Anu Klippi

Conversational dynamics between aphasics

Abstract The aim of this study was to determine how aphasic patients take part in conversations, the manner in which their conversations proceed, and how they compensate for their disabilities in maintaining conversational flow. The aphasia group studied contained five aphasics with different symptoms. Four conversations (54 minutes) were videotaped through a one-way mirror and subsequently transcribed. The analysis was based on a seven-category system (moves) and conversational flow was described in terms of active and reactive utterances. The results showed that, using the number of moves and total speech time as criteria, individual speakers varied greatly in their degree of participation in discussions and had different interactive profiles. The speakers were divided into two groups according to the type and severity of aphasia. It was discovered that the groups did not differ in conversational behaviour in terms of active and reactive moves, but the non-fluent speakers differed from the fluent aphasi...

Long- and short-term results of children's and adolescents' therapy courses for stuttering

BACKGROUND It is widely known that most young children recover from stuttering. Evaluations of this spontaneous recovery vary from 40 to 80% of stuttering children. However, if the child is already older than 6 years of age, the spontaneous recovery will be less likely. The effectiveness of stuttering treatment, and especially fluency shaping methods, has been frequently studied. Good results in the treatment of stuttering for school-aged children have been accomplished by several treatment methods. However, stuttering modification treatments have not been studied so intensively. AIMS This study addresses the effects of intensive therapy courses on the stuttering behaviour of children and adolescents. The courses included speech therapy, where stuttering modification treatment was used, and also parental guidance. METHODS & PROCEDURES Taking part in the study were 21 children/adolescents who stutter, and 29 of their mothers/fathers took part in the study. The children were between the ages of 6.8 and 14.0 years. The effectiveness of therapy was evaluated in three ways. First, the speech of the children who stutter was videotaped at both the beginning and the end of the course and the samples were transcribed and analysed. Second, the parents and adolescents completed a feedback questionnaire at the end of the course. And third, the parents and adolescents completed a follow-up questionnaire 9 months after the course. The aim was to evaluate the changes in stuttering behaviour after the therapy course. OUTCOMES & RESULTS The results indicate that stuttering severity became milder or did not change during the course. The percentage of syllables stuttered dropped with two-thirds of the participants. This result was replicated with avoidance behaviour and struggle behaviour. The quality of stuttering became milder, and by the end many children had shorter moments of stuttering and more repetitions and prolongation instead of blocks. Two participants did not complete the questionnaire. Of those who did, all but one adolescent, and all except one parent, reported that the positive changes in stuttering behaviour had continued during the follow-up period. CONCLUSIONS The implication is that intensive therapy courses can be helpful to some participants who stutter.

The top ten: best practice recommendations for aphasia

ABSTRACT Background: The move from nationally focused health services towards healthcare globalisation is apparent with the hope that healthcare services will ultimately follow similar quality standards and guidelines throughout the world. Aphasia United, an organisation representing a broad range of professionals and others interested in improving the lives of those with aphasia, undertook a project to gain consensus on best practices to guide aphasia rehabilitation across multiple countries. Aims: To develop and gain multinational consensus on an initial set of best practice recommendations for aphasia. Methods & Procedures: The project entailed three phases: (1) crafting a draft set of recommendations for aphasia management drawing from research evidence and stroke guidelines, (2) obtaining consensus on recommendations from healthcare experts across multiple countries and (3) creating a strategic plan to facilitate dissemination, revision, further development and uptake of best practices. This article reports on the first two phases of this process. Phase 1 entailed reviewing existing research reviews, national clinical guidelines for stroke and/or aphasia and evidence websites to identify recommendations based on high-quality evidence. Nine national stroke and/or aphasia guidelines were identified to serve as the primary source documents. A qualitative theme analysis was used to extract recommendations from these documents. An auditing reviewer examined the source documents and extracts to ensure that results were consistent with sources. Finally, the recommendations were circulated to an expert panel for input. Phase 2 involved a multiple stage consensus process: (1) discussion of draft recommendations by an expanded panel of experts, (2) cycles of revision by an expert working group, (3) an online survey soliciting agreement from a broader panel of experts and (4) an open-ended online survey soliciting consensus from professionals across multiple countries. Outcomes & Results: The cycles of revision and the final consensus of 500 aphasia experts across multiple countries resulted in 10 best practice recommendations for aphasia including screening, assessment, intervention and discharge recommendations. Conclusions: The top 10 recommendations achieved very strong consensus among participants. These results provide an initial set of recommendations that might serve as a basis for translating evidence into practice to improve aphasia services. Future efforts should be directed at determining barriers to implementation. In addition, individual countries or groups (whether represented in the consensus process or not) will necessarily need to consider the applicability of recommendations to their own cultural and ethnic traditions and national practices.

Pointing as an embodied practice in aphasic interaction

Background: Relatively few qualitative studies have been published on the role of the embodied practices related to aphasic language problems during talk-in-interaction. It has been suggested that one way of adapting to aphasic language is by using different types of embodied practices. The use of embodied practices may reflect an effort to facilitate impaired verbal processing or their use may function as compensatory behavior to deal with troubles arising during conversation or to avoid these troubles arising in the first place. Pointing gestures may refer to the immediate physical environment, such as to a specific object or a specific place, to another participant, or even to speakers themselves. Occasionally, a pointing gesture may refer to more abstract entities, such as distant places or specific moments. Aims: The aim of this article is to explore conversational sequences with persons with aphasia (PWAs) that contain several pointing gestures. It is analysed how PWAs use pointing gestures in conversation when they are faced with complex comprehension problems as well as verbal output problems. Methods & Procedures: The method of conversation analysis is applied in this study. Outcomes & Results: The qualitative analysis in this study supports the assertion that pointing gestures are significant actions in conversation. Pointing is used in various places in talk where PWAs are experiencing difficulty, such as when problems occur in language comprehension as well as in language production, for example, in the absence of a specific word or the grammatical constructions that are needed. The results suggest that pointing gestures are used in a number of ways as an interactional resource. However, the identification of the referent may need extensive interactional work by the participants. Conclusions: These findings suggest that embodied interaction should be explored more extensively in aphasic talk-in-interaction. Conversation with PWAs is a joint and multimodal activity, which also needs to be taken into account in intervention targeted at aphasia.

Lexical repetition as a communicative strategy in Broca's aphasia

This study examines the lexical self- and other-repetition and the strategic use of repetition by two aphasic speakers (J and M) with agrammatic and severe word-finding difficulties in group discussions. Whereas the speakers aphasia profiles were rather similar, as defined by clinical testing (Western Aphasia Battery), their use of lexical repetition as a communicative strategy was significantly different. One speaker (speaker M) had more contextually supported words, especially other-repetitions. M sometimes repeated her own lexical elements and elaborated the repetitions morphologically and prosodically and expanded them syntactically. These elaborated and expanded repetitions were attempts at communicative clarity and grammatical acceptability. After encountering problems in production, speaker M used selfand other-repetition both in affective confirmations and in meaning negotiations. Speaker J, on the other hand, did not attempt to produce grammatical well-formed utterances, but relied on his interlocutors interpretations of his turns. Speaker J did not elaborate or expand his one or two word utterances, but frequently repeated fillers and polite idiomatic phrases. He used more self-repetition, typically in confirmations, to express emotion and in turn keeping, and less other-repetition, which only occurred in negotiations to reach mutual understanding. The methods and results are discussed in the framework of the adaptation theory of agrammatism. We suggest that pathological and communicative repetitions form a continuum and that the study of strategic choices can contribute to the development of communicative speech therapy.

Current clinical practices in Aphasia Therapy in Finland: challenges in moving towards national best practice.

Aims: The objective of this article is to discover and document the state of clinical practices for aphasia therapy in Finland and to gather information for developing national best practice. Methods: Two surveys were administered in Finland that explored current clinical practices in aphasia rehabilitation and the resources available to speech and language therapists (SLTs). We integrated and compared the results of these surveys. The results are based on the responses of the 88 (45 + 43) returned questionnaires from SLTs. Results: Four principle themes were identified: planning the aphasia therapy, measures and assessment methods, current therapy service provision, and development suggestions and barriers to change. The results of this study showed considerable consistency in clinical practices among the respondents to the surveys. However, we noticed that there are some discrepancies between the recent research findings and present clinical practices. Conclusions: The findings from this study indicate that there are many challenges in clinical decision-making at the moment in Finland. The article helps clinicians to evaluate the practices they use and to execute justified modifications in order to implement more effective models of practice. It is evident that national best practice guidelines for aphasia therapy would support SLTs in clinical decision-making.

Grammatical structuring in Broca's and Wernicke's aphasia in Finnish

Abstract The purpose of this paper is to examine the linguistic problems of aphasic speakers of Finnish. The focus is on Brocas and Wernickes aphasia. First, we present an overview of the special characteristics of the grammar of Finnish. Secondly, there is a discussion of previous studies on aphasic speakers of Finnish. Thirdly, we present an analysis of our data from conversation and picture description task by speakers with Brocas and Wernickes aphasia. The analysis focuses on case marking, subject-verb agreement, word order and the expression of tense in the speech of Finnish aphasics. As a whole, many linguistic features are preserved both in Brocas and Wernickes aphasia. Even the neologistic words in Wernickes aphasia are appropriately inflected. However, our findings suggest that aphasic errors are not always systematic and furthermore, they may be context-dependent. For example, Brocas aphasics produced case marking and agreement patterns in some contexts correctly, whereas in some other contexts they were produced erroneously. The word order patterns were similar to those found in conversational discourse in general. However, it is sometimes impossible to give a definitive analysis of the word order or structure of a given grammatical construction. This is due to the fact that sentence structure is sometimes badly distorted both in Brocas and Wernickes aphasic cases because of difficulty in finding lexical content words. We conclude with a comparison of our findings with previous studies of Finnish aphasics, proposing some methodological implications for further studies.

Participating with limited communication means: Conversation analytical perspectives on the interactional management of participation structures

In the following, participation with limited communication means is discussed from an ethnomethodological and conversation analytical (CA) perspective. This perspective establishes a frame for the different contributions to the special issue at hand. The special issue provides a summary of reflections started and research results discussed in an exploratory workshop series on ‘Communicative impairment in interaction. A Nordic perspective on the social organization of disordered talk’, funded by the Joint Committee for Nordic Research Councils in the Humanities and Social Sciences (NOS-HS) in 2014 (Grant number: 229915/ F10). The articles are gathered on the basis of two goals. First, we have a methodological interest in CA studies on communication disorders and aim to highlight their impact for clinical practice. We find that an emphasis on CA may contribute to shifting the prevailing research focus on communication disorders from a cognitive impairment perspective to the interactional management of joint activities, which also includes the physical and organisational environments in which persons with limited communication means participate. Second, this special issue derived from an attempt to get an overview of existing CA research on communication impairment in the Nordic countries of Europe, where there is currently a strong and diverse research agenda developing within the field of CA and communication impairment. It should be noted, however, that the collection of articles in this special issue is not exhaustive, and there are many more Nordic researchers working on communication impairment from a CA perspective. However, the contributions to this special issue are representative for the kind of work that is currently going on, and is on the rise.

Collaborative participation in aphasic conversation before and after intensive language-action therapy

ABSTRACT This study applies conversation analysis to compare everyday conversation samples between a person with aphasia (PWA) and a familiar communication partner (CP) before and after intensive language-action therapy (ILAT). Our analysis concentrated on collaborative repair sequences with the assumption that impairment-focused therapy would translate into a change in the nature of trouble sources, which engender collaborative repair action typical of aphasic conversation. The most frequent repair initiation technique used by the CP was candidate understandings. The function of candidate understandings changed from addressing specific trouble sources pre-ILAT to concluding longer stretches of the PWA’s talk post-ILAT. Alongside with these findings, we documented a clinically significant increase in the Western Aphasia Battery’s aphasia quotient post-ILAT. Our results suggest that instead of mere frequency count of conversational behaviours, examining the type and function of repair actions might provide insight into therapy-related changes in conversation following impairment-focused therapy.

Good results with intensive language-action therapy

Background: Recent advances in neurorehabilitation research have several implications for aphasia therapy. Firstly, massed practice in a short time is emphasized as maximizing therapy quantity, and frequency also maximizes the behavioural and neuronal changes. Secondly, the intertwined nature of language and action calls for rehabilitation in a communicative context. A therapy approach to post-stroke aphasia, Intensive Language-Action Therapy (ILAT, previously CILT) based on neurorehabilitation principles has been developed (e.g., Difrancesco, Pulvermüller, & Mohr, 2012). ILAT or its variants called constraint-induced (CI) treatment approaches, has attracted considerable interest and given promising results (e.g., Meinzer, Rodriguez, & Gonzalez Rothi, 2012). Since conversation is the most common linguistic activity in our everyday life, conversational principles are included to ILAT. The therapy is delivered intensively in a small-group setting, which forms a relevant context for social language use. Aims: The broader aim of the study was to examine the effects of ILAT and transcranial magnetic stimulation as well as to examine the effect of their combination on aphasia. An important perspective of the study is the question of generalization and ecological validity of the therapy. Thus, a second aim of the study was to explore the impact of ILAT on everyday conversation. In this paper, we will focus on reporting the results of ILAT. Methods: Our randomized clinical control study recruited 17 persons with a neurological diagnosis of chronic aphasia (over 1 yr. post-stroke). Wemainly included persons with anterior type of aphasia originally (e.g., Broca’s → later anomic aphasia) but some persons with conduction aphasia were included as well. The subjects received either repetitive transcranial magnetic stimulation (rTMS) or sham-stimulation for 4 weeks (groups A and B) combined the first 2-week period with noun and verb naming exercise. The last 2 weeks of treatment was combined with ILAT. Thus, all subjects receive totally 30 h of ILAT treatment during 2 weeks. The primary outcome measure was the score change from baseline to the end points in the Aphasia Quotient (AQ) of the Western Aphasia Battery. In addition, the Boston Naming Test (BNT) and the Action Naming Test (ANT) were used as secondary outcome measures. All measurements were administered at four time points (at weeks 1, as baseline, and 4 and 7 and 3 months after therapy as follow-up). Data have been analysed statistically. During the study, we also collected data from interviews and the participants video-recorded everyday conversations with their significant others at their homes. Parts of special interest in the conversations (e.g., word-finding and repair sequences) have been transcribed and examined according to conversation analysis.