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Applying conversation analysis to aphasia: Clinical implications and analytic issues
Abstract
ABSTRACTS
This paper explores the impact of linguistic impairments on conversational ability in aphasia using conversation analysis (CA). Using a combination of quantitative and qualitative techniques, an analysis of the distribution of turns at talk in three aphasic participants' conversations with a relative and with the researcher is described. Using extracts from the conversations for illustration, three major factors are proposed which influence the sharing of conversational turns: (1) shared knowledge of interlocutors, (2) the manifestations of linguistic impairments in conversation, and (3) individual discourse styles. Finally, the implications of the findings for remediation are considered.
Cette étude utilise l'analyse de conversation pour examiner les conséquences des troubles acquis du langage sur la capacité de conversation dans les cas d'aphasie. L'on se sert ici d'un mélange de techniques qualitatives et quantitatives pour décrire comment dans le cours de conversations trois aphasiques prennent la parole en alternance avec un parent et avec le chercheur. Cette analyse est illustrée à partir d'extraits des conversations, et l'on propose trois facteurs principaux qui influent sur ces alternances: (1) dans quelle mesure les interlocuteurs sont au courant des mêmes choses, (2) les manifestations de troubles linguistiques lors de la conversation, (3) certains styles individuels de conversation. L'on considère enfin les conséquences thérapeutiques des faits mis en évidence.
Dieser Aufsatz untersucht mithilfe der Konversationsanalyse die Auswirkung linguistischer Behinderung auf die Konversationsfähigkeit. Unter Verwendung einer Kombination quantitativer und qualitativer Methoden wird eine Analyse der Verteilung von Einzelbeiträgen (‘Turns’) dreier Aphasiker im Gespräch mit einem Verwandten und mit der Versuchsleiterin präsentiert. Mit Beispielen aus den Gesprächen zur Illustration werden drei Hauptfaktoren vorgeschlagen, die die Proportion der Gesprächsanteile beeinflüssen: (1) das gemeinsame Wissen der Gesprächspartner, (2) die Manifestation linguistischer Behinderung im Gespräch, (3) individuelle Gesprächsstile. Die Implikationen der Ergebnisse für eine remediale Behandlung werden erwogen.
... experiencing problems in conversation (Beeke et al., 2007;Booth & Perkins, 1999;Lindsay & Wilkinson, 1999;Oelschlaeger & Damico, 1998). For example, research has shown that conversation partners may help people with aphasia in completing conversational turns when word finding difficulties occur (Bloch & Beeke, 2008;Oelschlaeger & Damico, 1998), and in repairing turns when the person with aphasia experiences a communication breakdown more generally (Lindsay & Wilkinson, 1999;Perkins, 1995;Samuelsson & Hyde, 2016). This means that for some people with aphasia, due to the presence of communicative difficulties, more of the efforts to achieve successful communication, or the conversational burden, lie with their conversation partner compared to neurologically healthy controls (Linebaugh et al., 2006). ...
... The response to breakdowns in conversation vary depending on the conversation partner, as people with aphasia show different patterns of conversational repair depending on who they are conversing with. This difference has been shown across types of conversation partners, such as speech and language therapists and people with aphasia's spouses (Laakso, 2014b;Lindsay & Wilkinson, 1999;Perkins, 1995). The difference between these two groups of conversation partners has often been explained by the 'institutional' nature of conversation with the speech and language therapist, while conversation with a spouse is more peer-like in nature. ...
... Some research suggests that individual characteristics of the conversation partner, such as their executive function skills, influence their ability to provide communicative support for the person with aphasia (Eriksson et al., 2016). In addition, differences in the amount of shared knowledge and individual discourse styles have also been proposed as possible explanatory factors (Ferguson, 1994;Green, 1982;Howe et al., 2008;Laakso & Godt, 2016;Perkins, 1995;Wirz et al., 1990). Research on the influence of speaker familiarity on communication will be discussed in "Communal and Personal Common Ground". ...
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.
... Stimulating conversation in a PWA consists of a set of therapeutic techniques combined with the goal of exposing the patient to communicative situations in which the rules of natural conversation are applied. [18][19][20] This approach is based on some fundamental principles which, compared with the previous methods, represent an innovation in the rehabilitation field: ...
... 27 Thus, the only way to obtain a true communicative exchange is to make it possible for the PWA to choose the topic of conversation and to let him/her be able to respond with his/her own words, words that are not chosen by the SLP. [18][19][20]27 As we said, when the linguistic disorder is severe, as in the case of global aphasia, it is not possible to adequately identify the functional damage within a cognitive model of language function. A most effective alternative with such patients would be to treat the consequences that the brain damage causes in everyday life. ...
... 1,15 On the contrary, the conversational approach is focused on the patient's residual communication abilities without taking into consideration the formal aspects (i.e., morphology, syntax) of his/her production or its linguistic contents. [18][19][20]27 Thus, compared CONVERSATIONAL THERAPY IN APHASIA/MARANGOLO, PISANO with the traditional approach, conversational therapy leaves the patient free to decide how and what to communicate. Indeed, within this approach, conversation becomes the fundamental and primary means of communicative exchange, a collaborative endeavor in which participants alternate between the role of speaker and listener and each participant recognizes a common goal: to communicate new information. ...
This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.
... However, the focus of CA is on interactional behaviors, rather than linguistic, and is thus concerned with how turn-taking, repair, topic management, and the sequence of turns in context are negotiated between speakers. Although CA provides valuable observations of natural conversation and mutual influence of partners on one another, as a qualitative discipline it does not seek to quantify the frequency of observed conversational behaviors (Perkins, 1995;Schegloff, 1993). In addition, given its focus on interaction, even when CA is applied to conversations including PWAs, variation in linguistic errors is not quantified. ...
... These two studies suggest that MC production varies across structured conversations, in both same and different partner conditions. Perkins (1995) collected data from three PWAs, each in one conversation with a home partner (Home-P) and one with herself, measuring the percentage of major turns taken by the PWAs (i.e., all turns except "mhm," "yes," and "alright"). Descriptive findings noted more major turns by the PWAs in conversation with the researcher than in conversations with the Home-Ps. ...
... To avoid overpenalization on syntactic measures, incomplete utterances were only analyzed if it was clear that the utterance was incomplete because of lexical retrieval difficulty (i.e., as demonstrated by struggle for a word and/or comment by the PWAs, such as "I can't think of the word). Incomplete utterances occurring due to partner interruptions or other behaviors seen in healthy adults, such as deferring to the partner in overlapped utterances or shift of focus mid-utterance (aposiopesis) as in "Do you/Let's go to the movies," were not analyzed (Marini et al., 2011;Perkins, 1995). ...
Purpose
The aim of this study was to determine if people with aphasia demonstrate differences in microlinguistic skills and communicative success in unstructured, nontherapeutic conversations with a home communication partner (Home-P) as compared to a speech-language pathologist communication partner (SLP-P).
Method
Eight persons with aphasia participated in 2 unstructured, nontherapeutic 15-minute conversations, 1 each with an unfamiliar SLP-P and a Home-P. Utterance-level analysis evaluated communicative success. Two narrow measures of lexical relevance and sentence frame were used to evaluate independent clauses. Two broad lexical and morphosyntactic measures were used to evaluate elliptical and dependent clauses and to evaluate independent clauses for errors beyond lexical relevance and sentence frame (such as phonological and morphosyntactic errors). Utterances were further evaluated for presence of behaviors indicating lexical retrieval difficulty (pauses, repetitions, and false starts) and for referential cohesion.
Results
No statistical differences occurred for communicative success or for any of the microlinguistic measures between the SLP-P and Home-P conversation conditions. Four measures (2 of lexical retrieval and 1 each of communicative success and grammaticality) showed high correlations across the 2 conversation samples. Individuals showed variation of no more than 10 percentage points between the 2 conversation conditions for 46 of 56 data points. Variation greater than 10 percentage points tended to occur for the measure of referential cohesion and primarily for 1 participant.
Conclusions
Preliminary findings suggest that these microlinguistic measures and communicative success have potential for reliable comparison across Home-P and SLP-P conversations, with the possible exception of referential cohesion. However, further research is needed with a larger, more diverse sample. These findings suggest future assessment and treatment implications for clinical and research needs.
Supplemental Material
https://doi.org/10.23641/asha.7616312
... Research has shown that conversation 320 partners can be actively involved in constructing PWA's contributions to conversation, i.e. in helping the PWA express themselves. For example, conversation partners have been shown to help the PWA in completing conversational turns when word finding difficulties occur (Bloch & Beeke, 2008;Oelschlaeger & Damico, 1998), and in repairing turns when the PWA experiences a communication breakdown more generally (Lindsay & Wilkinson, 1999;Perkins, 1995;Samuelsson & Hyde, 2016). ...
... Executive function skills 340 can, for example, influence the ability to hold several possible interpretations of the expressed message in mind, or to guide conversation to a particular end goal. The influence of different conversation partners has also been shown for SLTs compared to PWA's spouses (Laakso, 2014b;Lindsay & Wilkinson, 1999;Perkins, 1995). The difference between these two groups of conversation partners has often been explained by the 'institutional' nature of conversation with the SLT, while 345 conversation with a spouse is more 'peer'-like in nature. ...
... The difference between these two groups of conversation partners has often been explained by the 'institutional' nature of conversation with the SLT, while 345 conversation with a spouse is more 'peer'-like in nature. In addition, differences in the amount of shared knowledge and individual discourse styles have also been proposed as possible explanatory factors (Green, 1982;Perkins, 1995;Wirz et al., 1990;Laakso & Godt, 2016;Howe et al., 2008). Ferguson (1994Ferguson ( , 1998 attempted to systematically assess the effect of familiarity as well as the degree of knowledge of aphasia across conversation partners on communication. ...
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.
... Scholars from various disciplines, including rehabilitation medicine, pathology, cognitive neuroscience, sociology and linguistics, have conducted extensive researches on language disorders, focusing primarily on diagnosis and intervention. Researchers in the field have devoted significant attention to atypical populations (Wilkinson, 2019(Wilkinson, , 2020, such as people with aphasia (Olness, 2006;Perkins, 1995;Wilkinson, 2015), Alzheimer's disease (Cummings, 2019;Pistono et al., 2019;Williams et al., 2021), dyslexia (Adlof & Hogan, 2018), autism (Arutiunian et al., 2021(Arutiunian et al., , 2022, traumatic brain injury (Brady et al., 2006;Minga et al., 2021;Sherratt & Bryan, 2012), depression (Ma et al., 2022) and epilepsy (Parkinson, 2002;Reuber et al., 2022). During the 1990s, linguists began to investigate how people with aphasia communicate with others. ...
... During the 1990s, linguists began to investigate how people with aphasia communicate with others. Typically, Perkins (1995) used conversation analysis to examine the interactions between people with aphasia and others, highlighting the impact of shared knowledge, language deficits in aphasia. In this early phase, quite a few research topics emerged, mainly including the narrative abilities (Bohling, 1991), semantic memory (Grosse et al., 1991) and interaction features (Heller & Tanaka-Matsumi, 1999) of the patients with Alzheimer's disease or depression. ...
... The current data may reinforce the conclusions that the participation between family members and SLTs is different (see e.g. Perkins, 1995;Lindsay and Wilkinson, 1999). The present observations are analogous also with Laakso (2015) in thatjust like in everyday conversations in generalthe essential aspiration in the family conversation is to promote the topical flow of the conversation by managing the trouble as efficiently as possible. ...
... In fluent speaker data the family members use more direct methods than the SLT to deal with the trouble, much like the prompt word candidates described by Oelschlaeger and Damico (2000). Also noteworthy is that direct other-correction is not dispreferred, contrary to the prior findings of Perkins (1995) and Wilkinson (1995) on English aphasic conversation. ...
The present study compares the ways in which conversational partners manage expressive linguistic problems produced by participants with fluent vs. non-fluent aphasia. Both everyday conversations with family members and institutional conversations with speech-language therapists were examined. The data consisted of 110 conversational sequences in which the conversational partners addressed expressive aphasic problems. Most problems of the speaker with fluent aphasia were locally restricted phonological and word-finding errors, which were immediately repaired. In contrast, the sparse expression of the speaker with non-fluent aphasia was co-constructed by conversational partners in long negotiation sequences to establish shared understanding. Some differences between recipient participation in everyday and institutional conversation were found. The results emphasise the relevance of the nature of the expressive linguistic problems on participation in interaction. They also add to the clinical knowledge of handling aphasic problems in conversation. This knowledge can be used for developing interaction-focused intervention.
... Those therapies targeting conversation partners often revolve around the structural organisation of conversations and facilitate turn taking, management of topics, and repair strategies for when lexical retrieval and other difficulties arise (e.g. Lesser and Algar 1995;Perkins 1995;Wilkinson and Wierlaert 2012). They are intended to assist the conversational partner, and sometimes also the person with aphasia, in structuring and maintaining effective conversation. ...
... Instead, therapy is motivated by supporting people with aphasia to communicate effectively through enabling the person's competence to emerge rather than achieving linguistic accuracy (Perkins 1995;Kagan et al. 2001). The approach is predicated on the belief that conversation partners can be trained to enable the conversational and interactional skills of the person with aphasia. ...
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.
... Att närstående ändå ofta bättre kunde hjälpa till med information till samtalet ansågs vara mycket tack vare den förkunskap som de delar med personen med afasi. Perkins (1995) har dock noterat att individuell samtalsteknik och typen av problemkälla eventuellt bättre kan förklara skillnader i förhandlandet än graden av förförståelse. ...
... Personlighet och individuell talstil hos samtalsdeltagarna är faktorer som också kan påverka förekomsten av de studerade resurserna. Betydelsen av individuell samtalsteknik lyfts även fram i Perkins (1995). Då föreliggande studie inte främst syftar till att studera fenomen på individnivå har de faktorerna dock inte analyserats vidare. ...
... Conversation analysis is a powerful and empirically rigorous qualitative methodology that involves inductively uncovering patterns within conversations that highlight the processes and problems encountered by participants in their construction of conversations (Damico, Oelschlaeger & Simmons-Mackie, 1999;Perkins, 1995). This is done through the detailed transcription and analysis of the Recent work in aphasiology has highlighted the value of conversation analysis in understanding the psychosocial dimensions of aphasia. ...
... In this way, aphasiologists have shown some adaptations from the fundamental principles of conversation analysis (Hesketh & Sage, 1999), yet these deviations have been insightful and significant and can be applied to training interlocutors and implicitly or explicitly improving the communicative behaviour of therapists (Perkins, 1995;Wilkinson, 1999). For example, Booth and Perkins (1999) have 9 Ethnomethodology is the study of the codes and conventions that underlie social activities and interactions (The American Heritage Dictionary of the English Language, 2009, 4 th edition). ...
... Therefore, silence's function as a communicative device is not impacted by aphasia. This aligns with Perkins' (1995) finding that the understanding of conversational norms is not impaired by aphasia. PWA retain awareness of the sequential structure of turn-taking and can use silence to form a turn according to conversational norms. ...
Background: This article uncovers why people with severe expressive aphasia’s turns-at-talk are sometimes not treated as producing an action by their communication partners, and the impact this has on the person with aphasia’s (PWA’s) agency. We demonstrate resources PWAs use to pursue talk and which assist with the production of a recognizable action. Method: We examined turns produced by four PWAs and their communication partners (CPs), where present, using conversation analysis, identifying features that do not receive a response and features promoting action ascription. Analysis: The PWAs’ semantically empty or unclear turns, turns lacking sequential context, or the CPs’ focus on their own actions led to a lack of action ascription. However, CPs do attend to PWAs’ multimodal features of interaction, and PWAs’ repetition accompanied by an upgraded gesture was shown to pursue a response. Action ascription was aided by the PWAs’ preserved use of silence as a communicative device. Discussion: When PWAs’ actions are not appropriately ascribed, their agency may be diminished. Communication partners should attend to all features of the PWA’s turns, including gesture and silence, to progress the PWA’s action, rather than their own misappropriated action. This may mean accepting a delay in progressivity while the PWA pursues an appropriate response. Through this, the PWA’s agency in interaction can be maintained, and intersubjectivity achieved.
... Dentro del estudio de las afasias, el análisis de los marcadores discursivos ya cuenta con cierta tradición, desde los estudios pioneros de Lesser y Milroy (1993), Perkins (1995) y Lesser y Perkins (1999) hasta las investigaciones más recientes en el ámbito hispánico (Pietrosemoli et al., 2005;Gallardo y Marín, 2006;González, 2006;Mendoza y Guillén, 2016;Guillén, 2017). En general, la mayoría de los estudios ha concluido que los marcadores discursivos se conservan a pesar del déficit lingüístico ya que "cumplen una gran cantidad de funciones y permiten al hablante con problemas, una máxima participación en la interacción conversacional con un mínimo esfuerzo tanto articulatorio como mnemónico" (Pietrosemoli et al., 2005, p. 82). ...
Este trabajo tiene dos objetivos, (i) caracterizar las funciones de los apéndices comprobativos en dos hablantes con afasia fluente y (ii) contrastar estos resultados con los de dos hablantes sin patología con características sociales semejantes. Se busca, por un lado, determinar si los hablantes con afasia fluente emplean con mayor, igual o menor medida estos apéndices y, por el otro, describir si hay semejanzas en las funciones y en el tipo de comprobativos que se emplean en ambos grupos. Así pues, se conformaron dos muestras, la primera compuesta por dos hablantes diagnosticados con afasia fluente y, a partir de sus características demográficas, se seleccionaron dos entrevistas del volumen 3 del Corpus Sociolingüístico de la Ciudad de México (Martín Butragueño y Lastra, 2015). Los resultados indican que: (i) los comprobativos se conservan a pesar de la patología, (ii) los hablantes con afasia los emplean con mayor frecuencia para realizar funciones de: continuativo, gestión de la interacción fática, focalizador, intensificador y como parte de una estrategia de cortesía positiva, y (iii) los comprobativos más comunes en la variante del español de la Ciudad de México –¿no?, ¿verdad? y ¿eh?– son empleados en ambos grupos. Finalmente, se reitera la importancia de incluir en las investigaciones clínicas a un grupo de control, que comparta las características sociales de los pacientes, para poder comparar los usos reales de la competencia comunicativa de estos últimos.
... Родоначальники этого подхода и их коллеги сформулировали базовые принципы детального эмпирического анализа социальных взаимодействий (Sacks et al. 1974), которые затем были применены и к атипичной коммуникации. Сегодня существует значительное число исследований атипичного взаимодействия, выполненных в традиции конверсационнного анализа (напр., Yearley, Brewer 1989;Perkins 1995;Oelschlaeger, Damico 1998;Wootton 1999;Heeschen, Schegloff 1999;Goodwin 2000Goodwin , 2003Skelt 2010;Auer, Bauer 2011;Egbert, Deppermann 2012;Wilkinson 2013Wilkinson , 2014Wilkinson et al., 2011). Поэтому можно утверждать, что это сложившееся научное направление. ...
... He also points out the need to bring in the simultaneous actions and roles of the hearer to fully understand the interaction going on and particularly in reported speech. Apart from Goodwin's most prominent studies in brain damage and communication (2003,2004,2008), there are some relevant studies on aphasic discourse analysis (Anward 2003;Laakso 2003;Merlino 2018;Oelschlaeger 1999;Perkins, 1995) and aphasic conversation analysis (Wilkinson 2015). It is outside the scope of this paper to reflect on such work due to space restrictions, but the main conclusions of such studies have been inspiring for articulating our analysis, namely the notions of collaborative participation and repair, which will be explained in the analysis section. ...
More than 170 million people in the world have some kind of speech impairment. The lack of professional interpreters in this domain causes their families to need to learn new communicative strategies to interact with them and assist them as interpreters. The aim of this paper is to analyze the role of these non‐professional interpreters for adults with a speech impairment caused by an acquired brain injury. Data come from 13 qualitative interviews and participant observations of 7 persons with acquired brain injury and their families during 18 months. The paper shows the communicative and multimodal strategies these ad‐hoc interpreters use to understand the person with impaired speech and the strategies such persons use to make themselves understandable. It also shows how meaning is negotiated and jointly constructed, the power dynamics that emerge from interpreting practices and the impact this has on the speech‐impaired persons’ agency.
... In addition, such samples can be influenced by environmental factors such as familiarity between conversational partners and an individual's conversational "style" (e.g. Perkins, 1995), leading to considerable variability. Consequently, many researchers attempt to avoid these issues by eliciting connected speech using more structured tasks, such as role-play or story-telling, as these methods allow greater control and improve comparability between participants and testing sessions. ...
Purpose: Picture naming assessments are one of the most common methods of examining word retrieval in aphasia. However, currently, it is unclear whether these assessments are able to accurately predict word retrieval in “real-life” communication. This paper aims to explore the evidence in the current literature regarding the relationship between picture naming and word retrieval in connected speech in people with aphasia.
Method: Literature was reviewed that examined the correlation between picture naming and word retrieval in connected speech. The literature search was limited to articles that were English language, participants with aphasia, and that were not therapy studies.
Result: The existing studies showed mixed findings. However, comparison of study outcomes was complicated by inconsistency in the research methods used, including in word retrieval measures and connected speech elicitation.
Conclusion: While there is some evidence of a relationship between picture naming and word retrieval in connected speech, correlation outcomes were mixed with possible influences from participant characteristics, assessment method and speech sample type. We therefore suggest that clinical decision-making would benefit from supplementing picture naming tests with an analysis of word retrieval in connected speech. Further research is required with a focus on natural conversation and the development of standard testing procedures for connected speech.
... For PWA, questionnaires on communication often distinguish between the ability to communicate with familiar and unfamiliar CPs (e.g. the disability questionnaire of the Comprehensive Aphasia Test; Howard et al., 2004; or the Aphasia Impact Questionnaire-21; Swinburn et al., 2018). The assumption is often made that it is easier for PWA to speak to a familiar person than speaking to a stranger (Green, 1982;Wirz et al., 1990;Ferguson, 1994;Perkins, 1995;Howe et al., 2008;Laakso and Godt, 2016). The familiarity advantage has also been reported by PWA as an influential factor when it comes to ease of communicating (Dalemans et al., 2010). ...
Aphasia is language impairment due to acquired brain damage. It affects people’s ability to communicate effectively in everyday life. Little is known about the influence of environmental factors on everyday communication for people with aphasia (PWA). It is generally assumed that for PWA speaking to a familiar person (i.e. with shared experiences and knowledge) is easier than speaking to a stranger (Howard, Swinburn, and Porter). This assumption is in line with existing psycholinguistic theories of common ground (Clark, 1996), but there is little empirical data to support this assumption. The current study investigated whether PWA benefit from conversation partner (CP) familiarity during goal-directed communication, and how this effect compared to a group of neurologically healthy controls (NHC). Sixteen PWA with mild to severe aphasia, sixteen matched NHC, plus self-selected familiar CPs participated. Pairs were videotaped while completing a collaborative communication task. Pairs faced identical Playmobile rooms: the view of the other’s room was blocked. Listeners attempted to replicate the 5-item set-up in the instructor’s room. Roles were swapped for each trial. For the unfamiliar condition, participants were paired with another participant’s CP (PWA were matched with another PWA’s CP based on their aphasia profile). The outcomes were canonical measures of communicative efficiency (i.e. accuracy, time to complete, etc.). Results showed different effects in response to the unfamiliar partner for PWA compared to NHC: In the instructor role, PWA showed faster trial times with the unfamiliar partner, but similar accuracy scores in both conditions. NHC, on the other hand, showed similar trial times across CPs, but higher accuracy scores with the unfamiliar partner. In the listener role, PWA showed a pattern more similar to NHC: equal trial times across conditions, and an improvement in accuracy scores with the unfamiliar partner. Results show that conversation partner familiarity significantly affected communication for PWA dyads on a familiar task, but not for NHC. This research highlights the importance of identifying factors that influence communication for PWA and understanding how this effect varies across aphasia profiles. This knowledge will ultimately inform our assessment and intervention of real-world communication.
... Still, Nathan confirmed (line 09) the clerk's hypothesis (line 08). Furthermore, the other-repairs we observed also appear different from some interactions between PLWA and their usual communication partner in everyday conversation, where the former may sometimes resist participation in the repair process of problematic talk (Barnes & Ferguson, 2015;Perkins, 1995). When the repair process is not activated, disengagement from the interaction can occur such that intersubjectivity will neither be sought nor reached. ...
Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks’ responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.
... This delicacy about (putting it strongly) correcting others will be tested more frequently, as Wilkinson argues, in cases like aphasia, where one of the speakers is especially unclear (Wilkinson, 1995). Indeed, early reports by Perkins (1995Perkins ( , 2003 show when the person with aphasia is a family member, in at least some cases conversationalists will ignore their disfluencies, even at the expense of letting meaning slip, rather than risk seeming to, as Perkins puts it, attribute faulty talk to "personal insufficiency" and make a consequent "threat to face" (2003, p 159). Barnes & Ferguson (2015) take up Perkin's observation and systematically go through the ways in which a conversationalist handles an aphasic partner's turns without resorting to other-initiated repair (asking what?, and so on). ...
How do health and social care professionals deal with undecipherable talk produced by adults with intellectual disabilities (ID)? Some of their practices are familiar from the other-initiated repair canon. But some practices seem designed for, or at least responsive to, the needs of the institutional task at hand, rather than those of difficult-to-understand conversational partners. One such practice is to reduce the likelihood of the person with ID issuing any but the least repair-likely utterances, or indeed having to speak at all. If they do produce a repairable turn, then, as foreshadowed by earlier work on conversations with people with aphasia, their interlocutors may overlook its deficiencies, respond only minimally, simply pass up taking a turn, or deal with it discreetly with an embedded repair. When the interlocutor does call for a repair, they will tend to offer candidate understandings built from comparatively flimsy evidence in the ID speaker’s utterance. Open-class repair initiators are reserved for utterances with the least evidence to go on, and the greatest projection of a response from the interlocutor. We reflect on what this tells us about the dilemma facing those who support people with intellectual disabilities.
... Gernsbacher and Givón (1995) emphasized that coherence is a property emerging during speech production as well as comprehension, allowing a listener/reader to reconstruct discourse as a reader/writer had it in mind, or the mental representation of it. Studies on conversation in aphasia focused on the ability of people with aphasia to co-construct meaning in communication through the analysis of such phenomena as turn-taking, repair strategies, collaborative referencing, and the effects of aphasia severity, conversation partner, topic, and other potential factors on discourse production (e.g., Damico, Oelschlaeger, & Simmons-Mackie, 1999;Ferguson & Harper, 2010;Hengst, 2003;Linebaugh, Kryzer, Oden, & Myers, 2006;Perkins, 1995Perkins, , 2003. Different grammatical patterns were discovered in aphasic informal conversation compared to monologues or picture-induced discourse Wilkinson, Beeke, & Maxim, 2010). ...
Discourse production is crucial for communicative success and is in the core of aphasia assessment and treatment. Coherence differentiates discourse from a series of utterances/sentences; it is internal unity and connectedness, and, as such, perhaps the most inherent property of discourse. It is unclear whether people with aphasia, who experience various language production difficulties, preserve the ability to produce coherent discourse. A more general question of how coherence is established and represented linguistically has been addressed in the literature, yet remains unanswered. This dissertation presents an investigation of discourse production in aphasia and the linguistic mechanisms of establishing coherence.
... These findings cannot be generalised to everyday conversation but they do suggest 10 The concept of major and minor turns is derived from Perkins (1995) with all turns being classed as major except those containing tokens (sic) such as 'yes ' 'right' etc. in 'isolation'. Comrie et al. also include single word responses to questions as 'minor turns'. ...
A common symptom of acquired progressive neurological conditions like Motor Neurone Disease (MND) is deterioration in the neurological control of physical speech production. This is termed ‘dysarthria’. People with progressive dysarthria can thus experience deterioration in speech intelligibility and may, ultimately, be unable to use speech as a primary modality for communication, relying instead on the use of an augmentative and alternative communication (AAC) system to compensate for the progressive speech deterioration. Previous dysarthria research has examined this deterioration as a largely physical phenomenon, focussing upon the dysarthric speaker’s own output. The main aim of this thesis is to consider the interactive features of dysarthria, and to examine how such talk might be sequentially organised through everyday conversation. This thesis presents an analysis of naturally occurring conversation interaction between three adults with dysarthric speech and their family members. Utilising the principles and methods of Conversation Analysis (CA), the study provides an examination of the management of troubles in both dysarthric speech production and AAC system use. The analysis focuses on the nature of both ‘simple’ and ‘complex’ troubles, how they are revealed through the practice of other-initiated repair, and how they are finally resolved. Findings show that both unintelligible speech and AAC system outputs are jointly managed through other-initiated repair and collaborative turn constructions. It is also shown that troubles in talk can occur despite an achievement of intelligibility, and that the understandability of a turn’s action can be treated separately from its intelligibility. Examining the occurrence and resolution of troubles in talk between people with dysarthria and significant others, this thesis offers new insights and implications for clinical assessment, therapy and outcomes for people with acquired progressive dysarthria, family members, professionals and carers.
... While conversation analytic procedures have been successfully applied to the study of aphasia in recent years (e.g Copeland, 1989;Goodwin, 1995;Laasko & Klippi, 1999;Lindsay & Wilkinson;Milroy & Perkins, 1992;Perkins, 1995;Simmons-Mackie & Damico 1996Wilkinson 1995), it is not clear why these have not been employed to the same extent by those engaged in stuttering research. As a starting point, I would urge readers of this journal to familiarize themselves with the foundational work that has been carried out to date on ordinary conversation. ...
... In response, conversation analytic and discourse analytic approaches to assessment have increased, adding to social, interactional and sociolinguistic perspectives on a range of clinical concerns (e.g. Ferguson 1996; Perkins 2007;Perkins 1995;Tarling et al. 2006;Walsh 2007Walsh , 2008Wilkinson et al. 2010). At the same time, descriptions of pragmatic impairments in terms of their neurological, cognitive and behavioural substrates are also increasing. ...
Pragmatic disruption is associated with a range of acquired communication disorders of both neurogenic and psychiatric origin. This chapter provides an overview of the main themes in the research into pragmatic disruption in people with aphasia, right hemisphere language disorder, schizophrenia, traumatic brain injury, Alzheimer’s dementia, non-Alzheimer dementia and Parkinson’s disease. These disorders are associated with particular patterns of pragmatic disruption which, in some cases, have been linked to disturbances in cognitive abilities, most often in theory of mind and executive function. Pragmatic strengths have typically been overshadowed by a focus on the pragmatic deficits in any given population. However, it is argued that these strengths form a crucial component of the pragmatic presentation of any client or clinical group more generally. Pragmatic disorders have a pervasive impact on the individual with the disorder as well as on those around them. Assessment and intervention in pragmatic disorders of adulthood must account for the profile of deficits and strengths, while considering the broader impact of the disorder on the individual and their social network.
... We know that alternative methods exist for managing verbal interactions when one of the interlocutors experiences pragmatic failure. Numerous authors have studies these types of interactions based specifically on conversational analysis and in the presence of varying pathologies (e.g., Goodwin, 2003aGoodwin, , 2003bGoodwin, , 2004Perkins, 1995). Notably, the degree of complexity of the interactions when one of the two interlocutor experiences failure was described by Goodwin (2003a, p. 8), who wrote "[ . . . ...
This article describes a study in which conversation analysis was used to examine verbal interactions between caregivers and severely disabled adolescents or young children. It focused on the phenomenon of repetition, which seems to be the basis of the mutual-understanding process. We compared dialogue structures containing repetitions in the two corpora. To analyze the pragmatic functions of repetitions, we used the categorization scheme developed by Perrin, Deshaies and Paradis (2003). The results showed that the structure of the transactions was directly linked to the repetition's function, which was the organizing principle of the transactions in the vast majority of cases. However, in the disabled adolescent's corpus, the function of multiple repetitions within the same transaction could not be interpreted using the traditional categorization scheme. We interpreted this new function as a more basic function that facilitates the emergence of mutual understanding during conversations between caregivers and severely disabled young people.
... Studies on conversation in aphasia focused on the ability of PWA to co-construct meaning in communication through the analysis of phenomena such as turn-taking, repair strategies, collaborative referencing, and the effects of aphasia severity, conversation partner, topic, and other potential factors on discourse production. (e.g., Beeke, Maxim, & Wilkinson, 2007;Damico, Oelschlaeger, & Simmons-Mackie, 1999;Ferguson & Harper, 2010;Hengst, 2003;Linebaugh, Kryzer, Oden, & Myers, 2006;Perkins, 1995;Perkins & Goodwin, 2003). Different grammatical patterns were discovered in aphasic informal conversation compared to monologues or picture-induced discourse Wilkinson, Beeke, & Maxim, 2010). ...
Background: Discourse abilities play an important role in the assessment, classification, and therapy outcome evaluation of people with aphasia. Discourse production in aphasia has been studied quite extensively in the last 15 years. Nevertheless, many questions still do not have definitive answers.
Aims: The aim of this review is to present the current situation in the research on a number of crucial aspects of discourse production in aphasia, focusing on methodological progress and related challenges. This review continues the discussion of the core themes in the field, aiming to render it as up-to-date as possible.
Main Contribution: The review focuses on a number of unexplored theoretical issues, specifically, the interface between micro- and macrolinguistic abilities, and the relationship between linguistic competence and communicative success in aphasia. The emphasis on theoretical challenges, along with the thorough discussion of methodological problems in the field, makes this review a starting point and a comprehensive information source for researchers planning to address language production in people with aphasia.
Conclusion: Although the picture is not yet complete, recent advancements lead to a better understanding of the processes involved in aphasic discourse production. Different approaches provide insights into the complex multifaceted nature of discourse-level phenomena; however, methodological issues, including low comparability, substantially slow down the progress in the field.
... It is possible that P2 had greater difficulties in lexical retrieval than her conversation sample showed, as it is difficult to identify target words unless the participant provides sufficient information for the researcher to identify the target word. In confrontational naming tasks, the target word is known, and therefore it is easier to identify errors (Perkins, 1995). P2's performance in picture naming and conversation indicates that she had lexical retrieval difficulties. ...
Within the domain of inflectional morpho-syntax, differential processing of regular and irregular forms has been found in healthy speakers and in aphasia. One view assumes that irregular forms are retrieved as full entities, while regular forms are compiled on-line. An alternative view holds that a single mechanism oversees regular and irregular forms. Arabic offers an opportunity to study this phenomenon, as Arabic nouns contain a consonantal root, delivering lexical meaning, and a vocalic pattern, delivering syntactic information, such as gender and number. The aim of this study is to investigate morpho-syntactic processing of regular (sound) and irregular (broken) Arabic plurals in patients with morpho-syntactic impairment. Three participants with acquired agrammatic aphasia produced plural forms in a picture-naming task. We measured overall response accuracy, then analysed lexical errors and morpho-syntactic errors, separately. Error analysis revealed different patterns of morpho-syntactic errors depending on the type of pluralization (sound vs broken). Omissions formed the vast majority of errors in sound plurals, while substitution was the only error mechanism that occurred in broken plurals. The dissociation was statistically significant for retrieval of morpho-syntactic information (vocalic pattern) but not for lexical meaning (consonantal root), suggesting that the participants' selective impairment was an effect of the morpho-syntax of plurals. These results suggest that irregular plurals forms are stored, while regular forms are derived. The current findings support the findings from other languages and provide a new analysis technique for data from languages with non-concatenative morpho-syntax.
... Regardless of the cause, speech disfluency can be problematic for the listener, requiring greater effort to process and resulting in poorer recall of messages (Panico & Healey, 2009) and making speakers vulnerable to losing their conversational turn (Perkins, 1995). Self-corrections may be justified if they improve the eventual communicative message. ...
Purpose
To study the effects of masked auditory feedback (MAF) on speech fluency in adults with aphasia and/or apraxia of speech (APH/AOS). We hypothesized that adults with AOS would increase speech fluency when speaking with noise. Altered auditory feedback (AAF; i.e., delayed/frequency-shifted feedback) was included as a control condition not expected to improve speech fluency.
Method
Ten participants with APH/AOS and 10 neurologically healthy (NH) participants were studied under both feedback conditions. To allow examination of individual responses, we used an ABACA design. Effects were examined on syllable rate, disfluency duration, and vocal intensity.
Results
Seven of 10 APH/AOS participants increased fluency with masking by increasing rate, decreasing disfluency duration, or both. In contrast, none of the NH participants increased speaking rate with MAF. In the AAF condition, only 1 APH/AOS participant increased fluency. Four APH/AOS participants and 8 NH participants slowed their rate with AAF.
Conclusions
Speaking with MAF appears to increase fluency in a subset of individuals with APH/AOS, indicating that overreliance on auditory feedback monitoring may contribute to their disorder presentation. The distinction between responders and nonresponders was not linked to AOS diagnosis, so additional work is needed to develop hypotheses for candidacy and underlying control mechanisms.
Supplemental Material
https://doi.org/10.23641/asha.14963628
... Rather, all face-to-face interaction is a process of participants actively constructing and negotiating meaning in a coordinated and joint manner as the social action proceeds. In practice, we can focus on the aphasic or the non-aphasic interactant, the dyad or the group, but eventually any analysis or its interpretation should orient to the collaborative impact needed to construct an interaction (Goodwin & Heritage, 1990;Oelschlaeger & Damico, 1998;Perkins, 1995). ...
The article concerns conversation analysis (CA) as a method derived from sociology, and also used and developed in psychology, linguistics, and speech and language therapy. The article aims at presenting the potential of the method in describing various types of verbal interactions. The text presents the use of CA to explore the dialogic abilities of bilingual children. The authors study code switching (CS) patterns occurring in bilingual children’s speech, the features of these patterns, and conversational strategies that appear in interviews with children. It was found that CS is closely linked to lexical deficits in Polish. The features of conversational negotiation were noticed when using English. Moreover, due to deficiencies in the Polish linguistic repertoire, the speakers used repairs, and the statements of the interlocutors would often overlap.
At its most general level, the clinical management of clients with pragmatic disorders involves two main types of activity. In order to establish which pragmatic skills are impaired, clinicians must first engage in a process of assessment. Assessment is usually conducted over several sessions and can involve an extensive range of techniques. The results of assessment provide a basis for the planning of intervention as well as a baseline measurement of the client's pragmatic skills. We will see subsequently that this baseline measurement is vital in establishing a client's progress in therapy and in determining the efficacy of a particular programme of intervention. An equally eclectic group of techniques is used in the intervention or treatment of pragmatic disorders. These techniques often reflect the particular experience of a clinician and the availability of resources. Certainly, few of these techniques have been the subject of efficacy studies. There is a very important sense, therefore, in which most interventions of pragmatics lack the type of clinical validation that we have come to expect of interventions in areas such as phonology and syntax. In this section, we examine the full range of methods that are available to the clinician who is charged with the assessment and treatment of pragmatic disorders in children and adults. In doing so, we will make a distinction between formal and informal assessment methods. We will consider the types of clients that may be assessed and treated using these methods. We will also discuss the question of efficacy studies in the area of disordered pragmatics. Before engaging with these issues, however,
There are a growing number of investigations of aphasia using ethno-methodological conversation analysis (CA). This introduction outlines the importance of investigating aphasic conversation and the potential attraction of CA as a method of analysis. CA is defined and its main areas of analytic investigation outlined. The distinctive methodology of the approach is summarized and discussed in terms of four principles: analysis is participant-driven; assumption that conversation is orderly; importance of sequential context; and wariness of quantification.
Conversation analysis was applied to answer the question of when and how a conversation partner participates in the word searches of a person with aphasia. Thirty-eight videotaped conversational sequences from eight naturally occurring conversations of a single couple were analyzed. Sequences were characterized by the spouse’s participation in the self-initiated word searches of her partner, who had aphasia. Sequences were analyzed on a turn-by-turn basis to reveal their sequential organization. Results showed that participation was determined by interactional techniques and interactional resources. Interactional techniques included direct and indirect invitations to participate. Direct invitation was constructed via direct gaze or a wh- question. Indirect invitation was constructed with verbal and nonverbal signals, including specific metalanguage and downward gaze. Interactional resources were information states derived from both life experience and online analysis. Research and clinical implications are discussed.
Dementia: From Diagnosis to Management - A Functional Approach is a comprehensive description of a functional and behavioral approach to assessing and treating persons with dementia. While very practical, the information is embedded in a scientific context of the causes, neuropsychological manifestations, and complications of dementia. The management of the impairments of dementia is centered on its functional consequences and impact on daily living. The chapters describe behavioral interventions and environmental strategies that aim to improve daily activities and quality of life from a proactive communication and memory basis. Specific suggestions are provided to enhance family involvement and staff relationships, interdisciplinary cooperation, reimbursement, and documentation across various home and institutional settings.
Clinical linguistics is the application of linguistic concepts, theories, and methods to the study of language disorders. These disorders can result from impairment of, or breakdown in, one or more of the following language components: prosody, phonology, morphology, syntax, semantics, pragmatics, and discourse. Some language disorders have their onset in the developmental period (developmental language disorders), while others occur for the first time in late childhood and adulthood (acquired language disorders). Language disorders can compromise the reception or understanding of language and/or its expression or production, with impairments possible across a range of modalities (spoken, written, and signed language). This branch of linguistics is inextricably linked to speech-language pathology (also known as speech and language therapy in the United Kingdom), the clinical discipline responsible for the assessment, diagnosis, and treatment of clients with a range of communication disorders (and not just language disorders). However, clinical linguistics is nonetheless a distinct linguistic discipline that is not in any way subsumed by speech-language pathology. In addition to having a detailed knowledge of linguistic disciplines, the speech-language pathologist must understand a range of medical conditions and their likely impact on language skills in children and adults.
An essential study aid for students of speech and language pathology, this highly practical workbook includes short-answer questions and data analysis exercises which help students to test and improve their knowledge of pragmatic and discourse disorders. The book contains a detailed examination of the causes, language and cognitive features of these disorders and includes frequently encountered clinical populations and conditions that are overlooked by other texts. The use of actual linguistic data provides readers with an authentic insight into the clinical setting. • 200 short-answer questions help students to develop and test their knowledge of pragmatic and discourse disorders • 67 data analysis exercises provide readers with real-life clinical scenarios • Fully worked answers are provided for all exercises, saving the lecturer time and allowing the reader to self-test and improve understanding • A detailed glossary of terms makes the text a self-contained reference tool • Carefully selected suggestions for further reading are provided for each chapter.
Many children and adults experience significant breakdown in the use of language. The resulting pragmatic disorders present a considerable barrier to effective communication. This book is the first critical examination of the current state of our knowledge of pragmatic disorders and provides a comprehensive overview of the main concepts and theories in pragmatics. It examines the full range of pragmatic disorders that occur in children and adults and discusses how they are assessed and treated by clinicians. Louise Cummings attempts to integrate the fields of pragmatics, language pathology and cognitive science by examining the ways in which pragmatics can make a useful contribution to debates about cognitive theories of autism. The reader is encouraged to think in a critical fashion about how clinicians, experimentalists and theorists deal with pragmatic issues.
To investigate the influence of acquired dysarthria on conversational turn-taking, contributions from five stroke and 19 non-brain damaged (NBD) elderly subjects were analysed. It was hypothesized that the dysarthric (DYS) group would be less active participants. In subject-researcher conversations the DYS subjects contributed a lower percentage of the total conversational parameter turns than did the control subjects. Number of turns did not differ in the groups, but for the DYS group fewer of these were major turns and their length was shorter. This less active participation was consistent with subjects' perceptions of post stroke change to interaction style. Intelligibility may influence conversational contribution: the pattern of the more intelligible speakers more closely approached that of the NBD group. DYS subjects also paused more than NBD before turns. Dysarthria assessment should include appropriate evaluation of conversation, to guide management decisions. Future research should involve larger subject groups. Analysis should encompass further aspects of the conversational process, such as topic, repair and non-verbal responses, with attention to both participants, and preferably with familiar conversational partners.
This report documents the progress of four individuals with aphasia through a seven-week course of Conversation Partners Therapy using a conversation analysis (CA). The CA as used in this study reveals changes otherwise unavailable from more traditional testing methods. Four individuals with aphasia participated. Their treatment comprised a seven-week regimen of therapy which used a family member as a trained facilitator, with the speech-language pathologist serving as ‘coach’. Weekly conversation probes were later analysed to determine whether progress documented with formal measures was observable from conversation. In the two patients with more satisfactory progress with conventional testing, parallel changes were realised in the CA, particularly with measures of verbal output and use of conversation self-repair. In the two patients with less satisfactory progress, little change in verbal output was noted, and no change or a decrease in conversation self-repairs occurred. The analyses in this study led directly to modification of therapeutic goals and objectives for each conversational dyad. For example, when little or no change in verbal output was recorded, the conversational partner was trained to facilitate more elaborate utterances by the partner with aphasia.
Background: Problems with intersubjectivity (i.e., mutual understanding) are prevalent during interactions involving people with aphasia. The linguistic restrictions imposed by aphasia mean that conversation partners must often assist with repairing intersubjective problems if they are to be resolved efficaciously. However, conversation partners can resist participation in repair activities. This may have serious negative implications for how people with aphasia participate in conversation.
Aims: This study uses conversation analysis (CA) to examine responses to problematic talk produced by people with aphasia. It focuses on three alternatives to initiating, completing, or pursuing repair: receipting responses, accounting responses, and “other” responses. The interactional organisation and consequences of these responses are described.
Methods & Procedures: Three people with aphasia and nine of their familiar conversation partners were video-recorded during their everyday conversations. Approximately 9.5 hr of recordings was collected. Ninety-seven responses were identified in this data set and analysed using collection-based conversation-analytic practices.
Outcomes & Results: Receipting responses register that the person with aphasia has produced a turn, but provide little support for the action implemented by the turn. They do not index problems with intersubjectivity and often result in the problematic talk being abandoned. Accounting responses index problems with intersubjectivity, but do not work towards resolving them. Instead, they deal with why an appropriate response to the problematic talk cannot be delivered, and which party is responsible for its absence. “Other” responses comprise a more eclectic category. One type—non-serious responses—is examined. Non-serious responses take the appearance of repair, but ultimately delay authentic repair attempts.
Conclusions: The responses examined can have negative consequences for the participation of people with aphasia, restricting their ability to implement social action, and making relevant their status as linguistically incompetent. However, they can also help with navigating the sensitive environments created by problems with intersubjectivity. Interaction-focused interventions might focus on these practices in addition to repair practices when attempting to improve how communication breakdown is addressed. CA and qualitative interviewing are well suited to future explorations of how conversation partners decide that they will not initiate, complete, or pursue repair.
This paper uses Conversation Analysis to investigate the organisation of topic talk during interactions involving a person with aphasia (Valerie). Approximately three and a half hours of everyday conversation between Valerie and her conversation partners was collected and analysed. It was found that Valerie’s conversation partners took on primary speakership more often during topic talk, and held the floor for longer periods of time. It is argued that this pattern was the product of weak alignment with Valerie’s topic talk initiations, trouble that arose during Valerie’s extended turns, and Valerie’s promotion of speakership for her conversation partners. These observations point towards the importance of conversation partners’ conduct in promoting the success of extended turns produced by people with aphasia. Finally, it is suggested that the findings of interaction-focused research can help specify and expand notions of functional communication.
Pragmatics - the way we communicate using more than just language - is particularly problematic for people with speech disorders. Through an extensive analysis of how pragmatics can go wrong, this book not only provides a novel and clinically useful account of pragmatic impairment, but it also throws new light on how pragmatics functions in healthy individuals. Michael Perkins brings mainstream and clinical pragmatics together by showing that not only can our understanding of pragmatics be aided by the study of pragmatic impairment, but that clinical and theoretical pragmatics are better served by treating pragmatic ability and disability within a single framework. It is the first book on this topic to be aimed primarily at linguists and psycholinguists rather than clinicians, and includes illustrative material on conditions such as autism and aphasia and a wide range of other communication disorders in both children and adults.
Much of the recent literature in the field of stuttering has a primary reliance on experimental designs and quantitative analysis. Since human communication is complex and multidimensional, it is difficult to study in an unnatural experimental setting. This paper proposes an alternative methodology for queries into the complex behaviors that are associated with stuttering. Qualitative methodologies have already been used as effective research tools in anthropology, sociology, and several other social sciences. Their emergence in the field of speech-language pathology is recent. The purpose of these paper is to justify the use of qualitative methodologies as an adjunct and/or alternative to more traditional experimental methodologies. Educational Objectives: The reader will learn and be able to (1) describe the objectives of qualitative research, (2) contrast quantitative and qualitative research goals and methods, and (3) list the major strengths and weaknesses of qualitative research.
Background: It is well known that about 20% of patients with anomic aphasia still show residual aphasic symptoms 1 year post onset. As we do not have any tests to reliably diagnose residual aphasia it is difficult to decide whether these persisting problems are signs of residual aphasia that have to be treated, or are indications of a normal variability in language use, which also may occur in elderly people.Aims: The main aim of this research is to find out whether there are variables in spontaneous communication of persons with residual aphasia (P-RA) that enable us to distinguish them from persons without aphasia (P-NA).Methods & Procedures: Following a detailed linguistic analysis of spontaneous speech we employed binary logistic regression analysis to find the most relevant variables for differentiation between P-RA (N = 41) and P-NA (N = 25).Outcomes & Results: Significant group differences at different processing levels could be observed. Lexically varied, informative, and cohesively tied phrases in particular pose the main problem for P-RA. Regression analysis including variables of spontaneous communication explains 82.5% (R2) of the variation and correctly identifies 39 of 41 (95.1%) cases of P-RA and 21 of 25 (84.0%) cases of P-NA.Conclusions: Analysing spontaneous communication seems to be a promising possibility for diagnosing residual aphasia. The importance of spontaneous communication in everyday interaction, and its sensitivity to even slight deficits in language processing, promote the described analysis as a very useful screening instrument to distinguish P-RA from P-NA.
This paper examines the repair skills of three groups of 7 to 11-year old children: 1) children with Pragmatic Language Impairments (the PLIgroup); 2) children with Specific Language Impairments with no pragmatic difficulties (the SLI group); 3) children with normally developing communication skills (the mainstream group). The data comprise one-to-one interactions with a speech and language therapist, where the participants are engaged in a task devised to provide multiple opportunities for the initiation of repair The research also included a six-week period of therapy focusing on pragmatic skills for the children with PLI. Repair skills were compared pre-and post-intervention. Initially, both the mainstream and SLI groups achievedfar greater task success than the group with PLI, whose poor performance was largely attributable to their tendency not to initiate repair After the intervention period however, this group showed marked improvement (both in initiating repair and in task success). This reveals their potential to develop pragmatic skills that they have not spontaneously acquired if they are explicitly taught them.
Using data collected in a study of how people living with Parkinson's disease assess the efficacy of the alternative and complementary therapies they use, the author addresses the impact on qualitative data collection and analysis of communication problems between researchers and informants who experience speech difficulty. There is little literature that deals with these issues. In what little does, the emphasis is most often on the “problem” informants who experience speech difficulty present for communication, rather than seeing communication problems as a product of interviewer/informant interaction in which the researcher also plays a role in hindering communication. In this article, the author argues that a focus on the linguistic inability of informants, however unwitting, constructs the person who experiences difficulty speaking as problematic and the researcher as the “expert” who solves the communication problem the informant presents.
Conversation analysis was used to investigate a conversational partner's strategies when assisting with the word searches of an aphasic person. The purpose was to identify and detail how such strategies were accomplished and to examine the implications of these strategies from a social and participatory perspective. Review of a large, authentic database resulted in identification of 38 videotaped conversation sequences characterized by the initiation of a word search by an aphasic speaker and the joining of this search by the conversation partner. Sequences were analyzed on a turn-by-turn basis to identify patterns of sequential organization based on similarities in contextual and functional features and to infer social implications. Results were that four conversation strategies were systematically used: guess, alternative guess, completion, and closing strategies. Each was accomplished collaboratively with specific interactional resources and techniques and were used differentially for social purposes. Implications for clinical practices involving training of conversation partners are discussed.
The Profile of Communicative Appropriateness — a newly developed profile for the characterisation of pragmatics is described. The theoretical background to this profile is covered as well as its main components. Its application to a group of eighteen aphasic patients is outlined, results suggesting that patient groupings on the profile could be predicted in terms of severity but not in terms of type of aphasia. Explanations for this finding are discussed and the potential utility of this profile is suggested.
ABSTRACTS
A variety of methods has recently been used to assess everyday communication abilities in aphasic adults. This study compares three such methods for their clinical utility and the amount of a therapist's time they use. The three methods employed a standard rating schedule completed by relatives, analysis of speech elicited through role‐play and a partial analysis of everyday conversation samples. The utility of these assessments as a clinical tool was measured in terms of the therapist's time needed, and the assessment's ability to show stability or change of communicative effectiveness on test‐re‐test measures and to illuminate areas for therapeutic intervention. Eight aphasic adults (five acute and three chronic) were tested on all three assessments, then re‐tested after a period of 3 months. The results suggested that, although more time‐consuming, the partial conversational analysis was a more sensitive measure of stability or change of communicative effectiveness over time than the other two measures, and had the potential advantage for indirect intervention of revealing conversational strategies used by the partner as well as those used by the aphasic individual.
Un certain nombre de methodes ont été utilisées récemment pour évaluer les capacités communicatives quotidiennes des adultes aphasiques. La presente étude compare trois de ces méthodes en fonction de leur utilité clinique et du temps qu'elles prennent aux thérapeutes. Ces trois méthodes utilisent une liste de questions dont les réponses chiffrées sont fournies par l'entourage du patient, une analyse de langage suscité par des jeux de rôles et une analyse partielle d'extraits de conversations de la vie courante. L'utilité de ces évaluations en tant qu'outils cliniques a été mesurée en fonction du temps qu'elles prenaient au thérapeute, en fonction de leur capacité de diagnostiquer la stabilité ou le changement dans l'efficacité communicative lorsque les tests sont répétés, et en fonction de leur possibilité de mettre la lumière sur les zones d'intervention thérapeutiques possibles. Huit adultes aphasiques (cinq cas aigus et trois chroniques) ont été testés selon ces trois méthodes, puis un nouveau test a été fait au bout de trois mois. Les résultats suggèrent que, même si elle prend davantage de temps, l'analyse partielle de conversations est une mesure plus sensible de la stabilité ou de l'évolution de l'efficacité communicative dans le temps, et qu'elle a l'avantage potentiel de révéler les stratégies en matière de conversation utilisées tant par l'aphasique que par l'interlocuteur, ce qui peut permettre l'intervention directe.
Verschiedene Methoden sind in letzter Zeit eingesetzt worden, um das Kommunikationsvermögen aphasischer Erwachsener im Alltag zu erfassen. In dieser Studie werden drei solche Methoden im Hinblick auf ihren klinischen Nutzen sowie auf ihre zeitlichen Anforderungen an die Therapeutinnen verglichen. Die drei Methoden verwendeten einen standardmäßgen Einstufungsplan, der von Verwandten ausgefüllt wurde, die Analyse von im Rollenspiel elizitierter Sprache und die partielle Analyse von Gesprächsteilen aus dem Alltag. Der Nutzen dieser Bewertungsmodi als klinische Mittel wurde als Funktion einerseits der von den Therapeutinnen geforderten Zeit, andererseits der Möglichkeiten einer Methode, Stabilität oder Veränderung der kommunikativen Wirksamkeit bei Testwiederholung zu zeigen, sowie Bereiche der möglichen therapeutischen Intervention aufzuzeigen. Acht aphasische Erwachsene (5 akut, 3 chronisch) wurden mit allen drei Bewertungsmodi getestet und nach drei Monaten wieder getestet. Die Ergebnisse zeigen, daß die partielle Gesprächsanalyse, obgleich zeitintensiver ein sensitiveres Maß für die über die Zeit stabile oder veränderte Kommunikationsfähigkeit als die anderen beiden Methoden liefert. Sie hat auch den weiteren potentiellen Vorteil für indirekte Intervention dadurch, daß sie die Konversationsstrategien des Partners neben denen des Aphatikers zeigt.
This study investigated the influence of aphasia, familiarity and activity on conversational repair in interactions between nine aphasic individuals and 18 normal subjects (nine of whom lived with the aphasic subjects, and nine of whom were visiting the aphasic subjects). Data were collected in the homes of the aphasic subjects, and comprised unstructured conversation, semi-structured interaction involving retelling the events witnessed in a mock car accident, and structured testing. Conversation Analysis investigated the frequency of interactive trouble-indicating behaviour (metalinguistic comment and hypothesis forming per minute), and the nature of repair pattern (proportional pattern of repair trajectories used). Normal subjects increased their frequency of interactive trouble-indicating behaviour, and used more interactive repair patterns when conversing with aphasic partners as compared with when conversing with normal partners. The difference in familiarity between subjects did not appear to affect the frequency of interactive trouble-indicating behaviour, but it was noted that ‘visiting’ subjects tended to make more use of ‘other repair’ patterns than did subjects living with aphasic individuals. Conversational repair was found to differ across activities. The theoretical and clinical implications are discussed.
This paper describes the rationale and the data base upon which pragmatic approaches to the treatment of aphasia are based. It illustrates pragmatic treatment by describing three types of language therapy utilizing different treatment approaches. Strengths and weaknesses of pragmatic approaches are discussed. The paper concludes by suggesting that pragmatic treatment should be used in conjunction with other approaches more explicitly focused upon the language deficits exhibited by aphasic patients.
This paper proposes a collaborative model of repair in aphasic discourse, derived from the procedures of conversation analysis (CA). First, it is suggested that relative to other pragmatic orientations CA can offer a particularly illuminating and practically useful perspective on aphasic discourse. Repair strategies are then examined, first in relation to normal conversation then in relation to aphasic conversation' where one or more of the participants is aphasic. Next, Clark and Schaefer's CA-style model of conversational organization (1 987, 1989) is outlined, with attention to its relevance to the organization of repair in aphasic conversation. Finally, we apply this model in an analysis of some aphasic conversational sequences where the collaborative negotiation of repair is particularly evident.
A descriptive taxonomy, the pragmatic protocol, was developed for this study. The protocol consists of 30 pragmatic parameters of language. The purpose of the study was to test the utility of the tool to evaluate a range of pragmatic aspects of language in a sample of conversational speech from subjects in six groups. Among the disordered subjects, four distinct profiles emerged that separated the diagnostic groups. Individual differences in the way pragmatic deficits were distributed within a diagnostic category were also identified. The authors stress that the assessment of pragmatics should encompass a range of parameters that includes aspects of linguistic structure as well as those aspects of communication that have to do with principles governing language use. We offer our data as an early look at the way in which pragmatic deficits stratify across disordered populations.
Pertinent issues surrounding the utilisation of naturalistic communication therapy with adult aphasics are presented. Discussion centres around the need to place greater emphasis in management programmes on aphasics using language in everyday contexts, for different purposes. the relevance of discourse analysis is considered and procedures for the assessment and treatment of aphasic communication are outlined. the need to measure the effectiveness of such therapy is highlighted.
An analysis of the communication strategies employed by aphasics when conversing with other aphasics
- Flemingc
The impact of cognitive neuropsychological impairments on conversational ability in aphasia
- Perkinsl
An exploration of the impact of psycholinguistic impairments on conversational ability in aphasia
- Perkins L.