Pragmatik und Aphasie

Zusammenfassung

Patienten mit Aphasie zeigen neben typischen linguistischen Defiziten auch pragmatische Defizite, wobei die Differenzierung gegenüber funktional-kommunikativen Leistungen nicht immer leicht ist. Charakteristische pragmatische Probleme sind zum Beispiel ein reduzierter Informationsgehalt, ein veränderter Umgang mit Reparaturen, eingeschränkte Kohäsion und Kohärenz sowie andersartige Anpassungsprozesse im Gespräch. Neben Verfahren, bei denen die gesprochene Sprache anhand verschiedener Parameter analysiert wird (z. B. das Assessment Protocol of Pragmatic Linguistic Skills – APPLS [36], [56]) sind für den deutschen Sprachraum besonders Befragungen und Testbatterien relevant. Therapeutisch gibt es zum einen Materialien, die sich mit spezifischen Aspekten der Pragmatik (z. B. der Kohäsion) befassen, zum anderen wird aus dem Englischen das „Speaking Out”-Programm von Worrall und Yiu kurz vorgestellt [74]. Insgesamt lässt sich sagen, dass Aphasie und Pragmatik zurzeit noch zu wenig in Zusammenhang gebracht werden und dass in Zukunft pragmatische Aspekte einen essenziellen Teil der Betrachtung aphasischer Störungen darstellen sollten. Dieser Aspekt ist speziell unter Berücksichtigung des Teilhabegedankens der ICF von hoher Relevanz.

Abstract

Patients with aphasia primarily show linguistic deficits but they also have pragmatic difficulties. Typical pragmatic challenges of aphasic patients are modified repair sequences, reduced cohesion and coherence, limited information content, unclear thematic structure and different adaptation processes in dialogue compared to healthy control subjects. In German there are 3 categories of diagnostic methods to assess pragmatic disorders in aphasic patients. First of all we use analyses of spoken language where the aphasic speech production is rated along a variety of parameters. Good examples are the Pragmatic Protocol [57] and the Assessment Protocol of Pragmatic Linguistic Skills – APPLS [56]. Questionnaires answered by patients, relatives or speech language pathologists often comparing actual with premorbid pragmatic competence present a second possibility. Finally, there are some test batteries that focus on pragmatic and/or communicative competence like the ANELT [66], [67] and the Right Hemisphere Language Battery [70]. It is difficult to find an appropriate evaluated pragmatic therapeutic program. Specific aspects of pragmatic behaviour are trained by specially developed material. Additionally, we will present the Speaking Out Program by Worrall and Yiu [74]. In conclusion, it is argued that aphasia and pragmatics should still be more connected. In the future we will more often need a pragmatic approach to aphasic disorders. In this context the differentiation between pragmatic and communicative deficits will be discussed. Communicative aspects will be of special importance with respect to functioning and participation in terms of the ICF.

Schlüsselwörter

pragmatische Defizite - pragmatische Aphasietherapie - funktional-kommunikativer Ansatz - ICF – Teilhabe

Key words

pragmatic deficits - pragmatic aphasia therapy - communicative approach - ICF – participation

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