Pragmatic Protocol Research Articles

Modified calibration protocol evaluated in a model-based testing of SBR flexibility

The purpose of this paper is to refine the BIOMATH calibration protocol for SBR systems, in particular to develop a pragmatic calibration protocol that takes advantage of SBR information-rich data, defines a simulation strategy to obtain proper initial conditions for model calibration and provides statistical evaluation of the calibration outcome. The updated calibration protocol is then evaluated on a case study to obtain a thoroughly validated model for testing the flexibility of an N-removing SBR to adapt the operating conditions to the changing influent wastewater load. The performance of reference operation using fixed phase length and dissolved oxygen set points and two real-time control strategies is compared to find optimal operation under dynamic conditions. The results show that a validated model of high quality is obtained using the updated protocol and that the optimization of the system's performance can be achieved in different manners by implementing the proposed control strategies.

Pragmatic Abilities of Children With Hearing Loss Using Cochlear Implants or Hearing Aids Compared to Hearing Children

This study characterized the profile of pragmatic abilities among 24 children with hearing loss (HL) aged 6.3-9.4 years, 13 using hearing aids (HAs) and 11 using cochlear implants (CIs), in comparison to those of 13 hearing children with similar chronological and language ages. All the children with HL used spoken language, attended regular schools, and received communication therapy twice a week. They had no disabilities other than the HL. We assessed pragmatic abilities using the pragmatic protocol of C. A. Prutting & D. M. Kirchner (1987. A clinical appraisal of the pragmatic aspects of language. Journal of Speech and Hearing Disorders, 52, 105-119), which includes verbal, nonverbal, and paralinguistic aspects. Findings showed that children with HL used varied pragmatic functions but revealed more incidents of inappropriate use of the different abilities, compared to hearing children. Intergroup differences were significant only for verbal parameters. No differences emerged between children who used CIs vs. HAs. It seems that the CI group had the same pragmatic abilities as severe HA children. The different or less effective pragmatic abilities of children with HL may be explained by less flexible use of language structures, difficulties in theory of mind, difficulties in auditory perception of spoken language, and less exposure to varied pragmatic situations and strategies. Results indicated the need to incorporate pragmatic communication abilities into rehabilitation programs.

Pragmatik und Aphasie

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.

Alunos com distúrbios do espectro autístico em interação com professores na educação inclusiva: descrição de habilidades pragmáticas

OBJETIVO: Investigar as habilidades pragmáticas de alunos com distúrbios do espectro autístico durante a interação com suas professoras em salas comuns de escolas públicas. MÉTODOS: Participaram 14 alunos com distúrbios do espectro autístico, de ambos os gêneros, com idade entre três e oito anos (média=5,9; DP=1,8). Como parte do procedimento, foram realizadas filmagens em situações de sala de aula e para análise dos aspectos pragmáticos da comunicação dos participantes, foi utilizado o Protocolo de Pragmática. Os resultados foram tratados estatisticamente (p<0,05 e em alguns casos p<0,01; foram utilizados os testes de Wilcoxon, Friedman, Kruskal-Wallis, Spearman). RESULTADOS: Em média, o número de atos comunicativos expressos por minuto pelas professoras (3,4 atos/min) foi superior (p<0,05) ao apresentado pelos alunos com distúrbios do espectro autístico (2,7 atos/min). Os alunos demonstraram predomínio de utilização do meio gestual, com média de 36,2 ocorrências, e de funções comunicativas menos interativas, com média de 24,1 ocorrências. Além disso, ocorreu correlação positiva entre os atos/min de alunos e professoras (p=0,01). Observou-se, também, que a idade e a escolaridade dos alunos não apresentaram correlações com o estabelecimento da comunicação nas díades. CONCLUSÃO: Foi possível identificar os déficits e as habilidades dos alunos com distúrbios do espectro autístico em sala de aula comum e confirmar a influência exercida pelo professor no desempenho comunicativo de tais alunos. Estes dados podem contribuir para esclarecimentos de lacunas existentes na literatura e para subsidiar intervenções terapêuticas e educacionais nos distúrbios do espectro autístico.

Use of anti-infective serial prevalence studies to identify and monitor hospital-acquired infection

We developed the 'Pragmatic Proxy Protocol' (PPP) to estimate the prevalence of hospital-acquired infection (HAI) by integrating our existing pharmacy serial point prevalence studies of anti-infective prescribing practices with electronic data on microbiological and radiographic markers of infection. Our method was evaluated against the standard Hospital Infection Society/Infection Control Nurses Association Protocol (HIP). In the non-surgical patients, PPP has a sensitivity of 1.00 [confidence interval (CI): 0.70-1.00] and specificity of 0.97 (CI: 0.93-0.99). PPP suggests that for non-surgical patients, the prevalence of HAI using HIP could be underestimated by 42%. PPP takes about two-thirds of the time of HIP (75 vs 106 h) and is at least one-third cheaper. It could easily be adapted to advances in electronic reporting and, with the development of Anti-infective Care Bundles, would increase its sensitivity for the detection of HAI in surgical patients. PPP could be used to increase the frequency of routine HAI surveillance to determine the overall burden of infection and assess the efficacy of intervention strategies in a timely manner allowing rapid, direct feedback and engagement with clinicians.

Detection of synchronous lung tumors in patients presenting with squamous cell carcinoma of the head and neck

Screening for synchronous pulmonary tumors in patients presenting with squamous cell carcinoma of the head and neck (SCCHN) is important, because detection may alter subsequent management. We conducted a retrospective review, comparing effectiveness of pulmonary screening using thoracic CT or chest X-ray, in 1882 patients presenting with SCCHN. The overall rate of synchronous pulmonary tumors was 4.3%. The number needed to scan, ie, the number of thoracic CTs required to detect 1 pulmonary tumor, is reported for recurrent primary tumors, primary disease load (T and N classification), and individual primary sites. The incidence of pulmonary metastases is related to locoregional disease load while the incidence of bronchogenic carcinoma is sporadic. Although it is possible to propose a pragmatic screening protocol for pulmonary metastases, this is not possible for bronchogenic carcinomas. Therefore, we recommend that thoracic CT is used in all cases to screen for coexistent pulmonary pathology.

Coping with participant heterogeneity in dichotomous responses

Participant heterogeneity induces spurious dependence that may obscure dependence patterns displayed by a covariance matrix. A parsimonious method is proposed for the reduction of this confounding effect. The method is applied to dichotomous behavioral response data of participants diagnosed with schizophrenia, as assessed by the Pragmatic Protocol (J. Speech Hear. Disord. 1987; 52:105-119).

Investigating Movement within Irregularly Shaped Patches: Analysis of Mark-Release-Recapture Data Using Randomization Procedures

The analysis of net-displacement data extracted from mark-release-recapture (MRR) studies is usually based on the assumption that movement follows a random walk in homogeneous space. Yet given sufficient time, within-patch movement cannot conform to this assumption, as maximum net-displacement must be limited by the patch's dimension. We thus suggest a pragmatic protocol for analyzing such MRR data: (1) Test for correlation between the time intervals between captures and displacement distance; if such a correlation is weak, displacement does not follow the rules of a random walk. (2) Test whether net-displacement observed approaches an even density distribution (null-model). (3) Estimate whether net-displacement is limited by the individual's tendency to restrict movement to sub-regions of a patch. For this purpose we developed two randomization algorithms that generate patch-specific distance distributions given that (i) displacement distances converge to an even distribution and habitat use is homogeneous within patches, or that (ii) the spatial distribution of capture points is heterogeneous. Both methods are expanded to account for the influence of potential movement restrictions beyond those imposed by the patch's dimension. The sequential comparison of empirical distributions with distributions generated by these algorithms allows drawing conclusions about the rules underlying withinpatch movement. We exemplarily apply our protocol to an empirical MRR data set on the butterfly Maculinea teleius. The analysis indicates that habitat use within patches is heterogeneous and that Maculinea possibly establishes home ranges. Such analyses may convey important information about the biology of species and help to develop appropriate conservation strategies.

A Pragmatic Protocol for Reduction in the Metal Artifact and Radiation Dose in Multislice Computed Tomography of the Spine

To assess the correlation between the metal artifact degree and the tube voltage (in peak kilovolts; kVp) and tube current (in milliamperes; mA) in multidetector row computed tomography (MDCT) and evaluate the proper protocols for reduction in the metal artifact and the radiation dose. We performed MDCT examinations for 13 cadavers operated for transpedicular screw insertion from C3 to C7, bilaterally. We used 80, 100, and 120 kVp in all cadavers. For the mA, we arbitrarily applied 100, 150, and 200 in 6 cadavers (experiment 1); 140, 180, and 220 in 4 (experiment 2), and randomly used mAs between 60 and 220 in 3 (experiment 3). The lengths of the artifacts emanating from the anterior and posterior tips of the screw were used for the degree of artifact. In experiment 1, the mA did not significantly affect the metal artifacts (P > 0.05); but the kVp did (P < 0.05). In experiment 2, the mA and kVp did not significantly affect the metal artifact degree (P > 0.05). In experiment 3, the mA did not affect the metal artifacts, but the kVp caused changes in metal artifact degrees (simple quantitative analysis). The proper parameters for the simultaneous reduction in the artifact and radiation dose are suggested to be tube voltages from 100 to 120 kVp and tube currents lower than the generally used values of 200 to 220 mA.

Severe acquired brain injury: rehabilitation of communicative skills in children and adolescents

The purpose of this study was to examine the use of a descriptive taxonomy for assessment of communicative abilities, the Pragmatic Protocol, in a rehabilitation setting with brain-injured children and adolescents. Eight severely brain-damaged children/youths were assessed with the Pragmatic Protocol during an intensive 6-week rehabilitation period. The nature and extent of communicative functioning was rated independently by a speech language pathologist and a rehabilitation assistant. The data suggests that the number of inappropriate pragmatic behaviours is relatively high, above all regarding aspects of speech/language and nonverbal communication. Interrater agreement reached approximately 95% considering nature of the communicative dysfunction in each patient. Results indicate the use of the Pragmatic Protocol as a useful tool to trace aspects of communicative competence in need of further, detailed exploration. Information concerning intact abilities is clarified and can be used in designing treatment.

Pragmatic skills in people with HIV/AIDS

Purpose. Carers and health professionals who work with people with the human immunodeficiency virus (HIV) are reported to think that the communication skills of people with HIV are “odd” and a range of difficulties with communication have been identified. However, little research has examined the “pragmatic” skills of people with HIV.Method. Five men living with AIDS were assessed on a battery of measures of componential language to exclude aphasia. Their pragmatic appropriateness as judged using the the Pragmatic Protocol was then rated by ten experienced raters from representative portions of a semi-structured interview.Results. All cases were rated by some raters as inappropriate on: Lexical selection specificity/accuracy. 4/5 cases had problems with: fluency, turn taking quantity, turn taking interruption/overlap and vocal quality. 3/5 were scored by some raters as having problems with: intelligibility, lexical selection: cohesion, prosody, turn taking pauses, turn taking repair/revision and vocal intensity.Conclusions. Several pragmatic behaviours consistent with what might be expected in people with mild diffuse or subcortical brain impairment were clearly observed. Whilst the cause of their perceived pragmatic inappropriateness cannot be established, the results suggest that cognitive-communication problems might be a feature of language use in people with HIV-AIDS even when AIDS-related dementia has not been diagnosed.

Prevention of cryoprecipitation during cardiopulmonary bypass in a patient with HIV-HCV co-infections

There are no guidelines for the management of patients with cryoglobulins during cardiopulmonary bypass (CPB) necessitating core hypothermia. To evaluate a simple, pragmatic protocol of in vitro temperature-dependent cryoprecipitation of serum in patients with cryoglobulinemia before elective cardiac surgery with CPB. A 44-year-old female patient was known for chronic hepatitis C and type III cryoglobulinemia. Elective surgery was planned for an aortic arch aneurysm. A differential serum cryoprecipitation profile was established in vitro prior to surgery. Whereas, at temperatures < or = 15 degrees C, cryoglobulin levels were > or = 0.112 g/L (normal value < 0.05 g/L), at 20 degrees C and above, the precipitate was < or = 0.016 g/L. Accordingly, surgery was performed without any cryoglobulin-related complications at an extracorporeal circulation temperature of 22-24 degrees C, to minimise the risk of cryoprecipitation. In elective cases of surgery with CPB and hypothermia, temperature-dependent differential serum cryoprecipitation profile may be an easy and efficient way to assess a safe peroperative level of temperature to avoid complications due to cryoglobulins, without enhancing the patient's tissue ischemia risks.

A Pragmatic Protocol for I-131 rhTSH-Stimulated Ablation Therapy in Patients With Renal Failure

Ablation of thyroid remnants in patients with differentiated thyroid carcinoma and renal failure can be challenging because of the altered and variable clearance rates of iodine from the blood secondary to variations in dialysis protocols, which complicate the selection of the appropriate I-131 dose. The advent of recombinant human TSH allows a simpler approach to dosimetry and ablation without rendering the patient hypothyroid. Avoidance of hypothyroidism may be an important consideration for patients who are experiencing various morbidities from conditions associated with renal failure. Three patients on dialysis, who had undergone total thyroidectomy and were euthyroid on L-thyroxine replacement, were given diagnostic doses of I-131 followed by blood and whole-body retention measurements through serial dialyses to determine individual blood clearance rates. After administration of rhTSH, each patient received an ablative dose of I-131 calculated to keep total body dose below 1 Gy. The treatments were administered without complications, and in follow-up imaging of 2 available patients, the ablations were demonstrated to be complete. Dosimetry performed on euthyroid dialysis patients permits I-131 dose selection and avoids the additional morbidity of hypothyroidism.

Pragmatic performance and functional communication in adults with aphasia.

Abstract This study used linear regression to define relationship between pragmatic performance and communication by 27 individuals with aphasia, including 14 with fluent aphasia and 13 with non-fluent aphasia. Pragmatic performance was measured with Pragmatic Protocol. Functional communication was measured using ASHA Functional Assessment of Communication Skills (ASHA FACS). Results provide support for relationship between these variables and for their underlying link to linguistic competence. Nonetheless, standard language assessment (Western Aphasia Battery) appears insufficient for describing overall communicative competencies and for explaining differences between some participants' communication abilities. Implications for assessment and treatment of communicative effectiveness are discussed. Keywords: Aphasia Pragmatics Functional Communication. Introduction With any type of disorder, different assessment measures can be, and have been, constructed to assess different aspects of behavior. For example, numerous assessments for aphasia currently exist. Some assessments, such as Western Aphasia Battery (WAB) (Kertesz, 1982) or Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983) purport to assess type and severity of aphasia. Other assessment tools focus on different aspects of The Pragmatic Protocol (Prutting & Kirchner, 1983), for example, examines communication from an entirely different perspective. Pragmatics is study of relationship between language behavior and contexts in which language is used (Prutting & Kirchner, 1983). It involves acquisition and use of conversational knowledge and semantic rules necessary to communicate intent. In addition, pragmatics involves interactional aspects of including sensitivity to social contexts (Chapey, 1992). Specific pragmatic aspects investigated in adults with aphasia include communication acts (Gurland, Chwat, & Wollner, 1982; Wambaugh, Thompson, Doyle, & Camarata, 1991), speech acts (Doyle, Thompson, Oleyar, Wambaugh, & Jackson, 1994; Prinz, 1980; Wilcox & Davis, 1977), discourse analysis (Armstrong, 1987, 1991; Bottenberg & Lemme, 1991; Guilford & O'Connor, 1982; Mentis & Prutting, 1987) and use of nonverbal communication (Behrmann & Penn, 1984; Cicone, Wapner, Foldi, Zurif, & Gardner, 1979; Glosser, Weiner, & Kaplan, 1986; May, David, & Thomas, 1988). Researchers have investigated pragmatic performance in individuals with aphasia (Avent & Wertz, 1996; Holland, 1982; Prutting & Kirchner, 1987; Wilcox & Davis, 1977), and data suggest that individuals with aphasia maintain a high level of pragmatic appropriateness despite their linguistic impairments (Avent & Wertz, 1996; Prutting & Kirchner, 1987). Another area of assessment for aphasia has been referred to as functional communication. Functional communication is defined as the ability to receive or convey a message, regardless of mode, to communicate effectively and independently in a given [natural] environment (p.2)(ASHA, 1990). While profiling specific pragmatic strengths and weaknesses may assist in identifying nature and processes involved in communication, a communication assessment should help to outline consequences of communication deficit in an individuals' daily interactions. For example, when assessing pragmatic ability with an instrument such as Pragmatic Protocol (Prutting & Kirchner, 1987), speech act usage, turn-taking ability, and lexical selection categories may be rated as appropriate or inappropriate. Using a communication measure, such as American Speech Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) (Frattali, Thompson, Holland, Wohl, & Ferketic, 1995), rather than profiling specific deficits, overall quality of communication in real-life activities can be established, as well as amount of assistance needed during these activities. …

Pragmatic general multicast congestion control protocol for wireless networks

AbstractAccompanied by the widespread deployment of wireless networks, content and service providers are increasingly interested in supporting multicast communications over wireless network. The reliable multicast protocol can provide (assure) efficiency in data delivery carried by the new generation e‐services, such as news, advertisement, guiding messages, etc. Its congestion control function enables the transmissions to adapt the sending rate to the available bandwidth and fairly share bandwidth with the widely used transmission control protocol (TCP) traffic in the networks. Many e‐services can be brought and built on the reliable multicast congestion control protocols to the roaming mobile subscribers. However, the reliable multicast congestion control protocols are affected by the wireless packet losses, resulting in degraded multicast performance. This article presents PGMCCW, a pragmatic general multicast congestion control protocol for wireless networks. PGMCCW can differentiate the wireless losses as well as the congestion losses on multicast and can also elect the proper group representative from the multiple receivers in the different wireless sub‐networks. The simulation results validate that this scheme is effective to alleviate the influence of the wireless losses and improve the performance over wireless networks. Copyright © 2005 John Wiley &amp; Sons, Ltd.

Compétences de communication non verbale des traumatisés crâniens graves

Objective. – Discursive abilities of severe brain injured patient are always impaired: loss of flexibility, lack of cohesion and coherence, often more elliptic. We know few about nonverbal competencies during discourse. The objective is to verify nonverbal abilities of these patients by pragmatic analysis. Methods. – Four men were examined more than 7 years after severe traumatic brain injury. Nonverbal Prutting and Kirchner Pragmatic Protocol (1987) were done allowing to a qualitative and quantitative measurement of paralinguistic behaviour: prosody and quality of speech, facial expression, posture, gaze, gesture. Two conditions were recorded: dual (descriptive discourse) and group (conversational discourse). Associated impairments such as cognitive and dysexecutive functioning were also investigated. Results/discussion. – Impoverishment (loss of ability) or impaired inadequacity was observed in all patients. Paralinguistic competences of conversational discourse was worse than descriptive one. Facial expression, gaze functioning, referential gesture were more often impaired. Maladjustment could be interpretated in reference with dysexecutive syndrome. Conclusion. – In spite of the lack of information about the range of normal pragmatic behaviour, it seems that brain injured patients have shown poor nonverbal abilities during discourse. Rehabilitation training of communication skills would integrate this fact in order to improve interactivity and social relationship.

Perceptions of pragntatic differences in a Hawaii Creole English speaker

In the field of speech-language pathology it is imperative to determine if an individual truly has a communication disorder or whether communication is intact but influenced by cultural differences. Ten participants from the United States (US) mainland and ten participants from Hawaii reviewed a videotaped Hawaii Creole English (HCE) speaker in a didactic conversation. All pragmatic skills that were assumed to be ‘inappropriate’ were identified and recorded using a pragmatic protocol. The data was compared between groups, and a significant difference was found in how intelligibility of speech was viewed. A majority of the participants from the US mainland found the HCE speaker to be disordered in intelligibility.

Relationships among language impairment, functional communication, and pragmatic performance in aphasia

Background: Severity of and change in aphasia may be indexed by a language impairment measure or a functional communication measure, including assessment of pragmatic performance. The relationship of severity of and change in aphasia between different measures has not been clearly established. Aims: Performance on measures of language impairment, Porch Index of Communicative Abilities (PICA); functional communication, Rating of Functional Performance (RFP); and pragmatic performance, Pragmatic Protocol (PP) was examined to determine whether there are significant relationships among severity of performance deficits and among change in performance on each measure. The research questions were: Are there significant relationships among aphasic patients' language impairment, functional communication, and pragmatic performance at 4, 15, 26, 37, and 48 weeks postonset? Are there significant relationships among change scores between 4–15, 15–26, 26–37, 37–48, and 4–48 weeks postonset? Methods & Procedures: A total of 20 adults who were aphasic subsequent to a first, single thromboembolic stroke were administered the PICA, the RFP, and the PP at 4 weeks postonset and every 11 weeks thereafter during the first year postonset. A priori predictions about the relationships between measures were made, and correlational analyses were used to examine the relationships among measures. Partial correlations and comparisons of correlation coefficients were also employed. Outcomes & Results: Severity of both pragmatic performance and functional communication were significantly related with language impairment. Severity of pragmatic performance and functional communication were significantly related only at 4 weeks postonset. Correlations between measures of severity were not significantly different from each other. Correlations between change scores on repeated test administrations were significant only for the RFP and PICA between 4–15 weeks and 4–48 weeks. Conclusions: Results suggest that while a measure of language impairment may be significantly related with severity of functional communication and pragmatic performance, severity of pragmatic performance is significantly related with severity of functional communication only at 1 month postonset. Moreover, change on any one of the measures is generally not significantly related with change on the other measures. The use of correlational analysis to determine whether different assessments measure different constructs in aphasia is discussed, and alternative methods of analysis are presented.

Cardiac investigation and intervention prior to thoraco-abdominal aneurysm repair: coronary angiography in 35 patients.

retrospective studies indicate a high risk of cardiac events in patients undergoing thoraco-abdominal aneurysm repair. We aimed to determine the prevalence of coronary disease in these patients, define the role of non-invasive cardiac testing and assess the short-term outcome of coronary re-vascularisation. a prospective cohort study of consecutive patients referred to a single surgeon. forty patients recruited over 16 months (Type I, 6; II, 11; III, 8; IV, 15). Dobutamine stress echocardiography, coronary angiography and coronary re-vascularisation (PTCA or CABG) were performed according to a pragmatic protocol. Main outcome measures were the prevalence of coronary artery disease, sensitivity and specificity of clinical assessment and non-invasive cardiac testing, and adverse events associated with coronary investigation and intervention. seven patients (17.5%) were stratified as having high perioperative cardiac risk. The majority of patients (23, 57.5%) had no cardiac risk factor other than the operation type. Five patients (12.5%) had inducible ischaemia on non-invasive testing. Fourteen patients (40%) had haemodynamically significant coronary artery stenoses, of whom 12 (34%) underwent coronary revascularisation. Dobutamine stress echocardiography demonstrated 100% specificity and 71% sensitivity for the detection of significant coronary artery lesions. Coronary re-vascularisation by three-vessel bypass grafting was complicated by non-fatal stroke in one patient. Thirty-five patients (87.5%) proceeded to aneurysm repair. No patient who had been adequately investigated suffered a cardiac complication. the 40% prevalence of coronary artery disease in these patients is comparable to that of other patients undergoing arterial surgery. Non-invasive testing proved beneficial, both in screening low-risk patients and planning intervention in patients at higher risk. An aggressive approach to intervention was associated with an acceptable complication rate and favourable short-term outcome.

Discourse sampling in the 21st century

This paper examines the importance of evaluating discourse in individuals with a neurogenic language disorder. Discourse analysis is acknowledged as an important tool for speech-language pathologists, although it is often not the assessment tool of choice due to its apparent time-consuming nature and the overwhelming number of options available. The wide range of analyses available to clinicians such as the number of T-units and total words produced or Pragmatic Protocol checklists make it difficult to choose assessment measures. Even more difficult is the decision of where to direct treatment efforts. This paper aims to show that there are a number of levels of discourse analysis available to clinicians and that it is possible to sample a number of different genres in a clinical setting. The significance of the communication partner's contribution is discussed, particularly with regard to the limitations of the therapeutic interaction and the need to assess clients with a range of communication partners. The discourse opportunities we make available to people with communication problems will influence what is possible for them. To achieve this, the benefits of a theory of linguistic analysis, namely, Systemic Functional Linguistics (SFL) [Halliday, M. A. K. (1994). An introduction to functional grammar (2nd ed.). London: Edward Arnold.] will be explored.