"Speaking for another": the management of participant frames in aphasia

Looking at gesture: The reciprocal influence between gesture and conversation

INTRODUCTION

There is limited research in group communication treatment for people with aphasia but existing studies report benefits of gesture to support conversation. Gesture supports conversation through recipient design features and reducing linguistic demands of lexical retrieval and formulation. Additionally, gesture serves an affiliative function. However, the relationship between gesture use and gestural capacity has not been widely examined. As part of a larger study on group cohesiveness and conversation, this investigation examined the patterns of co-speech gesture within authentic conversations among persons with aphasia to discern the functions of gesture use for the participants, changes in the use of gesture over time, and the relationship between gesture use and gesture ability.

METHODS

Conversation Analysis (CA) was applied in an embedded case-study design. Three participants received an academic semester of group and individual conversation-based treatment according to Facilitating Authentic Conversation (Damico et al., 2015). Four conversations from the treatment were selected and transcribed for multi-modality communication with CA conventions applied, and then cyclically analysed for patterns of gesture.

RESULTS

Participants demonstrated gesture that served social and linguistic functions: ratifying clinicians' proxy turns, turn-allocation, turn repair, relaying novel visual information, emphasizing content, demonstrating affiliation with the prior speaker, demonstrating their assessment others' talk, and demonstrating humor. All three participants showed an increased rate of gesture per turn and increasingly used gesture to repair conversation breakdown. Increased gesture use over the course of the semester coincided with increased scores for pantomime on the Porch Index of Communicative Ability (Porch, 1981, PICA).

CONCLUSION

Individuals with aphasia demonstrated increased use of gesture for varied purposes and improved gestural processing following a semester of conversation-based treatment. This is significant because gesture is an effective support for the repair of conversation breakdown typical of persons with aphasia.

Dyadic Conversation between Mandarin-Chinese-Speaking Healthy Older Adults: From Analyses of Conversation Turns and Speaking Roles

Older adults' daily conversations with other older adults enable them to connect to their surrounding communities and improve their friendships. However, typical aging processes and fluctuations in family caring might cause conversation changes. The purpose of this study was to explore the quantitative contributions of conversation turns (CTs) and speaking roles (SRs) in Mandarin-Chinese-speaking conversation dyads between mutually familiar healthy older adults (HOAs). A total of 20 HOAs aged 65 or over were recruited. Each dyad conversed for ten minutes once a week for five weeks, five sessions per dyad, for a total of 50 sessions. The frequency and percentages of the coded CTs and SRs contributed by each HOA were individually tallied and calculated. Quantitatively symmetrical contributions of CTs and SRs occurred in Mandarin-Chinese-speaking conversation dyads between mutually familiar HOAs. Although typical aging processes might change conversations, both Mandarin-Chinese-speaking HOAs serve as active interlocutors to each other in taking CTs and SRs to co-construct their conversation processes and content in their dyadic conversation. Sufficient knowledge of conversation co-constructions might lead them to have more supportive environments to connect to surrounding communities and improve their friendships.

Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia

PURPOSE

This study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success.

METHOD

Twenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success.

RESULTS

All speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success.

CONCLUSIONS

Specific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17699423.

Collaborative talk in healthcare interactions between students and people with aphasia

BACKGROUND

People with language impairments are at a higher risk of receiving inappropriate or inadequate healthcare, often stemming from ineffective exchanges between patients and healthcare professionals. This study explores a possible factor in such exchanges: the use of collaborative forms of talk in interaction with people with aphasia.

AIMS

To investigate if and how collaborative forms of talk are used as a conversational resource in healthcare interactions by students and their effects on the acquisition of information from the patient.

METHODS & PROCEDURES

The transcripts of two simulated healthcare interactions between a man with aphasia and two students (i.e., a nursing student and a speech-language pathology student) were analysed through conversation analysis. The analysis aimed to locate instances of collaborative forms of talk, which included joint productions, acknowledgement tokens, reframing of questions, gesture, laughter and engagement with alternative communication methods. The analysis also tracked the progressivity of the interactions and information checking.

OUTCOMES & RESULTS

The students engaged in a range of collaborative forms of talk, which aided the person with aphasia to participate more fully in conversation. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information.

CONCLUSIONS & IMPLICATIONS

Communication training should include conversational strategies that help to promote collaboration, focusing on enhancing the ability to perceive, and attend to collaboration requests. Training also should help trainees to find ways to frequently check understanding.

WHAT THIS PAPER ADDS

What is already known on the subject People with language impairments, including those with aphasia, face important challenges when communicating with healthcare professionals and are often at risk of receiving inadequate care as a consequence. While it is known that some of the causes of such communicative issues may be tied to limited time availability on the part of healthcare professionals, the exclusion of spouses from interactions, and lack of communication training, it remains unclear whether these issues influence the use of collaborative forms of talk on the part of providers in interaction with people with aphasia. What this paper adds to existing knowledge Healthcare students seemed to be able to engage in a variety of collaborative forms of talk even without formal communication training. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided, or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information in these crucial interactions. Influencing factors may include the nature of institutional interactions, speaker unfamiliarity, concerns about speaking for patients and lack of training. What are the potential or actual clinical implications of this work? Potential clinical implications for communication training include the need to implement modules or activities which increase trainees' ability to perceive and attend to collaboration requests (i.e., pauses, gestures, gaze, etc.) and to frequently check understanding.

Conversation turns and speaking roles contributed by Mandarin Chinese dyadic conversations between adults who use speech-generating devices and adults who use natural speech

Few studies have critically examined contributed conversation turns and speaking roles in dyadic Mandarin Chinese conversations between adults who use natural speech and adults who use SGDs. An analysis of conversation turns considers how conversation participants co-construct conversation processes, whereas an analysis of speaking roles considers how conversation participants co-construct conversation contents. The purpose of the current study was to explore the quantitative contributions of conversation turns and speaking roles in familiar Mandarin Chinese conversation dyads between adults who use SGDs and adults who use natural speech. Five dyads were recruited, and each dyad contained two participants; an adult using an SGD and an adult using natural speech. Each dyadic conversation was individually video-recorded for about 20 minutes, six times. A total of 30 dyadic conversations were analyzed. The means and percentages of the coded conversation turns and speaking roles were computed. Quantitatively asymmetrical contributions of conversation turns and speaking roles occurred in the Mandarin Chinese conversation dyads between the adults who use SGDs and the adults who use natural speech. The adults who use natural speech contributed significantly more conversation turns and speaking roles than did the adults who use SGDs. Implications, limitations, and further research studies were discussed.

"By the Way"… How People With Aphasia and Their Communication Partners Initiate New Topics of Conversation

Purpose The ability to initiate new topics of conversation is a basic skill integral to communicative independence and agency that is susceptible to breakdown in aphasia (Barnes, Candlin, & Ferguson, 2013), yet this discourse skill has received little research attention. Healthy adults (HAs) follow 3 established patterns of structural organization to cue the conversation partner when an utterance is intended to initiate a new topic (Schegloff & Sacks, 1973; Svennevig, 1999). In addition, speakers have the option to use these mechanisms of topic initiation (TI) individually or in conjunction with one another. Occasionally, speakers do not follow these conversational macrostructure expectations, in which case TI occurs abruptly, referred to as a noncoherent TI (NC-TI; Mentis & Prutting, 1991). Understanding how TI is disrupted by aphasia requires foundational knowledge regarding the relative use/combined use of TI mechanisms and NC-TI in HAs and persons with aphasia (PWAs). The purpose of this study is to investigate how PWAs and their conversation partners initiate new topics of conversation and to determine the relationship between the number of TI methods used and communicative success (CS) in persons with mild aphasia (PWA-Mild) and persons with moderate and severe aphasia (PWA-Mod/Sev). Method Six PWA-Mild and 4 PWA-Mod/Sev engaged in 15-min unstructured conversations with different HA partners. Utterances were coded for types of TI used by both partners and were evaluated for CS using a 4-point scale (Leaman & Edmonds, 2019) for PWAs. Results/Implications PWAs used NC-TI with a much greater frequency than HAs who never used NC-TI. The rate of NC-TI was associated with increased severity of aphasia. HAs and PWA-Mild used cohesion most often as the method for TI, while PWA-Mod/Sev used it least often. CS was moderately positively correlated with the number of methods of TI used in PWA-Mod/Sev. However, no such correlation existed for PWA-Mild; this group achieved a high degree of CS on TI utterances, independent of the number of methods of TI used. Findings include the clinical implication suggesting PWA-Mod/Sev may benefit from simultaneous use of TI mechanisms to achieve better CS during conversation. Supplemental Material https://doi.org/10.23641/asha.9765164.

Humour in clinical-educational interactions between graduate student clinicians and people with aphasia

BACKGROUND

During clinical interactions, clinicians and people with aphasia (PWA) use humour and laughter for a range of purposes, most of which contribute to friendly interactions in which the participants appear to develop a positive regard for one another. Moreover, humour is a vital component of facework, or the processes interactants engage in to protect their own and one another's well-respected, public personas.

AIMS

To examine the ways in which speech-language pathology graduate student clinicians enlist humour during one-on-one therapy sessions for PWA.

METHODS & PROCEDURES

Three dyads composed of one graduate student clinician and one person with aphasia acted as participants. We recorded six routine individual aphasia therapy sessions that were each about 60 min in length. All sessions were orthographically transcribed by a trained research assistant. Transcriptions included verbal and non-speech communication (e.g., facial expressions, gestures, writing). For analysis, we employed an ethnographic microanalysis framework. First, by focusing on laughter produced by the interactants, we identified segments in the data that involved clinician-led humour. Next, we sought to understand patterns that represented potential functions of humour. We consciously sought out instances that did not appear consistent with our developing understanding of the functions of humour. Such negative cases were used to refine our description of how graduate student clinicians use humour. Other verification procedures included member checking and peer debriefing.

OUTCOMES & RESULTS

The findings illustrate that graduate student clinicians use laughter and humour for a range of interactional purposes when interacting with clients with aphasia. Humour was used as a means of (1) softening exposure to client's errors, (2) equalizing interactional power, (3) mitigating errors made by graduate student clinicians, (4) supporting own narrative production and (5) demonstrating affiliation.

CONCLUSIONS & IMPLICATIONS

The current study demonstrates that graduate student clinicians we observed, like the clinicians studied in previous investigations of humour in therapeutic encounters, possess the humour and laughter-related skills that help to foster positive interactions with PWA. Future investigations of the source of these skills should determine if students are adept because of natural abilities or if students can be taught to be better interactants via instruction. Findings emanating from these studies can be used to inform curriculum design, which will in turn help our field better meet the needs of clients.

Enhanced patient involvement in Swedish aphasia intervention

The present article is a case study in which participation is investigated in terms of the use of interactional practices that enhance the involvement of a man with severe aphasia in activities that aim to capture his and his wife's experiences of everyday communication, and their views of his speech and language intervention. Five practices are identified: 1) collaborative telling, 2) formulations, 3) yes/no questions, 4) declaratives and 5) hint-and-guess strategies. It is demonstrated how participants' (wife, a speech and language pathologist, and two research assistants) use of these practices are beneficial for making the viewpoints of the man with aphasia come across, despite his communication difficulties. Results are discussed in light of the importance of finding ways to make patients influence their own intervention, both in terms of a raised awareness of facilitative interactional practices and of activities such as interviews and retrospection sessions with patients and their significant others.

Communicating with individuals receiving home mechanical ventilation: the experiences of key communication partners

PURPOSE

The aim of the study was to explore the communication experiences of key communications partners (CPs) of individuals receiving home mechanical ventilation (HMV), with particular emphasis on the possibilities, difficulties and limitations CPs experienced in communication, possible support given to facilitate communication and exploring what made a skilled communicator.

METHOD

A qualitative research design using interviews was used. The participants included 19 key CPs of individuals receiving HMV.

RESULTS

The analysis resulted in five themes: Encountering communication limitations, Functional communication strategies, Being a communication facilitator, Role insecurity and Emotional reactions and coping. The findings revealed that CPs needed to develop partly new reference frames for communication. In particular, participants emphasised the need to understand and interpret subtle details in the communicative interaction.

CONCLUSIONS

The findings are discussed in the light of previous research, in particular an earlier study exploring another perspective; the ventilator-supported individuals' experiences of communication. Issues relating to the educational needs of CPs of individuals receiving HMV are discussed. The results are intended to enhance understanding of the challenges that individuals receiving HMV and their CPs face with communication, which should be of relevance not only to speech therapists, but for all healthcare practitioners in the field of HMV.

Communication experience of individuals treated with home mechanical ventilation

BACKGROUND

Mechanical ventilatory support seriously affects speaking and communication, and earlier studies show that many ventilator-supported patients experience difficulties and frustration with their speech and voice production. Since there is a growing number of individuals who require mechanical ventilatory support and there is a paucity of studies that examine ventilator-supported communication, this research area needs to be developed to ensure adequate health services for this population. The present study focused on ventilator-supported communication from the point of view of individuals receiving home mechanical ventilation (HMV).

AIMS

The specific aim was to examine the communication experience of individuals receiving HMV.

METHODS & PROCEDURES

A qualitative approach was adopted for this study, and data were collected by means of semi-structured interviews. Qualitative content analysis was used to structure, condense and interpret the data. The participants were recruited from the National Respiratory Centre (NRC) in Sweden, and included 19 individuals receiving HMV.

OUTCOMES & RESULTS

The main theme A long and lonely struggle to find a voice and six subthemes detailing different facets of it emerged from data analysis: Managing changed speech conditions, Prioritising voice, A third party supporting communication, Using communication to get things done, Depending on technology, and Facing ignorance. Important aspects influencing the ventilator-supported individuals' communicative performance (speech, support from others and technological solutions) are discussed.

CONCLUSIONS & IMPLICATIONS

The study revealed that healthcare practitioners involved in the care of individuals receiving HMV need to improve their understanding and knowledge of issues related to ventilator-supported communication. Individuals receiving HMV encounter a needlessly long and lonely struggle to achieve effective communication. They face numerous challenges regarding their communication, and they need to be heard in both literal and figurative senses. To overcome these challenges they need support from competent healthcare practitioners and personal assistants, and continuous follow-up by speech and language therapists tailoring communicative solutions to fit individual needs.

Co-constructed talk in the conversations of people with dysarthria and aphasia

This paper uses the methodology of conversation analysis (CA) to examine the practice of co-constructed turn and utterance production in impaired communication. An investigation of the conversations between two family dyads, featuring one person with dysarthric speech and one with aphasic language, reveals one way in which single turns and utterances are produced through the collaborative activities of two people in interaction. Such a practice is shown to operate without problems for the participants or the need for explicit acceptance by the speakers. It is proposed that co-construction in disordered speech and language is one way in which communicative competence is accomplished. By drawing attention to similarities in the consequences of dysarthria and aphasia in everyday interaction, it is suggested that researchers and clinicians might profitably look across disorder-specific boundaries.

Discovering Communicative Competencies in a Nonspeaking Child With Autism

Purpose

This article is intended to demonstrate that adapted conversation analysis (CA) and speech act analysis (SAA) may be applied by speech-language pathologists (SLPs) to (a) identify communicative competencies in nonspeaking children with autism spectrum disorder (ASD), especially during particularly successful interactions, and (b) identify communicative patterns that are exhibited by interventionists and communication partners that may positively or negatively impact interactions with such children.

Method

A case example involving an 8-year-old boy with autism and the author, an SLP, is explicated. A videotaped segment from an intervention session was transcribed and subjected to adapted forms of CA and SAA.

Results

CA and SAA helped reveal several underlying competencies in the boy’s communicative output, including an awareness of conversational structure and sequence, diversity of communicative acts, functional use of gaze and smile behavior, and the ability to spontaneously initiate interactions. Observations regarding the SLP’s interactive style included the use of multiple instances of “asking” as well as multiple “derailments” of the boy’s obvious communicative bids.

Conclusion

CA and SAA may be adapted to gain a clearer picture of what takes place during especially positive communicative interactions with nonspeaking children with ASD.