Discourse: Assessment and Therapy

Discourse is essential for interaction and for the expression of ideas, feelings and opinions. Telling personal stories, such as talking about your day or recounting what happened in the playground, is essential for communication and establishing relationships. However, due to their language impairments, people with aphasia (PWA) and children with developmental language disorder (DLD) often have problems with everyday discourse which impact on their lives more widely. While improvement in language skills is supported by speech-language pathology (therapy), it tends to focus on smaller linguistic components, such as single words and sentences. This chapter outlines how speakers construct discourse in everyday situations and focuses on the meanings that people use discourse to convey, as well as the lexical and grammatical resources they use to convey these meanings. Current methods for discourse analysis will be outlined and key developments in narrative discourse production therapy will be reviewed

The language–gesture connection: Evidence from aphasia

A significant body of evidence from cross-linguistic and developmental studies converges to suggest that co-speech iconic gesture mirrors language. This paper aims to identify whether gesture reflects impaired spoken language in a similar way. Twenty-nine people with aphasia (PWA) and 29 neurologically healthy control participants (NHPs) produced a narrative discourse, retelling the story of a cartoon video. Gesture and language were analysed in terms of semantic content and structure for two key motion events. The aphasic data showed an influence on gesture from lexical choices but no corresponding clausal influence. Both the groups produced gesture that matched the semantics of the spoken language and gesture that did not, although there was one particular gesture–language mismatch (semantically “light” verbs paired with semantically richer gesture) that typified the PWA narratives. These results indicate that gesture is both closely related to spoken language impairment and compensatory

The impact of impaired semantic knowledge on spontaneous iconic gesture production

Background: Previous research has found that people with aphasia produce more spontaneous iconic gesture than control participants, especially during word-finding difficulties. There is some evidence that impaired semantic knowledge impacts on the diversity of gestural handshapes, as well as the frequency of gesture production. However, no previous research has explored how impaired semantic knowledge impacts on the frequency and type of iconic gestures produced during fluent speech compared with those produced during word-finding difficulties. Aims: To explore the impact of impaired semantic knowledge on the frequency and type of iconic gestures produced during fluent speech and those produced during word-finding difficulties. Methods & Procedures: A group of 29 participants with aphasia and 29 control participants were video recorded describing a cartoon they had just watched. All iconic gestures were tagged and coded as either “manner”, “path only”, “shape outline” or “other”. These gestures were then separated into either those occurring during fluent speech or those occurring during a word-finding difficulty. The relationships between semantic knowledge and gesture frequency and form were then investigated in the two different conditions. Outcomes & Results: As expected, the participants with aphasia produced a higher frequency of iconic gestures than the control participants, but when the iconic gestures produced during word-finding difficulties were removed from the analysis, the frequency of iconic gesture was not significantly different between the groups. While there was not a significant relationship between the frequency of iconic gestures produced during fluent speech and semantic knowledge, there was a significant positive correlation between semantic knowledge and the proportion of word-finding difficulties that contained gesture. There was also a significant positive correlation between the speakers’ semantic knowledge and the proportion of gestures that were produced during fluent speech that were classified as “manner”. Finally while not significant, there was a positive trend between semantic knowledge of objects and the production of “shape outline” gestures during word-finding difficulties for objects. Conclusions: The results indicate that impaired semantic knowledge in aphasia impacts on both the iconic gestures produced during fluent speech and those produced during word-finding difficulties but in different ways. These results shed new light on the relationship between impaired language and iconic co-speech gesture production and also suggest that analysis of iconic gesture may be a useful addition to clinical assessment

Language and iconic gesture use in procedural discourse by speakers with aphasia

Background: Conveying instructions is an everyday use of language, and gestures are likely to be a key feature of this. Although co-speech iconic gestures are tightly integrated with language, and people with aphasia (PWA) produce procedural discourses impaired at a linguistic level, no previous studies have investigated how PWA use co-speech iconic gestures in these contexts.Aims: This study investigated how PWA communicated meaning using gesture and language in procedural discourses, compared with neurologically healthy people (NHP). We aimed to identify the relative relationship of gesture and speech, in the context of impaired language, both overall and in individual events.Methods & Procedures: Twenty-nine PWA and 29 NHP produced two procedural discourses. The structure and semantic content of language of the whole discourses were analysed through predicate argument structure and spatial motor terms, and gestures were analysed for frequency and semantic form. Gesture and language were analysed in two key events, to determine the relative information presented in each modality.Outcomes & Results: PWA and NHP used similar frequencies and forms of gestures, although PWA used syntactically simpler language and fewer spatial words. This meant, overall, relatively more information was present in PWA gesture. This finding was also reflected in the key events, where PWA used gestures conveying rich semantic information alongside semantically impoverished language more often than NHP.Conclusions: PWA gestures, containing semantic information omitted from the concurrent speech, may help listeners with meaning when language is impaired. This finding indicates gesture should be included in clinical assessments of meaning-making

Verb use in aphasic and non-aphasic personal discourse: What is normal?

Sentence and discourse analysis research provides evidence of both impaired and intact ability in verb production in aphasia, based on comparisons made within aphasic subtypes, and between aphasic and control speakers. Comparisons are complicated due to variation in elicitation tasks and genre, participant sample size, and aphasia subtype, as well as methodological differences in determining fluency. In this study, we examined the impact of aphasia on speakers’ capacity to talk about their quality of life, applying three analytical methods to 58 speakers’ discourse (29 predominantly fluent aphasic speakers; 29 non-aphasic speakers). Both speaker groups produced similar quantity, weight, and type of verbs, with substantial overlap in verb tokens. Relational, material and mental verbs were prevalent. Aphasic speakers had significantly lower predicate argument structure scores, and produced significantly more 0 argument structures, more [Aux+0] constructions, fewer 1 argument structures in general and fewer 1 argument structures with clausal embedding, compared to non-aphasic speakers. This study provides evidence for intact (semantic weight and type) and impaired (PAS) verb production in aphasia. The heterogeneity within both participant samples challenges assumptions of normality and typicality

The benefits of a 5-day dysphagia intensive placement

Finding practical dysphagia opportunities for students pre-qualification is challenging. Discussions with clinicians led to the development of a new placement model. The placement was just five days and had an accompanying workbook. The current study aimed to evaluate the benefits of the placement. Data were analysed from 40 students who attended an adult dysphagia placement and 13 who attended a paediatric dysphagia placement. Measures included a pre and post self-rating questionnaire, qualitative feedback from clinical educators and students and a pre and post measure of knowledge using concept maps. Student self-rating data indicated gains in experience, awareness, knowledge, clinical skills, competence, confidence and interest in dysphagia. Clinical educators and students also reported a range of benefits from this placement. Students who undertook a placement that focused on adult dysphagia significantly increased their knowledge of adult dysphagia, but this did not generalize to paediatric dysphagia. Despite reporting that they felt they had gained in knowledge of dysphagia, the students who did a paediatric dysphagia placement did not significantly increase their knowledge of dysphagia. The study raises a number of important considerations when designing placements including length, timing, intensity, how best to encourage generalization of knowledge, and how best to measure learning

A "novel" reading therapy programme for reading difficulties after a subarachnoid haemorrhage

Background: Although several treatments for acquired reading difficulties exist, few studies have explored the effectiveness of treatment for mild reading difficulties and treatment for reading difficulties associated with cognitive impairment. Aims: This study explored the effectiveness of an individual strategy-based reading treatment of 11 sessions given to a female participant (IW) who had mild reading difficulties following a subarachnoid haemorrhage (SAH). The impact of treatment on reading ability, confidence and emotions associated with reading were investigated. Methods & Procedures: Treatment focussed on the use of strategies to support IW’s memory when reading books, the use of a checklist to select appropriate reading materials, and increasing IW’s confidence in discussing the book she was reading with others. A person-centred approach and personally relevant materials were used throughout the treatment. Reading ability was assessed using the Gray Oral Reading Tests (GORT-4; Lee Wiederholt & Bryant, 2001), and IW’s perspective was obtained using the Reading Confidence and Emotions Questionnaire (RCEQ; see Cocks et al., 2010. Pre-treatment, post-treatment and maintenance (7 weeks post) assessments were undertaken, with an additional exit interview at the final time point. Outcomes & Results: Gains were noted in reading rate, accuracy, comprehension, and confidence, with parallel increased pleasure gained from reading and reduced negative emotions and frustration. Self-reported gains included conversing with others about material read, verbal communication, and re-engagement with the identity of being a reader. Conclusions: Strategy-based treatment resulted in positive gains in reading for pleasure, conversation, and identity, for an individual with mild chronic reading difficulties. Participant self-report and interview reveal the true value of this treatment for the individual. The positive results suggest that further research is warranted that investigates the effectiveness of strategy-based reading therapy approaches for others with acquired reading difficulties

Developing the Enquiring Student and Enhancing the Research-Teaching Interface: Student-led Pedagogical Research and Educational Initiatives in Enquiry Based Learning

This paper describes the progress of a project running at the University of Glasgow to develop elements of Enquiry Based Learning (EBL) in undergraduate degree courses across a range of disciplines. It focuses on the second part of the project but an overview of the first part is also given. During phase 1 of the project, in the summer of 2007, seven undergraduate students spent four weeks working together exploring enquiry based learning (EBL) in the institution’s central, educational development unit. This phase was approached as an EBL exercise itself; the student groups were given full responsibility for the process with the proviso that by the end of this phase they would have developed a guide for staff and students about EBL. The second phase of the project continues throughout the academic year 07/08. Here, each student worked alongside a member of staff from their department of study to develop discipline specific EBL activities taking a research-informed approach to this development. All pairings were charged with introducing EBL such that no major course change procedures had to be followed; this hopefully ensured the sustainability of such adjustments. Staff and students involved in the project represent dentistry, chemistry, biology, theology, law and psychology and the courses under development range from large first year classes to small honours level courses. An overview of the range of enquiry-based learning developments within the courses will be described

Developing the Enquiring Student and Enhancing the Research-Teaching Interface: Student-led Pedagogical Research and Educational Initiatives in Enquiry Based Learning

This paper describes the progress of a project running at the University of Glasgow to develop elements of Enquiry Based Learning (EBL) in undergraduate degree courses across a range of disciplines. It focuses on the second part of the project but an overview of the first part is also given. During phase 1 of the project, in the summer of 2007, seven undergraduate students spent four weeks working together exploring enquiry based learning (EBL) in the institution’s central, educational development unit. This phase was approached as an EBL exercise itself; the student groups were given full responsibility for the process with the proviso that by the end of this phase they would have developed a guide for staff and students about EBL. The second phase of the project continues throughout the academic year 07/08. Here, each student worked alongside a member of staff from their department of study to develop discipline specific EBL activities taking a research-informed approach to this development. All pairings were charged with introducing EBL such that no major course change procedures had to be followed; this hopefully ensured the sustainability of such adjustments. Staff and students involved in the project represent dentistry, chemistry, biology, theology, law and psychology and the courses under development range from large first year classes to small honours level courses. An overview of the range of enquiry-based learning developments within the courses will be described