Hammond Lauren, Christensen Thomas, Fridriksson Julius, den Ouden Dirk B
Arnold School of Public Health, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, USA.
Int J Lang Commun Disord. 2025 May-Jun;60(3):e70051. doi: 10.1111/1460-6984.70051.
The communicative effectiveness of persons with aphasia (PWA) has been assessed through a range of functional communication measures. However, variability in interpretations of what is covered by the term "functional communication" may have resulted in challenges to the implementation of appropriate and consistent patient-centred evaluations, with different measures focusing on subsets of the components of functional communication.
This paper aims to examine the current literature on informal and formal evaluation of functional communication in PWA and to identify gaps in currently available assessment tools.
This scoping review included studies published between 1965 and 2024 that assessed functional communication in PWA, excluding studies focused on non-aphasic populations or impairment-based assessments without real-world application. Systematic searches were conducted in PubMed, Embase, CINAHL, Scopus, and PsycINFO using predefined search terms. Of the 541 studies identified, 67 met the inclusion criteria after title/abstract and full-text screening. Measures were categorized as formal (standardized) or informal (non-standardized) and evaluated based on contextuality, multimodality, and interactiveness. Informal assessments also emphasized life participation, quality of life, augmentative alternative communication (AAC) strategies, conversational discourse, the informativeness and complexity of language use, and real-world communicative transactions.
In the 67 studies included in the literature review, 32 functional communication assessments were identified across the categories of informal and formal evaluation. Informal assessments (28) included patient-reported, clinician-reported, observer-reported, and performance-based outcome measures. Formal functional communication assessments (4) included systematically normed instruments provided to PWA under controlled conditions, yielding a diagnosis or level of specified functional communication capability. Of the reviewed informal and formal measures, a limited quantity met all criteria for a comprehensive assessment of functional communication in aphasia, namely, being contextual, multimodal, and interactive.
Existing assessments reveal gaps in the comprehensive evaluation of functional communication. The findings emphasize the need for standardized, multimodal, and context-sensitive tools that better reflect the dynamic, real-world communicative needs of PWA.
What is already known on the subject Functional communication is recognized as a cornerstone for assessing real-world abilities in persons with aphasia (PWA). However, current assessments vary in their design and implementation, reflecting the diverse approaches taken across clinical and research settings. What this paper adds to existing knowledge This study emphasizes the importance of integrating contextuality, multimodality, and interactiveness into functional communication assessments. It highlights the valuable contributions of informal tools, which offer adaptability and focus on life participation, and identifies opportunities to enhance formal tools to better address real-world communication needs. What are the potential or clinical implications of this work? Developing standardized, holistic tools for functional communication assessment will provide clinicians and researchers with more effective resources to evaluate and support PWA. These advancements will promote consistency in practice, enable meaningful comparisons across studies, and ultimately improve life participation and communication outcomes for PWA.
失语症患者（PWA）的沟通有效性已通过一系列功能性沟通测量方法进行评估。然而，对于“功能性沟通”一词所涵盖内容的解释存在差异，这可能给实施适当且一致的以患者为中心的评估带来挑战，不同的测量方法侧重于功能性沟通组成部分的不同子集。
本文旨在研究当前关于PWA功能性沟通的非正式和正式评估的文献，并找出现有评估工具中的差距。
本范围综述纳入了1965年至2024年间发表的评估PWA功能性沟通的研究，排除了专注于非失语症人群或无实际应用的基于损伤的评估的研究。使用预定义的搜索词在PubMed、Embase、CINAHL、Scopus和PsycINFO中进行系统检索。在541项确定的研究中，经过标题/摘要和全文筛选后，有67项符合纳入标准。测量方法分为正式（标准化）或非正式（非标准化），并根据情境性、多模态性和交互性进行评估。非正式评估还强调生活参与、生活质量、辅助和替代沟通（AAC）策略、对话语篇、语言使用的信息性和复杂性以及现实世界的沟通交流。
在文献综述纳入的67项研究中，在非正式和正式评估类别中确定了32种功能性沟通评估方法。非正式评估（28种）包括患者报告、临床医生报告、观察者报告和基于表现的结果测量。正式功能性沟通评估（4种）包括在受控条件下提供给PWA的系统标准化工具，得出诊断结果或特定功能性沟通能力水平。在所审查的非正式和正式测量方法中，只有少数符合失语症功能性沟通综合评估的所有标准，即具有情境性、多模态性和交互性。
现有评估揭示了功能性沟通综合评估方面的差距。研究结果强调需要标准化、多模态且对情境敏感的工具，以更好地反映PWA动态的现实世界沟通需求。
关于该主题已知的信息 功能性沟通被认为是评估失语症患者（PWA）现实世界能力的基石。然而，当前评估在设计和实施上存在差异，反映了临床和研究环境中采用的不同方法。本文对现有知识的补充 本研究强调将情境性、多模态性和交互性纳入功能性沟通评估的重要性。它突出了非正式工具的宝贵贡献，这些工具具有适应性并注重生活参与，并确定了改进正式工具以更好地满足现实世界沟通需求的机会。这项工作的潜在或临床意义是什么？开发用于功能性沟通评估的标准化、整体工具将为临床医生和研究人员提供更有效的资源来评估和支持PWA。这些进展将促进实践的一致性，实现跨研究有意义的比较，并最终改善PWA的生活参与和沟通结果。
