Noun phrases (NPs) are central to effecting linguistic reference, itself fundamental to human interactions. However, little research has examined the NPs used by people with the language disability, aphasia. This Element provides detailed analyses of noun- and pronoun-headed NPs in spoken narratives by twelve people with various aphasia types/severities, exploring NP elaboration and productivity along a continuum of spoken language capability. The Element explains how some observations challenge the rule-based theory that remains influential in aphasiology, while all can be predicted by a usage-based approach. It expands the emerging subfield of Cognitive Aphasiology, with potential implications for both linguistics and speech and language therapy.