Collaborative participation in aphasic word searching: comparison between significant others and speech and language therapists

Background: Searching for words is a common phenomenon in conversations of people with aphasia. When searching for a word the speaker interrupts the emerging conversational turn with a pause, vocalisation (e.g., uh), and/or a question (e.g., what is it). Previous studies suggest that gazing and pointing can be used to invite conversational partners to join the search.

Aims: This study compares the collaborative actions of different conversational partners of people with aphasia (significant others vs. speech and language therapists) during aphasic word searching. The aphasic speakers’ actions inviting assistance from the partners in the search are also examined.

Methods & Procedures: The data for the study comprised 20 conversations, half videotaped at the participants’ homes and half in aphasia therapy sessions. The conversations were transcribed and analysed sequentially with a special emphasis on taking non-verbal actions into account. In the analysis, word search sequences were identified and the collaborative participation of the significant others, as well as the speech and language therapists, compared.

Outcomes & Results: The analysis showed that institutional and non-institutional conversational partners collaborate in different ways during word searching. When invited to join the search, often non-verbally, the significant others quickly offer words for the aphasic speakers to complete the search. When successful, these immediate completions solve the search and the core conversation can continue. On the other hand, even if invited non-verbally, speech and language therapists do not join in searching by offering words. Instead, they ask questions or offer their candidate understandings that are more elaborate than one word. Furthermore, they regularly shift the speaking turn back to the aphasic speaker encouraging the aphasic speaker to continue the search by him or herself.

Conclusions: The institutional and everyday practices of sequential resolutions of word searching differ to a great extent. Everyday conversational practices of collaborative completion appear more effective in solving the search and allow the aphasic speaker to experience smoothly flowing conversational interaction. Everyday practices could also be systematically used within aphasia therapy. Furthermore, if necessary, speech and language therapists should promote the use of these practices within daily interactions of the aphasic clients and their significant others.     

Joint productions as a conversational strategy in aphasia

To address the longstanding question of the conversational ability of persons with aphasia, this study investigated the spontaneous occurrence of a specific type of conversational collaboration, joint production, that is known to occur in the conversation of ordinary speakers. A person with aphasia and his wife videorecorded eight of their naturally occurring conversations. These conversations were analysed and three types of joint productions were identified: word search, turn completion and appendor production. Additional sequential analysis revealed the linguistic, paralinguistic and contextual resources available to the interactants in designing their joint production. Results showed that, despite the presence of aphasia, this couple was able to successfully employ joint production as an interactive technique leading to conversational success. Implications of this study are discussed relative to the understanding of communicative ability of persons with aphasia and how aphasia is diagnostically and therapeutically approached.     

Spontaneous verbal repetition: A social strategy in aphasic conversation

Abstract

This study investigated the spontaneous verbal repetition of a person with aphasia during conversation. Research questions were: Does repetition occur as a spontaneous verbal behaviour? How is repetion effectively used? What are the motivations for its use? A person with aphasia and his wife video recorded eight of their naturally occurring conversations which were subsequently transcribed and sequenced into turns-at-talk. Frequency of repetition and the sequential organization of conversation sequences containing repetition were analysed. Repetition was a frequent behaviour, occurring an average of 8% of the time for all conversations. Repetition was effectively used to meet the social needs of the conversation relating to displays of uncertainty, agreement, alignment and acknowledgement. Motivations for repetition related to its use as a compensatory strategy to overcome specific language barriers and to establish perceptions of conversational proficiency.     

Effects of training volunteers to converse with nursing home residents with aphasia

Background: Nursing home residents with aphasia often experience social isolation. Providing trained conversation partners is one way to combat this problem, but evidence is needed for the effects of training conversation partners for persons with aphasia. The use of four college student volunteers was based on evidence for the benefits of intergenerational service‐learning programmes. Aims: The purpose of this study was to examine the effects of training four college student volunteers (SVs) to use multi‐modality communication with two nursing home residents with Broca's aphasia (RAs). Methods & Procedures: An ABA multiple baseline across subjects (SVs) and partners (RAs) design was used to examine the effects of the training programme in probe conversations. Each RA interacted with two SVs. Training consisted of five steps, with a criterion to move through each step of the programme, and to withdraw training. Thorough treatment fidelity procedures were used to ensure consistent training across subjects. Outcomes & Results: The SVs demonstrated marked increases in multi‐modality communication, with concomitant increases in RAs' comprehensibility. Sequential analyses revealed that multi‐modality communication is more likely than speech only to elicit RAs' comprehensible responses, with a stronger effect after training. Social validity ratings demonstrated that the changes in the quality of the conversations were clinically significant. Conclusions: This study revealed positive effects of training conversation partners of persons with aphasia to use multi‐modality communication. Intergenerational service‐learning programmes are one viable method to decrease social isolation and to increase opportunities for nursing home residents with aphasia to reveal their communicative competence.     

Trouble and repair during conversations of people with primary progressive aphasia

Background: Primary progressive aphasia (PPA) affects a range of language domains that impact on communication. Little is known about the nature of conversation breakdown in PPA. The identification of trouble in conversation, its repair and the success of repairs has been used effectively to examine conversation breakdown in neurogenic language disorders such as dementia of the Alzheimer type (DAT) and acute onset aphasia. This study investigated trouble and repair in the conversations of people with PPA.

Aims: The first aim of this study is to describe the contributions of individuals with PPA and their conversation partner to conversation. The second aim is to describe the trouble that occurs in dyadic conversations between three individuals with PPA and their communication partner. The third aim is to describe the repair behaviours used by the individuals with PPA and their communication partners.

Methods & Procedures: Dyadic conversations about everyday activities between three individuals with PPA and their partners and three control dyads were video recorded and transcribed. Number of words, number of turns and length of turns were measured and trouble-indicating behaviours (TIBs) and repair behaviours were categorised.

Outcomes & Results: Individuals with PPA had reduced mean length of turn but maintained their share of turn-taking. They demonstrated a variety of TIBs that differed from the noninteractive repairs, which do not require a response from the partner in the conversation and which have been observed in studies of conversation in DAT. Their partners bore the greater burden of highlighting trouble and need for repair using collaborative, interactive, TIBs. Three different conversational profiles were observed in the three PPA dyads, reflecting different patterns of language and cognitive impairment.

Conclusions: Individuals with PPA were active participants in conversation effectively indicating and responding to trouble. Understanding trouble and repair in the conversations of individuals with PPA has the potential to enhance assessment and inform clinical practice.     

“Speaking for” behaviours in spouses of people with aphasia: A descriptive study of six couples in an interview situation

Background: People with aphasia and their spouses frequently meet professionals to discuss health‐related issues. In this situation, which is often in an interview form, various strategies may be employed by spouses to facilitate communication. One of these strategies is “speaking for” the person with aphasia. Aims: (1) To identify the presence of “speaking for” behaviour, to measure the frequency of the spouses' “speaking for” and “rapid speaking for” behaviours, and to describe what preceded and followed these behaviours for all participating couples. (2) To describe each individual couple's patterns of “speaking for” in relationship to the members' perceptions of conversations before and after the onset of aphasia. Methods & Procedures: Six couples were studied in an interactive situation. Both the spouse with aphasia and the non‐aphasic spouse took turns being asked questions in a systematic way. Each member also participated individually in a semi‐structured interview aiming to obtain information on perceptions of communication before and since the aphasia. Outcomes & Results: Analysis of three‐way conversations revealed that all of the spouses without aphasia in this study used some “speaking for” behaviours. However, there was great variability in the frequency of the behaviours within couples. For some couples, “speaking for” the person with aphasia may reduce that person's ability or willingness to participate in conversations. The findings from the semi‐structured interviews suggest that “speaking for” a person with aphasia may be an integral behaviour for some couples that is consistent with pre‐stroke interaction patterns. Conclusions: It is important to consider the “speaking for” behaviour, the impact of this behaviour, and the pre‐stroke interaction pattern when helping couples adjust to the consequences of aphasia.     

The evaluation of a learner‐centred training programme for spouses of adults with chronic aphasia using qualitative case study methodology

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme. Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change. Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.     

Communication style before and after aphasia: A study among Finnish population

Background: Communication difficulties in aphasia have a big effect on communicative activity and social participation. Contacts with other people than family become more infrequent because of problems in communicating. Rehabilitation should make a real difference in being able to communicate and in the life of people with aphasia.

Aims: The aim of this study was to explore the impact of aphasia on the communication style of people with aphasia in the Finnish population. The term “communication style” is used to describe how active the person is in communication situations and in participating in social interaction. In addition, a clinical evaluation of the communication style was made 6 months after an intervention concentrating on training total communication and guiding the partner to facilitate the use of different communication methods and support the interaction.

Methods & Procedures: The data were collected during natural rehabilitation courses for people with aphasia and their communication partners. The participants were 38 communication partners of people with aphasia. The courses were carried out in two parts (8 + 4 days) with a 3-month interval. A questionnaire concerning the communication style of people with aphasia was constructed using parts of Green’s questionnaire (1984) and its unpublished Finnish modification. The communication partners estimated the communication style of people with aphasia. At first, they estimated how the communication style was before the onset of aphasia and how it was 2 weeks before the intervention. Six months after the intervention, they estimated the communication style again.

Outcomes & Results: Aphasia has a drastic impact on the communicative activity and social participation of people with aphasia in Finland. Activity in conversations decreases and contacts with people other than family members and relatives become much more infrequent. The social interaction occurs mostly at home. The conversation topics focus on health, home matters and TV programmes when other topics such as work, hobbies, leisure time and plans for the future are discussed much less often.

Conclusion: Aphasia has a drastic impact on communication style, activity in communication and participation in social interaction, also according to this study conducted in Finland. There seems to be a decrease in communication between the people with aphasia and people other than their significant others and outside the home. To be able to have an impact on social participation, interventions also including people other than family members are needed.     

Partners' self-perceptions of the use of different communication strategies during total communication intervention

Background: Collaboration between people with aphasia and their communication partners is needed to achieve success in communication. Some of the partners change their own behaviour spontaneously and start to use different strategies to ensure that conversations are successful, but many require training to do so.

Aims: The aim of the present study was to examine to what extent communication partners perceive they use different strategies to support the conversation and if they perceive changes in the use of these strategies during an intervention concentrating on total communication.

Methods & Procedures: The data were collected during regular rehabilitation courses, which were carried out in two parts (8?+?4 days) with a 3-month interval. People with aphasia participated in the whole course and the partners joined in for the last 2 days of the first part and the whole of the second part (2?+?4 days). The aim of the intervention was to encourage people with aphasia to use total communication and to guide the communication partners to facilitate the use of total communication and to support the conversation. A total of 43 communication partners participated in the present study: 33 participated in a course with their aphasic partners, but 10 did not and formed the control group. Before the first and second parts of the course and 6 months after the course the partners completed a questionnaire comprising 20 questions concerning different communication strategies.

Outcomes & Results: Before the intervention both the participating partners and the control group perceived that they quite often used different strategies to support the conversation. The means of the 20 questions were 62.9/100 and 58.9/100 respectively. Both groups perceived an increase in the use of different strategies after the first part of the course but the change was statistically significant only in the participating group, F(1, 32)?=?8.025, p?=?.016. The participating group perceived a significant increase in the use of strategies supporting verbal comprehension and production after the first part of the course, F(1, 32)?=?6.925, p?=?.026, but perceived a decrease in the use of them when measured 6 months after the course.

Conclusions: Communication partners perceive that they often use different strategies to support communication. The self-assessment method can make the partners more aware of these strategies. An intervention can increase the partners' awareness of the comprehension problems of their aphasic partners.     

Measuring transactional success in the conversation of people with aphasia

Background: Conversation is one of the most important forms of human communication. The way in which one participates in conversation is necessarily impacted by aphasia. Recent changes in delivery of rehabilitation services place greater emphasis on functional outcome and this, in turn, has been a catalyst for the development of rehabilitation approaches that focus on conversation. However, an important missing element in studies of the efficacy of such approaches is a method for evaluating success in conversation. Aims: The object of this study was to develop an ecologically valid and reliable measure of transactional success in conversation. Methods & Procedures: The procedures for measuring transactional success in conversation described in this study utilizes standardized procedures while simulating natural conversations as much as possible. It provides a method for measuring what has been understood/exchanged when the conversation concludes, and affords an external reference against which the accuracy of this information can be judged. Data for this study were gathered from 14 people with aphasia of moderate severity each of whom engaged in 4 semi-structured conversations with unfamiliar partners. Outcomes & Results: The method of measuring transactional success in conversation described in this study was shown to have good validity and reliability. Conclusions: Transactional success in conversation is clearly a unique construct that is not predicted by traditional aphasia assessment. The method for measuring transactional success in conversation developed in this investigation provides a much-needed means for clinicians to evaluate the efficacy of conversation therapy. Furthermore, combining this new measure with Conversation Analysis (CA) offers a potentially powerful tool to identify those conversational behaviors that contribute to successful transfer of ideas. Such information could then be used to inform the design of treatment programs that seek to improve conversational success for people with aphasia.     

Preliminary results from conversation therapy in two cases of Aphasia

Background: Few studies have investigated conversation therapy between a person with aphasia and a clinician. Furthermore, little information exists on generalisation of impairment-based stimulation treatment to conversational outcomes.

Aim: The purpose of this preliminary study was to compare the effects of stimulation therapy and conversation therapy on conversational outcome measures in two cases.

Method: We employed a single-subject AB₁AB₂A design with randomised ordering of interventions across two participants. Primary outcomes included 6-minute conversations coded for discourse functions of an utterance.

Outcomes & Results: The participant who received stimulation therapy first demonstrated improved conversational outcomes after the first phase. The participant who received conversation therapy first demonstrated improved conversational outcomes after the first phase. Although improvements were made in each type of therapy, the highest gains in conversational production were during or following conversation therapy in either treatment order for both participants.

Conclusion: Both types of therapy produced gains in conversational abilities. However, the small number of participants limits the generalisability of this study. Future research is needed to determine which participants may benefit most from conversation therapy and to improve the clinical feasibility of conducting and measuring conversational therapy.     

Development of a procedure to evaluate the contributions of persons with aphasia and their spouses in an interview situation

Background: Although there has been increasing interest in the study of conversations between people with aphasia and their partners, the participation of persons with aphasia in conversation with their spouses in the presence of a third party has not been extensively investigated. Nevertheless, opportunities for such situations are frequent, and therefore provide an interesting opportunity to examine how couples collaborate.

Aims: (1) To develop a procedure to analyse conversations that would specifically address the contributions of persons with aphasia and their spouses in an interview situation. (2) To describe spousal contributions in an interview situation, including what preceded and followed these contributions, in a group of couples with a member with aphasia. (3) To verify the inter‐judge reliability of the procedure.

Methods & Procedures: Videos of three couples with aphasia in an interview situation were analysed. Contributions of the spouse when the participant with aphasia was clearly speaking with the interviewer, contexts in which spouses contributed, reactions of persons with aphasia, and their participation following contributions were described. Definitions were created, operationalised, tested, and refined on 11 other similar couples in the same interactive situation. Eight other couples were then videotaped and studied.

Outcomes & Results: Results revealed that half the contributions produced by the spouse were “repairs” and the other half were “speaking for” behaviours. Most often, contributions were unsolicited. Generally, the person with aphasia approved the spouse's contribution and continued afterwards to take an active part in the conversation. Inter‐judge reliability coefficients varied between 89% and 97%.

Conclusions: The procedure employed is representative of situations encountered by couples affected by aphasia. The data collection and analysis methods could be applicable to clinical situations. It is important to consider spousal contributions and their impact on the person with aphasia in conversations when helping couples adjust to the consequences of aphasia.     

Conversational partner training programmes in aphasia: A review of key themes and participants' roles

Background: Conversational training programmes are increasingly being reported for partners of people with aphasia. While these all aim to increase communicative effectiveness between people with aphasia and their communication partners, and all report measurable success, the programmes vary in terms of selection criteria for participants, the methods used, and the way in which they have been evaluated. This paper critically reviews a group of studies that have carried out conversation partner training (CPT) programmes for both familiar partners of people with aphasia (spouse or relative of a person with aphasia) and volunteers.

Aims: The purpose of the review is (1) to identify the type of people CPT might benefit, i.e., whether particular characteristics of the participants have been considered influential to the outcome of interventions and (2) to consider the outcomes of such training programmes more generally, i.e., whether they have been effective, whether the effectiveness of the programmes is dependent on the format of the training and, to some extent, the measures that have been used to evaluate their effectiveness.

Main Contribution: The review highlighted the positive outcomes reported by the studies, irrespective of whether the usual conversation partner or a volunteer was involved, in relation to the evaluation measures used. A paucity of information was found for the conversation partner participants compared to the person with aphasia, along with a limited analysis of the impact of the partner on the effectiveness of the intervention. Criteria underpinning selection for training programmes was related primarily to availability rather than behavioural or conversational characteristics. Longer‐term follow‐up of interventions was also limited.

Conclusion: That CPT interventions can be effective is not disputed here. However, the measurement of such effectiveness needs scrutiny and for whom these interventions work remains largely unknown. This review highlights the need for more information on both participants, with particular regard to the partner of the person with aphasia, to be both established and documented when reporting the impact of this type of intervention. This will permit an examination of the extent to which particular variables or partner profiles are influential and potentially predictive when determining suitable candidates for CPT. Equally, systematic follow‐up of all those participating in training will enable a clearer picture to emerge of the effectiveness of such interventions.     

Implementing and evaluating aphasia therapy targeted at couples' conversations: A single case study

Background: In recent years conversation has become an area of interest for aphasia therapy, with several studies using conversation analysis (CA) to target and evaluate therapy. Most of these studies have focused on the main conversation partner of the person with aphasia, and in particular have targeted the partner's pedagogic behaviours in relation to the person with aphasia. Evaluations of therapy have primarily taken the form of qualitative analyses of change in conversational behaviours.

Aims: This single-case intervention study aims to advance research into interaction-focused intervention for aphasia in the following ways: by targeting intervention at the person with aphasia and the main conversation partner as a couple; by focusing on conversational behaviours where the person with aphasia can be seen to be restricted by the conversational actions of the conversation partner, in particular by recurrent questioning using closed questions and yes/no interrogatives; and by using a novel combination of qualitative and quantitative approaches to evaluate the intervention.

Methods & Procedures: CA was used to target and evaluate interaction-focused intervention for a couple where one partner has aphasia. Evidence for change was evaluated using qualitative and quantitative evidence of change in conversational behaviours; evidence from naïve raters of pre- and post-intervention conversation extracts; and interview/other feedback from the conversation partner.

Outcomes & Results: There was evidence that the intervention had changed the couple's conversational behaviours. In particular, the conversational behaviours of the non-aphasic partner were in general less restricting for the person with aphasia in that she was now using fewer questions and more instance of other types of turns, such as paraphrases. Following intervention the person with aphasia had also changed in that he was now producing turns that had more sentences, or attempts at sentences, and which developed the topic of talk across several of his turns.

Conclusions: The study provides evidence that directly targeting the conversational behaviours of the person with aphasia and/or a main conversational partner can produce positive change, and can achieve this in a way that is ecologically valid. In particular, it highlights the usefulness of targeting conversational behaviours that are proving to be maladaptive for the participants. It provides further evidence that creating change in the non-aphasic partner's conversational behaviour may facilitate change in the person with aphasia's conversational and linguistic performance.     

Multiple languages,memory, and regression: An examination of Ribot's Law

Background: Low-tech visual scene displays (VSDs) combine contextually rich pictures and written text to support the communication of people with aphasia. VSDs create a shared communication space in which a person with aphasia and a communication partner co-construct messages.

Aims: The researchers examined the effect of low-tech VSDs on the content and quality of communicative interactions between a person with aphasia and unfamiliar communication partners.

Methods &; Procedures: One person with aphasia and nine unfamiliar communication partners engaged in short, one-on-one conversations about a specified topic in one of three conditions: shared-VSDs, non-shared-VSDs, and no-VSDs. Data included discourse analysis scores reflecting the conceptual complexity of utterances, content unit analyses of information communication partners gathered from the interaction, and Likert-scale responses from the person with aphasia about his perception of communicative ease and effectiveness.

Outcomes &; Results: Comparisons made across conditions revealed: (a) the most conversational turns occurred in the shared-VSDs condition; (b) communication partners produced utterances with higher conceptual complexity in the shared-VSDs condition; (c) the person with aphasia conveyed the greatest number of content units in the shared-VSDs condition; and (d) the person with aphasia perceived that information transfer, ease of conversational interaction, and partner understanding were best in the shared-VSDs condition.

Conclusions: These findings suggest that low-tech VSDs have an impact on the manner and extent to which a person with aphasia and a communication partner contribute to conversational interactions involving information transfer.     

Conversational dynamics between aphasics

Abstract

The aim of this study was to determine how aphasic patients take part in conversations, the manner in which their conversations proceed, and how they compensate for their disabilities in maintaining conversational flow. The aphasia group studied contained five aphasics with different symptoms. Four conversations (54 minutes) were videotaped through a one-way mirror and subsequently transcribed. The analysis was based on a seven-category system (moves) and conversational flow was described in terms of active and reactive utterances. The results showed that, using the number of moves and total speech time as criteria, individual speakers varied greatly in their degree of participation in discussions and had different interactive profiles. The speakers were divided into two groups according to the type and severity of aphasia. It was discovered that the groups did not differ in conversational behaviour in terms of active and reactive moves, but the non-fluent speakers differed from the fluent aphasics in their use of deviant conversational moves. There was therefore no clear relation between the type and severity of aphasia and participation in discussions. Implications for aphasia therapy are discussed.     

Educating and training caregivers of persons with aphasia

Background: Because communication deficits caused by aphasia affect both persons with aphasia and their communication partners, most speech-language pathologists are aware of the importance of client and caregiver education. To maximise the effectiveness of their communicative interactions, training should be conducted for both the aphasic clients and their caregivers. Training conducted in group environments offers peer support through shared learning experiences and joint problem solving.Aims: The purpose of this study was to explore the benefits of a caregiver education and training programme in improving communication between caregivers and their aphasic partners using didactic and experiential approaches in a group setting.Methods & Procedures: Ten caregivers and their aphasic partners, ranging from 4 to130 months post-stroke, participated in a 12-week group training and education programme. Information about stroke and aphasia was provided in a didactic format, and facilitative communication strategies were discussed and practised using Kolb's (1984) experiential learning cycle model. The experiential learning cycle involved drawing on concrete experiences, engaging in reflective observation and abstract conceptualisation, and practising what was learned through active experimentation.Outcomes & Results: Analysis of communicative performance on transactional and interactional tasks demonstrated increased communicative success. Responses on a questionnaire indicated that participants had a better understanding of aphasia and were more confident using facilitating strategies.Conclusions: Group education and training for caregivers and their aphasic partners can be beneficial, even after the couple has been living with aphasia for a number of years. Having an opportunity to practise, observe, and reflect on their performances facilitated participants' learning, and there were observed and reported positive alterations in interactions.     

Conversational coaching: Treatment outcomes and future directions

Background: Conversational coaching involves teaching communication strategies to individuals with aphasia and their spouses. Strategies are chosen by the couple and are taught and practised in the context of a conversation. Although strategy training has been explored in previous research studies, many questions regarding treatment implementation and outcomes remain unanswered. Aims: The aims of this study were to investigate the effects of conversational coaching and to determine variables for consideration in future efficacy research of this treatment technique. Methods & Procedures: Two couples participated in a single-subject experimental design across subjects. Mr and Mrs Y were 76 and 70 years old, and Mr and Mrs G were 41 and 39 years old, respectively. During baseline sessions, the individual with aphasia watched a videotaped story about a real-life event and then attempted to share the content of that story with his spouse. During treatment sessions, the same procedure was used, but the clinician intervened and coached both participants in the use of selected verbal and non-verbal strategies to improve the quality of the conversation. The primary dependent measure in the study was the number of main concepts successfully communicated during conversations. Outcome measures included pre/post treatment probes, standardised testing using the Communications Activities of Daily Living - Second Edition (CADL-2; Holland, Frattali, & Fromm, 1999) and social validation ratings. Outcome and Results: Experimental data were variable for both dyads. However, positive outcomes were obtained. First, the percentage of main concepts successfully communicated was significantly greater during post-treatment probes than during pre-treatment probes for both dyads. Second, Mr Y demonstrated significant improvement in his total CADL-2 scores following treatment. Third, individuals who judged the quality of pre- and post-treatment conversations understood more of the conversation between both couples during post-treatment probe conversations than during pre-treatment ones. Conclusions: Positive outcomes, including participants' perceptions of treatment effects, support further experimental study of this technique. Strategy selection, stimuli for conversational topics, and procedural specificity of the intervention were variables identified as necessitating further research in a controlled experiment design.