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.     

Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia

Abstract

The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement. This is followed by examples of sequences occurring in the talk of two of these speakers that result in different, and more limited, turn construction opportunities, namely “test” questions asked in order to initiate a new topic of talk, despite the conversation partner knowing the answer. The contrast between extended turns and test question sequences illustrates the effect of interactional context on aphasic turn construction practices, and the potential of less than optimal sequences to mask turn construction skills. It is suggested that the interactional motivation for test question sequences in these data are to invite people with aphasia to contribute to conversation, rather than to practise saying words in an attempt to improve language skills. The idea that test question sequences may have their origins in early attempts to deal with acute aphasia, and the potential for conversation partnerships to become “stuck” in such interactional patterns after they may have outlived their usefulness, are discussed with a view to clinical implications.     

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.     

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.     

Effectiveness of a vocabulary data file,encyclopaedia, and Internet homepages in a conversation‐support system for people with moderate‐to‐severe aphasia

Background: In order to facilitate conversation for people with moderate‐to‐severe aphasia, a conversation‐support system has been developed. This system consists of three electronic resources: a vocabulary data file, an encyclopaedia, and homepages on the Internet. The vocabulary data file we created contains approximately 50,000 words, mostly consisting of various proper names, which are classified into 10 categories. These words function as keywords in conversation.

Aims: To evaluate the effectiveness of the three resources in eliciting new information from people with aphasia.

Methods & Procedures: Fifteen people with non‐fluent and moderate‐to‐severe aphasia participated in the experiment. Participants conversed with their communication partners about four topics under use and non‐use conditions. Under the use condition, partners showed pages from one of the three resources on the screen of a personal computer. Participants were asked to select words on the pages, or use other modalities (verbal or nonverbal), to answer questions. Three evaluators gave points for information conveyed correctly.

Outcomes & Results: Comparison of the points between the use and non‐use conditions showed that significantly more information was conveyed when the vocabulary data file was used. On the other hand, the amount of points did not increase in the use condition using the encyclopaedia or homepages.

Conclusions: The vocabulary date file succeeded in eliciting more information from people with moderate‐to‐severe aphasia within a limited timeframe. Presentation of the keyword or proper name lists related to the topics was shown to be a useful conversation resource for people with moderate‐to‐severe aphasia. As for the encyclopaedia and homepages, further research is required to determine whether or not these resources in collaboration with the data file can further facilitate conversation.     

Do picture‐naming tests provide a valid assessment of lexical retrieval in conversation in aphasia?

Background: Word‐finding problems commonly occur in aphasia and can significantly affect communication. Assessment of this deficit typically involves naming pictures. However, this method has been criticised as lacking ecological validity. Alternative methods include the measurement of lexical retrieval in narration or conversation, although few published studies have quantified word finding in the latter.

Aims: We aimed to identify a reliable and valid assessment of lexical retrieval in conversation, and to elucidate the nature of the relationship between lexical retrieval in picture naming and in conversation.

Methods and Procedures: We developed a quantitative measure of word finding in conversation in aphasia and established the reliability and stability of the method. We compared the scores of a group of people with aphasia on this measure with their scores on a picture‐naming test.

Outcomes and Results: We found significant relationships between picture‐naming scores and a number of key variables analysed in the conversation measure. We propose that scores on picture naming relate to the ability to retrieve nouns in everyday conversation for the people with aphasia who took part in this study.

Conclusions: The use of picture‐naming tasks is justified, providing a valid and rich means of assessment of lexical retrieval. Further research is required to replicate these results with more people with aphasia. We offer the quantitative assessment of conversation developed here for use in research and clinical spheres.     

Questioning in conversations before and after communication partner training for individuals with traumatic brain injury

Background: Social communication training involving individuals with traumatic brain injury (TBI) and their everyday communication partner(s) facilitates improvements in the quality of their interactions and information transfer. Recent research has indicated that the ways conversation partners use questions may play an important role in this improvement.

Aims: This study aimed to describe questioning patterns during casual conversations before and after communication partner training using Conversation Analysis.

Methods & Procedures: Samples of casual conversations involving four individuals with TBI and their everyday communication partners were examined. These samples were collected before and after intervention in the course of a larger clinical trial investigating the efficacy of a communication partner training program entitled TBI Express. Four dyads were chosen based on their Adapted Kagan Scale scores; a primary outcome measure in the clinical trial. Two dyads with the greatest change on these scales (“Kagan plus”) and two dyads with the least change (“Kagan neutral”) were selected. Approximately 10 minutes of casual conversations per dyad were transcribed in detail. Questions in each sample were identified and analysed qualitatively using conversation-analytic practices, focusing on aspects of sequence organisation.

Outcomes & Results: “Kagan plus” dyads had obvious changes in their questioning practices following training. These changes facilitated selection of topics and the development of related talk, i.e., improved communication. Conversely, the “Kagan neutral” dyads exhibited less obvious differences in their questioning practices after training, which meant that improved communication in the postintervention samples was less apparent.

Conclusions: The present study provides detailed insight into how everyday communication partners’ questioning practices contribute to communicative success. This information has the potential to help clinicians assess and improve interactions involving individuals with TBI and their everyday communication partners.     

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.     

How clerks understand the requests of people living with aphasia in service encounters

ABSTRACT

Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks’ responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.     

Singing behaviour in a client with traumatic brain injury: a conversation analysis investigation

Background: Traumatic brain injury (TBI) is associated with pragmatic communication difficulties that lead to difficulty in social interaction. Research on conversation abilities in persons with TBI is limited, but has revealed unique patterns of behaviour that result in success or breakdown in conversation. Only a handful of studies have examined real-world conversations of persons with TBI to better understand how these behaviours might be motivated by conversation moves of partners.

Aims: This study involved an exploration of a particular behaviour in a man with TBI, singing, to better understand the interactional environment, and goals associated with the behaviour.

Methods & Procedures: Over 7 h of conversation data were videorecorded from 10 therapy sessions in which a man with TBI recurrently employed singing during conversation. Instances of singing were identified and transcribed according to principles of conversation analysis (CA). A total of 39 instances were included and analysed independently, focusing on explaining the sequential context of the device and the interactional work that was achieved.

Outcomes & Results: Data analysis revealed four distinct sequences involving instances of singing. These included a normative sequence in which the participant inserted singing in ways similar to neurotypical speakers. The other three sequences comprised of unusual instances of singing that allowed the participant to nominate new topics, demonstrate disalignment, and close topics in conversation.

Conclusions: CA revealed that the participant produced singing in response to the actions of his conversation partners. All sequences were jointly produced and dependent upon the conversation turns before and after the instance of singing. The findings suggest that conversational partners pursue various interactional agendas during conversation in therapy sessions and the participant uses singing to perform facework in this context.     

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.     

Candidacy for conversation partner training in aphasia: findings from a Dutch implementation study

Background: Aphasia rehabilitation should comprise a family-centred approach, involving main conversation partners in the rehabilitation process as soon as possible. A standardised approach to conversation partner training (CPT) became available in the Netherlands with the release of Partners of Aphasic clients Conversation Training (PACT). PACT was introduced in clinical practice in a multi-centre implementation study with 34 participating dyads.

Aims: To explore candidacy for CPT by describing the characteristics of dyads where the conversation partner engaged in CPT and to identify which characteristics had the potential to predict benefit of PACT.

Methods and Procedures: A pre-post treatment design was used in a multi-centre study. Pre- and post-CPT measures of psychosocial characteristics (caregiver burden, depression and coping) from the partner and behavioural characteristics (cognitive, linguistic and communicative) from the person with aphasia (PWA) were collected. Partner experience was assessed using four scales from the Intrinsic Motivation Inventory. Pre-post measures were analysed using paired T-tests and Wilcoxon signed ranks tests. Multiple regression analyses were used to assess potential predictors of training outcomes.

Outcomes and Results: Partners of people with moderate to severe aphasia engaged in PACT when it was first introduced in clinical practice (N = 34 dyads). Mean time post-onset was 11.5 months. Partners enjoyed the practical training in which they actively engaged through experiential learning methods. Partner scores increased significantly over the intervention time on task-oriented and avoidance-oriented coping skills and their symptoms of depression lowered significantly. Caregiver esteem was found to be a positive predictor of feelings of competence and enjoyment with the training. Older partners enjoyed the training less. More effort was given to the training by the partner when the aphasia was more severe.

Conclusions: This study found that partners are willing to engage in CPT once the PWA returned home and the dyads were engaging in more everyday conversations in their home environment. The results underline the importance of partner characteristics, such as motivation, coping style and a positive outlook on caregiving as possible selection criteria for CPT.     

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.     

Adaptation to aphasia: grammar,prosody and interaction

This paper investigates recurrent use of the phrase very good by a speaker with non-fluent agrammatic aphasia. Informal observation of the speaker's interaction reveals that she appears to be an effective conversational partner despite very severe word retrieval difficulties that result in extensive reliance on variants of the phrase very good. The question that this paper addresses using an essentially conversation analytic framework is: What is the speaker achieving through these variants of very good and what are the linguistic and interactional resources that she draws on to achieve these communicative effects? Tokens of very good in the corpus were first analyzed in a bottom-up fashion, attending to sequential position, structure and participant orientation. This revealed distinct uses that were subsequently subjected to detailed acoustic analysis in order to investigate specific prosodic characteristics within and across the interactional variants. We identified specific clusters of prosodic cues that were exploited by the speaker to differentiate interactional uses of very good. The analysis thus shows how, in the adaptation to aphasia, the speaker exploits the rich interface between prosody, grammar and interaction both to manage the interactional demands of conversation and to communicate propositional content.     

The evidence for a life-coaching approach to aphasia

Background: A life-coaching and positive psychology approach to aphasia has recently been advocated by Audrey Holland, to whom this issue is dedicated.

Aims: This paper reviews our recent research which informs the three basic assumptions behind a life-coaching approach to aphasia: (1) learning to live successfully with aphasia takes time; (2) aphasia is a family problem; and (3) the goal is to help people with aphasia fit it into their lives.

Methods & Procedures: We assimilate results from three independent qualitative data sets: (1) a project that sought the perspective of 50 people with aphasia, their families, and their treating speech-language pathologist about their goals over time; (2) a project that seeks the views of 25 people with aphasia, their family, and speech-language pathologists about what it means to live successfully with aphasia; and (3) a qualitative structured interview on quality of life with 30 people with aphasia.

Outcomes & Results: The three basic assumptions of the life-coaching approach to aphasia are supported and extended by the data. Participants with aphasia in our studies report how their goals change over time to reflect how they are learning to live with aphasia, but the journey is different for each person. The stories from families elucidate how aphasia is indeed a family concern and requires family involvement. Finally, not only did participants in our studies fit aphasia into their lives, but they also fitted it into a new lifestyle after their stroke.

Conclusions: The assumptions behind the life-coaching approach are well supported by the narratives of people living with aphasia. Even if the life-coaching approach is not adopted wholeheartedly by the profession, the principles of positive psychology and the life goal perspective appear highly relevant to living successfully with aphasia.