Date of Award

Spring 2026

Document Type

Open Access Dissertation

Department

Communication Sciences and Disorders

First Advisor

William Matchin

Abstract

This dissertation examines functional communication in persons with chronic post-stroke aphasia (PWA), with a focus on how communication ability is conceptualized, measured, and related to real-world participation. While traditional aphasia assessments primarily measure impairment-level language abilities, they often fail to capture the contextual, multimodal, and interactive nature of communication as it occurs in everyday life. Addressing this gap, the present work investigates functional communication from multiple perspectives, including measurement approaches, assessment development, and real-world communication outcomes.

Aim 1 presents a scoping review of functional communication assessments used in aphasia research and clinical practice. Studies were reviewed to identify formal and informal tools used to measure functional communication in PWA. Assessments were evaluated based on three core criteria derived from contemporary communication frameworks. Findings revealed substantial variability in how functional communication is defined and measured across studies, with few assessments capturing all dimensions. These findings report important gaps in the comprehensive evaluation of real-world communication and emphasize the need for more ecologically valid and standardized assessment approaches.

Aim 2 describes the development and initial psychometric validation of the Computerized Adaptive Scenario Test (CAST), a novel scenario-based assessment designed to evaluate functional communication in ecologically valid contexts. Initial validation with PWA and healthy comparison participants demonstrated strong inter-rater reliability, internal consistency, and convergent validity with established language and functional communication measures. The results support CAST as a promising tool for capturing real-world communicative performance.

Aim 3 investigates social network structure in PWA. Using measures of network size, density, and relational closeness, this study examines how interpersonal connections may shape language recovery and how various demographic and clinical variables are associated with social relationships following stroke.

Aim 4 integrates findings across studies to examine broader relationships among functional communication, social participation, and quality-of-life outcomes in PWA. Together, these findings contribute to a growing body of research emphasizing the importance of measuring communication in ways that reflect real-world interactions. By advancing assessment methods and exploring the social contexts in which communication occurs, this dissertation aims to support more ecologically valid evaluation and ultimately improve participation and life outcomes for PWA.

Rights

© 2026, Lauren Marie Hammond

Download

Share

COinS