Pragmatic communication abilities refer to the capacity to use language in a social context. Despite evidence to the contrary, the left cerebral hemisphere of the majority of right handers has been considered exclusively specialized for control of language phonology, syntax and semantics, whereas the right hemisphere has been specialized for the control of language pragmatics. Many studies have shown the non-exclusivity of the left hemisphere for language skills. Communication deficits observed in these studies for patients with right hemisphere damage confirmed the necessity for integrity of the right hemisphere across a number of language components. The aim of this study is to investigate the specific role of the right and left hemispheres across several aspects of communication deficits, with particular attention given to the influence of these deficits on functional outcome. The second aim is to characterize possible correlations between pragmatic and other cognitive deficits. We evaluated 22 patients, 15 with left- and 7 with right-brain ischemic or hemorrhagic damage, using cognitive, pragmatic and language tests. We deployed the Right Hemisphere Language Battery–Santa Lucia and Montreal d’Evaluation de la Communication to assess pragmatic abilities. The results showed no statistically significant differences between patients with left- and right-brain damage, highlighting the importance of integration between the two hemispheres in the communication process. Multiple significant correlations were found between pragmatic abilities and cognitive tests assessing global cognitive functioning, pantomime expression and comprehension. Pragmatic deficits were also shown to correlate with functional cognitive outcome. It is important to assess pragmatic abilities in patients with cognitive deficits after both left and right stroke for tailoring neuropsychological intervention to mitigate pragmatic disabilities in functional outcomes.

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.