To investigate the effects of a familiar communication partner on the production of narrative after traumatic brain injury (TBI).
Ten participants with TBI were matched with 10 control participants for sex, age, and education. Participants independently retold a story from a picture sequence and also retold a video segment with a friend to a researcher. The resulting discourse was analyzed for productivity, cohesion, story grammar, informational content and exchange structure.
There was a significant difference between participants with and without TBI for all measures in the monologic narrative. In the jointly-produced narrative, there was no significant difference in performance and participation between individuals with TBI and control participants. Participants with TBI demonstrated a significant improvement between the monologic and the jointly-produced task in story grammar and informational content.
The natural scaffolding provided by the friends of participants with TBI in a meaningful narrative task facilitated competent participation in and production of narrative. These findings indicate an avenue for training everyday communication partners in supporting narrative skills after TBI, and for the use of jointly-produced narrative as an additional assessment tool to create a holistic view of everyday skills.
Background : There is evidence that language production requires specialised conceptual processes, or “thinking for speaking” (Slobin, 1996). These processes generate the pre-verbal message, which according to Levelt (1989, 1999) has propositional structure and perspective and is specifically adapted for the target language. Aims/Main Contribution : This paper presents evidence that thinking for speaking may be impaired in aphasia. Even when not impaired, its complexities may prevent people with aphasia from revealing grammatical competencies. This may explain why therapy often fails to bring about improvements in open speaking conditions, such as narrative, which impose heavy message-level demands. Conclusions : It is argued that, with some individuals, therapy should target thinking for speaking skills. Two therapy studies are reviewed that support this conclusion.
Background: Discourse analysis as a clinical tool in speech and language therapy remains underused, at least partly because of the time-consuming nature of the process of transcription that currently precedes it. If transcription-less discourse analysis were valid and reliable, then there would be the clinical opportunity to use this method in order to describe a person's communication impairment (for example aphasia), to help plan therapy and to measure outcomes. Aims: This study aimed to address the potential of transcription-less discourse analysis as a valid and reliable procedure for the measurement of gesture use, topic use, turn taking, repair, conversational initiation, topic initiation, and concept use. Methods & Procedures: Ten individuals with aphasia were audio- and video-recorded participating in a number of discourse tasks from three different discourse genres (conversation, procedural, and picture description). With the same analytical frameworks, the resulting data were compared using transcription-based discourse analysis and a transcription-less method in which the analysis was made directly from the recordings. Outcomes & Results: Validity was measured by comparing transcription-based and transcription-less analyses. Overall the results from that comparison demonstrated the potential of the latter method - none of the measures gave significant differences between scores from the two methods. The main (non-significant) disparities related to some aspects of gesture use and repair. The inter-rater reliability of the transcription-less method was also acceptable in general. Reliability was measured by the intraclass correlation coefficient (ICC) for the continuous measurements: it was strongest for the gesture totals and varied among the attributes of turn taking and repair. For the categorical measures (topic and conversation initiation and concept analysis) the percentage agreement was very good. Conclusions: These results indicate the potential availability of a valid and reliable transcription-less approach to analysis that speech and language therapists can apply to analyse their clients' discourse.
Background: Perceptual ratings provide a means of evaluating conversations involving individuals with aphasia. The influence of sampling segments of conversation and of segment length has not been established. Aims: To investigate the impact of the duration of the conversational segment on judges' perceptual ratings of elements of conversations between individuals with aphasia and their conversation partners. Methods Procedures: A total of 64 speech pathology student judges rated two previously video-recorded conversations, elicited through a video-retelling task, between two individuals with severe aphasia and their respective partners via the Measure of Skill in Supported Conversation and the Measure of Participation in Supported Conversation (Kagan et al., 2004). Each judge was randomly assigned a segment from one or both conversations. The segment lengths were 3 minutes, 5 minutes, 10 minutes (for the longer conversation only), and the entire conversation (10:30 minutes and 19:17 minutes). The effect of segment duration and the interaction between conversation and segment duration were analysed for each rating scale using a 2 x 3 factorial analysis of variance. Outcomes Results: There was no significant main effect for segment duration for any of the four rating scales of the Measure of Skill in Supported Conversation and the Measure of Participation in Supported Conversation. Conclusions: Aphasiologists who utilise these ratings of conversation as outcome measures can base the ratings on a segment of the conversation rather than the entire conversation. A 3- or 5-minute segment of a longer conversation on which no time limit has been placed is adequate to provide an accurate perceptual judgement.
Narratives help individuals make sense of their experiences (Bochner, Ellis, " Tillmann-Healy, 1997; Weber, Harvey, " Stanley, 1987). This is particularly true for people trying to make sense of difficult or traumatic experiences. Joint storytelling, or collaborative narration, however, introduces elements not at work in individual tellings. In this study, we looked for evidence of sense-making in joint stories about difficult family experiences told by 12 families. Families' level of engagement, perspective-taking, turn-taking, and expressed interpretations all emerged as features relevant to the sense-making process. During the storytelling episode, families engaged in three forms of sense-making: (a) family-unit sense-making in which members actively engaged in the process of telling the story together and reached a shared conclusion concerning the meaning of the experience, (b) individual family member sense-making in which family members participated in the storytelling by sharing separate versions of the story and reached individual conclusions about the meaning of the story, and (c) incomplete sense-making in which one or more family members were not engaged in the storytelling and no clear understanding of the story's meaning emerged at either the family or the individual level. This study offers an approach to aid in identifying communication behaviors that accompany and help differentiate the sense-making process in jointly told family stories about difficult family experiences.
This article gives an overview of the application to aphasia of conversation analysis (CA), a qualitative methodology for the analysis of recorded, naturally occurring talk produced in everyday human interaction. CA, like pragmatics, considers language use in context, but it differs from other analytical frameworks because the clinician is not making interpretations about how an aspect of language should be coded or judging whether an utterance is successful or adequate in terms of communication. We first outline the CA methodology before discussing its application to the assessment of aphasia, principally through the use of two published assessment tools. We then move on to illustrate applications of CA in the field of aphasia therapy by discussing two single case study interventions. Key conversation behaviors are illustrated with transcripts from interactions recorded by the person with aphasia and the person's habitual conversation partner in the home environment. Finally, we explore the implications of using CA as a tool for assessment and treatment in aphasia.
Background: Increasingly there is a call from clinicians and researchers for measures that document the impact of aphasia on a person's everyday communication. Do existing assessments of communication disability adequately sample communication activities relevant to our clients? Communication skills and networks change with age. A need exists to determine the everyday communication activities of older people and in particular those with aphasia. Aims: The primary aim of this study was to describe and compare the everyday communication activities of older people with aphasia and healthy older people who are living in the community. A secondary aim was to investigate the content validity of the American Speech-Language Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS, 1997) for older Australians. Methods & Procedures: Naturalistic observation was the method of choice for detailing the everyday communication of 15 older people with chronic aphasia following stroke and a matched group of 15 healthy older people who were living in the community. Researchers, in the role of participant observer, took field notes for 8 hours, over three occasions within a week. A total of 240 hours of observation have been coded in terms of communication activity, topic, communication partners, and place of communication. A brief 5-day diary served to check the representativeness of the observational data. After each hour of observation, the researcher checked which ASHA FACS items had been observed. Outcomes & Results: Naturalistic observation provided a rich, rigorous, and systematic methodology for detailing the dynamics and complexities of authentic communication. The most common communication activities for both groups were conversations at home and in social groups. Real-life communication was revealed to serve the dual purposes of transaction and interaction. Results indicate that older people with aphasia engage in similar communication activities to healthy older people although differences were evident in the frequency of communication and in specific activities such as story telling, writing, commenting, and acknowledging. ASHA FACS items were generally relevant to older Australians living in the community. Conclusions: This study demonstrated that communication activity is multifaceted in terms of the type of communication and contextual factors. The observational data describe the effects of aphasia on a person's everyday communication activity and reveal the impact of aphasia on the social functions of communication including sharing information, maintaining and establishing relationships, and telling one's story. Functional communication assessment requires a greater focus on the interactional and uniquely interpersonal aspects of social communication.
This paper argues that some of the patterns seen in aphasia may reflect difficulties in the cognitive preparations for language. In particular, some individuals might be unable to carry out processes of 'Thinking for Speaking' (Slobin 1996), which frame thoughts for language production. Evidence to support this proposal is presented, together with signs that such thinking can be assisted with cues and therapy. It is argued that these preliminary data need to be pursued via a more comprehensive investigation of thinking therapy.
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.