Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia.

A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours

Correction and turn completion as collaborative repair strategies in conversations following Wernicke's aphasia

This study explores repair practices deployed by the interlocutor of a speaker with Wernicke’s aphasia, their relationship to types of aphasic difficulty, and how mutual understanding and the progression of talk is maintained. A 75-year-old woman with Wernicke’s aphasia of 16 months duration and her friend video recorded 36 minutes of conversation at home. Using conversation analytic methods two patterns of other-repair by the non-aphasic interlocutor were identified. The first practice was turn completion, which occurred in the context of self-initiated word search by the person with aphasia. The second was correction in the context of trouble with reference to person or place, manifested as an erroneous word, mis-selection of a gendered pronoun, or use of a pronoun where a person’s name was expected. This correction was mainly overt, completed via a short side sequence dealing with the repair, although a few examples were embedded, where a word or phrase was replaced with a corrected form without overtly drawing attention to the correction. None of the examples included an account for the error. Unlike in typical talk, the person with aphasia did not repeat or use the corrected form in subsequent talk. For this dyad, correction and completion function as interactionally acceptable collaborative repair strategies, maintaining progressivity and a focus on topic development rather than on repair itself. There is no evidence that other-correction is dispreferred, which accords with recent findings for typical interaction but differs from other studies of aphasic talk. Correction should not be dismissed out of hand as a negative interactional practice when talking to someone with Wernicke’s aphasia

Joint planning in conversations with a person with aphasia

This study explores practices employed by a person with aphasia (PWA) and his wife to organize joint planning sequences and negotiate deontic rights (a participants' entitlement to initiate planning sequences and the entitlement to accept or reject a plan). We analyze two different conversations between a man with aphasia and his wife and their adult daughter. Using Conversation Analysis (CA), we identify practices that further the PWA's participation in the interaction while planning afternoon activities together with his wife. The PWA contributes to the planning talk by initiating and modifying planning sequences. The spouse supports his participation by aligning with his initiated actions and inviting him to collaborate in planning talk she initiates. Deontic authority is shared between the conversation partners and the PWA's agency is facilitated even during disagreement. The analysis offers insight into practices that allow a PWA to use his limited communicative resources to contribute competently to planning talk

Professionals’ perspectives on delivering conversation therapy in clinical practice

Background: Aphasia and other acquired language impairments have the potential to impact greatly on quality of life by disrupting everyday conversation. Different intervention approaches are available to speech and language therapists (SLTs), such as targeting the language impairment itself and/or addressing activity or participation barriers. Conversation therapy is one approach that is gaining in popularity, with a growing evidence base. However, it is not clear how SLTs currently use conversation approaches and what factors may influence delivery. Aims: To investigate how SLTs (i) define conversation therapy, (ii) deliver it in clinical practice, and identify (iii) any challenges faced. Methods & Procedures: An online survey and focus group explored how SLTs working in the south east of England currently deliver conversation therapy to support people with a range of communication disorders, in particular aphasia. Data were analysed using descriptive statistics and thematic content analysis. Outcomes & Results: A total of 50 SLTs completed the survey and 6 participants attended the focus group. Conversation therapy was found to be widely employed by participants, however there was considerable variation in the approaches used, and a number of major challenges were raised. SLTs reported delivering conversation therapy with a range of client groups and preferably working with the client and partner together. Conversation goals predominantly reflected an approach based on: (i) strategy use and/or total communication (TC), and (ii) Conversation Analysis. Three overarching themes around conversation therapy emerged from the focus group: (1) What is conversation therapy? (2) showing it works, and (3) complexities of delivering it. SLTs acknowledged the benefit of conversation therapy but felt they lacked the tools and skills needed to deliver it. Conclusions: SLTs wanted to use conversation therapy and desired clear outcome measures to demonstrate its effectiveness, but were not accessing the available evidence base, highlighting the ongoing difficulty of translating research into clinical practice. Whilst these data are limited by the small number of participants, the study provides a first view of how conversation therapy is articulated in practice. Further investigation of conversation therapy delivery is warranted with a larger sample of SLTs based across the United Kingdom, as is comparison with practice in other countries

Assessing emergence from a prolonged disorder of consciousness: Current opinion and practice in the UK

BACKGROUND: A patient in PDOC must demonstrate functional object use or functional communication to confirm they have emerged from this state. A range of tasks and stimuli are used and patients must achieve 100% accuracy. As consciousness occurs along a continuum, determining emergence is not straightforward. OBJECTIVE: To establish the opinions of expert clinicians on how emergence is determined in practice. METHODS: An online survey was completed by clinicians working in specialist rehabilitation settings across the UK. Questions were asked about diagnosis and confidence, informal assessment, formal assessment, and family involvement. Descriptive statistics were used to analyse responses to closed questions. Responses to open questions were analysed using thematic analysis. RESULTS: Seventy-five surveys were analysed. Approximately a third (30.4 %) used tasks other than those recommended to determine emergence. A lack of confidence in tasks to detect the return of functional communication was reported by 46.4%. The majority (78.6%) reported they worked with patients who they felt had emerged, but could not demonstrate it based on the current criteria. A range of stimuli were employed, but 30.6% of respondents were not confident they could choose stimuli appropriately. Respondents reported a range of benefits and challenges when involving family in assessment

Collaborative storytelling with a person with aphasia

INTRODUCTION: This study explores practices employed by a person with aphasia (PWA) and his wife to organize collaborative storytelling in a multiparty interaction. We identify practices that further the PWA’s agency – his impact on action – while he is telling a story together with his wife. METHOD: Using conversation analysis (CA), we carried out a case study of a successful storytelling sequence involving a 39-year-old man with anomic aphasia during a conversation with friends. ANALYSIS: The PWA contributed to the storytelling by initiating the story sequence and by producing short but significant utterances in which he provided essential information and displayed epistemic authority. The spouse aligned with the PWA’s initiated actions and supported his agency by giving him room to speak, for example, by gaze retraction. DISCUSSION: The analysis offers insight into practices that allowed this PWA to achieve agency. Our findings show that communication partner training could benefit from implementing activities such as collaborative storytelling

Searching for active ingredients in rehabilitation: applying the taxonomy of behaviour change techniques to a conversation therapy for aphasia

PURPOSE: A taxonomy of behaviour change techniques has been developed to help specify the active ingredients of behaviour change interventions. Its potential for rehabilitation research is significant, however, reliable use among allied health professionals has not yet been explored. This article describes the content of a conversation therapy for post-stroke aphasia using the taxonomy and investigates inter-rater reliability among Speech and Language Therapists. METHODS AND MATERIALS: Two Speech and Language Therapists undertook the same half day, self-led training programme in the behaviour change technique taxonomy and independently coded all materials in the “Better Conversations with Aphasia” programme. Inter-rater reliability was evaluated using the kappa coefficient and percentage agreement. Reliably agreed techniques were categorised according to the speaker and type of behaviour they targeted. RESULTS: Sixteen behaviour change techniques were reliably agreed to be present. Inter-rater reliability was moderate (K = 0.465), and in line with satisfactory percentage agreement (79.8%). More techniques were used to target the adoption of new behaviours (15) than the termination of old ones (3). People with aphasia received fewer behaviour change techniques (10) than their communication partners (16). CONCLUSIONS: Describing the content of conversation therapy with the taxonomy of behaviour change techniques offers clinically useful insights with potential to enhance both research and practice. The intervention is shown to target different types of behaviour in different ways, and offer different speaker groups different content. Non-psychologist users of the taxonomy may encounter challenges working with unfamiliar concepts and terminology, which may impact on reliable use

Measuring outcomes of a peer-led social communication skills intervention for adults with acquired brain injury: A pilot investigation

Reduced social competence following severe acquired brain injury (ABI) is well-documented. This pilot study investigated a peer-led group intervention based on the claim that peer models may be a more effective mechanism for behaviour change than clinician-led approaches. Twelve participants with severe ABI were recruited from a post-acute neurorehabilitation setting and randomly assigned to either a peer-led intervention or a staff-led activity group (usual care) (Clinicaltrials.gov: NCT02211339). The groups met twice a week for 8 weeks. A peer was trained separately to facilitate interaction in the intervention group. Training comprised 16 individual sessions over 4 weeks. Group behaviour was measured twice at baseline, after intervention and at maintenance (4 weeks), using the Adapted Measure of Participation in Conversation (MPC) and the Interactional Network Tool (INT), a newly devised measure of group conversational interaction. Outcome measures showed differential sensitivity. The groups did not differ in baseline behaviour. Findings showed a significant improvement in the treated group on the MPC transaction scale post-intervention (p = .02). The intervention group showed more balanced interaction post-intervention on the INT and at follow-up. Findings show preliminary evidence of the advantage for peer-led groups. The INT shows promise as a method to detect a change in group communication behaviour. / Trial registration: ClinicalTrials.gov identifier: NCT02211339

TeleCPT: Delivery of a Better Conversations Approach to Communication Partner Training During a Global Pandemic and Beyond

Purpose: This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice. // Method: We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies. // Results: Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area. // Conclusions: TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT

Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus

Purpose: International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool. // Materials and Methods: A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round. // Results: Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool. // Conclusions: Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed