Faculty Bibliography

Standard measures do not generally account for functional communication performance. Traditionally the measures used to assess verbal impairment in the brain-damaged patient generally sample performance under artificial conditions rather than the unforced , voluntary, and habitual utterances which characterize natural language use. An awareness of the potential for functional communication in even the most severely brain-damaged patients requires enlightened medical management. Man is a social being capable of communicating in many ways other than the verbal mode. Under appropriate circumstances, with guidance and encouragement, he can and does accommodate and adjust. Communication assessment must go beyond the restricted information derived from standardized language tests. In practical terms, this means that rehabilitation evaluations must incorporate observations of the aphasic or dysarthric patient in his natural environment as a part of the overall communication assessment or using an established measure of functional communication. It is hard to imagine that a functional philosophy is not universally implemented. The speech pathology literature is a clear case in point

Fifty-six closed head injured patients referred to a rehabilitation medicine center were examined to determine the presence and nature of verbal deficits. Eighteen (32 per cent) presented classical symptoms of aphasia, 21 (38 per cent) had motor dysarthria, and 17 (30 per cent) had no discernible aphasic deficit in spontaneous speech, but showed clear evidence of verbal deficit on testing. No patient admitted with sequelae of closed head injuries was spared some degree of verbal impairment, however mild or apparent. Dysarthric patients, without exception, showed subclinical linguistic deficits. Although the patients studied were thought to be more severe than most of those reported in the literature, our findings suggest the desirability of a careful linguistic evaluation of all closed head injured patients because of the potential impact of verbal deficits on rehabilitation out come