Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review
Authors: Kuyler Ariné , Johnson Ensa , Bornman Juan 
Published: December 2021

AbstractBackgroundUnaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication).AimTo identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours.Methods & ProceduresThe study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full‐text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies.Main contributionThe subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non‐linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories.Conclusions & ImplicationsAlthough unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person‐partner communication.What is known?Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours.What the paper adds…This paper emphasises that unaided communication behaviours range from non‐linguistic to linguistic, and they can support unintentional, pre‐intentional and intentional communication functions.Clinical implications
Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations.
This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA.

Future research should include more untrained communication partners.