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.     

Conversation partner responses to problematic talk produced by people with aphasia: some alternatives to initiating,completing, or pursuing repair

Background: Problems with intersubjectivity (i.e., mutual understanding) are prevalent during interactions involving people with aphasia. The linguistic restrictions imposed by aphasia mean that conversation partners must often assist with repairing intersubjective problems if they are to be resolved efficaciously. However, conversation partners can resist participation in repair activities. This may have serious negative implications for how people with aphasia participate in conversation.

Aims: This study uses conversation analysis (CA) to examine responses to problematic talk produced by people with aphasia. It focuses on three alternatives to initiating, completing, or pursuing repair: receipting responses, accounting responses, and “other” responses. The interactional organisation and consequences of these responses are described.

Methods & Procedures: Three people with aphasia and nine of their familiar conversation partners were video-recorded during their everyday conversations. Approximately 9.5 hr of recordings was collected. Ninety-seven responses were identified in this data set and analysed using collection-based conversation-analytic practices.

Outcomes & Results: Receipting responses register that the person with aphasia has produced a turn, but provide little support for the action implemented by the turn. They do not index problems with intersubjectivity and often result in the problematic talk being abandoned. Accounting responses index problems with intersubjectivity, but do not work towards resolving them. Instead, they deal with why an appropriate response to the problematic talk cannot be delivered, and which party is responsible for its absence. “Other” responses comprise a more eclectic category. One type—non-serious responses—is examined. Non-serious responses take the appearance of repair, but ultimately delay authentic repair attempts.

Conclusions: The responses examined can have negative consequences for the participation of people with aphasia, restricting their ability to implement social action, and making relevant their status as linguistically incompetent. However, they can also help with navigating the sensitive environments created by problems with intersubjectivity. Interaction-focused interventions might focus on these practices in addition to repair practices when attempting to improve how communication breakdown is addressed. CA and qualitative interviewing are well suited to future explorations of how conversation partners decide that they will not initiate, complete, or pursue repair.     

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.     

Treatment of aphasia through family member training

Background: Studies describing communication between people with aphasia and family members have suggested that family members are not always skilled communication partners. For example, spouses or significant others sometimes adopt conversational strategies that do not facilitate communication with their aphasic loved one. Therefore, management of aphasia should address the communication skills of regular communication partners in order to maximize communication with individuals with aphasia.Aims: This study was designed to provide communication training to the wife of a man with aphasia in order to reduce the occurrence of her behaviors identified as “nonfacililative.” Nonfacilitative behaviors of the wife included spouse interruptions, convergent questions and negative teaching.Methods & Procedures: A single subject multiple baseline design examined the effects of training on the occurrence of three nonfacilitative behaviors across several conditions (spontaneous conversation in the clinic, discussion of television programs in the clinic and conversation at home).Outcomes & Results: Training the spouse resulted in reduced occurrence of the target behaviors (spouse interruptions, convergent questions) in probes of the training condition (news discussions). These improvements consistently generalized from the treatment situation to untrained conditions such as spontaneous conversations with her husband. In addition, this improvement was observed in an untrained behavior (negative teaching). Improvements in both trained and untrained behaviors were maintained on follow-up probes. Furthermore, this training resulted in improvements not only in the spouse's conversational interaction, but also in her aphasic husband's expressive communication during their conversations even though he was not included in the training.Conclusions: Direct training of interactive behaviors of a speaking partner might be an effective and efficient means of enhancing communication between family members and people with 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.     

Communication therapy for people with aphasia and their partners (APPUTE)

Background: Severe aphasia is a chronic condition and can have a big effect on how people with severe aphasia (PWSA) succeed in their communication. The communication partner’s support for the person with aphasia has been shown to be essential in achieving successful communication. However, interventions combining training both the partner and the PWSA to use hierarchical strategies in nonverbal communication are still needed.

Aims: The aim of the present paper is to describe a new intervention (APPUTE) where both the person with aphasia and the partner receive therapy equally and practise finding functional communication strategies to convey everyday messages or more complicated ones. The data collection during the APPUTE intervention is also presented.

Methods & Procedures: The data were collected during a development project including an evaluation period, two rehabilitation periods and follow-up measurement. Thirty-four PWSA and their partners participated. The linguistic functions and communication efficiency of PWSA were evaluated three times during the rehabilitation. The communication skills of the partner were also assessed, along with the success of the mutual communication.

Outcomes & Results: The communication skills and communication efficiency of the PWSA and their partners improved significantly during the rehabilitation period, and the acquired skills were retained for 6 months after the intervention. The linguistic skills of the PWSA also improved. The advanced age of the partner explained both the variance of the partner’s communication skills and the success in the mutual communication. The amount of earlier outpatient speech therapy explained the variance of the communication efficiency of PWSA as evaluated by the partners. Regarding success in mutual communication, all of the couples were able to communicate at least simple issues at the end of the rehabilitation period. The more demanding the tasks, the more difficult it became for them to succeed, especially for older PWSA with severe motor paralysis. Both the people with aphasia and their partners mainly experienced benefits from the APPUTE intervention and for the most part, the benefits were retained during follow-up.

Conclusions: The APPUTE method appears to improve the communication skills of PWSA and their partners, as well as the linguistic skills of PWSA.     

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.     

Training communication partners of people with traumatic brain injury: A randomised controlled trial

Background: Communication disorders after traumatic brain injury (TBI) are difficult to modify due to the cognitive limitation imposed by frontal lobe damage. As an alternative approach, this paper describes a training programme designed to improve communication partners' responsiveness to people with TBI during routine service inquiries with a community agency. Aims: To evaluate the effectiveness of a training programme aimed at improving the communication of police officers during service encounters with people with TBI. Methods & Procedures: A total of 20 police officers were randomly assigned to two groups (training or control). Prior to the 6‐week training programme, participants with TBI made a routine telephone inquiry to the police officers. Training focused on specific aspects of telephone inquiries previously documented to be aberrant in service encounters of people with TBI. Following the training programme, police subjects received another telephone service inquiry. Service encounters were transcribed and analysed using generic structure potential analysis. Outcome & Results: Comparison of pre‐ and post‐training measures indicated that trained police had learned strategies to successfully establish the nature of the inquiry, provide a clear answer to the inquiry, and ensure appropriate leave taking, resulting in more efficient, focused interactions in the post‐training telephone calls. People with TBI also altered their communication in the post‐training calls, with reduced episodes of unrelated utterances and an increased proportion of the interaction devoted to completing the service encounter. This appeared to be in response to the communicative options they were given. Conclusions: This study demonstrates the efficacy of an approach based on training communication partners rather than people with TBI themselves. Training communication partners led to the provision of appropriate feedback, support, and structure of everyday interactions. Service encounters account for a significant amount of everyday communication exchanges, therefore training service providers has the potential to have a significant impact on the communicative effectiveness of people with TBI.     

Differences in Assessment of Everyday Preferences Between People With Cognitive Impairment and Their Care Partners: The Role of Neuropsychiatric Symptoms

ObjectiveAs cognitive impairment progresses, people with dementia increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about concordance on everyday preferences between persons with cognitive impairment and their care partners.MethodsThe sample included 69 dyads of persons with cognitive impairment (Clinical Dementia Rating Scale ≥0.5) and their care partners. We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle choices among persons with cognitive impairment. The PELI was concurrently but separately administered to care partners, who answered as surrogate decision-makers. Factor analysis was used to ascertain factor structure of the PELI; reliability measures were computed within the sample. Paired sample t-tests were used to estimate differences in scores of corresponding PELI items for each factor. Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to agreement levels.ResultsFour factors were identified from the PELI: autonomous choice, social engagement, personal growth, and keeping a routine. Significant participant-care partner discrepancy was found in “social engagement” preferences (e.g., regular contact with family, meeting new people, volunteering). Geriatric Depression Scale-15 score and care partner sex were significantly associated with participant-care partner discrepancies in “social engagement” preferences.ConclusionThis study yields new insights regarding the most important preferences for persons with cognitive impairment and clarifies a path to optimizing surrogate decision-making around everyday preferences by highlighting areas of apparent disagreement and identifying potential predictors of discrepancy.     

Sales assistants serving customers with traumatic brain injury

Background: General lack of awareness regarding neurogenic communication disorders generally, and cognitive communication disorders following a traumatic brain injury (TBI) specifically, has resulted in pervasive environmental and attitudinal barriers for these individuals. While collaborative communication partner training programmes have been advocated as a means to remove barriers and provide social supports to enhance participation, a dearth of published programmes is evident within the field of TBI specifically. Similarly within the corporate context, in spite of legislative changes and diversity awareness programmes for employees, few training programmes exist worldwide, and in South Africa particularly, that remove barriers between employees and customers with a communication disability, and with a TBI specifically. In order to address this, the current research targeted the retail supermarket environment as a context in which a significant number of everyday communicative exchanges take place.

Aims: The study examined the effects of a specialised once‐off training session on the confidence and knowledge of sales assistants in identifying barriers to, and facilitators of, sales interactions with customers with cognitive‐communication disorders following a TBI. To do this, a randomised controlled trial design was used.

Methods and Procedures: Two questionnaires were developed and administered on two different occasions to the experimental group pre and post training, as well as the control group, to determine the confidence and knowledge with which they identified barriers and facilitators during videotaped sales interactions. The training session was developed based on previously established principles of diversity awareness training. Training and its evaluation used original on‐site videotaped scenarios within small group discussion format.

Outcomes and Results: Inter‐ and‐intra group comparisons were analysed on the derived confidence and knowledge constructs from item analysis of the questionnaires. All results pointed consistently to the impact of the once‐off training session on experimental group participants, who also rated the training session highly.

Conclusions: The need for companies to expand their concept of customer service to include the customer with a disability is emphasised. Training programmes empowering their employees to interact with greater knowledge and confidence specifically with customers with a TBI will potentially facilitate deeper participation for both. The current research lays the groundwork for more in‐depth research that can be generalised beyond this specific population of individuals with a communication disorder.     

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.     

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.     

Training total communication

ABSTRACT

Background: Many people with severe or moderate aphasia begin to use nonverbal methods of communication spontaneously, but some need special training to do so. Use of total communication, including different nonverbal techniques, is often recommended to enable communication and participation in social interaction. Emphasis has also been placed on the importance of a communication partner in facilitating interaction and co-constructing the meaning in a discussion.

Aims: The aim of the present study was to examine the way people with severe or moderate aphasia perceive they communicate, and if they and their partners perceive changes in the use of different means of communication during an intervention where the aphasic participants are stimulated to use total communication and the communication partners are guided to support the interaction and to facilitate the use of different means of communication.

Methods & Procedures: The data were collected during a regular rehabilitation course. The course was carried out in two parts (8 + 4 days) with a 3-month interval. A total of 38 aphasic respondents, mainly with severe or moderate aphasia, aged 26 to 65 years, and 38 of their partners aged 29 to 71 years participated in the study. The research involved an initial, interim, and delayed post-test questionnaire design stretched over a 9-month period. An investigator-constructed, self-assessment questionnaire called Use of Different Communication Methods (UDCM) was used. With the aphasic participants a pictorial version of the questionnaire was administered in the form of an interview. The partners completed the questionnaire independently.

Outcomes & Results: The results indicate that persons with aphasia and their partners perceive the use of different communication methods quite similarly. The participants with aphasia perceive they use mostly the remaining ability of speech they possess and spontaneous nonverbal communicative methods and in lesser degree low-tech and high-tech devices. Both parties perceived that the use of spontaneous nonverbal means of communication and low-tech devices increased during and after the intervention.

Conclusions: The results indicate that people with severe and moderate aphasia and their partners perceive that total communication, i.e., all available means of communication as for instance, limited speech, spontaneous nonverbal means of communication and low-tech devices is often in use. They also perceive that the use of these different communication methods can further be increased by training and by guiding the communication partner to facilitate and support the use of them.     

A multimodal analysis of enactment in everyday interaction in people with aphasia

ABSTRACT

Background: “Multimodal communication” is a relatively common term in aphasia research. However, the scope of studies on multimodal interaction in aphasia is generally restricted to one or two multimodal resources, and the type of discourse analysed is often not representative of authentic interaction. Finally, the interpersonal (versus referential) functions of multimodal resources are frequently overlooked.

Aims: The purpose of this study was to explore the multimodal realisation of enactments by people with aphasia in everyday interaction.

Methods & Procedures: Authentic interactions of six people with aphasia interacting with communication partners of their choice were systematically analysed. Frameworks originating from non-brain-damaged studies were applied to examine the characteristics and functions of linguistic, multimodal, and stance-taking resources used to realise enactments.

Outcomes & Results: Even though the participants used the same multimodal resources as non-brain-damaged communicators, the frequencies and characteristics were different. The relationship between multimodal resources and interpersonal functions was different as well.

Conclusions: People with aphasia use the same multimodal resources as non-brain-damaged communicators, indicating their retained strengths. However, their higher use of intonation, gesture, and – to a lesser extent – facial expression indicates that these may be important “meaning making” resources for them, which could be utilised more in therapeutic endeavours.     

Communication strategies used by 'good' versus 'poor' speaking partners of individuals with aphasia

Ten nonaphasic volunteers and 10 individuals with aphasia were assigned to dyads and videotaped in conversation. Judges ranked each volunteer in the videotaped conversations from 'best' to 'worst' communication partner. The two best and two worst interactions were submitted to detailed analysis using Conversation Analysis (CA) methodology. Discourse devices and resources employed by speaking partners in the dyads were identified. Results abstracted from the CA were compared to contrast discourse characteristics between the high ranked and low ranked partners. Specific strategies identified and implications for aphasia intervention are discussed.     

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.     

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.