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People who suffer from aphasia as the result of a cerebrovascular accident become isolated because of their language impediment and lack of communication. Speech therapy is a long process and recovery can be slow. At the start of the decade we still had no way of re-establishing any form of useful functional exchange with the most severely affected patients. At the Physical Medicine and Rehabilitation clinic ‘Les Grands Chenes’ in Bordeaux we therefore decided to work at bypassing some of the communication difficulties encountered when admitting and taking care of patients with aphasia. We created and tested a new tool which can compensate for some language deficiencies, and help ease a person9s handicap: the C.COM communication book. This communication tool is an individualised directory of photographed items where information passes using a visual checklist. Repairing the breakdown in interaction is then based on a mediator: digital photography. It also relies on the ability of the communicator to adapt as they communicate with the patients. We decided to start with a basic computer database and adapt it to our specific needs at the Clinic, and then teach our colleagues how to use the C.COM. First of all we used the basic file and incorporated elements that were specific to our clinic and to the care and medical treatment given there. We modified some of the existing pages, adding extra photos, and we also created new pages. The resulting ‘Clinic’ file was produced in six different versions according to the needs of the different departments (secretaries, physiotherapists, dieticians, etc). These different versions were also placed in various communal areas where people come together. We then showed the file to physiotherapists, nurses, porters, reception and administrative staff and held a series of information sessions to train them to communicate with an aphasic patient. Finally we assessed the effectiveness of the C.COM file for communicating information by devising a test consisting of 6 complex communication tasks, then comparing the semantic improvements that were observed after using it. The first adaptation to the basic file produced the first version of our Clinic Book. We then made some changes to existing pages whenever necessary and produced additional pages that reflected some of the interactions and exchanges that take place on a daily basis in the Clinic. This book was distributed to all physiotherapy departments. It was inevitable that further changes would be needed in line with the specific topics covered in the different departments that the patients visited. Every department was provided with its own specific book. Twenty-three one-hour sessions were organised to train 110 people in three sectors of activity: administration and the hotel department, physiotherapy, hospitalisation. A representative sample of users in our institution were interviewed. For 78% of them, the first version of this communicative tool was effective in assisting communication. Staff rated its utility and ease of use at 83%. The teamwork generated around the communication book was identified as exemplary by visiting health accreditation experts from ANAES who came to asses the Clinic in 2001 and 2005. Between 2005 and 2008, an open pilot study using 6 pragmatic and relevant tasks demonstrated the efficiency of the C.COM in transmitting information. In fact, in a study of 10 patients, 90.99% of the six tasks that patients had initially failed without C.COM were then successfully completed using the C.COM book specifically adapted to the department. Based on the results achieved in our clinic, a new multicentre Hospital Research Protocol conducted by Bordeaux CHU was started in February 2009. Its aim is to confirm how efficient the C.COM communication book can be when it is suitably adapted and when nursing and care staff in all departments are properly trained, given the diversity of contexts to be found in university or general hospitals or in physiotherapy centres. Les personnes aphasiques a la suite d9un accident vasculaire cerebral sont isolees par un trouble du langage et l9absence de communication. La reeducation du langage est longue et ne leur permet pas toujours une recuperation rapide. Au debut des annees 2000, nous n9avions encore aucun moyen qui nous permettre de retablir des echanges fonctionnels chez les patients les plus severement touches. Au sein de la Clinique de Medecine Physique et de Readaptation Les Grands Chenes a Bordeaux nous avons choisi alors de travailler au contournement des difficultes de communication dans l9accueil et la prise en soins des personnes aphasiques. Nous avons construit puis valide un outil permettant de pallier les deficiences du langage et soulager la situation de handicap: le Classeur de Communication C.COM. Cet outil de communication est un repertoire d9items photographies personnalises permettant la circulation des informations par pointages. La reparation de l9interaction repose sur un mediateur: la photographie numerique. Elle s9appuie sur la competence de l9interlocuteur a s9adapter a l9echange. Nous avons decide de partir de la base informatisee de reference en l9adaptant a la Clinique pour repondre a nos besoins, et d9eduquer les partenaires institutionnels a l9utilisation du C.COM. Dans un premier temps nous avons donc repris le classeur de base en y integrant les elements specifiques propres a la structure et aux soins. Nous avons modifie les planches existantes par des photographies complementaires et cree des planches nouvelles. Le classeur institutionnel ainsi obtenu a ete decline en six versions, selon les besoins des interlocuteurs de la structure (secretariat, reeducateurs, dietetique…). Les versions ont ete installees sur divers lieux d9echange. Puis nous avons sensibilise et forme reeducateurs, soignants, brancardiers, personnel d9accueil hotelier et administratif aux echanges avec un patient aphasique, sous la forme de sessions d9information. Enfin, nous avons evalue l9efficacite du C.COM dans la transmission d9informations par la creation d9un test comportant 6 tâches complexes de communication, en comparant le gain semantique apporte par son utilisation. Une premiere adaptation du classeur de base nous a permis d9obtenir le classeur initial de la Clinique. Nous avons procede a des modifications ponctuelles des planches existantes ainsi qu9a la creation de planches complementaires, ajustees aux echanges quotidiens au sein de la Clinique. Ce classeur a ete diffuse dans les differents services de reeducation. D9autres adaptations etaient indispensables, en fonction des themes d9echanges particuliers attaches aux lieux frequentes par les patients. Chacun a ete equipe d9un classeur specifiquement construit. 23 sessions d9une heure ont ete organisees pour former 110 personnes appartenant a 3 secteurs d9activites: administration et hotellerie, reeducation, hospitalisation. Un echantillon representatif d9utilisateurs institutionnels a ete interroge. Pour 78% d9entre eux, l9outil adapte initial est efficace pour faciliter la communication. Son utilite et son aisance d9utilisation ont ete evaluees positivement a 83% par le personnel. Le travail d9equipe autour du classeur de communication a ete identifie comme une action exemplaire par les experts visiteurs accrediteurs de l9ANAES venus evaluer la Clinique en 2001 et 2005. Entre 2005 et 2008, une etude ouverte pilote utilisant 6 tâches pragmatiques a montre l9efficacite du C.COM dans la transmission d9informations. En effet, sur un effectif de 10 patients evalues, 90,99% des six tâches initialement echouees sans C.COM sont reussies avec le classeur C.COM adapte a la structure. A partir des resultats obtenus au sein de notre structure, un Protocole Hospitalier de Recherche Clinique multicentrique conduit par le CHU de Bordeaux a debute au mois de fevrier 2009. Il a pour but de confirmer l9efficacite du classeur de communication C.COM supporte par une adaptation et une formation des equipes soignantes de chaque site, dans le contexte diversifie d9hopitaux universitaires, generaux et de centres de reeducation.