, Grimes
1975, Saffran et al. 1989, Schwartz et al. 1994) and see it best characterized in terms of
its constituent sentences as well as lower constituent ranks, such as the phrase and word.
Functionalist approaches (Halliday 1979, 1985a, Martin 1992), on the other hand, are
concerned with the way discourse is achieved in terms of more global issues such as
overall success in conveying meaning, appropriateness of particular patterns of language
to a particular situation, topic maintenance and turn-taking, with social context being
an integral part of the framework and the analysis. Cognitivists (Kintsch and Van Dijk
1978, Frederiksen et al. 1990) fall somewhere in between and are concerned with specific
discourse content, but often at the macrostructure level (in terms of the overall organization of the text into meaningful `chunks such as orientation, complication, resolution) rather than the microstructure analysed in a structuralist approach.
While these different frameworks could be seen as complementary, research has rarely
addressed the potential connections between them. Consequently, there is little information available on, for example, how text macrostructureis realized through words and
sentences, why relatively structurally intact sentences do not always lead to a coherent
text, or how topic maintenance and appropriate turn taking skills are actually realized in
the language itself. This leads to difficulty in identifying processes involved as well as
planning discourse level interventions based on anything other than broad notions.
While notions such as text structure and topic maintenance describe important aspects
of coherent discourse, discussion of the ways in which they are achieved linguistically
may well shed light on the processes involved and hence on the potential reasons for
breakdown, not to mention clarifying the specific linguistic skills that are required in
order to support their perception.
In addition to and in many cases, because of their numerous different theoretical
bases, discourse studies have also employed very different methodologies and have used
different amounts of data as representative samples of discourse. For example, a variety
of elicitation techniques has been usedsome studies obtaining discourse samples
through the use of pictures, some using interactive conversation, while others have relied
on monologic recounts. The nature of the elicitation technique has major theoretical
ramifications in that each one elicits a different discourse genre. Genres are defined by
Eggins and Martin (1997) as `different ways of using language to achieve different
culturally established tasks (p. 9), with examples of genres being a recount, discussion or
report, a buying/selling encounter, a recipe, a poem, etc. There is much evidence to
suggest that texts of different genres are composed of different patterns of wording and
grammar (Halliday 1985b, Martin 1992, Eggins and Martin 1997). Hence, there is
potential for much variability between genres, and comparisons of data based on different genres can be problematic.
The amount of data analysed is also important in that many picture descriptions tend to
be brief and more controlled than more spontaneous discourse and abilities may not always
be well represented. While what constitutes a representative sample is still controversial,
the issue needs to be recognized when reviewing and comparing discourse results.
The aim of this paper is to provide a critical overview of the major findings thus far in
the study of aphasic discourse, highlighting philosophical as well as methodological
issues and their ramifications.

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What is discourse?
There are two main definitions of discourse which reflect the different theoretical perspectives. The first comes from a formalist or structuralist perspective and describes
discourse as a unit of language above the sentence (Harris 1963, 1988, Grimes 1975).
Using this definition, discourse is best characterized through analysis of its constituent
sentences as well as lower constituent ranks such as phrase and word. A text (the terms
`text and `discourse will be used interchangeably in this paper) is viewed as being the
sum of its parts. While a text is obviously used for a purpose, the linguistic nature of the
text and the context in which it is used are seen as separate entities, with little attention
paid to the latter in a structuralist framework.
A second definition comes from a functional perspective which regards discourse as
language in use (Goffman 1981, Halliday 1985a, 1985b) and sees text and context as
inextricably interwoven. The discourse or text is seen as a semantic unit rather than a
grammatical one and its length is irrelevant. A text or discourse could be a STOP sign on
the road, a chapter in a book or a casual conversation. It is the fact that the language is
semantically complete and coherent in its context which makes it a text or discourse.
Important in the functional paradigm is the purpose of the language and its characterization according to that purpose. From the functional perspective, the social
context and purpose of the discourse is integrally related to its lexicogrammatical realization, i.e. the wording and the grammar. For example, educational discourse will be
different from medical discourse, a lecture will vary from a casual conversation and a
story retold will be different from a procedure outlined. Examples of differences include
the following:
. type of vocabulary used, reflecting different topics, levels of technicality;
. verb tenses, reflecting e.g. recounts (past tense) vs. an explanation of a procedure
(present tense);
. pronoun usage, reflecting degrees of explicitness/implicitness required (e.g. between
familiar vs. unfamiliar participants); and
. verb types, reflecting different genres, e.g. material verbs predominating in recounts,
relational verbs (e.g. `be) predominating in explanations.
While the structuralists focus on the language as a system in and of itself, the
functionalists see language as a social phenomenon, grounded in social context.
Discourse findings to date
Structuralist-oriented research
Much aphasiological research has come from the formalist or structuralist perspective in
which samples of spontaneous speech have been analysed in terms of different levels of
constituencyfocusing mainly on what has been termed text `microstructure. `Spontaneous speech or `discourse in this research has included single picture descriptions,
stories produced in response to a series of pictures, stories retold from previous accounts,
stories told as a recount of a culturally well-known fable, as well as monologues obtained
by the speaker being asked to speak about a particular topic, e.g. family, his/her illness,
occupation.
These analyses have focused on microlinguistic aspects of the speakers discourse
both lexical and syntactic. Lexis has been examined from both a semantic perspective
(e.g. incidence of paraphasias, non-specific lexical items) (Wagenaar et al. 1975, Nicholas

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et al. 1985, Dressler and Pleh 1988, Glosser et al. 1988, Vermeulen et al. 1989) and a
grammatical one (varieties of word classes used) (Berko-Gleason et al. 1980, Saffran et al.
1989). Studies have documented the word-finding difficulties also evidenced and welldocumented on naming tasks (Dressler and Pleh 1988, Larfeuil and Le Dorze 1997)
although discrepancies between findings on single word-retrieval tasks and lexical
performance during spontaneous discourse have been reported (Williams and Canter,
1981, Nicholas et al. 1985, Vermeulen et al. 1989, Armstrong 1997).
Analyses of word classes used by aphasic speakers has primarily focused on the
structural problems demonstrated by agrammatic aphasic speakers. Findings suggest
that they use more nouns than verbs, less closed class words, less pronouns than normal
and demonstrate frequent omissions of determiners. Wernickes aphasic speakers, on the
other hand, have been found to use more verbs than nouns (Berko-Gleason et al. 1980).
Syntactic abilities during discourse have been explored in terms of grammatical
complexity of sentences, syntactic error and more recently clause argument structure
(Miceli et al. 1989, Roberts and Wertz 1989, Saffran et al. 1989, Brenneise Sarshad et al.
1991, Goodglass et al. 1993, Schwartz et al. 1994, Bird and Franklin 1996). Agrammatic speakers in general have been found to have less grammatically complex language
than normal speakers, use verbs with the simplest argument structures and demonstrate
a range of omissions of various grammatical structures e.g. the subject of a sentence, its
main verb, required functors and inflections. Most recently, however, attention has
turned to the grammatical patterns observed in the discourse of fluent aphasic speakers
(Edwards 1995, Bastiaanse et al. 1996, Bird and Franklin 1996, Marshall et al. 1997,
Bastiaanse and Jonkers 1998, Edwards and Bastiaanse 1998). Grammatical errors have
been found to occur (Martin and Blossom-Stach 1986), although the amount and
quality of the errors are obviously different from those found in the discourse of
agrammatic speakers (Caplan 1987, Grodzinsky 1990, Kolk and Heeschen 1992). In
addition, fluent aphasic speakers have also been found to have reduced syntactic complexity (Edwards, 1995) and a reduced frequency and diversity of verbs (Bastiaanse et al.
1996, Edwards and Bastiaanse 1998).
Functionalist-oriented research
More functionalist-oriented research has attempted to investigate discourse from the
perspective of its meaning within a certain contextmore at the level of text `macrostructure. While this level could be considered to be yet another level of constituency
from a structuralist perspective, it is more semantic than syntactic in nature. This level is
concerned with the overall meaning of the text and the way meanings are organized
within the text. In this light, it is also concerned with context and the purpose of the text
from a social perspective. Ulatowska and colleagues were one of the first groups of
aphasia researchers to differentiate between the text structures of different types of
discourse, e.g. narrative and procedural discourse, exploring the aphasic speakers ability
to produce appropriate overall text structure suitable to the purpose of the discourse.
Researchers have found that mildly and moderately impaired aphasic speakers are still
often capable of creating a text based on the same structural principles as employed by
non-brain-damaged speakers. For example, they retain the structural aspects of setting,
complicating action and resolution in a narrative (Ulatowska et al. 1981, 1983, Glosser
and Deser 1990), and the obligatory elements in procedural discourse (i.e. the discourse
of giving directions, instructions on how to complete a particular task), although the
optional elements tend to be omitted quite often (Ulatowska et al. 1983). Ulatowska et

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al. (1983) describe the texts of mildly and moderately aphasic speakers as being on a
continuum with those of normal speakersvarying in terms of reduced quantity and
complexity, rather than containing many specific qualitative differences.
Audrey Holland led a significant movement in the late seventies/early eighties which
addressed the success of discourse in terms of the meanings conveyed by the aphasic
speaker, despite the microstructural linguistic breakdowns observed at the clause level.
Holland (1982) was concerned with what she termed `functional communicationthe
communication occurring in everyday situations rather than that being tested on
standardized, decontextualized language tests. In efforts to address such functional
communication, researchers utilized such notions as speech acts, as defined by Searle
(1969) (Wilcox and Davis 1977, Gurland et al. 1982, Kimbarow 1982, Prutting and
Kirchner 1987, Armstrong 1989), speech functions (Ferguson 1993), as defined in
Systemic Functional Linguistics (Halliday 1979, 1985b, Martin 1992) non-verbal and
paralinguistic behaviours during communication (Prutting and Kirchner 1987) as well
as a variety of rating scales of communicative effectiveness/success of discourse (Holland
1980, 1982, Penn 1985, Lomas et al. 1989, Cunningham et al. 1995). These studies have
largely demonstrated that mildly and moderately aphasic speakers are still able to use
language for a variety of functions, despite the breakdown in lexicogrammatical form.
(See Manochiopinig et al. 1992, for a detailed review of this area).
Specific interactive phenomena in the development of conversation between an
aphasic speaker and his/her conversational partner have also been examined, e.g. conversational repair, adjacency pairs, turn-taking (Lubinski et al. 1980, Florance 1981,
Newhoff et al. 1982, Flowers and Peizer 1984, Linebaugh et al. 1985, Gerber and
Gurland 1989, Coelho et al. 1991, Ferguson 1992, 1993, 1994, Milroy and Perkins
1992, Ulatowska et al. 1992, Lindsay and Wilkinson 1999). This research has
demonstrated that many conversational strengths are actually retained by aphasic
speakers, e.g. the ability to successfully repair conversational breakdown (Lubinski et al.
1980, Newhoff et al. 1982, Linebaugh et al. 1985, Ferguson 1992, 1993, 1994, 1998),
maintain appropriate script knowledge (Armus et al. 1989, Ulatowska et al. 1992), as
well as use a similar distribution of turn types as normal speakers (i.e. substantive and
management moves) (Ulatowska et al. 1992). However, differences in aphasic-normal
speaker interactions include reduced complexity in terms of adjacency pair structure
(Ulatowska et al. 1992), increased usage of repair strategies by normal speakers as well a
different distribution of strategy types used by the normal speakers when adjusting to
conversing with an aphasic speaker (Ferguson 1993, Lindsay and Wilkinson 1999). One
of the biggest contributions of this type of conversational analysis has been the
acknowledgment of the two-way construal of conversation, rather than the largely
monologic focus which has prevailed in much analysis of aphasic discourse to date.
Not really fitting into either of the above categories, but belonging to some aspects of
both are analyses which have addressed the notions of content and efficiency of language
used. Yorkston and Beukelmans (1980) `content units, Berko-Gleason et al.s (1980)
`themes and Nicholas and Brookshires (1993) `correct information units and their
1995 `main concepts are examples of measurements used to measure `amount of
information conveyed by the speaker. When these are quantified and related to time,
they produce efficiency measures which can be useful in examining the effort needed by
the speaker to produce discourse and the consequent effort needed by the listener in
receiving the information effectively.
Some of these measures, however, are not generalizable beyond a particular stimulus
picture used in a particular study. More importantly, the significance of the units to the

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text as a whole is unclear, apart from a measure of amount of information (i.e. facts)
conveyed in the text. While Nicholas and Brookshire (1993) tackled the issue of relevance in their definition of correct information units, the notion is incomplete, as
relevance and meaning are not necessarily reflected only by the relevance of individual
words to a texts overall topic. As Hasan (1985, p. 91) noted in her discussion of
cohesion, a text could be full of words relevant to a particular topic but still be totally
incoherent. Consider her following example:
Girl bananas two spend shopkeeper
Apples own girls dollars grapes
Buy fifty sell cents shopkeepers
Girls fruit

In this example, the words all relate to a shopping encounter and yet there is insufficient
structure for this text to be coherent.
Limitation of such units as the content unit and the correct information unit makes
generalizations about aphasic difficulties problematic. For example, while a count of
content units gives some idea of amount of information given, it tells little of what
problems were encountered and how one unit impacted on another in terms of overall
coherence. In addition, while the aim of these analyses was to provide some kind of
evaluation of effectiveness of communication, the lack of adequate linguistic description
of what was actually said makes it difficult to infer just how the speaker achieved the
content units s/he did. Hence, there is a gap existing between the notion of effectiveness
and the actual mechanism(s) for achieving this.
The gap between microstructure and macrostructure and its
implications for analysis of aphasic discourse
What stands out in much of the research to date is the lack of connections made between
conversational behaviours, text macrostructure and text units and the actual wording/
grammar of a text, i.e. the different levels of language being analysed by the different
frameworks. While information is available on clause argument structure and word
classes available to different types of aphasic speakers, how are they related to the
functions mentioned above such as speech acts, turn-taking and topic maintenance?
What are the crucial ingredients for topic maintenance? What enables members of a
conversational dyad to take turns? What are the linguistic cues for turn-taking? And
what are the linguistic criteria for success?
The different `levels of language have been separated in aphasia research to the point
where it has been suggested that a dissociation between the skills required for intact text
microstructure and text macrostructure may exist (Glosser and Deser 1990, Ulatowska
et al. 1990). Ulatowska et al. (1990) note that while sentential difficulties must
obviously impact on discourse meaning, the relatively intact macrostructure of aphasic
texts suggests that these two aspects of language are independent to some extent.
Glosser and Deser (1990) are in agreement with this hypothesis, finding that a group of
fluent aphasic speakers with significant intrasentential and lexical deficits were still able
to be rated as coherent in discourse by listeners.
Glosser and Deser suggest two possibilities: that macrolinguistic skills (related to
the construction of the macrostructure of texts) may be related to the right hemisphere
rather than the left hemisphere, which may be responsible for microlinguistic abilities

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only or that `macrolinguistic processes rely on the integrity of neurologically distributed systems which may be nonspecifically distributed with different kinds of
multifocal or diffuse cerebral pathology (p. 86). Their supporting evidence for this
came from the same study which also looked at closed head-injured and demented
speakers. Unlike the aphasic speakers, both these groups demonstrated breakdown in
text coherence in terms of the texts macrostructure but not so much in terms of intrasentential microstructure. The demented speakers demonstrated no intrasentential
problems, while the closed head injured speakers demonstrated some syntactic and
lexical problems, but not as many as the aphasic speakers and did not differ from
normal speakers in terms of syntactic complexity. Both of these groups had diffuse
cerebral pathology rather than the specific left-hemisphere damage of the aphasic
subjects.
Christiansen (1995) on the other hand, raised the question as to whether coherence
actually is still relatively intact in aphasic discourse and queried the kind of dissociation
described above. Christiansen analysed the discourse of 15 fluent aphasic speakers from a
perspective of propositional coherence, i.e. the texts were divided into propositions and
the propositions were rated in terms of coherence violations (violations of completenessinformation gaps, progression and relevance). Christiansen found that her three
aphasic groups (anomic, conduction and Wernickes aphasic speakers) differed from
normal speakers. While she attributed the anomic and conduction speakers violations to
compensation strategies (e.g. the anomic speaker skipped propositions due to wordfinding difficulty rather than to a lack of awareness of the information which was
required), the Wernickes aphasic speakers indeed had an actual impairment with
respect to coherence, i.e. they produced an inordinate number of irrelevant propositions
and `. . . seemed to have difficulty in organizing and detailing their narration in a way
that aided the listener in deducing the intended propositional macrostructure (p. 311).
Huber (1990) also reported similar problems in Brocas, amnesic and Wernickes aphasic
speakers.
Of course the notion of textual coherence and its measurement is a relatively controversial one. Hence, the disparate findings above may perhaps reflect slightly different
definitions of coherence or difference in methodologies for measuring it. While there is
insufficient space here to explore the notion and definition of coherence, the question
remains as to whether a dissociation between micro-structure and macrostructure exists
or is even possible. Perhaps the question itself is misleading and that in fact a continuum
of coherence exists, which is closely linked to text microstructure. Obviously a certain
degree of clear word and clause level meanings is required before interpretation of a text
can be made, and context and linguistic information surrounding a problematic section
of text may facilitate a listener `guessing at meanings. However, there may be a point at
which the clause level breakdown becomes so significant as to negate the contributory
clues of context and the text structure as a whole and make the text functionally
incoherent.
Further analysis of texts in terms of their microstructure and macrostructure and the
ways these are linked to each other is of prime importance in working out the essence of
coherence. What makes some aphasic speakers able to be understood, while others are
not? Is it merely the level of breakdown in microstructure which is the deciding factor?
Or could interpretation of problematic meaning at the clause level be facilitated if
macrostructurewas better organized? And how is macrostructure realized if not through
the microstructure?

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Cohesion analysis

Possibly one of the only analyses used in aphasia research to date which directly attempts
to link the micro and macro aspects of a text is the cohesion analysis. As defined by
Halliday and Hasan (1976), cohesion refers to the phenomenon which occurs when `the
interpretation of some element in the discourse is dependent on that of another.
Cohesion is thus a semantic relation realized by cohesive devices which are either lexical
or grammatical in nature. These include grammatical devices such as pronouns,
demonstratives, the definite article, ellipsis and substitution as well as lexical devices
such as repetition, synonymy, antonymy and collocation. Halliday and Hasan proposed
a direct relationship between the amount of cohesion in a text and its overall coherence
(Halliday and Hasan 1976, Hasan 1985). This is a clear example of microlinguistic
phenomena being linked to macrolinguistic phenomena.
Cohesion has been explored in aphasic discourse, with aphasic speakers being found to
have significant difficulties in creating successful cohesive ties. In particular, pronouns
and demonstratives are often used either completely without antecedents Ulatowska et
al. 1981, 1983, Lemme et al. 1984, Piehler and Holland 1984, Bottenberg et al. 1985,
Nicholas et al. 1985, Armstrong 1987, Penn 1987, Dressler and Pleh 1988, Glosser and
Deser 1990). Similarly, the use of the definite article has often been found to be problematic, with no previous reference available to the lexical item highlighted by the
article. Lexical cohesion has been studied to a lesser extent but has been found to be
restricted in variety in aphasic discourse (Armstrong, 1988), while cohesive harmony
(the interaction of cohesive elements within a text) has also been found to be reduced in
aphasic speakers discourse compared to that of normal speakers (Bottenberg et al.,
1985, Armstrong, 1988). The amount of cohesive harmony in a text has been correlated
with listener perceptions of coherence (Armstrong, 1987), reflecting the role of the
cohesive devices in pulling together the text, creating texture and ultimately contributing to overall coherence.
Cohesion analysis allows examination of explicit linguistic links between clauses and
in so doing, it looks at both grammatical and semantic continuity across the discourse.
When one looks at meanings imparted during discourse, i.e. language operative in some
context, one immediately sees that their `nature is far from simple. Referential meaning
of individual words is certainly part of the picture, as is the meaning conveyed by
individual clauses/sentences. However, it is very clear that the meaning of a text or
discourse is not simply a sum of the meanings of all the individual sentences. For
example, if a clause was taken out of a text, it may not always make sense standing alone,
e.g. he saw it in the distance. There is clearly some dependency operating here through
which the identities referred to by the pronominals he and it are identified explicitly
elsewhere in the text. Again, distance implies distance from some point in (abstract or
concrete) space; and typically the identity of the latter would become accessible textually/contextually. Similarly, in a narrative discourse, temporal or causal connections
may be made between clauses which are essential to the texts continuity/coherence. In
these cases, the ordering of the clauses and/or the conjunctive relationships between
them are as important as the content of the individual clauses, and a sentence-focused
approach to discourse is not well equipped to handle these complexities.
Longitudinal studies
While not always using greatly different measures from many of the studies already
discussed, longitudinal studies often appear to be attempting to link some of the micro-

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and macro- aspects of discourse as they try to account for changes observed. This could
be the case because the researcher is faced with the challenge of quantifying the changes
that are often evident so intuitively in aphasic discourse over time but which are difficult
to capture in any one measure. There is also an inherent difficulty in classifying changes as
improvements or deteriorations,based on quantitative data alone, as noted by Prins et al.
(1978). Before one can say that a certain phenomena represents one or the other, one has
to look at the success of the meanings conveyed in the text overall, i.e. the macrolinguistic aspects of the text. To say that fluent speakers produced less complex utterances over time and hence were deemed to have `deteriorated on this dimension may
well be a misinterpretationof the type of discourse they were producing. Fluent aphasic
speakers are notorious for using convoluted tangential language. It may be that in using
less of this detailed florid language the logic of their inter-clausal connections became
slightly simplified and hence clearer to the listener. Saying that their syntactic complexity lessened is not necessarily equivalent to saying that this constitutes a deterioration in their discourse. Similarly, it is successful co-reference which is a measure of
effective pronoun usage rather than simply examining amounts of pronouns used. As a
further example, counting average numbers of words per utterance may assist in
characterizing the amount of discourse produced, however it tells little of the quality of
the discourse.
A group of longitudinal studies focusing more on specific discourse measures such as
cohesion and text structure described changes from a more qualitative perspective in this
regard. In looking at cohesion, Piehler and Holland (1984), Coelho et al. (1994) and
Armstrong (1997) all reported increasing numbers of cohesive ties in the discourse of
their subjects over time, potentially improving overall textual coherence. However,
Armstrongs finding that the more global measure of cohesive harmony (a measure of
interactions of cohesive ties purportedly reflecting overall textual coherence to a greater
extent than just the counting of ties) did not change in the discourse of three aphasic
speakers over a twelve month period complicates the issue somewhat, and obviously
requires further investigation of other factors related to cohesion and coherence.
While studies of text structure have generally found relatively intact macro-structural
abilities as reported above, Coelho et al.s (1994) single case study found that story
grammar abilitiesin particular the ability to produce a number of complete episodes in
each storydid not change over the twelve month period and that the subject was
unable to generate more than two complete episodes as compared to the three normal
subjects who produced four and five complete episodes on the same task.
The findings of this study are particularly interesting in that to date, microlinguistic
abilities (sentence level grammar and cohesion) have been reported to be more severely
impaired in aphasia than macrolinguistic ones (involving such things as story grammar)
(Ulatowska et al. 1981, 1983, 1990, Glosser and Deser 1990). The findings of this study
suggest that some types of macrolinguistic abilities can also be significantly impaired
even in a mildly aphasic speaker. Interestingly, it was the so-called micro-linguistic
aspect of cohesion which improved in this speaker more than the macrolinguistic one of
story grammar which remained significantly impaired over the period studied.
Other studies have included a number of conversational phenomena in their analyses
including conversational turn-taking, conversational `successes and `failures (Holland et
al. 1985, 1985b) as well as a set of pragmatic components (Murray and Holland 1995)
such as `facilitator functions (e.g. queries, social `lubricants), `tangler functions, i.e.
unsuccessful conversation strategies (e.g. unintelligible and incoherent responses),
`metaconversational functions such as fillers (e.g. uh, um) and spoken failures (e.g.
perseverations, failed word search). In addition, comments were made which attempted

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to connect the word/clause measures with the discourse as a whole. For example, instead
of simply looking at mean length of utterance as a measure in isolation, remarks are
made about the quality of the utterance in terms of its level of coherence, confabulation
and the degree of semantic (informational) error contained in the utterance. Also,
information was provided on how the patients used the language they had in terms of
introducing new topics, commenting on already existing topics and turn-taking
attempts. This described more qualitatively how the patients were actually communicating in real-life situations with a communication partner.
Another study examining a variety of measures and their relationship to each other is
that of Penn (1987) who used both pragmatic measures (subjective ratings of `sociolinguistic sensitivity, fluency, appropriateness of response to interlocutor and control of
semantic content) as well as syntactic measures based on the LARSP (Crystal et al. 1976)
to analyse the discourse of two chronic aphasic speakers. This study is of particular
interest as, together with Hollands studies, it was one of the first which really attempted
to link the functional adequacy of the communication of the aphasic speaker with
specific linguistic forms. Penn found that both subjects demonstrated changes on these
measures while showing no change in performance on standardized aphasia tests. Penn
then classified certain patterns in terms of their compensatory value for the aphasic
speakers. For example, the compensatory strategy of `elaboration was identified and
defined as `expansion or elaboration of the message to ensure effective transmission (p.
236). One of the subjects demonstrated this strategy by an increase in use of adjectives
and adverbials and a change in sentence length, while the other demonstrated increase in
post-verbal expansion, co-ordination and postmodification. This study is one of the first
in aphasiology to attempt to link linguistic form and function in this way. Utilization of
results from grammatical analysis for the purpose of examining communication function
rather than grammatical accuracy or frequency of occurrence of different word classes
alone was an innovation in the analysis of aphasic discourse at that time and certainly
still is to a large extent.
A small number of studies have looked at the variety of words used over time and
their semantic significance in order to gauge their contribution to the quality and
meaning of the discourse. Holland et al. (1985a) reported an increasing vocabulary in the
discourse of a bilingual aphasic speaker in the acute stages of recovery, but noted in
particular the emergence of an increasing number of `mental verbs (e.g. think, wonder,
believe) as well as words expressing time relationships (e.g. always, until, begin). The
authors utilized these two features as they have been purportedly related to conceptual
development (Piaget 1971), the assumption being that the increasing frequency of usage
of such items corresponds with increasing conceptual development. Hence, Holland et
al. felt it may also reflect a growing `semantic sophistication and suggested that the
patient was not merely acquiring a larger number of words but was actually expressing
more complex ideas.
Methodological issues: Language sampling
While methods of analysis constitute the main focus of discussion with respect to the
study of aphasic discourse, the nature of the discourse samples obtained is equally
important. In this regard, there appears to be little consistency across studies in sampling
methods or in the definitions used to describe the methods and the subsequent discourse
samples obtained. It is important to acknowledge the methodological differences if a
clear picture of the findings amassed so far is to be obtained.

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Elicitation techniques
A variety of techniques have been used in aphasia research to elicit language samples.
Texts have been elicited from single picture descriptions or descriptions of picture
sequences (Lemme et al. 1984, Nicholas et al. 1985, Bottenberg et al.1987, Nicholas
and Brookshire 1993, Coelho et al. 1994, Menn et al. 1994, Christiansen 1995), some
have been elicited through the subject being asked to retell a story just read to them
(Ulatowska et al. 1981, Dressler and Pleh 1988, Williams et al. 1994), some are retellings of a well-known narrative, e.g. the story of Cinderella (Byng 1988, Saffran et al.
1989, Byng et al. 1994) while some are elicited through more spontaneous means such
as `tell me about a memorable experience (Ulatowska et al. 1981) or by being asked to
discuss family (Glosser and Deser 1990), home (Vermeulen et al. 1989) or other familiar
topics. Others have required subjects to describe procedures such as changing a tyre or
brushing teeth (e.g. Ulatowska et al. 1983, Williams et al. 1994). Some studies
(Brookshire and Nicholas 1994, Nicholas and Brookshire 1995) used different combinations of some of these. Only one to date has used role-play as a means of eliciting the
sample for analysis, in which the aphasic speaker had to assume a certain role in a
conversational situation (Ulatowska et al. 1992).
One of the difficulties not often highlighted is that many of these elicitation procedures produce different genres of discourse. The different characters of texts from different genres are well-documented (Sinclair and Coulthard 1975, Longacre 1976,
Halliday 1985b, Martin 1992) and different patterns of language usage across genres
have also been confirmed in the discourse of aphasic individuals (Ulatowska et al. 1980,
1981, 1990, Williams et al. 1994). While the narrative genre is claimed to be used most
often in aphasia research, definition of this term as it is used in many studies is not
consistent. For example, Glosser and Deser (1990) describe their data as narratives and
yet the study involved their subjects being asked to discuss their family. Discussion of
such a topic may or may not have resulted in actual narrative production. It may have
resulted in an expository discourse, in which the speaker discussed the family in terms of
its functioning, the roles of the different members, etc, or it may have been a simple
description of names and physical characteristics. Similarly, a single picture may elicit a
description of a static situation rather than a narrative, which typically involves some
orientation, precipitating action and resolution. in addition, there may be considerable
differences between a personal recount of an event, a narrative of a fictional nature and a
culturally entrenched narrative such as `Cinderella. Some studies also collapse data from
more than one genre (Prins et al. 1978 Vermeulen et al. 1989, Brookshire and Nicholas
1994, Nicholas and Brookshire 1995), ignoring possible genre effects.
While studies have addressed some of the potential differences between texts elicited
through different procedures, few have used the notion of genre, per se, to differentiate
conditions. Distinctions have been made on the bases of number of picture stimuli
involved (Bottenberg et al. 1987, Potechin et al. 1987), the presence or absence of picture
stimulipicture-elicited discourse versus more spontaneous conversation or storyretelling (Glosser et al. 1988, Doyle et al. 1995, Doyle et al. 1998). The main motivation
for these kinds of distinctions has been to discover the efficacy of the traditional use of
pictures in language sampling procedures in aphasiology. Pictures have been used as
they tend to: (1) encourage speech in a controlled clinical or research environment; and
(2) generate discourse in which the analyst is more easily able to investigate target words
and potential errors than in spontaneously generated discourse where the target word/
meaning is not always obvious.

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Overall, few differences have been found between different conditions, although picture sequences have been noted to produce higher narrative levels (as defined by Applebee
1978) (Lemme et al. 1984, Bottenberg et al. 1985) and cohesive harmony (Bottenberg et
al. 1985) than single pictures, and higher efficiency scores (Doyle et al. 1995) and cohesive
harmony (Armstrong 1988) have been found in spontaneous discourse than have been
found in discourse elicited through pictures. Doyle et al. (1998) reported no significant
differences between narratives produced with and without the support of pictures in
terms of verbal productivity, information content, grammatical complexity, verbal disruption and grammatical well-formedness, while Glosser et al. (1988) found that pictures
elicited texts of less verbal complexity (a measure subsuming length of utterance, clausal
complexity including subordination, and vocabulary size in terms of word frequency)
than more spontaneous texts. Again, however, Doyle et al.s findings related to a story
retelling task while Glosser et al.s involved more spontaneous speech.
There is still much to discover about the effects of different elicitation techniques,
including the effects of different listeners, different levels of familiarity between interlocutors and topic, to name but a few parameters and work is being undertaken in all of
these areas (Ferguson 1994, Williams et al. 1994, Lindsay and Wilkinson 1999).
However, the notion of genre is a useful one for future researchers to utilize in studies
which are concerned with language sampling issues and in all studies which need to
more clearly and theoretically define their samples. Comparisons of data from different
genres is essentially problematic, unless generic differences are acknowledged from the
outset. Finer differentiation of genres may enable the aphasiologist to more clearly see
how the aphasic speaker uses his/her resources across a variety of situations.
Length of samples
The amount of data collected is also a relevant issue when drawing conclusions, as data
should aim to be representative of a speakers overall skills. It is unclear from some
studies just how much discourse was actually analysed. While length is not a defining
characteristic of a text, it is, however, significant in terms of the opportunity for a variety
of devices to be used by the speaker. Of those studies which do document length of texts,
the amount of data forming the basis for analysis is, on the whole, relatively small. For
example, amounts of data which have been detailed range from texts made up of 11
318 words (Potechin et al. 1987), 75 words on average (Nicholas et al. 1985), to a
composite set of texts resulting in a mean total of 35.2 T-units or 56.9 clauses per
subject (Ulatowska et al. 1981). However, overall, it would appear that the length of the
texts used as the basis for the findings reported thus far has been relatively short and that
the extent, then, to which they are representative of the speakers overall discourse
abilities could be open to question.
Researchers who have addressed the question of `how much is enough? in relation to
discourse sampling include Brookshire and Nicholas (1994) and Boles and Bombard
(1998). In terms of number of words and correct information units produced as well as
the percentage of correct information units used, Brookshire and Nicholas found that
test-retest stability was always higher for scores based on sets of stimuli rather than for
scores based on one single stimulus, suggesting greater test-retest reliability for scores
based on larger speech samples. They suggested that around 5 stimuli of the types
suggested might yield a relatively stable measure and be clinically practical in terms of
time spent transcribing and analysing. The authors reported sample size from these
stimuli ranging from 300400 words.

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Boles and Bombard (1998) examined sample size in terms of minutes of discourse
sampled. In investigating conversational repair behaviours and speaking efficiency
(length of utterance and speaking rate), they found that in terms of speaking efficiency, 5
minute samples were sufficient in most cases, whereas 10 minute samples were required
for repairs to be adequately represented. Overall, for behaviours occurring once per
minute, 10 minute samples were adequate, whereas for behaviours occurring three times
per minute, 5 minute samples were adequate.
Of course the procedure of extracting part of a discourse for analysis may be problematic in itself. Glosser and Deser (1990) based their analysis of coherence on listener
ratings of the aphasic subjects first twenty verbalizations of two texts from each subject.
They did this in order `. . . not to penalize those subjects who produced lengthier discourse which is more likely to veer away from the designated topic, that is, to become
less coherent globally (p. 74). However, the validity of rating such small sections of text
must be queried, as it would appear to be somewhat self-contradictory to be concerned
with global coherence and yet not present the whole text and its macrostructure to a
listener for rating. The potential `veering away from the designated topic may be an
important part of the pathological impairment and one that is potentially central to the
global coherence of the text. Hence, again, the purpose of the analysis may be important
in deciding what may be a representative sample.
Future directions
The study of aphasic discourse to date has used numerous frameworks to investigate the
way(s) in which people talk in everyday situations. On one hand, the variety has provided researchers and clinicians with a rich armoury of analyses which have yielded
much information on the different levels of language involved in the construction of
discourse. On the other hand, the variety has, to some extent, impeded the development of a coherent and clinically useful model of discourse which can be used to relate
these different levels in a way that is both theoretically sound and can be used to plan
specific yet practical treatment goals. While only one model may not in fact be either
realistic or desirable, as discourse is obviously multi-faceted and can be viewed from
different perspectives, it will be important in the future for researchers from all perspectives to address the potential interface between the so-called micro and macro
linguistic aspects of discourse. Such an interface will provide a clearer understanding of
how micro-aspects are utilized for everyday purposes and how what we know about
communicative functions and purposes is realized in specific language structures.
Making connections between the two `levels will add to our understanding of the
linguistic processes involved in discourse production and should also provide clearer
paths to treatment.
Methodological issues also need to be addressed in the future. Finer definition and
classification of samples obtained for analysis may reveal further information on how
aphasic speakers talk across a variety of situations. Greater attention to genres and the
function of discourse should allow aphasiologists to examine differences in language
requirements across situations and whether or not aphasic speakers are able to meet
these requirements through the use of their limited linguistic resources. Comparison of
results across studies would also be easier and more valid if the samples were better
defined. Similarly, in terms of sample length, a `reasonable amount of discourse should
be obtained so that the widest possible variety of phenomena can be observed. However,
while current research suggests that the traditional `one-picture description is certainly

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inadequate, a reasonable upper limit, which would cover a variety of analyses, is yet to be
determined.
Conclusions
Ongoing analysis of aphasic discourse promises both the researcher and the clinician
greater insight into how aphasic speakers communicate as they do in everyday situations. By addressing connected speech, discourse analysis directly taps into the language
system `in action, rather than having to extrapolate how the system works from artificial language tasks involving various constituents in isolation. However, in so doing, it
automatically and concurrently encompasses a multitude of variablesboth linguistic
and extralinguisticwhich are often difficult to define and certainly difficult to control.
Much work has yet to be done in clarifying theoretical and methodological issues, but
as the study of discourse continues to grow across a number of disciplines (e.g. linguistics, psychology, sociology), aphasiology, as an applied field, has many resources
from which to draw in order to address some of these issues. Conversely, the study of
aphasic discourse may also inform theories of normal discourse production, as patterns
that differ from normal can either support or refute proposed models of `normal processing. For example, the proposed prerequisites for textual coherence may well be
revised in light of an aphasic text which remains coherent and yet lacks some of these
prerequisites.
Increasing knowledge of how aphasic speakers communicate in everyday discourse
should increase the clinicians awareness of realistic treatment aims and ways in which to
achieve these, incorporating both broad `functional notions and associated specific
linguistic notions.
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