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Bartolini G, Laschi L, Dorgali F, Abbruzzese L, Damora A, Stocchi A, Saieva MA, Ferretti F, Ferroni L, Papagno C, Caporali A, Mancini G, Mancuso M. "Communicative competence assessment of the person with aphasia caregiver: Standardization of the ACCA-CHECKLIST". Neuropsychol Rehabil 2024:1-23. [PMID: 38441810 DOI: 10.1080/09602011.2024.2315772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/03/2024] [Indexed: 05/20/2024]
Abstract
Aphasia constitutes a very complex clinical entity that requires a "competent" caregiver to interact with the person with aphasia (PWA). The literature lacks a valid and reliable set of standardized tools which can offer objective and quantifiable data of a caregiver's communicative competence. The aim of the study was to develop, standardize and validate an evaluation tool suited to measur the caregivers' competence in communicating with family members affected by aphasic disorders. Forty-two patients with aphasia and their respective caregivers were enrolled in the study. Caregivers' communicative competence was assessed through a new evaluation tool called ACCA-cl. Aphasia severity and functional communication abilities of the PWA were also investigated. Our data showed encouraging results regarding the reliability and the validity of the ACCA-cl scale in detecting the caregiver's communicative competence, especially as far as verbal content was considered. This scale can also be used to assess the improvement achieved by the caregiver after a communication training. The analysis provides encouraging findings for verbal content scales of the ACCA-cl and its possible use in clinical settings as a quantitative tool for detecting changes induced by the educational method of the caregiver. The tool is currently available in Italian.
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Affiliation(s)
| | - Lara Laschi
- Tuscany Rehabilitation Clinic, Arezzo, Italy
| | | | | | | | | | | | - Fabio Ferretti
- Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, University of Siena, Siena, Italy
| | - Lucia Ferroni
- Physical and Rehabilitative Medicine Unit, NHS-USL Tuscany North-West, Lucca, Italy
| | - Costanza Papagno
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Alessandra Caporali
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | | | - Mauro Mancuso
- Tuscany Rehabilitation Clinic, Arezzo, Italy
- Physical and Rehabilitative Medicine Unit, NHS-USL Tuscany South-East, Grosseto, Italy
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Volkmer A, Beeke S, Warren JD, Spector A, Walton H. Development of fidelity of delivery and enactment measures for interventions in communication disorders. Br J Health Psychol 2024; 29:112-133. [PMID: 37792862 DOI: 10.1111/bjhp.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES This study was part of a process evaluation for a single-blind, randomized controlled pilot study comparing Better Conversations with Primary Progressive Aphasia (BCPPA), an approach to communication partner training, with no speech and language therapy treatment. It was necessary to explore fidelity of delivery (delivery of intervention components) and intervention enactment (participants' use of intervention skills in the form of conversation behaviours comprising facilitators, that enhance the conversational flow, and barriers, that impeded the flow of conversation). This study aimed to: (1) Outline an adapted methodological process that uses video observation, to measure both fidelity of delivery and enactment. (2) Measure the extent to which the BCPPA pilot study was delivered as planned, and enacted. DESIGN Observational methods were used alongside statistical analysis to explore the fidelity of intervention and enactment using video recordings obtained from the BCPPA pilot study. METHODS A 5-step methodology, was developed to measure fidelity of delivery and enactment for the BCPPA study using video-recorded data. To identify delivery of intervention components, a random sample of eight video recorded and transcribed BCPPA intervention sessions was coded. To examine the enactment of conversation behaviours, 108 transcribed 10 -min-video recorded conversations were coded from 18 participants across the control and intervention group. RESULTS Checklists and guidelines for measurement of fidelity of treatment delivery and coding spreadsheets and guidelines for measurement of enactment are presented. Local collaborators demonstrated 87.2% fidelity to the BCPPA protocol. Participants in the BCPPA treatment group increased their use of facilitator behaviours enacted in conversation from a mean of 13.5 pre-intervention to 14.2 post-intervention, whilst control group facilitators decreased from a mean of 15.5 to 14.4, over the same timescale. CONCLUSIONS This study proposes a novel and robust methods, using video recorded intervention sessions and conversation samples, to measure both fidelity of intervention delivery and enactment. The learnings from this intervention are transferable to other communication interventions.
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Affiliation(s)
- Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Suzanne Beeke
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Jason D Warren
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Aimee Spector
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Holly Walton
- Psychology and Language Sciences, University College London, London, UK
- Dementia Research Centre, University College London, London, UK
- Department of Applied Health Research, University College London, London, UK
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Thiel L, Conroy P. 'I think writing is everything': An exploration of the writing experiences of people with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1381-1398. [PMID: 35929726 PMCID: PMC9805004 DOI: 10.1111/1460-6984.12762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate. AIMS This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives. METHODS & PROCEDURES Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis. OUTCOMES & RESULTS Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals. CONCLUSIONS & IMPLICATIONS The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed. WHAT THIS PAPER ADDS What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual.
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Affiliation(s)
- Lindsey Thiel
- Leeds School of Social SciencesLeeds Beckett UniversityLeedsUK
| | - Paul Conroy
- Division of Human Communication Development and Hearing, School of Health SciencesUniversity of ManchesterManchesterUK
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Thilakaratne R, Loftus AM, Cocks N. Assessing and treating conversations with partners in Parkinson's disease: A scoping review of the evidence. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:427-436. [PMID: 34565250 DOI: 10.1080/17549507.2021.1978545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This is a scoping review of the methods used in published research to assess conversations and the interventions used to treat conversations between people with Parkinson's disease and their partners. Communication partners were defined as significant others or next-of-kin. The aims were to describe the assessment methods and interventions used, and to identify gaps in the literature.Method: Four online databases were used to identify peer reviewed journal articles in English, which assess and/or treat conversations in this population. The titles and abstracts of the obtained articles were screened and irrelevant articles were excluded. The full texts of the remaining articles were read to determine which studies met the inclusion/exclusion criteria of this review. The methods used, conversational aspects assessed, the treatments conducted and outcome measures used, and the speech and language domains targeted were charted in order to examine the extent of the evidence to inform future research directions.Result: Eight studies met inclusion criteria. "Conversation analysis" was the most widely used method to assess conversations. These studies assessed conversational aspects relating to the domains of pragmatics, fluency, prosody and semantics. They highlighted the role of communication partners to support conversational interactions by using repair strategies during a communication breakdown. Only one study treated conversations by implementing communication partner training.Conclusion: The findings of this review emphasise gaps in the literature. It highlights the need for future research implementing communication partner training. There is also a need to assess conversation skills of partners in order to determine which strategies would be most effective to support their interaction. It highlights the importance of incorporating a participation-based approach to assessment and intervention involving all communication partners. This may lead to enhanced support for people with Parkinson's disease and their families, thus improving their quality of life.
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Affiliation(s)
| | - Andrea M Loftus
- School of Public Health, Curtin University, Bentley, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Bentley, Australia
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Wylie K, Carrier HM, Loftus AM, Thilakaratne R, Cocks N. Barriers and Facilitators to Conversation: A Qualitative Exploration of the Experiences of People with Parkinson’s and Their Close Communication Partners. Brain Sci 2022; 12:brainsci12070944. [PMID: 35884750 PMCID: PMC9321478 DOI: 10.3390/brainsci12070944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/02/2022] Open
Abstract
Conversations are an important part of our daily lives, enabling us to interact with others and participate in a range of activities. For people with Parkinson’s, conversation can be challenging when communication is impacted. This qualitative exploratory study investigated the experiences of people with Parkinson’s and their close communication partners in conversations. The study explored influences on conversational participation, considering perceived barriers and facilitators to participation in conversation for people with Parkinson’s. Interviews were conducted with eight dyads, with participants interviewed both jointly and separately (24 interviews). Five themes revealed that conversation appears to be influenced not only by the communication skills of the person with Parkinson’s, but also by factors associated with the communication partner, the complex nature of conversations, the communication environment, and the impact of experience in shaping participation in conversation. Specific barriers and facilitators to conversational participation were identified. This study offers important insight into the lived experience of people with Parkinson’s affected by communication difficulties. The findings support the notion that it is more than simply the communication skills of the person with Parkinson’s that influence conversations. It is important that other factors influencing conversational success should be included in interventions supporting communication for people with Parkinson’s.
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Affiliation(s)
- Karen Wylie
- School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia; (A.M.L.); (R.T.); (N.C.)
- School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 25, Ghana
- Correspondence: ; Tel.: +61-8-92664908
| | | | - Andreas M. Loftus
- School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia; (A.M.L.); (R.T.); (N.C.)
| | - Ramishka Thilakaratne
- School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia; (A.M.L.); (R.T.); (N.C.)
- Rocky Bay, P.O. Box 53, Mosman Park, WA 6912, Australia
| | - Naomi Cocks
- School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia; (A.M.L.); (R.T.); (N.C.)
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El-Wahsh S, Layfield C, Bogaardt H, Kumfor F, Ballard KJ. Perspectives from the patient: A content analysis of communication changes, impact, and strategies to facilitate communication in multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:173-189. [PMID: 34493141 DOI: 10.1080/17549507.2021.1973101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Communication changes in multiple sclerosis (MS) are under-explored and under-recognised. Persons with MS (PwMS) are experts in their condition and play a valuable role in informing clinicians and researchers of their condition. This study aimed to investigate the perspectives of PwMS on: (1) MS-related communication changes, (2) the impact of these communication changes across key aspects of a person's life, including work/studies, relationships, and general quality of life, and (3) strategies used to facilitate communication in daily interactions.Method: Two-hundred and sixty PwMS were recruited internationally and completed an online questionnaire. Content analysis was used to analyse open-ended questionnaire responses.Result: One-hundred and ninety-seven (75.8%) participants reported communication changes, including language, cognitive, speech, voice, and fluency changes. Participants described a variety of personal and environmental factors that influence communication negatively, such as fatigue, stress, and heat. Communication changes were reported to impact on psychological wellbeing, interpersonal relationships, participation and identity in the workforce and career pathways, and tertiary studies. Around 40% of participants reported using a range of overt and covert strategies to manage communication changes. Only 11.2% (n = 22/197) of participants who reported communication changes accessed speech-language pathology (SLP) services.Conclusion: PwMS can experience a wide spectrum of communication changes. These communication changes can have a profound and far-reaching impact on psychological wellbeing and societal participation. Engagement with SLP services is limited compared to the reported prevalence of communication changes. There is a need to raise awareness of the role of SLP in service provision for PwMS to manage communication changes. This paper discusses and provides suggestions for SLP services for PwMS with communication changes. There is a timely need to develop evidence-based interventions to support PwMS manage communication changes and reduce their impact.
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Affiliation(s)
- Sarah El-Wahsh
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire Layfield
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, Australia, and
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation. Neuropsychol Rev 2022; 32:937-973. [PMID: 35076868 PMCID: PMC9630202 DOI: 10.1007/s11065-021-09531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.
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Leaman MC, Archer B, Edmonds LA. Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:322-341. [PMID: 35007425 PMCID: PMC9135006 DOI: 10.1044/2021_ajslp-21-00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Marion C. Leaman
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City
| | - Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
| | - Lisa A. Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Volkmer A, Spector A, Swinburn K, Warren JD, Beeke S. Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA. BMC Geriatr 2021; 21:642. [PMID: 34781875 PMCID: PMC8591912 DOI: 10.1186/s12877-021-02561-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia. Methods The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement. Results Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future. Conclusions Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02561-8.
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Affiliation(s)
- Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK. .,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK.
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Kate Swinburn
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
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Tetnowski JT, Tetnowski JA, Damico JS. Patterns of Conversation Trouble Source and Repair as Indices of Improved Conversation in Aphasia: A Multiple-Case Study Using Conversation Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:326-343. [PMID: 32551823 DOI: 10.1044/2020_ajslp-19-00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Social approaches to intervention for aphasia are being increasingly employed to address the functional communication barriers experienced by persons with aphasia. One specific approach is the use of conversation-based treatment in both group and two-person dyads. Although there are several methods to measure improvement for stimulation and cognitive neurolinguistic approaches, researchers have consistently indicated a need for outcome measures that can objectively demonstrate improved communication following conversation treatment. This study aims to demonstrate the utility for examining the patterns of conversation trouble source and repair as indices for improved communication as a positive response to intervention. Method The conversations of 20 consecutive participants, before and after 3 months, or 40 hr, of group and individual conversation-based treatment, were transcribed using conventions of conversation analysis, and sociolinguistic discourse analysis was applied. Measures of trouble source and repair were aggregated and subjected to statistical analysis. Results Persons with aphasia demonstrated statistically significant improvement in patterns of conversation trouble source and repair posttreatment for the rate of conversation trouble source and the length of repair. However, measures of self-initiation and self-completion of repair did not reach significance. Conclusion The study indicates that, following conversation-based treatment, the conversations of persons with aphasias were more efficient, experiencing fewer trouble sources and shorter repair sequences. These findings suggest that measures of conversation for the rate of trouble source and length of the repair sequence are valid indices of improved conversation.
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Affiliation(s)
| | - John A Tetnowski
- Department of Communication Disorders, University of Louisiana at Lafayette
| | - Jack S Damico
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
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Barnes S, Beeke S, Bloch S. How is right hemisphere communication disorder disabling? Evidence from response mobilizing actions in conversation. Disabil Rehabil 2020; 44:261-274. [PMID: 32449410 DOI: 10.1080/09638288.2020.1766123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim: Assessment and intervention strategies for communication disorders caused by right hemisphere stroke are at an early stage of development. There is also little evidence on how right hemisphere communication disorder is disabling for everyday life. This study explores how a woman with conversational problems following right hemisphere stroke participated in everyday conversation with family members.Method: One hour of triadic conversation was recorded and analyzed using the descriptive qualitative methodology of conversation analysis. It focused on attempts by the woman with right hemisphere stroke to direct conversation with "response mobilizing" communicative acts, i.e., communicative acts that set out clear expectations about who should speak, and how they should respond.Results: Seventy-eight communicative acts produced by the woman with right hemisphere communication disorder were divided into five groupings based on how her conversation partners addressed them. Around half of her response mobilizing communicative acts received unsupportive responses from her conversation partners, including minimal acknowledgements, explicit rejections, and ignoring responses.Conclusion: The findings of this study provide novel insight into the ways that right hemisphere communication disorder affects routine communication, and the nature of the disability it causes. This information will support the future development of evidence-based speech pathology assessment and intervention for right hemisphere stroke.IMPLICATIONS FOR REHABILITATIONRight hemisphere stroke can have complex implications for communication, but little is known about how they manifest in daily life.Familiar communication partners may deal with troublesome communicative acts in conversation by preventing them from developing, which may be useful information for speech pathology assessment.Speech pathologists should consider sampling everyday conversation because it can provide insight into the ways that communication disorders caused by right hemisphere stroke restrict participation in daily life.
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Affiliation(s)
- Scott Barnes
- Department of Linguistics, Macquarie University, Sydney, Australia
| | - Suzanne Beeke
- Department of Language and Cognition, University College London, London, UK
| | - Steven Bloch
- Department of Language and Cognition, University College London, London, UK
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Leaman MC, Edmonds LA. "By the Way"… How People With Aphasia and Their Communication Partners Initiate New Topics of Conversation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:375-392. [PMID: 31491343 DOI: 10.1044/2019_ajslp-cac48-18-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Marion C Leaman
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Lisa A Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Lee JJ, Finch E, Rose T. Exploring the outcomes and perceptions of people with aphasia who conversed with speech pathology students via telepractice: a pilot study. SPEECH, LANGUAGE AND HEARING 2019. [DOI: 10.1080/2050571x.2019.1702241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeslyn J. Lee
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Archer B, Azios JH, Moody S. Humour in clinical-educational interactions between graduate student clinicians and people with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:580-595. [PMID: 30779411 DOI: 10.1111/1460-6984.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/26/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, OH, USA
| | - Jamie H Azios
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Samantha Moody
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
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Chang HF, Power E, O'Halloran R, Foster A. Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:1094-1109. [PMID: 30151877 DOI: 10.1111/1460-6984.12421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Communication partners (CPs) find it challenging to communicate with people with communication disorders post-stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post-stroke. While evidence for the efficacy of aphasia-based CPT is strong, implementation in healthcare settings is unclear. AIMS To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence. METHODS & PROCEDURES Speech pathologists in Australia who had worked with people post-stroke were invited to complete a 99-item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis. OUTCOMES & RESULTS A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post-stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face-to-face education and skills training. Only 13.3% and 10.0% of participants used evidence-based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice. CONCLUSION & IMPLICATIONS A significant evidence-practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post-stroke communication disorders, developing freely accessible step-by-step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed.
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Affiliation(s)
- Huey Fang Chang
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Abby Foster
- Speech Pathology, Monash Health, Melbourne, VIC, Australia
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O'Rourke A, Power E, O'Halloran R, Rietdijk R. Common and distinct components of communication partner training programmes in stroke, traumatic brain injury and dementia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:1150-1168. [PMID: 30295014 DOI: 10.1111/1460-6984.12428] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Communication partner training (CPT) programmes for health and care staff working with people with the neurologically based communication disorders associated with stroke, traumatic brain injury (TBI) and dementia are efficacious in improving communication. However, current programmes are lengthy and disorder specific, and therefore may not be suitable as staff training tools in environments with people with multiple communication disorders, and services with a variety of neurological populations. AIMS To identify common and distinct components of CPT programmes for stroke, TBI and dementia in order to determine whether there are common delivery methods and content that can be consolidated to improve implementation of CPT in health and care services. METHODS & PROCEDURES A qualitative enquiry was used. Four CPT programmes targeting three disorders were identified from systematic reviews and literature searches. Programme data were recorded onto data sheets from manuals, study articles and supplementary materials, and were categorized using the Intervention Taxonomy (ITAX). Content analysis and elements of constant comparative analysis were employed to analyse the CPT programmes. OUTCOMES & RESULTS Delivery characteristics were similar across all four programmes. All were delivered face to face in either group or individual contexts. However, duration varied from 1 to 35 h. Six of the 12 categories of information provided were common across all programmes, including 'strategy' 'background to disorder', 'information about communication', 'information about program', 'negative behaviours to avoid' and 'purpose of program'. Programmes differed in the types of skill-building techniques used, with the most common being videos (3/4 programmes), discussions (2/4 programmes) and trainer demonstrations (2/4 programmes). While strategies provided to trained partners targeted similar domains of communication, only 3/96 individual strategies were common to all programmes. CONCLUSIONS & IMPLICATIONS There are both common and distinct components in content and delivery methods across CPT programmes. Further research is needed to evaluate the distinct components of the programmes, to determine which individual strategies are efficacious, and which approach to skill-building techniques is most effective. The present study has contributed a comprehensive list of programme components, which can form a basis for describing and refining CPT programmes in future.
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Affiliation(s)
- Angela O'Rourke
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Rachael Rietdijk
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Barnes S, Nickels L. Interaction-focussed therapy for aphasia: Effects on communication and quality of life. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:528-540. [PMID: 28682118 DOI: 10.1080/17549507.2017.1329851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 02/21/2017] [Accepted: 05/06/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study examined the effects of an interaction-focussed therapy for aphasia, which involved both people with aphasia and their familiar conversation partners. It was hypothesised the interaction-focussed therapy would lead to positive changes in targeted conversation behaviours, and improved quality of life for participants with aphasia. METHOD Three people with chronic aphasia and three of their familiar conversation partners completed an 8-week interaction-focussed therapy programme. A series of single case multiple-baseline ABA experiments were conducted. Outcome measures focussed on changes in targeted behaviours between pre- and post-therapy conversation samples, and changes in quality of life. RESULT All participant dyads improved their conversations. Familiar conversation partners demonstrated significant changes in targeted behaviours, while only one participant with aphasia achieved significant improvements. There was little evidence of a positive impact on quality of life for participants with aphasia. CONCLUSION Interaction-focussed therapy enhances everyday communication for people with aphasia and their conversation partners. However, the complex nature of learning in this intervention means that further, likely interdisciplinary work is required to better understand what mediates skill acquisition and therapeutic change and its psychosocial impact. This information is particularly important for optimising interaction-focussed therapy for people with aphasia.
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Affiliation(s)
- Scott Barnes
- a Department of Linguistics , Macquarie University , Sydney , Australia and
| | - Lyndsey Nickels
- b Centre for Cognition and its Disorders, Department of Cognitive Science , Macquarie University , Sydney , Australia
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Heard R, O'Halloran R, McKinley K. Communication partner training for health care professionals in an inpatient rehabilitation setting: A parallel randomised trial. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:277-286. [PMID: 28264588 DOI: 10.1080/17549507.2017.1290137] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study is to determine if the E-Learning Plus communication partner training (CPT) programme is as effective as the Supported Conversation for Adults with Aphasia (SCATM) CPT programme in improving healthcare professionals' confidence and knowledge communicating with patients with aphasia. METHOD Forty-eight healthcare professionals working in inpatient rehabilitation participated. Participants were randomised to one of the CPT programmes. The three outcome measures were self-rating of confidence, self-rating of knowledge and a test of knowledge of aphasia. Measures were taken pre-, immediately post- and 3-4 months post-training. Data were analysed using mixed between within ANOVAs. RESULT Homogeneity of variance was adequate for self-rating of confidence and test of knowledge of aphasia data to continue analysis. There was a statistically significant difference in self-rating of confidence and knowledge of aphasia for both interventions across time. No statistically significant difference was found between the two interventions. CONCLUSION Both CPT interventions were associated with an increase in health care professionals' confidence and knowledge of aphasia, but neither programme was superior. As the E-Learning Plus CPT programme is more accessible and sustainable in the Australian healthcare context, further work will continue on this CPT programme.
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Affiliation(s)
- Renee Heard
- a Speech Pathology Department, St. Vincent's Hospital , Melbourne , Australia and
| | - Robyn O'Halloran
- a Speech Pathology Department, St. Vincent's Hospital , Melbourne , Australia and
- b School of Allied Health, La Trobe University , Melbourne , Australia
| | - Kathryn McKinley
- a Speech Pathology Department, St. Vincent's Hospital , Melbourne , Australia and
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Beckley F, Best W, Beeke S. Delivering communication strategy training for people with aphasia: what is current clinical practice? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:197-213. [PMID: 27349484 DOI: 10.1111/1460-6984.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/04/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. AIMS To investigate UK SLTs' current CST practices. METHODS & PROCEDURES Thirty-seven UK SLTs completed an online questionnaire, eight of whom attended a follow-up focus group. A clinical consistency scale was applied to the questionnaire data and tasks that were most consistently used were explored in the focus group and analyzed using a primarily deductive thematic data analysis approach. OUTCOMES & RESULTS Three key CST findings arose: (1) the rarity with which SLTs focus equally and explicitly on both communication partners' strategies; (2) SLTs' differing understandings of CST terminologies and concepts and underuse of formal assessment; and (3) the absence of video feedback. CONCLUSION & IMPLICATIONS This study's survey findings suggest that conversation partners not only receive half the amount of CST given to people with aphasia but also play a more passive learning role when they are present. This is an interesting point to consider when the current evidence base contains stronger evidence for the effectiveness of conversation partner CST over other CST approaches, it being described as an effective method that may be maintained over time.
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Affiliation(s)
- Firle Beckley
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Wendy Best
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
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Wielaert SM, Berns P, van de Sandt-Koenderman MWME, Dammers N, Sage K. 'Now it is about me having to learn something ….' Partners' experiences with a Dutch conversation partner training programme (PACT). INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:143-154. [PMID: 27363586 DOI: 10.1111/1460-6984.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The increase in the number of reported conversation partner programmes for conversation partners of people with aphasia demonstrates increased awareness of partner needs and the positive effect of trained partners on the communicative abilities of the person with aphasia. Predominantly small-scale studies describe the effectiveness of conversation partner training (CPT) and how partners perceive this training. The view of partners on this service commission remains largely unknown. AIMS To explore the experiences of partners of people with aphasia with a CPT programme when it was newly introduced into rehabilitation settings. METHODS & PROCEDURES Seventeen partners of people with aphasia were interviewed using a semi-structured format about their experience with Partners of Aphasic Clients Conversation Training (PACT). Transcribed interviews were analysed using qualitative content analysis. OUTCOMES & RESULTS Four categories representative of the practical nature and individual tailoring of PACT were identified: engaging with PACT; learning from PACT; reflecting on behaviour and emotions; and experiences with earlier speech and language therapy (SLT). Two themes were identified cutting across all categories: the nature of communication is difficult to grasp; and balancing roles as partner, carer and client. CONCLUSIONS & IMPLICATIONS Partners appreciated the training programme once their initial lack of awareness of the interactive nature of communication had been addressed. SLTs need to be clear about the collaborative nature of conversations and what can be offered within the rehabilitation trajectory to address conversation alongside language training.
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Affiliation(s)
- Sandra M Wielaert
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Philine Berns
- Rotterdam University of Applied Sciences-School of Health Care and Research Centre, Innovations in Care Programme for Speech and Language Therapy, Rotterdam, the Netherlands
| | - Mieke W M E van de Sandt-Koenderman
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
- Erasmus Mc Rotterdam, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - Nina Dammers
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
| | - Karen Sage
- Faculty of Health and Well Being, Sheffield Hallam University, Sheffield, UK
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Wielaert S, van de Sandt-Koenderman MW, Dammers N, Sage K. ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings. Disabil Rehabil 2016; 40:76-89. [DOI: 10.1080/09638288.2016.1243160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Nina Dammers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Best W, Maxim J, Heilemann C, Beckley F, Johnson F, Edwards SI, Howard D, Beeke S. Conversation Therapy with People with Aphasia and Conversation Partners using Video Feedback: A Group and Case Series Investigation of Changes in Interaction. Front Hum Neurosci 2016; 10:562. [PMID: 27872588 PMCID: PMC5097900 DOI: 10.3389/fnhum.2016.00562] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
Conversation therapies employing video for feedback and to facilitate outcome measurement are increasingly used with people with post-stroke aphasia and their conversation partners; however the evidence base for change in everyday interaction remains limited. We investigated the effect of Better Conversations with Aphasia (BCA), an intervention that is freely available online at https://extend.ucl.ac.uk/. Eight people with chronic agrammatic aphasia, and their regular conversation partners participated in the tailored 8 week program involving significant video feedback. We explored changes in: (i) conversation facilitators (such as multi-modal turns by people with aphasia); and (ii) conversation barriers (such as use of test questions by conversation partners). The outcome of intervention was evaluated directly by measuring change in video-recorded everyday conversations. The study employed a pre-post design with multiple 5 minute samples of conversation before and after intervention, scored by trained raters blind to the point of data collection. Group level analysis showed no significant increase in conversation facilitators. There was, however, a significant reduction in the number of conversation barriers. The case series data revealed variability in conversation behaviors across occasions for the same dyad and between different dyads. Specifically, post-intervention there was a significant increase in facilitator behaviors for two dyads, a decrease for one and no significant change for five dyads. There was a significant decrease in barrier behaviors for five dyads and no significant change for three dyads. The reduction in barrier behaviors was considerable; on average change from over eight to fewer than three barrier behaviors in 5 minutes of conversation. The pre-post design has the limitation of no comparison group. However, change occurs in targeted conversational behaviors and in people with chronic aphasia and their partners. The findings suggest change can occur after eight therapy sessions and have implications for clinical practice. A reduction in barrier behaviors may be easier to obtain, although the controlled case series results demonstrate a significant increase in conversation facilitators is also possible. The rehabilitation tool is available online and video technology was central to delivering intervention and evaluating change.
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Affiliation(s)
- Wendy Best
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London London, UK
| | - Jane Maxim
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London London, UK
| | - Claudia Heilemann
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London London, UK
| | - Firle Beckley
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London London, UK
| | - Fiona Johnson
- Homerton University Hospital NHS Foundation Trust London, UK
| | - Susan I Edwards
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College LondonLondon, UK; Psychology and Clinical Language Sciences, University of ReadingReading, UK
| | - David Howard
- Speech and Language Sciences, School of Education, Communication and Language Sciences, University of Newcastle upon Tyne Newcastle upon Tyne, UK
| | - Suzanne Beeke
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London London, UK
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Plejert C, Samuelsson C, Anward J. Enhanced patient involvement in Swedish aphasia intervention. CLINICAL LINGUISTICS & PHONETICS 2016; 30:730-748. [PMID: 27624643 DOI: 10.1080/02699206.2016.1208274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Charlotta Plejert
- a Department of Culture and Communication , Linköping University , Linköping , Sweden
| | - Christina Samuelsson
- b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Jan Anward
- a Department of Culture and Communication , Linköping University , Linköping , Sweden
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Eriksson K, Hartelius L, Saldert C. On the diverse outcome of communication partner training of significant others of people with aphasia: an experimental study of six cases. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2016; 51:402-414. [PMID: 26947265 DOI: 10.1111/1460-6984.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Communication partner training (CPT) has been shown to improve the communicative environment of people with aphasia. Interaction-focused training is one type of training that provides an individualized intervention to participants. Although shown to be effective, outcomes have mostly been evaluated in non-experimental case studies. AIMS The aim of the controlled experimental intervention study was to evaluate an individualized approach in a CPT programme directed to significant others of people with aphasia. Specifically the effects on conversation partners' ability to support the person with aphasia in conversation and on the individuals with aphasias' perception of their functional communication were explored. METHODS & PROCEDURES Six dyads consisting of a person with aphasia and a significant other were included in a replicated single-subject design with multiple baselines across individuals. The intervention followed the interaction-focused communication training programme included in Supporting Partners of People with Aphasia in Relationships and Conversation (SPARRC). The main elements of the training consisted of supervised viewing of the couples' own video-recorded natural interaction and the formulation of individual goals for the adaptation of particular communicative strategies. Outcome was measured via blinded ratings of filmed conversational interaction obtained once a week throughout the different phases of baseline, intervention and follow-up. A rating scale to assess overall quality of conversation was used, taking into account both transfer of information and social aspects of conversation. Measures of perceived functional communication in the persons with aphasia were also collected from the individuals with aphasia and their conversation partners. OUTCOMES & RESULTS The results were mixed, with two of the six participants showing small improvements in ability to support their partner with aphasia in conversation. Half the participants with aphasia and half the significant others reported improvements on perceived functional communication in the person with aphasia after intervention, but no changes were statistically significant. CONCLUSIONS & IMPLICATIONS This study adds to the growing body of research concerning CPT by pinpointing the importance of careful consideration regarding set-up of training, suitability of participants and evaluation of outcome.
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Affiliation(s)
- Karin Eriksson
- University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Lena Hartelius
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Charlotta Saldert
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
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Krummheuer AL, Klippi A, Raudaskoski PL, Samuelsson C. Participating with limited communication means: Conversation analytical perspectives on the interactional management of participation structures. CLINICAL LINGUISTICS & PHONETICS 2016; 30:721-729. [PMID: 30919699 DOI: 10.1080/02699206.2016.1225124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Anu Klippi
- b Institute of Behavioural Science, University of Helsinki , Helsinki , Finland
| | | | - Christina Samuelsson
- c Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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Eriksson K, Forsgren E, Hartelius L, Saldert C. Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease. Disabil Rehabil 2015; 38:1187-203. [DOI: 10.3109/09638288.2015.1089952] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harmon TG, Jacks A, Haley KL, Faldowski RA. Listener Perceptions of Simulated Fluent Speech in Nonfluent Aphasia Aphasiology. APHASIOLOGY 2015; 30:922-942. [PMID: 34650319 PMCID: PMC8513757 DOI: 10.1080/02687038.2015.1077925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with aphasia (PWA) are frequently perceived less favorably by listeners than their peers. These perceptions include incorrect assumptions that can prevent successful social interactions. While communication partner training has been shown to improve social outcomes related to the listener (see e.g., Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001), changing the verbal output of PWA may also yield more favorable listener perceptions about the speech, speaker, and their own affective response. We investigated the effects of artificially altered fluency (i.e., simulated fluency) on listeners' subjective impressions. AIMS The purpose of the study was to (1) confirm that listeners perceive PWA less favorably than their neurologically healthy peers and (2) determine the effects of simulated fluency on listener perceptions about PWA. METHOD & PROCEDURES Thirty-eight listeners heard nine narrative monologue language samples from three conditions (i.e., speakers with nonfluent aphasia, simulated fluent samples from the same speakers, and neurologically healthy speakers). Listeners responded to a nine-item questionnaire that probed perceptions about speech output, speaker attributes, and listener feelings. OUTCOMES & RESULTS Listeners perceived PWA less favorably than their neurologically healthy peers. Simulated fluency yielded more positive listener perceptions for all questionnaire items except speech intelligibility, which was unchanged by simulated fluency. CONCLUSIONS Simulated fluency improved listener perceptions of PWA significantly, indicating that speech fluency may be a socially valid treatment target in aphasia. Beyond direct training of communication partners, changing the verbal output of aphasic speech can also yield more positive listener perceptions of PWA.
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Affiliation(s)
- Tyson G Harmon
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam Jacks
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Richard A Faldowski
- Office of Research, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Beeke S, Beckley F, Johnson F, Heilemann C, Edwards S, Maxim J, Best W. Conversation focused aphasia therapy: investigating the adoption of strategies by people with agrammatism. APHASIOLOGY 2015; 29:355-377. [PMID: 25632169 PMCID: PMC4299855 DOI: 10.1080/02687038.2014.881459] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a complex behavioural intervention is in the early stages of development and evaluation. Aims: This article aims to evaluate an intervention that targeted a PWA and their conversation partner (CP), a dyad, as equals in a novel conversation therapy for agrammatic aphasia, using both quantitative and qualitative evidence of change. The intervention aimed to increase the insight of a dyad into facilitator and barrier conversation behaviours, to increase the understanding of the effect of agrammatism on communication, and to support each speaker to choose three strategies to work on in therapy to increase mutual understanding and enhance conversation. Methods & Procedures: Quantitative and qualitative methods are used to analyse multiple pre-therapy and follow up assessments of conversation for two dyads. Outcomes & Results: Results show that one person with severe and chronic agrammatic aphasia was able to select and practise strategies that led to qualitative and quantitative changes in his post-therapy conversations. The other PWA showed a numerical increase in one of his three strategies post therapy, but no significant quantitative change. Although both CPs significantly reduced barrier behaviours in their post-therapy conversations, neither showed a significant increase in the strategies they chose to work on. For one CP, there was qualitative evidence of the use of different turn types. Conclusions: Individually tailored input from a speech and language therapist can assist some people with chronic agrammatism to develop conversational strategies that enhance communication. Outcomes are influenced by the severity and extent of language deficits affecting, for example, single word writing. In terms of behaviour change for CPs, it appears that it may be easier to reduce barrier behaviours rather than to increase the use of facilitatory strategies. The results have implications for collaborative goal setting with clients undergoing conversation therapy.
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Affiliation(s)
- Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
- Corresponding author.
| | - Firle Beckley
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Fiona Johnson
- Division of Psychology and Language Sciences, University College London, London, UK
- Guys & St Thomas’ NHS Foundation Trust, London, UK
| | - Claudia Heilemann
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Susan Edwards
- Division of Psychology and Language Sciences, University College London, London, UK
- Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jane Maxim
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Wendy Best
- Division of Psychology and Language Sciences, University College London, London, UK
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Davidson B, Howe T, Worrall L, Hickson L, Togher L. Social Participation for Older People with Aphasia: The Impact of Communication Disability on Friendships. Top Stroke Rehabil 2015; 15:325-40. [DOI: 10.1310/tsr1504-325] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Simmons-Mackie N, Savage MC, Worrall L. Conversation therapy for aphasia: a qualitative review of the literature. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:511-526. [PMID: 24861277 DOI: 10.1111/1460-6984.12097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND A diverse literature addresses elements of conversation therapy in aphasia including intervention rooted in conversation analysis, partner training, group therapy and behavioural intervention. Currently there is no resource for clinicians or researchers that defines and organizes this information into a coherent synopsis describing various conversation therapy practices. AIMS To organize information from varied sources into a descriptive overview of conversation therapy for aphasia. METHODS & PROCEDURES Academic search engines were employed to identify research articles published between 1950 and September 2013 reporting on conversation therapy for aphasia. Thirty articles met criteria for review and were identified as primary sources for the qualitative review. Using qualitative methodology, relevant data were extracted from articles and categories were identified to create a descriptive taxonomy of conversation therapy for aphasia. MAIN CONTRIBUTION Conversation interventions were divided into descriptive categories including: treatment participants (person with aphasia, partner, dyad), primary guiding orientation (conversation analysis, social model, behavioural, relationship centred), service delivery (individual, group), focus of intervention (generic/individualized; problem/solution oriented; compensatory), training methods (explicit/implicit; external/embedded), activities or tasks, and outcomes measured. Finally, articles were categorized by research design. There was marked variation in conversation therapy approaches and outcome measures reported and a notable gap in information about one-on-one conversation therapy for individuals with aphasia. CONCLUSIONS & IMPLICATIONS This review provides a description of various conversation therapy approaches and identified gaps in the existing literature. Valid measures of natural conversation, research on one-on-one conversation approaches for individuals with aphasia, and a systematic body of evidence consisting of high quality research are needed.
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Affiliation(s)
- Nina Simmons-Mackie
- Communication Sciences & Disorders, Department of Health & Human Sciences, Southeastern Louisiana University, Hammond, LA, USA
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Facilitate communication to facilitate social participation: Example of a dyade with one member has aphasia. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Beeke S, Beckley F, Best W, Johnson F, Edwards S, Maxim J. Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia. CLINICAL LINGUISTICS & PHONETICS 2013; 27:784-804. [PMID: 23848370 PMCID: PMC3934521 DOI: 10.3109/02699206.2013.808267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 06/05/2013] [Indexed: 05/27/2023]
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.
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Affiliation(s)
- Suzanne Beeke
- Division of Psychology and Language Sciences, University College LondonUK
| | - Firle Beckley
- Division of Psychology and Language Sciences, University College LondonUK
- St Georges NHS TrustLondonUK
| | - Wendy Best
- Division of Psychology and Language Sciences, University College LondonUK
| | - Fiona Johnson
- Division of Psychology and Language Sciences, University College LondonUK
- Guys & St Thomas’ NHS Foundation TrustLondonUK
| | - Susan Edwards
- Division of Psychology and Language Sciences, University College LondonUK
- Psychology and Clinical Language Sciences, Reading UniversityUK
| | - Jane Maxim
- Division of Psychology and Language Sciences, University College LondonUK
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Valla E, Croteau C, Léopold P, Rochon M, Le Dorze G, Lefebvre H. Faciliter la communication pour faciliter la participation sociale : exemple d’une dyade dont un membre présente de l’aphasie. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Higginbotham DJ, Engelke CR. A primer for doing talk-in-interaction research in Augmentative and Alternative Communication. Augment Altern Commun 2013; 29:3-19. [PMID: 23521349 DOI: 10.3109/07434618.2013.767556] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study of talk-in-interaction is focused on how people conduct social interactions in real world situations, in real-time. The purpose of this article is to provide a primer for understanding talk-in-interaction research, conversation analysis and microanalysis in the AAC field. An overview of talk-in-interaction research and a discussion of important issues in the field will be presented, followed by a tutorial on conducting microanalytic investigations in AAC.
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Beckley F, Best W, Johnson F, Edwards S, Maxim J, Beeke S. Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2013; 48:220-239. [PMID: 23472961 DOI: 10.1111/j.1460-6984.2012.00204.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND & AIMS A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours. METHODS & PROCEDURES A 55-year-old man with chronic agrammatism and his wife took part in eight weekly sessions of conversation therapy, adapted from Supporting Partners of People With Aphasia in Relationships and Conversation (SPPARC). Language and conversation were assessed before and after therapy, and the couple's views on conversation and disability were elicited. Conversation analysis was used to analyse: (1) pre-therapy conversation patterns, (2) how the PWA engaged and learned during therapy and the forms of facilitation that aided this process, and (3) qualitative change in post-therapy conversation behaviour. OUTCOMES & RESULTS After therapy, the PWA showed increased insight and acceptance of the use of strategies such as writing and drawing in the face of conversational difficulty. However, use was prompted by his wife and was rarely spontaneous. CONCLUSIONS & IMPLICATIONS This single case study suggests that conversation training based around an experiential learning process is able to engage a PWA directly in learning about the effects of aphasia on conversation. Key facilitators were self-study via video and experience of practising conversation whilst receiving online feedback from a speech and language therapist. However, increased insight did not automatically change conversation behaviour. Although he better understood the effects of his aphasia on conversations with his wife, learning stopped short of the ultimate goal of the conversation training programme; the spontaneous use of strategies worked on in therapy when faced with conversation breakdown. One explanation may be that limited cognitive flexibility lead to problems with switching from one strategy to another.
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Forsgren E, Antonsson M, Saldert C. Training conversation partners of persons with communication disorders related to Parkinson's disease—a protocol and a pilot study. LOGOP PHONIATR VOCO 2012; 38:82-90. [DOI: 10.3109/14015439.2012.731081] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Howe T, Davidson B, Worrall L, Hersh D, Ferguson A, Sherratt S, Gilbert J. 'You needed to rehab … families as well': family members' own goals for aphasia rehabilitation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:511-21. [PMID: 22938062 DOI: 10.1111/j.1460-6984.2012.00159.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Aphasia affects family members in addition to the individuals with the communication disorder. In order to develop appropriate services for the relatives of people with aphasia post-stroke, their rehabilitation goals need to be identified. AIM The aim of the current investigation was to identify the rehabilitation goals that family members of individuals with aphasia have for themselves. METHODS & PROCEDURES Forty-eight family members of adults with aphasia post-stroke participated in in-depth semi-structured interviews to identify the rehabilitation goals they had for themselves. All the interviews were transcribed verbatim and analysed using qualitative content analysis. OUTCOMES & RESULTS Analysis revealed seven categories of goals that the family members had for themselves: to be included in rehabilitation, to be provided with hope and positivity, to be able to communicate and maintain their relationship with the person with aphasia, to be given information, to be given support, to look after their own well-being, and to be able to cope with new responsibilities. A few participants reported that, at certain times during the rehabilitation process, they did not have any goals for themselves. CONCLUSIONS & IMPLICATIONS This study highlights that family members of individuals with aphasia have a number of aphasia-related rehabilitation goals for themselves. In order to provide a family-centred approach to rehabilitation, health professionals, including speech-language pathologists, need systematically to identify and address family members' goals in light of the categories revealed in this investigation.
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Affiliation(s)
- Tami Howe
- University of Canterbury, Christchurch, New Zealand.
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Johansson MB, Carlsson M, Sonnander K. Communication difficulties and the use of communication strategies: from the perspective of individuals with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:144-155. [PMID: 22369055 DOI: 10.1111/j.1460-6984.2011.00089.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. AIMS To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. METHODS & PROCEDURES Semi-structured interviews were conducted with four women and seven men with chronic aphasia (n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. OUTCOMES & RESULTS Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. CONCLUSIONS & IMPLICATIONS The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed.
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Affiliation(s)
- Monica Blom Johansson
- Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
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Armstrong E, Mortensen L. Everyday Talk: Its Role in Assessment and Treatment for Individuals With Aphasia. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.7.3.175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article discusses the significance of conversation in current clinical practice with individuals with aphasia and their conversation partners. It explores the nature of everyday talk, and provides an overview of how studies to date have examined the conversations of individuals with aphasia and have provided some promising treatment avenues. It also proposes another framework, Speech Function Analysis, that may assist further in incorporating conversational principles into the therapy context. The framework provides a system network for examining speech functions in dialogue, while considering the effects of both lexical and syntactic limitations, and context. Examples of conversations between three individuals with aphasia and their partners are used to illustrate the analysis. The authors suggest that further knowledge of both aphasic speakers' and their partners' interactions as well as clinician–client interactions may increase our insights into this area, and make authentic and meaningful conversation more accessible in the clinical situation and beyond.
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Pearl G, Sage K, Young A. Involvement in volunteering: an exploration of the personal experience of people with aphasia. Disabil Rehabil 2011; 33:1805-21. [DOI: 10.3109/09638288.2010.549285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Griffiths S, Barnes R, Britten N, Wilkinson R. Investigating interactional competencies in Parkinson's disease: the potential benefits of a conversation analytic approach. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2011; 46:497-509. [PMID: 21899668 DOI: 10.1111/j.1460-6984.2011.00012.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Around 70% of people who develop Parkinson's disease (PD) experience speech and voice changes. Clinicians often find that when asked about their primary communication concerns, PD clients will talk about the difficulties they have 'getting into' conversations. This is an important area for clients and it has implications for quality of life and clinical management. AIMS To review the extant literature on PD and communication impairments in order to reveal key topic areas, the range of methodologies applied, and any gaps in knowledge relating to PD and social interaction and how these might be usefully addressed. METHODS & PROCEDURES A systematic search of a number of key databases and available grey literatures regarding PD and communication impairment was conducted (including motor speech changes, intelligibility, cognitive/language changes) to obtain a sense of key areas and methodologies applied. Research applying conversation analysis in the field of communication disability was also reviewed to illustrate the value of this methodology in uncovering common interactional difficulties, and in revealing the use of strategic collaborative competencies in naturally occurring conversation. In addition, available speech and language therapy assessment and intervention approaches to PD were examined with a view to their effectiveness in promoting individualized intervention planning and advice-giving for everyday interaction. MAIN CONTRIBUTION A great deal has been written about the deficits underpinning communication changes in PD and the impact of communication disability on the self and others as measured in a clinical setting. Less is known about what happens for this client group in everyday conversations outside of the clinic. Current speech and language therapy assessments and interventions focus on the individual and are largely impairment based or focused on compensatory speaker-oriented techniques. A conversation analysis approach would complement basic research on what actually happens in everyday conversation for people with PD and their co-participants. CONCLUSIONS & IMPLICATIONS The potential benefits of a conversation analysis approach to communication disability in PD include enabling a shift in clinical focus from individual impairment onto strategic collaborative competencies. This would have implications for client-centred intervention planning and the development of new and complementary clinical resources addressing participation. The impact would be new and improved support for those living with the condition as well as their families and carers.
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Affiliation(s)
- Sarah Griffiths
- Institute of Health Services Research, Peninsula College of Medicine & Dentistry, University of Plymouth, UK.
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Manders E, Mariën A, Janssen V. Informing and supporting partners and children of persons with aphasia: A comparison of supply and demand. LOGOP PHONIATR VOCO 2011; 36:139-44. [DOI: 10.3109/14015439.2011.562534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilkinson R, Lock S, Bryan K, Sage K. Interaction-focused intervention for acquired language disorders: facilitating mutual adaptation in couples where one partner has aphasia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 13:74-87. [PMID: 21329413 DOI: 10.3109/17549507.2011.551140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper discusses the implementation and evaluation of an interaction-focused intervention single case study for a couple where one partner has aphasia. Drawing on conversation analytic research, naturally occurring conversations of the couple at home pre- and post-intervention were collected and analysed. Analysis of the speaker with aphasia's topic initiating turns in the pre-intervention conversation showed that in each case a feature of the attempt was that the speaker had difficulty in getting the topic initiation accepted and established. Drawing on conversation analytic work on topic initiations in normal conversation, intervention focused on training the couple to co-produce these topic initiating turns of the speaker with aphasia in a collaborative and step-by-step manner. Post-intervention, there was evidence that the couple were now using this new method, albeit in a slightly different way to that worked on in the intervention sessions. Drawing on work into adaptation by speakers with aphasia and their conversation partners, these results are discussed in terms of a process of mutual adaptation by the couple.
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Affiliation(s)
- Ray Wilkinson
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, University of Manchester, Manchester, UK.
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Best W, Grassly J, Greenwood A, Herbert R, Hickin J, Howard D. A controlled study of changes in conversation following aphasia therapy for anomia. Disabil Rehabil 2010; 33:229-42. [PMID: 21128833 PMCID: PMC3956489 DOI: 10.3109/09638288.2010.534230] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [ 1 ] and Best et al. [ 2 ]). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. [ 3 ]) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5 min of conversation (r = 0.50, p < 0.05, one-tailed) and the number of nouns produced per substantive turn (r = 0.55, p < 0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.
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Affiliation(s)
- Wendy Best
- Division of Psychology and Language Sciences, University College London, London, UK.
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Johansson MB, Carlsson M, Sonnander K. Working with families of persons with aphasia: a survey of Swedish speech and language pathologists. Disabil Rehabil 2010; 33:51-62. [DOI: 10.3109/09638288.2010.486465] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Togher L. The dilemma of discharge and some possible solutions. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:320-332. [PMID: 20590515 DOI: 10.3109/17549501003749859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Discharging clients with acquired brain injury can be a challenging process for all parties involved. In this response to Hersh (2010), three issues are raised which are relevant to the discussion of discharge and may offer some solutions to the dilemmas faced during this time. The first issue is that discharge may not always be necessary depending on the service delivery model that is used. The second issue is that recent advances in experience-dependent neuroplasticity research may change the way clinicians determine treatment goals, which has implications for discharge decisions. Finally, an alternative strategy to assist with discharge is the facilitation of social engagement for the person with brain injury and their social networks. While it is acknowledged that discharge can be a positive time for some clients, it can also be a time where people feel abandoned, even bereft and, in some cases, angry. Avoiding this scenario requires forward planning from the outset of treatment and the use of strategies to ensure that the person is well supported at the time of discharge. This paper presents some of these strategies which may be useful for clinicians to consider as they plan discharge in collaboration with their clients.
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Jorgensen M, Togher L. Narrative after traumatic brain injury: A comparison of monologic and jointly-produced discourse. Brain Inj 2009; 23:727-40. [DOI: 10.1080/02699050903133954] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stribling P, Rae J, Dickerson P. Using conversation analysis to explore the recurrence of a topic in the talk of a boy with an autism spectrum disorder. CLINICAL LINGUISTICS & PHONETICS 2009; 23:555-582. [PMID: 19669991 DOI: 10.1080/02699200802491165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Some higher functioning individuals with autism spectrum disorders (ASDs) are reported to produce perseverative talk, especially around 'special interests'. Topic perseveration is a form of pragmatic impairment captured in Prizant and Rydell's (1993) continuum of unconventional verbal behaviour in autism. Although widely reported, there is little systematic empirical research into this phenomenon. This paper considers the utility of Conversation Analysis in developing knowledge in this area, drawing upon data involving a boy with an ASD interacting with a researcher and a mobile robot platform. Although a frequency analysis of the boy's talk on a single topic may suggest that it is perseverative in nature, in a sequential analysis of both talk and non-spoken activities this study aims to show how these may be interactionally-embedded. It is suggested that, in considering the interactional salience of apparently perseverative talk, it can be useful to explore the participation framework in which the topic is revisited.
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Affiliation(s)
- Penny Stribling
- Centre for Research into Cognition, Emotion & Interaction, School of Human & Life Sciences, Roehampton University, Whitelands College, Holybourne Avenue, London SW154JD, UK.
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Beeke S, Wilkinson R, Maxim J. Prosody as a compensatory strategy in the conversations of people with agrammatism. CLINICAL LINGUISTICS & PHONETICS 2009; 23:133-155. [PMID: 19197582 DOI: 10.1080/02699200802602985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Historically, agrammatism, a symptom of Broca's aphasia, has been associated with dysprosody, on account of speakers' slow, halting, and effortful speech. Almost all investigations of this phenomenon use experimental methods (reading, repetition). Thus, little is known about how prosody is used by speakers with agrammatism and understood by their interlocutors in everyday conversations. This paper takes an interactional approach to prosody, using Conversation Analysis to explore everyday conversations between three speakers with agrammatism and their family members/friends, recorded in the home. A distinct prosodic pattern is revealed in their talk, whereby non-final words in an agrammatic utterance are produced with mid-level or minor rising pitch, and final words with a prominent pitch excursion. The analysis shows that conversation partners orient to terminal pitch movement as a signal of turn completion. Conversely, they do not take the floor when pitch signals continuation, despite significant pausing and severe grammatical disruption. Thus, prosody appears to function to regulate turn taking in the same way as it does in typical (non-language disordered) conversation. For these three speakers, intact prosodic skills appear to compensate for impaired grammatical ability, by packaging a series of haltingly produced words into an utterance, the meaning of which is responded to by the conversation partner as the sum of its agrammatic parts.
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Affiliation(s)
- Suzanne Beeke
- Research Department of Language and Communication, Division of Psychology and Language Sciences, University College London, UK.
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