I was working the other day with a woman who has moderate aphasia and severe ataxia of speech. Her family said that she understands "everything". When I tested her, she did respond correctly to simple sentences. However, she did not respond correctly to complex sentences in which comprehension depended on grammatical structure, for example, "She gave a give to him" vs "She gave a gift to her". I was not sure if she was understanding only the substantive words, or if she understood some grammar as well.
While I was there, her husband came in and asked, "What day is this, Thursday?" (It was Tuesday). The woman laughed out loud. It seemed clear that she understood both the question and what day it was. This comprehension seemed to involve more than just understanding the word "Thursday". Maybe she recognized the intonational pattern of the sentence.
As I was getting ready to leave, I accidently put her workbook (which looks like my therapy book) into my backpack. She immediately made a sound and swiftly extracted her book from my backpack. If it was me, it would have taken a minute to see which book was which. So she was tracking her book and saw where I put it.
In these two situations, the person with aphasia did seem to understand everything. Comprehension involves more than grammar and words, it involves situations and paralinguistic cues.
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