CLINICAL LINGUISTICS & PHONETICS,

1991,

VOL.

5,

NO.

1, 39-5 1

The potential of cohesion analysis in the

Analysis and Treatment of Aphasic
Discourse
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ELIZABETH M. ARMSTRONG
Speech Pathology Department, Royal Prince Alfred Hospital, Missenden Road,
Camperdown, NSW 2050, Australia
(Received 24 April 1990; accepted 24 August 1990)

Abstract

This paper describes Halliday and Hasans cohesion analysis (1976) and Hasans
later extension of this work to the cohesive harmony analysis (1985), and relates
both to aphasic discourse. The roles of both lexical and grammatical cohesive
devices are outlined, the lexical devices including repetition and collocation and
the grammatical devices including reference (through the use of pronouns, definite
articles, demonstratives and comparatives), substitution and ellipsis. The applicability of these analyses to treatment of the aphasic deficit is also discussed, with
the notions of discourse and cohesion being related to communication across
aphasic types and from the mild to the severe end of the aphasic continuum.
Keywords: Aphasic discourse, cohesion, discourse analysis, cohesive harmony,
aphasia treatment.

The role of spontaneous speech analysis has become of increasing interest in aphasiology over the past few years. While it has been used in some cases for specific
diagnostic purposes such as the classification of aphasic patients into fluent and nonfluent groups (Benson, 1967), more recently the main motivation has been to characterize the aphasic deficit as it is evidenced in more natural conditions than those
involved in standardized tests.
The spontaneous speech analyses to data have provided us with measures of
such features as rate of speech, amount of information conveyed in terms of content
units, efficiency of communication, etc. (Wagenaar, Snow and Prins, 1975; Yorkston
and Beukelman, 1980; Shewan, 1988). However, what seems lacking in these analyses
to date is a logical direction to the remediation of the problems they often highlight.
A possible reason for this lack of connection between assessment and treatment
is that many of these analyses originate from a psycholinguistic tradition which in
aphasiology has focused primarily on the single-word and sentence levels. They thus
lead to quantitative approaches providing tallies of instances of individual phenomena which may or may not be related to each other and which, when put together,
do not necessarily form a clear picture of the aphasics discourse. In other words
the analyses have not used a theory of discourse as their basis, and in some cases
have tried to characterize all aspects of language, i.e. semantics, syntax and phonology, in a relatively brief analysis. What these analyses have done is to use a
0269-9206/90 $3 00

0 1990 Taylor & Francis Ltd.

Elizabeth M . Armstrong

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40

selection of ideas drawn from theories based on single-word lexical processing or

sentence grammar, and assume that they can be applied to connected speech. Taking
current linguistic theory into account this may indeed by a false premise. It is thus
not surprising that clinicians often ask the question-OK, weve done the spontaneous speech analysis, where do we go from here? Or, after having performed
them, then go back to therapy which again is single-word-based and rarely related
to the analyses just completed. These types of analyses are notoriously time-consuming for clinicians. Therefore, if they are to be efficient uses of their time, the analysis
have a responsibility to provide direction for the clinician as to what sorts of
remediation are appropriate.
This paper discusses a spontaneous speech analysis (the cohesion analysis) which
is based on normal discourse theory and which looks for connections of ideas across
the discourse rather than counting words or ideas as completely separate entities.
The analysis is described in necessarily brief detail and is then related to pathological
discourse, with its implications for treatment of the aphasic patient also discussed.
Cohesion analysis

The cohesion analysis described in this paper is based on Halliday and Hasans 1976
work and Hasans later developments in 1980 and 1985. In 1976 Halliday and Hason
published a book entitled Cohesion in English, which dealt with the issue of cohesion
of discourse and provided the most comprehensive work to date on the relationship
between cohesion and the coherence of a discourse.
It is important from the start, however, to understand Halliday and Hasans
view of discourse or text (the terms will be used interchangeably). They define a text
as: any passage, spoken or written of whatever length that does form a unified
whole (Halliday and Hasan, 1976, p. 1). They stress that a text is not determined
by its length. It is not the equivalent of a paragraph, for example. It could be a
novel, a lecture, a proverb or even simply a STOP sign on the road. Its length is
irrelevant-it is the completeness of the message that makes it a text. It is therefore
not a grammatical unit and can best be described as a semantic one. It is a unit of
language in use which conveys a certain meaning.
This is extremely important to understand, as if one is to adopt this discourse
approach it forms the whole basis of analysis and treatment. One is not simply
looking beyond the word or the sentence. The clinician is focusing on how the
patient is getting his meaning across. Hence it is relevant to all types of aphasicsthose who are speaking in single words only and those who speak fluently and at
length.
It is also important to remember that discourse or text in this framework is
intricately related to the context of situation. Halliday in particular has written at
length (1970, 1978, 1984) on the interdependence of the linguistic and extralinguistic
features of a situation in contributing to meanings conveyed. Hence, the cohesion
analysis must consider language in context for true interpretation.

What is cohesion.?

Cohesion is defined as the set of linguistic resources that every language has (as
part of the textual metafunction) for linking one part of a text to another (Halliday,

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Cohesion analysis in treatment of aphasic discourse

41

1985, p. 48). Halliday and Hasan (1976) postulated that the cohesive devices formed
the building blocks for textual coherence. In forming connections between parts of
the text, and in establishing unity of meaning in the text, the cohesive devices make
the structure of a text discernible as well as being responsible for its overall texture.
Cohesion occurs when the interpretation of some element in the discourse is
dependent on that of another. The cohesion analysis, therefore, looks for connections
between words in a piece of discourse, rather than looking at words as they carry
meaning individually. It involves analysis of both lexical and grammatical mechanisms.
Lexical cohesion refers to the relationship that exists between words in a text. In
Halliday and Hasans terms it is the cohesive effect achieved by the selection of
vocabulary (1976). The main types of relationships involved here are those of
reiteration and collocation. Reiteration occurs when the same person, place or event
is referred to more than once, but in different ways through the use of these devicesrepetition of the same word, use of a synonym, superordinate or general word.
Collocation, on the other hand, refers to the way in which related words occur in a
text, not necessarily referring though to the same event as with reiteration. The
words could refer to related events, people or simply ideas which are associated with
a particular event or person. Words which can be used to create collocation in a
text include synonyms, antonyms, complementaries, meronyms or words that are
related causally, e.g. laugh/joke. Examples of lexical cohesion are given in
Appendix 1.
In terms of grammatical cohesion there are three main categories of devices:
reference, substitution and ellipsis. Reference or co-reference in a text is achieved
through the use of the following devices: pronouns, definite articles, demonstratives
and comparatives. Interpretation of these items is always dependent on referents
either further back in the text (anaphora) or forward in the text (cataphora).
Substitution occurs when a word or phrase substitutes for another word, phrase or
clause in the text. Ellipsis involves omission of a word, phrase or clause which has
been mentioned once, but is then implied by reference back to the original statement
rather than reiterated. Examples of the grammatical devices are given in Appendix 2.
While conjunction is an integral part of the cohesion of a text, Halliday and
Hasan consider it separately from the above device. The devices mentioned above
link parts of clauses with parts of other clauses, while conjunction is responsible for
the linking of complete clauses. As conjunction is a complex area of its own, the
various types of conjunction will not be discussed in this paper. Suffice to say,
though, that it constitutes another important linking device in the text.
The above mechanisms therefore form what are called cohesive ties in a text.
Two lexical items make up such a tie: the pronoun and its referent, the adjective
and its synonym. The notion of two-ness is central to cohesion.
When looking for connections between items in a text one can often see relationships, however, which extend beyond two lexical items. At times, five or 10 references
may be made to the same person, or five or 10 adjectives are all related to each
other. Hence, Halliday and Hasan, and more especially Hasan in her later work,
proposed the notion of cohesive chains which ran throughout a text, encompassing
all those items which are related to each other.
Halliday and Hasan postulated that the more items in a text which went to form
chains, the more coherent the text would be. However, in further work, Hasan (1980,
1985) discussed the fact that chains were not the whole picture. In fact it was possible

42

Elizabeth M . Arnzstrong

to form a text in which all the lexical items formed chains, and yet was obviously
not coherent, e.g.:

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girls bananas two spend shopkeeper

apples own girls dollars grapes
buy fifty sell cents shopkeeper
girls fruit
Hasan acknowledged the fact that in looking solely at chains, one is looking at
components of a message separately from the message itself-hence one would be
trapped again into an analysis which, like may other spontaneous speech analyses,
misses the point of the 'unity' of a text. Her solution to this problem was to look
at relations between the chains, and this analysis was called chain interaction analysis.
Chain interaction was said to occur when at least two members of one chain stood
in the same relationship to two members of another chain. The relationship is a
grammatical one such as actor-action, action-location, etc.
In examining chaining and chain interaction of a text, one is interested in placing
the interaction in the perspective of the total text, i.e. to see what proportion of the
text participates in such chain interaction. In order to do this the total tokens in the
text are counted. A token is defined as a lexical item carrying content. The tokens
are then assigned to chains. Those tokens entering into chains are called relevant
tokens. The remainder are called peripheral tokens. The tokens which interact with
tokens from another chain are described as central tokens. A cohesive harmony
index (CH1)- an index postulating the coherence of the text-is calculated by
getting a percentage of the central tokens of the total number of tokens in the text.
Hasan postulates that for a text to be reasonably coherent a CHI of approximately
50% should be expected, i.e. 50% of the total tokens should enter into chain
interaction.
As an example of how the analysis works on a normal speech sample, consider
the following narrative text (Text A). This text was obtained in response to a series
of pictures making up a story, known as the Cat Story, used by Ulatowska and her
co-workers in a number of studies of aphasics' productions of narrative (Ulatowska,
North and Macaluso-Haynes, 1981 ; Ulatowska, Freedman-Stern, Weiss-Doyell and
Macaluso-Haynes, 1983). The tokens are italicized:
Text .4
I . A little girl's kitten was caught in a tree
2. The child \+'as very upset
3. Because she couldn't get it down
4. A man came along
5 . And tried to get the cat down
6. He climbed the tree
7 . But before he reached the cat
8. It jumped down
9. And the child was happy
10. He then crawled hack along the brunch
I I . But got caught himselfon a twig
12. And theJire brigade had to come
13. And get the man d o ~ x
Figures 1 and 2 demonstrate how this system works on Text A. As can be seen from

Cohesion analysis in treatment of aphasic discourse

Fl

11. c a u g h t

9.

child

3. g e t down

7.

cat

43

rl
6. t r e e

10. branch
11. t w i g

reach
1 3 . g e t down

7 . he

10. crawl

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1 0 . he

11. m a n ( E )
11. h i m s e l f
13. man

f i r e brigade

9 . happy

E = e l l i p t e d tokens
RELEVANT TOKENS = 39

Figure 1. Chains formed from Text A [normal text).

5 . man(E)
7 . man

1 0 . he

~ 1 - 1
I

11. c a u g h t

1. t r e e
11. t w i g

CENTRAL TOKENS = 2 4

COHESIVE HARMONY I N D E X = 5 0 %

Figure 2. Chain interaction occurring in Text A [normal text).

Fig. 2, a considerable amount of interaction occurs, drawing the text together. Also,
within the chains themselves there is a variety of relationships, e.g. synonymy,
antonymy, etc.
Cohesion as applied to aphasic discourse

Much of the work using cohesion analysis in pathological discourse so far has used
the notion of the cohesive tie as its basis, as described by Halliday and Hasan in

44

Elizabeth M . Armstrong

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i976. Data have emerged from this work documenting cohesion problems in aphasics
(Ulatowska, Macaluso-Haynes and North, 1980; Ulatowska et d.,1981, 1983;
Lemme, Hedberg and Bottenberg, 1984), Alzheimers patients (Nicholas, Obler,
Albert and Helm-Estabrooks, 1985; Ripich and Terrell, 1988) and head injuries
(Mentis and Prutting, 1985). The main differences found between these pathological
populations and normal speakers have been the following:
1.
2.
3.
4.
5.
6.

Less use of cohesive ties.

Less use of lexical ties.
Poor use of logical connectors.
Greater than normal use of deictics.
Use of pronouns without antecedents or referents.
Increased use of elliptical ties (head injuries).

However, as well as counting cohesive ties and rating adequacy of pronoun usage,
qualitative analyses are also extremely useful in discovering just how the aphasic is
building up his/her discourse. For example, in the study done in 1984 by Piehler
and Holland, very useful profiles of the discourse of an acute Wernickes and an
acute Brocas patient were developed over their initial stages of recovery, tracing
not only the amount of cohesive devices used, but the different types involved, e.g.
these workers found that the Brocas patient began with only lexical and elliptical
ties and gradually developed use of all other types of devices, while the Wernickes
patient increased his use of referential and elliptical ties but decreased his use of
conjunction.
Such information is central to discovering the quality of the discourse, i.e. its
coherence, rather than merely measuring the quantity of cohesive ties used. Quantity
in this case does not equate with quality as, for example, Rochester and Martin
(1 979) highlighted when they profiled schizophrenic speech using the 1976 analysis
and found that schizophrenic patients had a higher degree of lexical ties than normal.
The differences between normals and aphasics is obvious in some texts. Text B
again used the Cat Story. but is this time an example of the aphasics response to
the picture sequence.
Text B: Total tokens = 42
1. There was kitten up in the tree
2. And the little girl tried to . . .
3 . wanted it down
4. And a chap came along
5 . And he .. . he tried to get it down
6. He didnt work too good
7. Because he upset the business
8 . And the kitten jumped doun
9. And Ieft him hanging up in the tree there before
10. But he should have had a guard
11. Somebody come to have done it
12. Should have somebody else . . , proper one
The chain and chain interaction analyses are displayed in Figs. 3 and 4. There is
obviously both less chaining and chain interaction present compared with the normal
text.

Cohesion analysis in treatment of aphasic discourse

45

1. k i t t e n
7. kitten
8. k i t t e n ( $ )

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9.

him

RELEVANT TOKENS = 1 7

Figure 3. Chains formed from Text B (aphasic text)

p Z q < >Fl
2. kitten

CENTRAL TOKENS = 4
C O H E S I V E HARMONY I N D E X = 10%

Figure 4. Chain interaction occurring in Text B (aphasic text).

Consider another aphasic text, again of the Cat Story:

Text C: Total tokens=44
1. Well he goes
2. It goes off with a chap and his sister
3. And he sees a cat on top of the hen .. . no
4. He sees a cat on top of the (what do you call it) ... tree
5. And shes down there
6 . And she gets down there
7 . And she and the chap comes up
8 . And she and he gets to the tree
9. And then hes there
10. And he throws the cat down to her
1 1. And then the little girl ... and the fireman are there getting
The chaining and chain interaction are displayed in Figs. 5 and 6 . In this text there
is a significant amount of chaining, but little chain interaction. However, one must
also note the types of chains present in this text. Many of the chains are merely
reiterative, made up of the same items, with a more restricted range of lexical
relationships between them, e.g. few synonyms, superordinates, etc. Many of the
lexical items in the text are not related to others within that text; also many are
ambiguous, e.g. the pronouns, and therefore cannot be chained with each other.
When the text is examined in terms of its chain interaction specifically, the
differences between the aphasic and the normal speaker become even more obvious.
Not only is there less chain interaction (as found by Bottenberg, Lemme and
Hedberg, 1985 and Armstrong, 1988), but the chains themselves are also very
repetitive. Similarly, the grammatical interactions occurring are also restricted in

Elirabeth M . Arnzstrong

46

II

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2. s i s t e r
5. s h e
6. she
7. s h e
8. s h e
10. her
1 1 . girl

chap
2. h i s ?
7.chap
2.

4. t o p
5. down

6. g e t s down
7. c r a w l s u p
8. gets

? = ultimate referent ambiguous or unavailable

RELEVANT TOKENS = 3 4

Figure 5. C'huins fi)rinrdfroni T e . ~ tC' (uphasic t . u t ) .

6. g e t s down
7. c r a w l s u p
8. g e t s

6. she

CENTRAL TOKENS =

COHESIVE HARMONY INDEX = 1 4 %

occitrrrizg in Test C (rIphasic. t e x t )

Figure 6. Chuin intc~rac~tion

variety. A recent study looking at Cookie Theft descriptions (Armstrong and Ferguson, 1989) found that the aphasics used half the number of different grammatical
interactions that normal speakers did on the same task.
Such analysis allows us. as has been our normal tendency, to look at the aphasic's
weaknesses. However, this analysis also enables us to look at his strengths. The
devices which the patient is using to attempt coherence can be identified, e.g. in the
case of the head injuries they tend to 'overuse' ellipsis, depending more than usual
on the other speaker's utterances (Mentis and Prutting, 1987). This may be considered
pathological. as it varies from normal, but it may also be seen as a strategy which
may possibly be encouraged, depending on its success. This latter remark is an
integral part of using this analysis, i.e. it is the clinician's job to check with listeners
the effect that certain patterns of cohesion have on them in terms of their ability to
make sense of what the aphasic is saying. After all, the clinician is not necessarily
aiming at normal coherence for the client, simply understandable language, i.e.
functional language. As another example, the Broca's patient may have higher lexical

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Cohesion analysis in treatment of aphasic discourse

47

cohesion as a percentage of his discourse than normal, as he lacks grammatical

connectors. One might say, however, that instead of his grammar being a weakness,
his lexical system is his functional strength. Hence, in looking at his disorder in this
perspective, the clinician may choose to work on increasing his lexical abilities rather
than his syntax. This would obviously depend, though, on how his speech sounded
to a listener. If the listener was depending on the lexical chaining for interpretation,
then increasing chaining may increase coherence. If, on the other hand, the lack of
grammatical relationships was a definite interference to coherence, then one could
work more from a chain interaction point of view. This would be focusing on
grammar, but rather than a strictly syntactic approach it would aim at increasing
grammatical relationships within the text from a discourse point of view, which
would use context and discourse connections more than would a sentence/syntax
approach.
Treatment

One can see here how the transition can be made from analysis to intervention, the
analysis being intricately interwoven with subsequent treatment goals.
As various patterns of lexical and grammatical cohesion emerge from the samples
of patients, the clinician is then focused on devices which are either misused totally,
overused, underused or in some cases not used at all. Bearing in mind Halliday and
Hasans basic premise of the text being a unit of meaning, the clinician can then
look at how these patterns affect listeners understanding of what the aphasic is
saying. The lexical chaining notion is particularly different from any other analysis,
as it offers the clinician information on the patients semantic system as it functions
in connected discourse. Instead of getting results from a naming test or a test of
lexical accessing of the semantic field via other types of single-word tasks, or even
getting a quantitative result from a spontaneous speech analysis providing a measure
of amount of content in a discourse, the cohesion analysis provides the clinician
with a picture of how the patients semantic fields are working functionally. It taps
not only the patients ability to access a word as needed in a discourse, but also his
ability to connect one lexical item with a related one to create a continuity of
meaning.
In the case of mild to moderate aphasics whose comprehension is sufficiently
intact to take in the required information, simply pointing out and increasing their
awareness of their cohesion errors may be of some value. On-line feedback about
unclear referents, for example, or tape-recorded speech samples with the patients
acting as rater/analyst, may be of help in highlighting the breakdown to the patient
in the same way that self-monitoring skills are taught in other treatment regimes.
Written transcripts containing discourse errors for correction may also provide
material for therapy. Another way of attacking the problems may be to focus on
the basic chains and chain interactions which form the basis of the discourse. Such
chains can provide what could be seen as a plan of discourse. In treatment, then,
it may be possible to introduce a discourse visually to a patient, providing him with
component parts, i.e. the chains, while at the same time incorporating the concept
of continuity and relationships between the words he is using to create a functional
meaning. Regardless of his level, he is required to produce ideas which are connected
to each other and which are related to a functional context. Discourse structure as
well as texture must be taken into account in any text, of course. Hence a narrative,

Elizabeth M . Armstrong

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48

for example, must have certain components, e.g. the setting, the complicating action,
and the resolution as outlined by Van Dijk (1979). However, the cohesion plan
provides the building blocks for this structure.
Using the written word as the stimulus, a functional context is first introduced
and is usually most easily provided in the form of topics with which the patient is
familiar. e.g. family activities, current affairs, personal interests. As an example, the
occasion of a patients family birthday could be discussed. Drawing on the cohesion
concepts. the clinician could begin by establishing some of the lexical connections
in the proposed text. In this situation collocational activity could be used first, with
the clinician writing down words associated with birthday, i.e. cake, presents, party,
food, family. eating, drinking. laughing, cooking, candles and various sub-categories,
e.g. the types of food, the family members names, presents received, etc. These
words could then be grouped into chains; for example the first chain might contain
the family present at the party-Iris, Peter, Marie, Sally and Sean. Chain connections
could then be made to indicate I and we. Another chain could include the food
provided-pumpkin
soup, roast beef. potatoes, carrots, birthday cake, pudding.
Another one could contain the verbs cook, eat, drink, etc. The working out of these
chains can either be done by the clinician or can be a joint effort between clinician
and patient. If the patient has gross lexical retrieval problems the clinician can simply
provide all the words to begin with. For a less severe deficit the words can be
provided and the patient has to categorize into chains. For even less severe ones the
patient is required both to provide the words and construct the chains, with varying
amounts of cueing as required.
The chains are then displayed in front of the patient (see Fig. 7). Depending on
the level of the discourse the clinician is aiming for, this may be sufficient to stimulate
at least some attempt at discourse. If, however, the patient is capable of more than
single-word utterances, chain interaction can be introduced (see Fig. 8). The relationships between the chains can then be pointed out to the patient, with simple texts
being constructed from simple grammatical relationships to begin with, then increasing the range of relationships used and the length of the text.
Again the level of the patient will determine how much the clinician has to
provide and how much is required of the patient alone. Traditional methods of
imitation, reading aloud or sentence completion, etc., can be used to facilitate the
patients performance with the visual cues being gradually faded.
For those patients who cannot cope with the above concepts at a conscious level
(and it is the authors experience that very few cannot use the strategy in at least

Iris
Peter
Marie

Fi
drink

soup

roast
potatoes
cake
pudding

birthday
candles
presents

Figure 7.

Chains formed as basic of text construction for patient.

Cohesion analysis in treatment of aphasic discourse

Marie
Marie

cook

Peter

49

roast

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Iris
Marie

Figure 8. Chain interactions visually displayed for patient in treatment.

some modified form), cohesion concepts can also be incorporated into a conversational approach to stimulation, with the clinician focusing on chain relationships.
For example, with a global patient, rather than working on single words which are
unrelated to each other, a familiar topic is chosen, with words provided as stimulation
which relate to that particular topic only. Depending on the patients output the
clinician can develop chains and collocational words for the patient, which the
patient can then model or respond to in some fashion, using the traditional methods
of pointing to words named by the clinician, identifying objects, etc. The key notion
of this whole approach is to have the patient focus from day one, regardless of type
or severity of aphasia, on the basic unit of functional language, which Halliday and
Hasan propose is not the word, but discourse, regardless of its length-a semantic
unit which functions to convey meaning at whatever level and patient is capable of
attaining.
The cohesion analysis done within the framework of language in context provides
clinicians with a way of looking at their patients language as it appears in real life
and also treating it in this context. Instead of extrapolating information from
standardized tests of varying types, looking predominantly at single words, it addresses linguistic skills directly as they are used by speakers and listeners. While it
does not attempt to address syntactic or phonological aspects of discourse directly,
it does address the issue of the ways in which a speaker conveys meaning via his
lexico-grammatical system. While structural aspects are also of vital importance to
textual coherence, cohesive devices can be considered the building blocks of the text.
One of the beauties of this approach to treatment is that the patient is allowed to
talk about things which interest him and which are topical-not just in a nondirected way under the heading of functional activity, but in a manipulated and
directly constructive way. The possibilities for treatment approaches using this
analysis appear numerous, and will hopefully provide an opportunity to unite the
structural approaches with the functional ones which have emerged more recently
in speech-language pathology.

Appendix 1: Examples of lexical cohesive devices

Reiteration-use

of synonymy (synonyms italicized):

The boy reached for the box.

He was quite a tall lad for his age.

Elizabeth M . Armstrong

50

Collocation-semantically

related words italicized:

The heavy storm which hit Sydney last night brought chaos to many suburbs.
Huge hailstones were reported along with high winds and blinding rain.

Appendix 2: Examples of grammatical cohesive devices

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A : Reference--to-referentia f items italicized

1 . The pronoun:
The dog was very playful.

It was only three months old.

2. The definite article:
The Neighbourhood Watch Scheme has been in our neighbourhood for six
months
The scheme has cut the crime rate by half.
3. The demonstrative:
Theres been a huge media takeover recently.
It seems nothing can be done about this.
4. The comparative:
We received exactly the same report.
As the report we received two months ago.
B. Substitution
The substitute is italicised in the second clause, replacing, I lost my way:
I lost my way to the park.
The same thing happened when I tried to find the zoo.
C . Ellipsis
Do you have coffee?
Yes.
In this example the words I have coffee are simply left out of the response, rather
than repeating them.

References
ARMSTRONG,
E. M. (1987) Cohesive harmony in aphasic discourse and its significance in
listener perception of coherence. I n R. H. Brookshire (Ed.), Clinical Aphasiology;
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