Clinical and Linguistic Correlates of Functional Communication Abilities After Stroke: A Longitudinal Study

Background: Aphasia, a common consequence of left-hemisphere stroke, significantly impairs communication and daily functioning. Various studies have explored language recovery but only few have focused on the predictors of recovery of functional communication in patients with stroke. Objective: To identify clinical and linguistic factors associated with functional communication outcomes in patients with post-stroke aphasia. Methods: We enrolled 61 patients with aphasia due to left-hemispheric stroke, admitted to post-acute neurorehabilitation centers. Patients underwent neuropsychological, functional, and language assessments at admission (T0) and discharge (T1). Language abilities were evaluated with the Brief Exam of Language-II (BEL-II), and functional communication was measured through caregiver-rated I-CETI scores. Depression, basic (ADL) and instrumental (IADL) activities of daily living were also assessed. Correlations and regression models were used to examine predictors of functional communication recovery (ΔCETI). Results: Significant improvements were observed in all language domains, functional independence, and mood symptoms from T0 to T1 (p < 0.003). Regression analysis showed that demographic and general clinical variables (e.g., age, etiology, dysphagia) were not significant predictors of ΔCETI. However, ADL score, comprehension skills (Token test and comprehension sub-score of BEL-II) were significantly associated with functional communication recovery (β = 0.51, β = 0.68 and β = 0.75, respectively; p < 0.05). Conclusions: Functional communication recovery in post-stroke aphasia is strongly associated with initial comprehension abilities and functional autonomy in basic life activities, rather than demographic or general clinical variables. These findings highlight the need for targeted interventions aimed at improving receptive language and the importance of including ecologically valid communication assessments in post-stroke rehabilitation protocols.