What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation.

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person's ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual's ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person's communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as "situated language use", borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.

Prevalence of pain flashbacks in posttraumatic stress disorder arising from exposure to multiple traumas or childhood traumatization.

BACKGROUND: Flashbacks are a form of multisensory memory that are experienced with a "happening in the present" quality. Pain flashbacks are a re-experiencing of pain felt at the time of a traumatic event. It is unclear how common pain flashbacks are. AIMS: The current study was designed primarily to assess the prevalence of pain flashbacks in a sample of patients with posttraumatic stress disorder (PTSD). METHODS: We assessed the prevalence of pain flashbacks over a period of 2 years in patients (n = 166) referred to a psychological trauma service in the UK. Patients underwent a clinical screen for PTSD and completed a self-report measure of pain flashbacks. RESULTS: Pain flashbacks were classified as present in 49% of a sample of complex trauma patients meeting criteria for PTSD. Pain flashbacks were positively associated with the extent of pain at the time of trauma. CONCLUSIONS: Pain re-experiencing in PTSD, and its relative absence in nonclinical populations, supports an account of memory in which perceptual details can be re-experienced when memories have been encoded under conditions of extreme stress. It may be possible to conceptualize some cases of unexplained pain as pain flashbacks or of having a trauma origin.

Contexte: Les flashbacks sont une forme de souvenir multisensoriel qui se manifeste en donnant l'impression de se dérouler dans le présent. Les flashbacks douleureux sont une reviviscence de la douleur ressentie au moment d'un évènement traumatique. On ne sait pas à quel point les flashbacks douleureux sont communs.But: La présente étude a été conçue principalement pour évaluer la prévalence des flashbacks douleureux au sein d'un échantillons de patients souffrant d'un trouble de stress post-traumatique (TSPT).Méthodes: Nous avons évalué la prévalence des flashbacks douleureux sur une période de deux ans chez des patients (n = 166) référés à un service spécialisé dans les traumstismes psychologiques en Grande-Bretagne. Les patients ont été soumis à un dépistage du TSPT et ont répondu à un questionnaire portant sur les flashbacks douleureux.Résultats: Les flashbacks douleureux étaient présents chez 49 % des participants d'un échantillon complexe de patients souffrant de traumatismes qui répondaient aux critères pour le TSPT. Une association positive a été observée entre les flashbacks douleureux et le degré de douleur ressenti au moment du traumatisme.Conclusions: La reviviscence de la douleur dans les cas de TSPT et son absence relative au sein de populations non cliniques semblent démontrer que les détails perceptuels d'un souvenir peuvent être revécus lorsqu'ils ont été encodés dans des conditions de stress extrême. Certains cas de douleur inexpliquée peuvent être considérés comme des flashbacks douleureux, ou comme ayant une origine traumatique.