In literature on speech therapy and neurology a broad criterion is applied when addressing “severe patients”. Within our line of work, a patient presents a severe pragmatic compromise when he or she does not perform the eight basic speech acts of asserting, rejecting, requesting (object), action, greeting, giving information and requesting information (Abraham & Brenca, 2016). A complexity progression criterion is followed (from the most basic to the most developed).

Three degrees of severity including levels were established by taking into account pragmatic features of each of the basic speech acts above mentioned. Such degrees allow to record severity variations due to spontaneous recoveries, advances resulting from therapeutic work or a typical deterioration of the clinical condition. We believe that considering minimal alterations related to nonverbal and linguistic basic pragmatic performance in the severity stage contributes to outlining more precise specific goals and identifying plateau, progression and retrogression clearly.

Degrees of severity

Assessment 1

a- No verbal and gesture production:

The three forces of the speech act are compromised (illocutionary, locutionary, perlocutionary).

b- No verbal production. Incoherent use of gestures.

• The patient expresses a communicative intent with gestures (IF) but with a partial or total coherence compromise, no locutionary force.
  
• Perlocutionary force is affected in both.

c- The patient has a minimal verbal and gesture production, both with coherence failures.

• He makes gestures to compensate his verbal problems partially.
  
• Minimal verbal production consists of: sound emissions, intonation, vocatives, deictics, nouns.
  
• The addressee needs to infer in order to decode.

d- Occasionally the patient achieves verbal and gesture minimal productions, both coherent, but not in a systematic way.

• He can occasionally express his communicative intent coherently.
  
• Sometimes he successfully communicates with gestures, sometimes verbally and occasionally in both ways (in the simplest speech acts of the eight basic speech acts.
  
• Minimal verbal production is: sound emissions, intonation, vocatives, deictics, nouns.

Assessment 2

a- Minimal verbal production and coherent use of gesturese

• The patient still does not perform any speech act. He has a communicative intent.
  
• He has a minimal verbal production (i.e. vocatives, deictics, nouns).
  
• He successfully compensates his verbal problems with gestures.
  

b- Coherent verbal and gesture production in some of the eight basic speech acts (asserting, rejecting, greeting and calling).

Assessment 3

a- Gesture production in the speech acts of “Giving new information” and “Requesting information”.

b- esture and verbal production in the speech acts of “Giving new information” and “Requesting information”.

Assessment 4

Consolidation of the Communication Minimum Circuit.

• Coherent verbal and gesture production in the eight basic speech acts.