18 . . „ Γ α r H n p r η Pragmatic aspects of com- Foldi, N.S., Cicone Μ · > & « . f a g s . L s e g a l o w i t z (Ed.), munication in bram-damaged pat ents. ^ Y o r ^ L a n g u a g e junctions and brain organisa G o u T s . Treasure of ma. New York, W.W. Norton and _ £ ° Τ 7 μ 1 9 & O'Connor, J . K . Pragmatic functions in apha- sia J. Comma, Disord., 15, 337-346, 1982. Holland, A.L. Some practical considerations in aphasia rehabilita- tion.In M. Sullivan and M.S. Kommers (Eds.), Rationale for adult aphasia therapy. Nebraska, University of Nebraska Med- ical Center, 1977. Holland, A.L. Communicative abilities in daily living. Baltimore, University Park Press, 1980. Holland, A.L. Observing functional communication of aphasic adults. J. Speech Hear. Disord., 47, 50-56, 1982. Holland, A.L. Spontaneous recovery from stroke: An investigation of its earliest phases. Paper presented at the Academy of Apha- sia, Minneapolis, Minnesota, 1983. Kazdin, A.E. Assessing the clinical or applied importance of be- haviour change through social validation. Behaviour Modifica- tion, 1, 427-452, 1977. Kertesz, A. Western Aphasia Battery. London, Ontario Canada, University of Western Ontario, 1980. Linebaugh, C.W., Kryzer, K.M., Oden, S.E. & Myers, P.S. Re- apportionment of communicative burden in aphasia: A study of narrative interactions. In R.H. Brookshire (Ed.), Clinical Claire Penn aphasiology conference proceedings. Minneapolis, MN, BRK Publishers, 1982. Mueller, S.L. An investigation in social competence using clinical and societal profiles. MA thesis, University of California, Santa Barbara, 1983. Penn, M.C. Syntactic and pragmatic aspects of aphasic language. Doctoral dissertation, University of the Witwatersrand, Johan- nesburg, South Africa, 1983. Prutting, C.A. Pragmatics as social competence. J. Speech Hear. Disord., Al, 123-134, 1982a. Prutting, C.A. Observational protocol for pragmatic behaviours. Developed for the University of California, Santa Barbara Speech and Hearing Clinic, Clinic Manual, 1982b. Prutting, C.A., & Kirchner, D. Applied pragmatics. In T. Gal- lagher and C. Prutting (Eds.), Pragmatic assessment and inter- vention issues in language. San Diego, College-Hill Press, 1983. Prutting, C.A., Kirchner, D., Hassan, P., & Buen, P. A societal appraisal of pragmatic behaviours. Unpublished manuscript, University of California, Santa Barbara, 1984. Wertz, R.T., Weiss, D., Kurtzke, J.F., et al., A comparison of clinic, home and deferred treatment of aphasia. Veterans Ad- ministration Cooperative Study Protocol, V.A. Hospital, Mar- tinez, California, 1978. Wertz, R.T. Personal communication, V.A. Hospital, Martinez, California, 1984. Wilcox, M.J. Aphasia: Pragmatic considerations. Topics in Lan- guage Disorders, 3, 35-48, 1983. The Profile of Communicative Appropriateness: A Clinical Tool for the Assessment of Pragmatics Claire Penn Ph.D (Witwatersrand) Department of Speech Pathology & Audiology, , University of the Witwatersrand, Johannesburg ABSTRACT I The Profile of Communicative Appropriateness — a newly developed profile for the characterisation of pragmatics is described. The theo- retical background to this profile is covered as well as its main components. Its application to a group of eighteen aphasic patients is outlined, results suggesting that patient groupings on the profile could be predicted in terms of severity but not in terms of type of aphasia. Explanations for this finding are discussed and the potential utility of this profile is suggested. 1 OPSOMMING Die Profile of Communicative Appropriateness — 'n nuutontwikkelde profiel vir die karakterisering van pragmatiek word beskryf. Die teo- retiese rasionaal hieragter en die hoofkomponente van die profiel word behandel. Die toepassing hiervan op 'n groep van agtien afatiese pasiente word omskryf Resultate dui daarop dat die pasientgroeperings aanduidend kan wees van die erns van afasie maar nie van die tipe afasie nie. Verduidelikings hiervoor en die potensiele bruikbaarheid van die profiel word bespreek. The clinical profile is a method of characterising language which has become increasingly popular in recent years. Essentially " . . . a linguistic profile is a principled description of . . . those features of a person's . . . use of language which will enable him to be iden- tified for a specific purpose." (Crystal, 1982). The format of such a profile is the presentation of a wide range of variables simultane- ously so that the clinician is able to see at a glance the communica- tive assets and deficits of a patient. The main purpose of such a profile according to Crystal (1982) is to provide not only a comprehensive description of a patient's data but also an adequate basis for remedial intervention. It is not a standardized measure; nor is it an exhaustive linguistic descrip- tion. The profile is, however, a compromise to the clinician faced with the realisation that language disability requires comprehen- sive and individual description. The amount of information con- tained on a profile is determined by the behaviours being measured © SASHA 1985 The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) Profile of Communicative Appropriateness : a Clinical Tool for the Assessment of Pragmatics as well as the purpose of the tool. However, it is imperative that the categories are clinically relevant i.e. that they can potentially distinguish patients with differing symptoms. The language behaviours which can be characterised by profile are numerous. Crystal and his co-workers developed the LARSP pro- file in 1976 to characterise expressive syntax and have subsequently introduced profiles to describe phonology, prosody and semantics (Crystal, 1982). Prutting has developed a profile (protocol), based on speech act theory designed to characterise pragmatic capabili- ties (Prutting and Kirchner, 1983). This paper will describe an alternative pragmatic profile, developed over some years viz. The Profile of Communicative Appropriate- ness (PC A). The PCA is a linguistic profile designed to characterize the com- municative competence of a clinical subject. It was developed to identify the features of communication evading description by tradi- tional methods. It is concerned primarily with language use beyond the sentence level and is based on a number of theoretical assump- tions from the field of pragmatics. Before a consideration of the PCA and its application, this theoretical basis will be examined in further detail. THEORETICAL BACKGROUND The field of pragmatics has been defined as the study of " . . .the rules governing the use of language in context" (Bates, 1976). Ac- cording to Prutting (1982) "the context in which communication takes place is highly complex and includes multidimensional aspects of the environment". It takes into account the people present in the interaction, what was said before, the topic of conversation, the task of communication and the time and place of the interaction. I In Figure 1 the main components of the communicative context are isolated viz. participants, codes, channels, setting and content. T H E C O M M U N I C A T I V E C O N T E X T C O N V E R S A T I O N A L M A X I M S Figure 1 The Realm of Pragmatics Although in the field of linguistics and in language pathology, there is at present what Prutting (1983) calls a "paradigm shift" towards the field of pragmatics, the area is a complex one and as yet ill defined Many linguists have declared a reluctance to incorporate such contextual factors into a model of language, their claim being that such considerations fall outside the realm of linguistics per se. On the other hand, there is ample evidence to suggest that many aspects of communicative competence are amenable to analysis and can be systematically described and related. These aspects have for the most part been dealt with largely independently in the litera- ture and have different frameworks of analysis. Aside from the work of Bates (1976) there is as yet no cohesive theory of pragmatics which attempts to combine the study of language use into a unified whole. At this stage a discussion of pragmatics therefore probably necessitates a consideration of its component parts. Central com- ponents selected for discussion here are reflected schematically in Figure 1 - viz. Response to Interlocutor, Topic Control, Cohe- sion, Fluency, Sociolinguistic Sensitivity and Non-verbal Commu- · nication. To separate these particular aspects is a somewhat artificial exercise as there are many areas of overlap. The reasons for con- sidering them separately are governed by their distinction in the literature their relative independence from a methodological per- spective, but most important by their potential practical separation as useful areas for the characterization of pathological language. It is beyond the scope of this paper to present in any depth the scope and theoretical underpinnings to the aspects discussed. This has been described elsewhere (Penn 1983a). Presented here is merely an out- line of the main components of Communicative Competence with their respective definitions. COMPONENTS OF COMMUNICATIVE COMPETENCE Probably the most important area of control which the normal speaker-hearer has over his language in real life is his competence with regard to discourse. Most human communication takes place beyond a sentence level i.e. in dialogue or in conversations. Ap- propriate response to an interlocutor thus involves knowledge of the rules of discourse and an understanding of the speaker's inten- tion with regard to a particular utterance. Coherence is a central feature of discourse i.e. the property that makes a discourse more than a collection of unrelated simple sentences. Two aspects of co- herence in discourse may be identified - the first is related to Con- trol of topic or of Semantic Content. Keenan and Schieffelin (1976) define discourse topic as the proposition about which the speaker is either providing or requesting new information. The rules for topic cooperation are very complex including those for topic shift- ing, shading (expansion) and reintroduction. The notion of cohe- sion is the second major component of coherence. This refers to the way in which sentences are linked within a discourse. Cohe- sion may be expressed through the syntax or vocabulary and in- cludes components such as reference, substitution, ellipsis and conjunction, all of which have been discussed at length by wor- kers such as Halliday and Hasan (1976). Fluency is another aspect of communicative competence which has been examined in considerable detail by both linguists and speech pathologists. It is considered as a sensitive indicator of the potency of the communicative system. Dalton and Hardcastle (1977) point out that there are two possible ways to view fluency. The first em- phasizes temporal and sequential aspects of speech and includes factors such as pauses and interruptions. The second meaning of fluency is derived from the context of language usage and includes adherence to the rules of language. Clearly in characterizing com- munication, we are concerned with both aspects, though speech ther- apists have traditionally concerned themselves more with temporal and sequential aspects of fluency (Penn, 1983b). The term Sociolinguistic Sensitivity coined by Bates and Johnston (1977) describes the speaker's awareness and sensitivity to the con- textual features of his utterance and his ability to modify his mes- sage in terms of this context. The speaker who is sensitive to the Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 20 Claire Penn t .he situation will take into account the A communicatively competent speaker will also show good con- trol and understanding of non-verbal transmission of messages. Much has been written during recent years on this channel of com- munication (Behrmann & Penn, 1984). It includes areas such as kinesics, proxemics and paralanguage. The function of non-verbal communication changes according to context and the patient's specif- ic abilities. Non-verbal communication is in fact an important com- ponent of all aspects of communicative competence discussed previously. Finally on a more esoteric level, there are certain properties of con- versation which determine its overall qualitative level of appropri- ateness. In order to communicate effectively certain ground rules must be followed by the communicative participants. Borrowing from Kant, Grice (1975) has suggested that four maxims apply in Conversation: quantity, quality, relation and manner and that these are basic to the rules of cooperative discourse. By way of a summary of the preceding discussion, Figure 1 illus- trates the aspects discussed. It demonstrates the primacy of com- municative context over the speaker's use of language and the basic influence of the cooperative principles of conversation. It also in- dicates the separate (but overlapping) areas of communicative com- petence discussed above. The PCA reflects an attempt to capture such aspects for the pur- poses of clinical description and prediction. A clinically viable ver- sion of the PCA is presented in Figure 2. The six main areas of communicative competence are presented as well as the specific linguistic behaviours subsumed under each scale. The PCA evolved from a study designed to investigate the expressive output of a group of adult aphasic patients. It is not the intention of this paper to describe the detailed outcome of this study. What seems important is a consideration of how the PCA evolved and its utility in describ- ing and separating out aphasic subjects. Date Person eliciting sample Features of sampling Unit of analysis / . t f V / / / CONTENTS Request 2 ο Reply % = = Ο Clarification request o S. g- s Acknowledgement S. ζ Teaching probe Others Topic initiation Topic adherence ° -S s Topic shift ο £ - Lexical choice £ Ε ο Idea completion υ " Idea sequencing Others Elipsis Tense Use c Reference •2 Lexical Substitute forms -C Relative Clauses υ Prenominal Adjectives Conjunctions Others Interjections Repetitions > » Incomplete phrases c ο False starts κ Pauses Word-finding difficulties Others Polite forms Reference to interlocutor υ Placeholders, fillers, stereotypes ts >» Acknowl edgements Self correction Comment clauses Sarcasm/humour (Λ Control of direct speech Indirect speech acts Others Vocal aspects: Intensity Pitch Rate Intonation _ Ο W 'Ζ. Quality ϋ .a Non-verbal aspects: Facial expression ι 3 s ι Ζ Ε Head movement ι 3 s ι Ζ Ε Body posture υ Breathing Social distance Gesture and pantomime Others TOTAL Figure 2 Profile of communicative appropriateness The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) The Profile of Communicative Appropriateness : a Clinical Tool for THE PCA AND APHASIA The PCA evolved in a two-part study conducted over five years. In the first part (part A) the interactive language samples from a group of six aphasics were analysed syntactically using the LARSP profile (Crystal et al, 1976). This syntactic analysis was found not to identify the main communicative features clinically differentiat- ing the subjects. Among such features were factors relating to man- ner of production, control of content and control over rules of discourse. This led to the derivation of a taxonomy of behaviours designed to represent these aspects. As an audiotaped data base was the basis for analysis, non-verbal communication could not be con- sidered in Study A. In Study Β which employed videotaped analy- sis of the interactive language samples of fourteen subjects, a non-verbal scale was included. The PCA thus measures three broad areas of communicative competence - Control of discourse (meas- ured by Scales Α. Β and C), Fluency (Scale D) and more global aspects of interactive communication (Scales Ε and F). A major concept underlying the PCA is the notion of appropriate- ness The language behaviour of an individual may only be judged as being appropriate within the context of a communicative event. The term "appropriate" implies a societal framework of judge- ment based on the performance of the individual in a social con- text, rather than on his ability on an "all or none" measure ot language on a traditional test. In the writer's opinion, the perceived impact of an aphasic patient's difficulty can not be evaluated in terms of a score or a quantitative measure, but in terms of qualitative appropriateness. The issue of how to characterize appropriateness was considered in the present study which used, like Holland (1982) and Prutting the Assessment of Pragmatics 21 and Kirchner (1983), a dichotomy rating of Appropriate/Inappropri- ate in Study A. In Study Β a five-point rating scale was used. In Study A, the task of the judges (six qualified and specially trained speech pathologists) was to rate each conversational turn in terms of its appropriateness for each aspect of the PCA. A conversation- al turn was defined as one Therapist-Patient interaction. Difficul- ties were experienced in analysing the data using statistical procedures for a number of reasons. Firstly, the nature of the judge- ment proved too precise for the nature of the data under evalua- tion. Secondly, the large number of judges, while providing valuable insight into the clinical utility of the tool, provided difficulties in the calculation of inter-rater agreement. As a result, in Study B, a five-point rating scale was employed, illustrated in Figure 2. Two trained judges were required to rate the data of the subjects using the five point scale to evaluate each one minute chunk of language data (designated the Conversational Unit) in the sample of each of the subjects. Inter-rater agreement (measured by means of Cohen's weighted Kappa coefficient (Cohen, 1968) reached acceptable lev- els for each of the six scales. Additional measures for each of the subjects included the administration of the Boston Diagnostic Apha- sia Examination (BDAE) (Goodglass & Kaplan 1972) Holland's CADL (1980), and Sarno's Functional Communication Profile (1975). The approach to data analysis was essentially taxonomic making use of a technique known as hierarchical cluster analysis. This al- lows for the clustering of subjects on a particular measure on the basis of their similarity. The outcome of the cluster analysis can be portrayed schematically by means of cluster fields. In Figure 3(a-f) the outcome of the cluster analysis on the separate scales of BDAE Severity Rating (a) High High Ο Ο ) ο BDAE Severity Rating (b) BDAE Severity Rating (C) High (C 3 £ C 3 BDAE Severity Rating (d) BDAE Severity Rating (e) BDAE Severity Rating (f) Figure 3(a-f) Clustering of the subjects on Scales A-F of the PCA in relation to Appropriateness and severity ratings (Study B) Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 22 Claire Penn the PCA in Study Β is demonstrated as a function of the subjects' the "LA in y reveal that the subjects severity ratings on the BUAfc. Clustered i n t o several distinct groups on the basis of appropriate- ness - the size and the composition of the groups varying accord- ing to the scale. On the whole, results suggested a better retained competence for scales Α, Β, Ε and F than for Scales C and D. When results for all scales combined are viewed (Figure 4) two broad subject splits can be identified — The appropriate group (consisting of eight sub- jects) and the inappropriate group (containing six subjects). These splits correlated broadly with severity (as measured on the BDAE) and with performance on other measures of communication (see Figure 5) but not with the subjects' syntactic capacities nor with type of aphasia. High Med Low 2 3 BDAE Severity Rating Figure 4 Clustering of the subjects on all Scales of PCA in relation to Appropriateness and severity ratings (Study B) Below median Above median Performance on FCP and/or CADL Figure 5 Comparison of Subjects' performance on PCA and other communication measures Results thus suggest that the subjects showed differential retention of communicative skills as measured on the PCA — a finding sup- ported by Goldblum (1983) who applied Prutting's protocol to adult aphasics. Further the results lend support to the idea that traditional methods of classification and assessment may need some reconsideration. POSSIBLE EXPLANATION FOR RESULTS Returning to the pragmatic framework presented in Figure 1, the results of the present study suggest that within a given communica- tive context (whose participants, channels, code, setting and con- text are at least partially specified) aphasic patients' rules for communicating differed from those of normals and between in- dividual subjects. No striking evidence was observed however which suggested that such differences reflected the use of a completely distinct set of rules within any particular group. Rather, the pa- tients' capabilities seem to lie on a continuum. Discourse, fluency, sociolinguistic sensitivity and non-verbal aspects were assessed in terms of communicative appropriateness. Results suggested that communicative competence is often well retained in aphasia and that difficulties pattern those of normals, occurring however with greater frequency. Davis (1983) has suggested that "Adult apha- sia can be understood in part as a disturbance of normal process- es". The effect of aphasia appears to be that of limiting or reducing the individual's capacity to apply the conversational maxims ef- fectively. The maxims of quality and relation are properties of con- versation concerned with basic truth conditions and. semantic content. Control of such matters (particularly in scales A and B) was implicated in certain subjects. Quality and manner of produc- tion (reflected on Scales C and D) are also affected by brain damage. The behaviours measured on Scales Ε and F might be seen as those strategies employed by the subject to overcome the communica- tive difficulties imposed by his defect. The fact that there was a considerable degree of overlap between scales and between patients on the scales confirm that communica- tion is after all a global process. The aphasic patient's control of communication and his adaptation to his difficulties reflects his over- all communicative competence. UTILITY OF THE PCA With regard to the PCA, the results of the study have indicated in a preliminary sense the potential clinical utility of the profile as a measure to characterise aspects of aphasic language use. 'It ap- pears to have fulfilled many of the criteria suggested by Crystal (1982) as being necessary properties of a linguistic profile: ι — It will provide at a glance a simultaneous appraisal of the pa- tient's areas of strength and weakness in a communicative sense. — It may be used as a diagnostic or screening measure. For screen- ing purposes only broad areas of communicative competence (e.g. Control of Semantic Content) need be characterised. For diagnostic purposes an in depth appraisal of specific aspects (e.g. topic management) could be explored. — The PCA is flexible and by no means finite. It provides an op- portunity to code 'Other' behaviours and also has a category for unanalysable features, (Could not Evaluate). Further the Con- versational Unit may be varied according to the interest and the needs of the Examiner. It may be time- or turn-based. An addi- tional flexible component of the PCA is that it can be used to characterize interaction between a patient and any interlocutor, not necessarily his therapist. — Although unlike other linguistic profiles developed on children, it is not graded, it does appear to provide a basis for remedial intervention in that it has generated many hypotheses regard- ing the direction of future therapy for those patients examined . in the present study. The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) The Profile of Communicative Appropriateness : a Clinical Tool for Finally, although the PCA emerged initially from the study of adult a p h a s i c ' l a n g u a g e , this certainly does not preclude its use with other l a n g u a g e - i m p a i r e d populations. Encouraging preliminary data has e m e r g e d from the application of the PCA to a group of head in- jured subjects (Irvine, 1984), a schizophrenic subject (Cohen, 1984) and some hearing impaired children (Sacks, 1984). Further ongo- ing research exploring the usefulness of the PCA in the area of learn- ing disability, dementia and in the clinical supervision of students is being explored by the author. It is hoped that the next few years will see a burgeoning number of studies concerned with the refinement and broadened applica- tion of this apparently useful clinical tool. ACKNOWLEDGEMENTS The writer is indebted to Professor M.L. Aron, Head, Department of Speech Pathology and Audiology, University of the Witwaters- rand for her valuable supervision of the research on which this paper was based. For financial assistance, the writer is indebted to the Human Sciences Research Council and to the Senate and Council Research Committees of the University of the Witwatersrand. REFERENCES Bates, E. Language in Context. New York, Academic Press, 1976. Bates', E. & Johnston, J.R. Pragmatics in Normal and Deficient Child Language. Short course presented at ASHA Convention, 1977. Behrmann, M. & Penn, C. Non-Verbal Communication of Aphasic Patient's. Brit. J. Dis. Comm. 19, 155-168, 1984. Cohen, J. Weighted Kappa: Nominal scale agreement with provi- sion for scaled disagreement or partial credit. Psychological Bulletin 70, 213-220, 1968. Cohen, L. The Communicative Competence of a Paranoid Schizophrenic. Undergraduate Research Report. Dept. Speech Pathology & Audiology, University of the Witwatersrand, 1984. Crystal, D., Garman, M. & Fletcher, P. The Grammatical Analy- sis of Language Disability. London, Edward Arnold, 1976. Crystal, D. Profiling Linguistic Disability. London, Edward Ar- nold, 1982. I Dalton, P. Hardcastle, W.J. Disorders of Fluency. London, Ed- ward Arnold, 1977. the Assessment of Pragmatics 23 Davis, G.A. Aphasia and normal adult language processes. Paper presented at ASHA Convention, 1982. Goldblum, G.M. Aphasia: A Societal and Clinical Appraisal of Pragmatic and Linguistic Behaviours. Unpublished M. A. Dis- sertation. Dept. Speech. University of California, Santa Bar- bara, 1984. Goodglass, H. & Kaplan, E. The Assessment of Aphasia and Related Disorders. Philadelphia, Lea & Febiger, 1972. Grice, H.P. Logic and Conversation. In P. Cole & J.L. Morgan (Eds.) Syntax and Semantics. Speech Acts Vol. 3. New York, Academic press, 1975. Halliday, M.A.K. & Hasan, R. Cohesion in English. Hong Kong, Longman, 1976. Holland, A.L. Communicative Abilities in Daily Living. Baltimore, University Park press, 1980. Holland, A.L. Observing Functional Communication of Aphasic Adults. J. Speech Hear. Dis., 47, 50-56, 1982. Irvine, L. The Communicative and Cognitive Deficits following Closed-Head Injury. Undergraduate Research Report, Dept. Speech Pathology & Audiology, University of the Witwaters- rand, 1984. Keenan, E.O. & Schieffelin, B.B. Topic as a Discourse Notion: A study of topic in the Conversations of Children and Adults. In C.N. Li(Ed.) Subject and Topic. New York, Academic Press, 1976. Penn, C. Syntactic and Pragmatic Aspects of Aphasic Language. Unpublished Doctoral Thesis. University of the Witwatersrand, 1983. Penn, C. Fluency and Aphasia: A Pragmatic Reconsideration. S.A. j' Comm. Dis., 30, 3-9, 1983. Prutting, C.A. Pragmatics as Social Competence. J. Speech Hear Dis., 47, 123-134, 1982. Prutting, C.A. The pragmatics of Language. S.A.J. Comm. Dis., 31, 3-5, 1984. Prutting, C.A. & Kirchner, D.M. Applied Pragmatics. In T.M. Gallagher & C.A. Prutting (Eds.) Pragmatic Assessment and Intervention Issues in Language. San Diego, College Hill Press, 1983. Sacks, J. Some Grammatical Discourse Features in the Older Hear- ing Impaired Child. Undergraduate Research Report. Dept. Speech Pathology & Audiology, University of the Witwaters- rand, 1984. Sarno, M.T. The Functional Communication Profile. New York, Institute of Rehab. Medicine, 1975. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) Medical Software and Hardware Specialities - PRACTICE ACCOUNTING PACKAGES - REHABILITATION AIDS - PATIENT HISTORY MANAGEMENT - COMPUTERS AND PERIPHERALS ALSO AVAILABLE - BUREAU FACILITIES CLINICAL COMPUTER CONCEPTS CC CK 85/03210/23 103 Highlands North Medical Centre, cr. Louis Botha Avenue & 3rd Avenue, Highlands North 2192. South Africa. PHONE (011) 440-9412 FOR EXPERT ADVICE / The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2)