Charlotta Plejert

Response Practices in Multilingual Interaction with an Older Persian Woman in a Swedish Residential Home

In the present case study, a care encounter between an older multilingual (Farsi/Swedish/English) Persian woman and staff in an ordinary, Swedish residential home is investigated. The woman is perceived as suffering from dementia symptoms, but has not received any formal diagnosis of the disease. More specifically, the study focuses on how the womans contributions in her mother tongue, Farsi, are responded to by a carer, who is also multilingual and speaks Swedish as a second language (L2), but has a very limited knowledge of Farsi. The data consists of recorded material from a mundane morning activity in the residential home, as the woman is undressed and prepared to go to the shower. The method employed is conversation analysis, and the study addresses the interactional outcome of this type of multilingual encounters, highlighting the way the establishment of mutual understanding is negatively affected by the fact that the participants do not or only to a limited extent share a common language. Analysis of the data shows that most of the womans contributions in Farsi are responded to in L2-Swedish by the carer, primarily by means of seven different response practices: soothing talk, instrumental talk, minimal responses, explicit expressions of understanding, mitigating talk, questions, and appraisal. The findings are discussed in light of new demands on Swedish (and Western) care- and health care systems to adapt to the increasing number of multilingual, older people, who will become residents in care facilities and attend day centers within the coming years.

‘There’s a letter called ef’ on Challenges and Repair in Interpreter-Mediated Tests of Cognitive Functioning in Dementia Evaluations: A Case Study

In the Scandinavian countries Sweden, Denmark, Norway, and Finland, the number of first generation migrants reaching an old age, who will be in need of age-related health-care, is rapidly increasing. This situation poses new demands on health-care facilities, such as memory clinics, where patients with memory problems and other dementia symptoms are referred for examination and evaluation. Very many elderly people with a foreign background require the assistance of an interpreter in their encounter with health-care facilities. The use of, and work by an interpreter is crucial in facilitating a smooth assessment. However, interpreters, clinicians, as well as patients and their companions, may be faced with many challenges during the evaluation procedure. The aim of this case-study is to highlight some of the challenges that occur in relation to a specific activity within the dementia evaluation, namely the test of cognitive functioning. Special attention will be paid to the phenomenon ‘repair’, i.e., participants’ joint attempts to solve upcoming difficulties during the course of interaction. Results show that sources of trouble may be related to the lack of cultural, linguistic, and educational adaptation of the test to the patient, and to interpreter and clinician practises. Findings will be discussed in terms of test-validity, clinician and interpreter training, and the institutional goals and constraints of the dementia evaluation. The methodology Conversation Analysis has been used to conduct a highly detailed analysis of participants’ practices and actions during the administration of the test.

Dementia care for people from ethnic minorities: a Nordic perspective

Most Western countries have a sizeable ethnic minority migrant population. Although traditionally culturally homogenous, this is also true for the Nordic countries. In 2013, the population of foreign-born and first degree descendants constituted 21% of the population in Sweden (http://www.scb.se), 14% in Norway (http://www.ssb.no), 9% in Denmark (http://www.statistikbanken.dk), and 4% in Finland (http://www.stat.fi). Ethnic minority groups differ substantially between countries. Although differences also exist between the Nordic countries, migrants from former Yugoslavia, Turkey, Pakistan, and Poland represent some of the largest ethnic minority groups across the countries. The ethnic minority populations in Nordic countries are younger than the majority populations, but during the next decades, many will reach old age. Thus, the number of people from ethnic minorities with dementia is expected to increase considerably during the next 25 years (Figure 1). On the basis of this fact, Nordic countries now face an increasing demand for assessment, treatment, support, and care for people from ethnic minority groups. Although pioneering studies on dementia care for people from the Finnish minority in Sweden were conducted in the early 1990s (Ekman, 1993), it is not until the last 5 years that research and developments in the field of dementia and ethnic minorities have slowly emerged throughout the Nordic countries. Taken together, the research and clinical experiences indicate that the current practice for care for people from ethnic minority groups is suboptimal. Older members from ethnic minority groups and their families seem to underuse dementia services, and only 11% of the expected number of elderly from ethnic minorities with dementia receives a formal dementia diagnosis (Nielsen et al., 2011). This is concerning as it may lead to poorer dementia outcome and care for people from ethnic minorities. The barriers to accessing dementia services have not been well studied but may include language barriers, different help-seeking patterns, poor knowledge, and misconceptions about dementia, in addition to different cultural views on caregiving. When evaluating memory problems in patients from ethnic minorities, clinicians sometimes rely on unqualified interpreters or family members as interpreters. This may affect the evaluation and be a barrier for efficient communication. Also, most clinics perform assessments with cognitive instruments that are only validated in Western populations. These challenges are not only present in the Nordic countries but seem to be similar across Europe (Nielsen et al., 2011). Although the Rowland Universal Dementia Assessment Scale has been validated (Nielsen et al., 2013) and implemented for multicultural cognitive screening in several dementia clinics across Denmark, Sweden, and Norway, culture sensitive dementia services are generally lacking. In Nordic countries, few older members from ethnic minority groups live in care facilities, and when they do, the communication and interaction between staff and elderly, who do not have any language in common, has proven to be challenging and to affect the quality of care (Plejert et al., 2014). Mainstream care facilities are rarely prepared to provide appropriate services for patients and families from ethnic minorities, as they often will have different needs and expectations to the dementia services. Although efforts to deliver culturally sensitive and appropriate care for elderly from ethnic minorities exist in all Nordic countries, they are scarce. Figure 1 Prognosis for foreign-born and first degree descendants with dementia in Denmark. Prevalence estimates are based on demographic data from Statistics Denmark and West European dementia prevalence rates from the World Alzheimer Report 2009.

Embodiment in tests of cognitive functioning: A study of an interpreter-mediated dementia evaluation.

This study explores how manners of mediation, and the use of embodiment in interpreter-mediated conversation have an impact on tests of cognitive functioning in a dementia evaluation. By a detailed analysis of video recordings, we show how participants—an occupational therapist, an interpreter, and a patient—use embodied practices to make the tasks of a test of cognitive functioning intelligible, and how participants collaboratively put the instructions of the tasks into practice. We demonstrate that both instructions and instructed actions—and the whole procedure of accomplishing the tasks—are shaped co-operatively by embodied practices of all three participants involved in the test situation. Consequently, the accomplishment of the tasks should be viewed as the outcome of a collaborative achievement of instructed actions, rather than an individual product. The result of the study calls attention to issues concerning interpretations of, and the reliability of interpreter-mediated tests and their bearings for diagnostic procedures in dementia evaluations.

On the use of Conversation Analysis and retrospection in intervention for children with language impairment

Models of speech and language intervention for communicative disabilities vary from structured programmes to more interactive and ecological methods (Fey, 1986). Ideally, a model for intervention should fit the interests and personality of the patient, focus on crucial aspects of speech and language, and be suited to the patient’s everyday communication needs (Johnston, 2006). The present article addresses how features of everyday interaction and speech and language intervention may be captured and used for children with language impairment (LI), their caretakers, and speech and language therapists (SLTs), within and outside of clinical practice. Specifically, the aim of the study is to explore the use of retrospection (Erickson and Schultz, 1982), based on Conversation Analytical (CA) methodology (e.g. Schegloff, 2007), and to establish if and how CA-based retrospection may contribute to raising participants’ awareness of their own and others’ interactional behaviours. Retrospection here refers to sessions where participants watch and comment on sequences of video-recordings from intervention, as well as from situations captured in a variety of everyday settings. Four children with LI and three speech and language therapists participated, as well as parents of the children. The procedure comprised analysis and transcription of video-recordings of everyday interaction and intervention involving the children, retrospections with the children, the parents of the children with LI, and the SLTs, and analysis and transcription of the recordings made of the retrospections. The analysis of the retrospections generated four categories of phenomena relevant for intervention and everyday interaction: (1) Observations of well-functioning interaction strategies; (2) Observations of less well-functioning interaction strategies; (3) Assessment of positive performance; and (4) Comments relating to intervention. The results show that CA-based retrospection may be used to raise the participants’ awareness of their own interactional behaviours, and provide the opportunity to discuss strategies relevant for both intervention and everyday interaction for children with LI.

Enhanced patient involvement in Swedish aphasia intervention

ABSTRACT The present article is a case study in which participation is investigated in terms of the use of interactional practices that enhance the involvement of a man with severe aphasia in activities that aim to capture his and his wife’s experiences of everyday communication, and their views of his speech and language intervention. Five practices are identified: 1) collaborative telling, 2) formulations, 3) yes/no questions, 4) declaratives and 5) hint-and-guess strategies. It is demonstrated how participants’ (wife, a speech and language pathologist, and two research assistants) use of these practices are beneficial for making the viewpoints of the man with aphasia come across, despite his communication difficulties. Results are discussed in light of the importance of finding ways to make patients influence their own intervention, both in terms of a raised awareness of facilitative interactional practices and of activities such as interviews and retrospection sessions with patients and their significant others.

Video Recording as a Tool for Assessing Children’s Everyday Use of Features Targeted in Phonological Intervention

The last decades, speech and language pathology services have been subject to changes, and there has been a growing demand for intervention activities to be effective and evidence-based. The aim of the present study was to investigate if and how video recording can be used to assess the use of features targeted in phonological intervention, in everyday talk by children with LI. Three five-year-old girls with phonological problems participated in the study, and data consist of video recordings of intervention sessions and of interaction at home. Three different paths of development were identified: Some targeted speech sounds are displayed in everyday interaction; Targeted speech sound is present in intervention-like activity; No displays of targeted sounds. The results of the present study clearly demonstrate that the use of video recordings, transcriptions and analysis of interaction outside of the clinical setting contribute important information that may guide planning, goal-setting and evaluation of intervention.

Defusing practices as mitigation in speech and language intervention

In the present paper, speech and language intervention was investigated in order to explore the use and function of defusing practices. Defusing practices may be viewed as a special form of mitigation. In previous research, including studies on clinical interaction, mitigation has been described mainly as devices used in order to reduce the unwelcome effects of an utterance, or reduce the discomfort of bad news. Defusing practices, however, appear to serve somewhat different functions, which are examined here. Data comprises video and audio recordings of eight intervention sessions with children with language impairment (LI), and six intervention sessions with adults with aphasia, The analysis revealed the following kinds of defusing practices: circumscriptions/figurative language, diminutive words, words like ‘try’ or ‘test’, placing the problem outside of the patient, collective pronouns, diminishing the speech and language pathologist’s own competence, encouragement, and references to well-known phenomena. If speech and language therapists (SLPs) are made aware of the practice and function of defusing, they may make conscious use of these practices in order to reduce face-threatening situations in intervention

Language Development in Normal Children and in Disease – An Interactional Approach to Typical Language Development and Children with Language Impairment

The aim of the present chapter is to give an account of an interactional perspective on language development of typical children as well as of children in disease, more specifically children with language impairment (LI). The chapter presents three important theoretical frameworks for child language development: nativism, connectionism, and interactionism. This is followed by an overview of the commonly accepted stepwise progression in the development of language in children and a presentation of the characteristics and etiology of LI. An interactional perspective is brought to the fore, particularly focusing on aspects of child–adult interaction in everyday and clinical contexts. It is claimed that language acquisition ought to comprise not only features of vocabulary and grammar development but also the subtleties of human social interaction. It is argued that to become and be perceived as a competent participant in social interaction requires the development of interactional skills such as learning and adapting to turn-taking patterns, acquiring an interactional behavior adequate for specific social activities, and participation frameworks. The opportunities for doing so are often more limited for children with LI than for children with typical language development, which in turn may have a negative effect on the developmental potential in children with LI.