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Background: Recent studies have demonstrated success in training partners to facilitate conversation in people with aphasia (e.g., Booth & Swabey, 1999; Kagan, Black, Duchan, Simmons‐Mackie, & Square, 2001). Among other issues highlighted by these studies are those related to partner selection and suitability, or candidacy, for such an approach, an...
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... profile placed him in the category of a high-candidacy conversation partner, with a total of 12 of the conversational behaviours and attitudes to communication satisfying or surpassing the recommended frequency (see Figure 1); 75% of the defining criteria for a high-candidacy partner were therefore reached. PM failed to meet one of the criteria on the nonverbal section of the profile (i.e., appropriate use of tone and volume). ...
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Background: Aphasia has an impact beyond the person with aphasia; relatives of people with aphasia are affected by communication difficulties and are service users in their own right, requiring information, support, and training. Research studies have consulted relatives of people with aphasia, but the evidence is complex and widely dispersed in th...
Citations
... Most of these studies are based on the idea that communication strategies employed by the non-aphasic conversation partner can create an environment that enables the person with aphasia to communicate optimally. Put differently, changes in the conversation partner's behaviour can reveal communicative competence in the person with aphasia (Kagan et al., 2001;Turner & Whitworth, 2006). Indeed, these studies show changes in the person with aphasia's degree of participation in conversation (Kagan et al., 2001;Wilkinson et al., 2010). ...
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.
... Although not explicitly acknowledging CA, Hopper et al. (2002) drew on co-construction (Goodwin in Hopper et al.), with meaning being negotiated between speaker and listener, and applied this to their outcome measurement as their main concept of analyses. Family Group studies also draw on similar aspects of CA (Booth & Perkins, 1999;Booth & Swabey, 1999;Saldert et al., 2013;Saldert, Johansson, & Wilkinson, 2015) whilst Clark and Shaeffer's (1987) model of repair underpinned others (cited in Turner & Whitworth, 2006). Experiential learning theory, including self-reflection was a key theoretical basis for some studies across recipient groups (e.g., Beckley et al., 2013;Purdy & Hindenlang, 2005;Sorin-Peters, 2004;Sorin-Peters & Patterson, 2014) generally citing Kolb (1984). ...
... Video-and video-derived data were key aspects of most of the studies regardless of recipient group, and were used in a number of ways. Video clips of own conversations (dyads) were typically used for explanation of concepts, to facilitate discussion of key features (positive and negative) of interaction and thus raising awareness of own communication behaviour (e.g., Turner & Whitworth, 2006). Such video clips were most of all used in Family dyads (e.g., Beckley et al., 2013) and in Family group interventions (e.g., Saldert et al., 2015). ...
... Education in groups ranged in length from one shorter session (e.g., one 60 min-lection in Cameron et al., 2015) to a whole day (Kagan et al., 2001), and included learning on topics described earlier (see item 3). Conversation strategies were modelled by an SLT (e.g., Lyon et al., 1997;Rautakoski, 2011b;Sorin-Peters & Patterson, 2014), exemplified from video clips (Hickey et al., 2004;McVicker et al., 2009;Rayner & Marshall, 2003;Turner & Whitworth, 2006), or discussed with SLT or among the other participants (Sorin-Peters & Patterson, 2014). When using a group format for education, the content typically (but not exclusively) were more general in type (e.g., Jensen et al., 2015), compared to studies targeting dyads where information was tailored to that specific dyad (e.g., Sorin-Peters, 2004). ...
Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesised mechanisms of change (Coster, 2013).
Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered.
Methods & Procedures: A critical review and narrative synthesis was carried out through: (i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010, 2016)) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and (ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items.
Outcomes & Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0–63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported; however, the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and actual intervention adherence/fidelity.
Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include
... Ferguson (1998) (Kagan et al., 2001;Lindsay & Wilkinson, 1999;Nykanen et al., 2013;Simmons-Mackie et al., 2010;Wilkinson & Wielaert, 2012;Pound et al., 2000;Lesser & Algar, 1995;Rayner & Marshall, 2003;Howe et al., 2008;Cruice et al., 2018). Most of these studies are based on the idea 14 that communication strategies employed by the non-aphasic conversation partner can create an en-365 vironment that enables the PWA to communicate optimally, i.e. that changes in the conversation partner's behaviour can reveal the PWA's communicative competence (Kagan et al., 2001;Turner & Whitworth, 2006). For example, volunteers who were trained to use communication strategies ...
There is a growing realization that the traditional approach to studying language, i.e. as a decontextualized,linguistic phenomenon, does not allow us to fully understand communication in the real world. Bystudying the way people process words and sentences in isolation, a wealth of variables that play a role innaturalistic communication are missed. In the study of aphasia, a language impairment caused by acquiredbrain damage such as stroke, a thorough understanding of the mechanisms of naturalistic communicationis imperative, as this is the behaviour therapy aims to improve. The field of aphasiology currently lacksa comprehensive, theoretically founded definition of communication. This lack of understanding, we willargue, makes it nearly impossible to accurately describe a person’s level of communicative ability in everydaylife as well as to predict with certainty what kind of intervention will lead to a change at the levelof communication. In this article we propose a model of situated language use borrowed from sociology,psychology, communication sciences and psycholinguistics, which covers both internal (e.g. individual) andexternal (e.g. environmental) factors that influence communication, including the traditional linguisticskills that have been extensively researched in the past. The model defines language use as: (1) interactive,(2) multimodal, and (3) based on context (common ground). An extensive review of existing researchon each component of the model in non-brain damaged adults and people with aphasia is provided. Theconsequences of adopting this approach to diagnosis and therapy for aphasia are discussed. The aim of thisarticle is to encourage a more systematic approach to the study of situated language use in aphasia.
... Although not explicitly acknowledging CA, Hopper et al. (2002) drew on co-construction (Goodwin in Hopper et al.), with meaning being negotiated between speaker and listener, and applied this to their outcome measurement as their main concept of analyses. Family Group studies also draw on similar aspects of CA (Booth & Perkins, 1999;Booth & Swabey, 1999;Saldert et al., 2013;Saldert, Johansson, & Wilkinson, 2015) whilst Clark and Shaeffer's (1987) model of repair underpinned others (cited in Turner & Whitworth, 2006). Experiential learning theory, including self-reflection was a key theoretical basis for some studies across recipient groups (e.g., Beckley et al., 2013;Purdy & Hindenlang, 2005;Sorin-Peters, 2004;Sorin-Peters & Patterson, 2014) generally citing Kolb (1984). ...
... Video-and video-derived data were key aspects of most of the studies regardless of recipient group, and were used in a number of ways. Video clips of own conversations (dyads) were typically used for explanation of concepts, to facilitate discussion of key features (positive and negative) of interaction and thus raising awareness of own communication behaviour (e.g., Turner & Whitworth, 2006). Such video clips were most of all used in Family dyads (e.g., Beckley et al., 2013) and in Family group interventions (e.g., Saldert et al., 2015). ...
... Education in groups ranged in length from one shorter session (e.g., one 60 min-lection in Cameron et al., 2015) to a whole day (Kagan et al., 2001), and included learning on topics described earlier (see item 3). Conversation strategies were modelled by an SLT (e.g., Lyon et al., 1997;Rautakoski, 2011b;Sorin-Peters & Patterson, 2014), exemplified from video clips (Hickey et al., 2004;McVicker et al., 2009;Rayner & Marshall, 2003;Turner & Whitworth, 2006), or discussed with SLT or among the other participants (Sorin-Peters & Patterson, 2014). When using a group format for education, the content typically (but not exclusively) were more general in type (e.g., Jensen et al., 2015), compared to studies targeting dyads where information was tailored to that specific dyad (e.g., Sorin-Peters, 2004). ...
... Candidacy for a treatment, meaning the likelihood that a PWA can withstand the rigors of a particular procedure and derive benefit from that treatment (Segen, 2010), is a judgment collaboratively made by the clinician, client, and family. Despite the lack of unequivocal criteria for candidacy, numerous variables can contribute to the decision of good or poor candidacy for a treatment (Brookshire & McNeil, 2015;Turner & Whitworth, 2006). For example, one might consider neurological factors such as the type and extent of brain injury, patient factors such as stamina and motivation, and treatment protocol factors such as dosage and materials. ...
Background: Reading difficulties often present as a consequence of aphasia. The specific nature of reading deficits varies widely in manifestation, and the cause of these deficits may be the result of a phonological, lexical semantic, or cognitive impairment. Several treatments have been developed to address a range of impairments underlying reading difficulty.
Aims: The purpose of this review is to describe the current research on reading comprehension treatments for persons with aphasia, assess the quality of the research, and summarize treatment outcomes.
Methods & Procedures: A systematic review of the literature was conducted based on a set of a priori questions, inclusion/exclusion criteria, and pre-determined search parameters. Results were summarized according to treatment type, methodologic rigor, and outcomes.
Outcomes & Results: Fifteen studies meeting criteria were identified. A variety of reading comprehension treatments was implemented including: oral reading, strategy-based, cognitive treatment, and hierarchical reading treatments. Quality ratings were highly variable, ranging from 3 to 9 (on a 12-point scale). Overall, 14 of the 18 individuals for whom individual data were provided demonstrated some degree of improvement (oral reading 4/5 participants, strategy based 4/6, and cognitive treatment 6/7). Gains were also evident for hierarchical reading treatment administered to participant groups via computer; however, the degree to which improvement reached statistical significance varied among studies.
Conclusions: Reading comprehension treatments have the potential to improve reading comprehension ability in persons with aphasia; however, outcomes were variable within and among treatment methods. We suggest focusing future research on factors such as participant candidacy and treatment intensity using increased methodological rigor.
... Specifically, while most CP used all strategies (although 3 CP never read aloud, 2 CPs never initiated a repair, and 2 CPs never gestured) many PAs did not use particular strategies (17 PAs never used an assistive technology and 13 PAs never read aloud, however, only 1 PA did not gesture). This variability likely reflects the nature and extent of the aphasia [16], participants' attitudes towards strategies [54], the particularities of the dyad's relationship and trial and error experience with the strategies. We will consider the strategies used by CPs and PAs in turn. ...
... Starting with the CPs, it is important to note that few strategies were used by all CPs. This likely indicates that CPs, on the basis of their familiarity with the PAs, were making selective use of strategies [17,54]. The most common scaffolding strategies used were steering, reformulating, prompting, offering options, gesturing, reading aloud, repairing, and checking agreement. ...
... Scaffolding failure exacerbates the paradox of helping because it makes salient the help being provided and the problems that the disability is causing for the relationship. To this end, our findings support more research on training interventions for CPs [7,[10][11][12][13]54]. We would also advocate the use of redundant scaffolding, such as gesturing while speaking and demonstrating understanding, because these strategies do not result in explicit failures. ...
When interacting with people with aphasia, communication partners use a range of subtle strategies to scaffold, or facilitate, expression and comprehension. The present article analyses the unintended effects of these ostensibly helpful acts. Twenty people with aphasia and their main communication partners (n = 40) living in the UK were video recorded engaging in a joint task. Three analyses reveal that: (1) scaffolding is widespread and mostly effective, (2) the conversations are dominated by communication partners, and (3) people with aphasia both request and resist help. We propose that scaffolding is inherently paradoxical because it has contradictory effects. While helping facilitates performing an action, and is thus enabling, it simultaneously implies an inability to perform the action independently, and thus it can simultaneously mark the recipient as disabled. Data are in British English.
... A systematic review by Simmons-Mackie et al. (2016) concludes that CP training is effective, and is likely to improve participation in conversations for people with chronic aphasia. Although perhaps not emphasizing the use of technology, from the outset conversation-focused aphasia interventions have deployed video feedback for raising CP awareness of maladaptive conversation behaviors, and for outcome measurement (see reviews by Turner and Whitworth, 2006;Simmons-Mackie et al., 2014, 2016. Approaches based on conversation analysis (CA) view video feedback as key to the success of this therapy, and make use of it to enhance the learning of PWA as well as CPs (for a review see Wilkinson, 2014). ...
... While the study is one of the largest in the field, inclusion of more dyads would strengthen the research and would enable further exploration of candidacy issues (Turner and Whitworth, 2006;Eriksson et al., 2016) and of the links between patterns in pre-therapy conversations and outcome. Future studies, with more participants, could also explore in more depth the finding that it may be easier to reduce barrier behaviors than increase facilitator behaviors. ...
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.
... However, it has also been reported that a gap exists between the evidence for CPT and its provision in clinical practice (Johansson et al. 2011. The acknowledgement of conversation as a collaborative act has been described as a requirement for CPT candidacy (Turner and Whitworth 2006). However, the theme of 'the nature of communication is difficult to grasp' in this study showed that the collaborative nature of conversation was a vague, if not new, concept for these partners. ...
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.
... In some cases both participants of a dyad are involved in the elaboration of conversational strategies (Beckley et al. 2013, Beeke et al. 2015, 2011. In other studies the intervention targets the behaviour of the CP of the person with aphasia (PWA), most commonly a significant other (Booth and Perkins 1999, Lesser and Algar 1995, Saldert et al. 2013, Simmons-Mackie et al. 2005, Turner and Whitworth 2006b. ...
... Role play, reading and discussion of written material, supervised watching and discussion of own and others' video-recorded interaction, and home assignments to try out strategies and reflect on communicative behaviour in between sessions are methods applied. The programme, or adapted versions thereof, has been used in several studies, most of them case studies (Beeke et al. 2007, 2011 or reports of case studies drawn from larger studies (Beckley et al. 2013, Beeke et al. 2014, Turner and Whitworth 2006b. In one study the results from all three participating CPs were reported (Saldert et al. 2013). ...
... Qualitative analyses of natural conversation samples have been the dominant approach, performed in order to uncover changes in behaviour (Beckley et al. 2013, Beeke et al. 2007, Wilkinson et al. 2011. This is sometimes supplemented by a quantification of certain types of behaviour (Beeke et al. 2014, 2015, Turner and Whitworth 2006b. Rating scales to assess overall quality of conversation have been used in one study (Saldert et al. 2013). ...
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.
... Therapies focused on everyday conversations between people with aphasia and significant others (e.g. family, carers) in their environment generally aim to modify the conversational behaviour of the partner, emphasising the collaborative nature of conversations and the partner's potential to provide a more facilitative conversational environment (see Turner and Whitworth (2006a) and Simmons-Mackie et al. (2010) for reviews). ...
Drawing from a range of disciplines that stretch from neuroscience to sociology, our understanding of aphasia, both as a neuropsychological and linguistic entity and from the perspective of the person with aphasia, has seen major advances over the past few decades. This has led to a burgeoning of different approaches to assessment and intervention. This chapter provides an overview of aphasia assessment and therapy. It sets out the different assessment and therapeutic approaches that reflect current practice in the management of aphasia. In doing so, no attempt is made to provide an exhaustive list of the approaches and techniques currently, or previously, reported in the field. Rather, the objective is to provide an insight into why approaches have developed and how they aim to achieve change in aphasia, to consider briefly the evidence base of these approaches and to highlight the often complementary nature of seemingly different perspectives on aphasia. It is also not the aim of this chapter to closely examine the effectiveness of these approaches. The reader is directed to review papers (e.g. Robey 1998; Bhogal et al. 2003; Moss and Nicholas 2006; Cherney et al. 2008) and the Cochrane library (Greener et al. 1999; Kelly et al. 2010; Brady et al. 2012) to obtain more detailed coverage and closer scrutiny of therapy impact within certain research paradigms, e.g. randomized controlled trials (RCTs).The broadening of approaches to aphasia management in recent years can be attributed to a number of influences, including the widespread international adoption of a more comprehensive definition of physical and mental health, a heightened interest in issues related to therapy effectiveness and measurement of real-life outcomes, and the influences of the healthcare context and user engagement in driving the health agenda in many countries. This chapter will provide an overview of the main approaches to aphasia management using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) (World Health Organization 2001) as a framework to consider the multifaceted and integrated nature of these approaches.
