An interaction-focused intervention approach to training everyday communication partners: a single case study

Background: Communication partner training (CPT) appears to be a growing area within aphasiology. Much of the work carried out so far has focused on training volunteers to have conversations with people with aphasia in order to improve communication and the person with aphasia’s (PWA’s) psychosocial well-being and/or on improving the ability of significant others to communicate information with the PWA within clinical tasks. In this paper, we present the results of a single-case intervention study that used an interaction-focused approach to target the conversational behaviours of the significant other of a PWA with the aim of improving the dyad’s everyday conversations within the home environment. Aims: To discuss the targeting, implementation, and evaluation of an interaction-focused intervention programme for a significant other of a PWA. Methods & Procedures: Conversation Analysis was used both to guide choice of individualised target behaviours for the intervention and to explore changes in the conversational interaction between a woman with mild-moderate aphasia and her life partner. Three samples of video-recorded natural conversational interaction from before and after the partner took part in a six-session long group intervention were analysed. The evidence for change that emerged from qualitative analysis of the conversational data was further analysed by an independent and blinded assessor doing quantitative comparisons. Outcomes & Results: There was qualitative and quantitative evidence that two of three targeted conversational behaviours had changed following the intervention programme. Following the completion of the intervention, the dyad spent significantly less time in pedagogic activities. Furthermore, the significant other showed an increased attention towards PWA’s conversational contributions. The combination of qualitative and quantitative analyses also revealed that postintervention, the communication partner displayed changes in an interactional behaviour that was not targeted in the intervention, that is, dismissive language towards the PWA. Conclusions: This study adds to the existing literature in presenting positive results from an intervention that used an interaction-focused approach, here targeted towards the everyday communication partner of a PWA. Notably, this study supplemented qualitative outcomes with blinded and statistical quantitative analyses. Also, the fact that no transcriptions were used during the intervention process and that therapy was delivered via group intervention shows the feasibility of this form of CPT in clinical settings. Furthermore, the study suggests that intervention programmes targeting the behaviours of a communication partner may produce positive change in conversational behaviours that have not been directly targeted in the intervention

Negotiating disagreement in picture symbol supported decision making

This study explores how meaning is co-constructed and negotiated when couples affected by Parkinson’s disease use a symbol supported decision making process (Talking Mats) to talk about their daily lives. Interaction data from three couples of men with Parkinson’s disease, their female partners and a facilitator were examined using Conversation Analysis (CA). Three negotiation sequences in which the partners disagreed regarding the ability of the person with Parkinson’s disease were used to explore the management of divergent views. Negotiation was an individualized process in which the men with Parkinson’s disease were at risk of not being fully involved. Negative assessment and disagreement were displayed in different ways. Strategies such as the use of pronouns and proper names seemed to play important functions in negotiation. Use of pictures such as with Talking Mats may support the handling of different views but partners need to be aware of the potential difficulties involved

Semantic trouble sources and their repair in conversations affected by Parkinson’s disease

Background It is known that dysarthria arising from Parkinson's disease may affect intelligibility in conversational interaction. Research has also shown that Parkinson's disease may affect cognition and cause word-retrieval difficulties and pragmatic problems in the use of language. However, it is not known whether or how these problems become manifest in everyday conversations or how conversation partners handle such problems. Aims To describe the pragmatic problems related to the use of words that occur in everyday conversational interaction in dyads including an individual with Parkinson's disease, and to explore how interactants in conversation handle the problems to re-establish mutual understanding. Methods & Procedures Twelve video-recorded everyday conversations involving three couples where one of the individuals had Parkinson's disease were included in the study. All instances of other-initiated repair following a contribution from the people with Parkinson's disease were analysed. Those instances involving a trouble source relating to the use of words were analysed with a qualitative interaction analysis based on the principles of conversation analysis. Outcomes & Results In 70% of the instances of other-initiated repair the trouble source could be related to the semantic content produced by the individual with Parkinson's disease. The problematic contributions were typically characterized by more or less explicit symptoms of word search or use of atypical wording. The conversation partners completed the repair work collaboratively, but typically the non-impaired individual made a rephrasing or provided a suggestion for what the intended meaning had been. Conclusions & Implications In clinical work with people with Parkinson's disease and their conversation partners it is important to establish what type of trouble sources occur in conversations in a specific dyad. It may often be necessary to look beyond intelligibility and into aspects of pragmatics to understand more fully the impact of Parkinson's disease on everyday conversational interaction

Interaction between nursing staff and residents with aphasia in long-term care: A mixed method case study

INTRODUCTION: Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia. METHODS: A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored. RESULTS: From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: a focus on getting the task done with minimum interaction; topics related to the task, but not necessary to get the task done; and personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents’ severity of aphasia nor the activity as such. CONCLUSIONS: An endeavour to interact socially with the residents with aphasia influences the nurses’ foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia

Person reference as a trouble source in dysarthric talk-in-interaction

This chapter provides an analysis of talk between people with acquired motor speech disorders (dysarthria) and family members. Using conversation analytical principles it focuses on how person references are treated as trouble sources in everyday interaction, how they arise and are collaboratively managed. Following a review of relevant literature we present a detailed examination of person references produced by people with dysarthria in conversation with family members. We will show that person references are vulnerable to becoming trouble sources given their potential ambiguity or relatively weak relationship to immediately prior talk

Problematic topic transitions in dysarthric conversation

Purpose: This study examined the nature of topic transition problems associated with acquired progressive dysarthric speech in the everyday conversation of people with motor neurone disease. Method: Using conversation analytic methods, a video collection of five naturally occurring problematic topic transitions was identified, transcribed and analysed. These were extracted from a main collection of over 200 other-initiated repair sequences and a sub-set of 15 problematic topic transition sequences. The sequences were analysed with reference to how the participants both identified and resolved the problems. Result: Analysis revealed that topic transition by people with dysarthria can prove problematic. Conversation partners may find transitions problematic not only because of speech intelligibility but also because of a sequential disjuncture between the dysarthric speech turn and whatever topic has come prior. In addition the treatment of problematic topic transition as a complaint reveals the potential vulnerability of people with dysarthria to judgements of competence. Conclusion: These findings have implications for how dysarthria is conceptualized and how specific actions in conversation, such as topic transition, might be suitable targets for clinical intervention