Claire Croteau

Overprotection, “speaking for”, and conversational participation: A study of couples with aphasia

Background: Spouses play a major role in adaptation following the onset of their partners aphasia. Sometimes, overprotection can occur in the relationship and this may be a disadvantage in adapting to aphasia. Overprotection from spouses can manifest itself in conversation when the spouse “speaks for” the person with aphasia and this could affect his or her participation in conversation. This research was supported by a grant from Social Sciences and Humanities Research Council of Canada. The participants are gratefully acknowledged. We would like to also thank the speech‐language pathologists and the associations of people with aphasia who referred us many participants. Aim: The aim of the present research was to study the phenomenon of overprotection, “speaking for” behaviours in conversation as well as the person with aphasias participation in conversation. Methods & Procedures: A total of 18 couples, each including one person with aphasia, participated in this study. The perceptions of overprotection by persons with aphasia and their spouses were measured with the Overprotection Scale for Adults (Thompson & Sobolew‐Shubin, 1993) and the Questionnaire on Resources and Stress for Families with Chronically Ill or Handicapped Members (Holroyd, 1987). The participants were also videotaped in an interview situation where they answered questions on a systematic turn‐by‐turn basis. “Speaking for” behaviours, defined as the conversational turns in which the non‐aphasic spouse expressed an opinion or added information when the person with aphasia was clearly talking with the interviewer, were measured. Participation was measured by tabulating the number of contributive turns produced by the person with aphasia and the spouse in the nine turns following the “speaking for” behaviour. Participation of the aphasic person was considered “minor” if the number of those turns was fewer than those produced by the spouse. Outcomes & Results: Results showed that overprotection reported by spouses was positively associated with “speaking for” behaviours produced by spouses. “Speaking for” behaviours were positively related to minor participation in conversation. Aphasia severity and motor disability were also associated to minor participation of persons with aphasia in conversation. Conclusions: More research on overprotection and its effects on conversation is needed to further our understanding about the links between communication and psychosocial aspects of aphasia. In rehabilitation, attention should be given to overprotection and “speaking for” behaviours on the part of the spouse. In fact, the person with aphasia and the rehabilitation teams efforts to improve language and communication could be labour in vain if overprotection and “speaking for” behaviours on the part of the spouse develop and persist.

A description of the personal and environmental determinants of participation several years post-stroke according to the views of people who have aphasia

Background: People with aphasia face situations of handicap in their daily life and activities for which they were not fully prepared in rehabilitation. Aims: The present research aimed to explore the factors that facilitate or hinder participation according to people who live with aphasia. Methods & Procedures: Seventeen persons with chronic aphasia were interviewed in semi-structured small discussion groups. The transcripts of the discussions were analysed qualitatively by breaking them up into excerpts and regrouping the excerpts with similar meaning. Outcomes & Results: Participants mentioned more factors facilitating than hindering participation. Facilitating factors included: helpful family members, aphasia community organisations and their own positive personal characteristics, such as determination. Barriers to participation were, for example, poorly adjusted speakers and limited services post-stroke. Specific impairments such as communication problems and physical limitations as well as unfavourable identity factors, such as pride and fears, were also described. Conclusions: Rehabilitation professionals should refocus the services they provide to families, couples and friends to ensure that people with aphasia maintain a positive identity, optimal communication and satisfying relationships. Persons with aphasia should be empowered to ask for services in their community post-rehabilitation. Participation-based models of therapy may better serve the needs of people with aphasia and prepare them for living with aphasia.

A qualitative longitudinal case study of a daughter's adaptation process to her father's aphasia and stroke

Background: Aphasia has repercussions on the lives of families who adjust to the new situation of their parent. Most data concerning how family members adapt to aphasia concern spouses, and less so children. However, adult children are likely to encounter specific problems because of the different nature of parent–child relationships. Aims: This study aimed to describe the experience of a daughters adaptation process to her fathers stroke and aphasia during the first year post‐stroke. Methods & Procedures: A qualitative approach was employed to explore the experience of one individual recounted in the context of face‐to‐face interviews. The participant was a 31‐year‐old woman living with her parents at the time her father became aphasic at the age of 60 years. Three interviews were conducted: (1) when her father began outpatient rehabilitation, (2) near the end of outpatient rehabilitation, and (3) three months later. Outcomes & Results: Results revealed that the sources of stress for this participant evolved over time from initial concerns for her fathers survival and health, to preoccupations concerning her fathers communication and their relationship, and lastly to concerns about how her own life had been altered. In reaction to stress the participant was proactive, obtained information, modified her communication with him, and oversaw his health and treatments. Over time some of the negative consequences diminished and more positive indicators emerged. The strategies the participant employed allowed her to feel she did the right thing, and also she preserved her self‐esteem. However, at the last interview she still suffered from the changes in her relationship with her father and their communication restrictions. Conclusions: The results indicate that the experience of a daughter was an evolving process, involving negative and more positive consequences. The process of adaptation was influenced by the particular life situation of this participant, her perception of stresses, and the types of strategies she employed. These results show that children may be stressed by many changes associated with a stroke, such as communication limitations. When possible, adult children should be included in the rehabilitation process since they provide skills, abilities, and affection in caring for their parent with aphasia. These may contribute to the reduction of overall stress related to a familys adaptation to the consequences of aphasia and stroke.

Development of a procedure to evaluate the contributions of persons with aphasia and their spouses in an interview situation

Background: Although there has been increasing interest in the study of conversations between people with aphasia and their partners, the participation of persons with aphasia in conversation with their spouses in the presence of a third party has not been extensively investigated. Nevertheless, opportunities for such situations are frequent, and therefore provide an interesting opportunity to examine how couples collaborate. This research was supported by grants from Social Sciences and Humanities Research Council of Canada and Les Fonds de la Recherche en Santé du Québec. The participants are gratefully acknowledged. We would like to also thank Christiane Malaborza, Claudia Morin, Ève Nadeau, the speech‐language pathologists, and the associations of people with aphasia who referred many participants to us. We also extend our gratitude to Nina Simmons‐Mackie for helpful comments. Aims: (1) To develop a procedure to analyse conversations that would specifically address the contributions of persons with aphasia and their spouses in an interview situation. (2) To describe spousal contributions in an interview situation, including what preceded and followed these contributions, in a group of couples with a member with aphasia. (3) To verify the inter‐judge reliability of the procedure. Methods & Procedures: Videos of three couples with aphasia in an interview situation were analysed. Contributions of the spouse when the participant with aphasia was clearly speaking with the interviewer, contexts in which spouses contributed, reactions of persons with aphasia, and their participation following contributions were described. Definitions were created, operationalised, tested, and refined on 11 other similar couples in the same interactive situation. Eight other couples were then videotaped and studied. Outcomes & Results: Results revealed that half the contributions produced by the spouse were “repairs” and the other half were “speaking for” behaviours. Most often, contributions were unsolicited. Generally, the person with aphasia approved the spouses contribution and continued afterwards to take an active part in the conversation. Inter‐judge reliability coefficients varied between 89% and 97%. Conclusions: The procedure employed is representative of situations encountered by couples affected by aphasia. The data collection and analysis methods could be applicable to clinical situations. It is important to consider spousal contributions and their impact on the person with aphasia in conversations when helping couples adjust to the consequences of aphasia.

Life habits of school-aged children with specific language impairment as perceived by their parents and by school professionals

PURPOSE Describe social participation of a group of children with specific language impairment. METHOD 26 parents of children with specific language impairment (SLI) aged from 5 to 13 years and 11 school professionals participated in the study. Data collection was performed with the adapted version for children aged from 5 to 13 years old of the Assessment of Life Habits (Fougeyrollas et al., 2001). The questionnaire encompasses 196 life habits, grouped in 12 dimensions: nutrition, fitness, personal care, communication, housing, mobility, responsibilities, interpersonal relationships, community life, education, work and recreation (Fougeyrollas, 2010). RESULTS According to their parents and school professionals, children in this study carried out without difficulty life habits related to housing and mobility. However, they experienced difficulty with life habits related to interpersonal relationships, recreation and responsibilities, in addition to communication and education. CONCLUSIONS Children with SLI are perceived by their parents and school professionals as having reduced social participation in many aspects of their daily life. Social participation should be considered as a major outcome when offering services in school to these children. This study proposes specific ways to help children with SLI.

Exploration of a quantitative method for measuring behaviors in conversation

ABSTRACT Background: The literature on communication partner training (CPT) includes mainly studies with a small number of participants, because methods to measure changes in conversation pose practical challenges limiting the analysis of large samples. Aim: The aim of this study was to explore a quantitative procedure that would allow one to measure specific behavioral changes occurring in conversational exchanges involving a person with aphasia and a partner. Methods & Procedures: Forty-three problem-solving situations presented visually as well as with a simple written explanation were created to elicit conversation. In order to test the situations and develop further a procedure, we used data from a spouse of a man with aphasia during CPT delivered in a clinical setting. We developed specific definitions related to conversational behaviors targeted in the CPT. These defined behaviors were analyzed using a transcription-less method and an annotation software in the couple’s 39 conversation samples collected before, throughout, and 3-months post CPT. Reliability data were collected. Outcomes & Results: The procedure enabled us to create a protocol with two types of conversational situations and reliable definitions for measurement of conversational behaviors in a timely fashion. Pilot data of the measures are provided. Conclusions: It is expected that the method presented in this pilot study may be used to document the outcomes of CPT. It could be used with single-subject designs that require repeated measures and multiple group designs that require comparable data over large samples. It provides a method of data collection and analysis to better evaluate the effects of conversation-based treatments such as CPT.

Perspectives on Aphasia Intervention in French-Speaking Canada

The current status of intervention for aphasic persons in French-speaking Canada shares characteristics with the culture of Quebec, the Canadian province where most persons speak French. Although Quebec is North American both geographically and in terms of its institutions, historically and linguistically it is French. American and French cultural influences have intermingled to create a unique combination. Thus, just as the legal institutions in Quebec proceed both from English and French influences (the institutions themselves are British but the civil code is Napoleonic), intervention for aphasia proceeds from both the American and the French schools. The result is a unique combination of these two influences.

How training to improve interactions with people having a communication disorder changed communication strategies used by adapted transport drivers

Background: To facilitate the social participation of persons with aphasia in the society, people who work in public spaces could learn to communicate better with them (Dalemans, de Witte, Wade, & van den Heuvel, 2010; Howe, Worrall, & Hickson, 2008). Indeed, without adaptations, people with aphasia can experience difficult social interactions, which could limit their access and participation in the community (Bunning & Horton, 2007). Communication Partner Training could be an intervention offered to unfamiliar partners. A systematic review suggested that it should be offered to partners of people with chronic aphasia to improve their skills to facilitate communication (Simmons-Mackie, Raymer, & Cherney, 2016). However, the effects of unfamiliar partner communication training are less documented. Aims: To develop and document the effect of a training programme aiming to facilitate the interactions between adapted transport drivers and users with a communication disorder. More specifically, the objective is to measure the changes in the communication strategies used by adapted transport drivers who followed the training programme. Methods & Procedures: Design. A pre-post design was used. Participants. Thirteen adapted transport drivers participated in the training programme. Intervention. The training programme, delivered by a speech-language pathologist, was 6 h long and divided into 2 sessions. It used a participative approach and employed training methods such as discussion, role play, and video analysis. It was developed using a developmental research approach (Harvey & Loiselle, 2009). The training prototype was based on the communication needs of people living with a communication disorder (PWCD), on the literature about training unfamiliar partners and interviews with seven drivers. The prototype of the training was presented to an expert committee in order to make sure that it met its stated goals. It was then adjusted based on their feedback. Communication strategies taught in the programme were organised in three communication profiles (expressive, receptive and pragmatic). For example, participants were taught to use visual support, gestures, closed questions, etc. Data collection. To

The effects of a conversational intervention aiming to increase pleasant moments in conversation in a dyad in which one member has a severe aphasia

Background: Communication partner training is a recommendation consistently made in documents describing best practices for aphasia rehabilitation (e.g., Power et al., 2015). Studies are still needed to improve the knowledge about this type of intervention and its effects. More precisely, more information is needed regarding general conversational behaviors that should be targeted in this type of training or in conversational intervention (Simmons-Mackie, Savage, & Worrall, 2014). It would be relevant to know which behaviors facilitate conversation the most and how intervention should be conducted. Aims: Measure the effects of a conversational intervention offered to a couple where one member has severe aphasia. Methods & Procedures: A mixed methods study was conducted. Conversational measures were gathered at each session before (three sessions), three sessions during intervention as well as 1 month (three sessions) and 4 months (three sessions) after the end of intervention. The overall goal of the intervention was for the couple to have more pleasant conversations, as a lot of tension was observed in the pre-intervention videos. In order to achieve this goal, three behaviors were targeted, two being considered as barriers and one as supportive: (1) the interruptions with tension (for example, with a loud voice) made by the person with aphasia (PWA), (2) the corrections made on the PWA ideas or words by the spouse, (3) the use of written words by the spouse. During intervention, the speech-language pathologist (SLP) and the couple looked at excerpts of the couple’s conversations and discussed which strategies and behaviors supported or not the conversation. The SLP suggested different topics of conversations in order to practice the use of the written word strategy and to recognize behaviors that were barriers in conversation. She then asked the couple to assess the pleasantness of the conversation on a score from 0 to 10. This also helped the participants verbalize how they felt in conversation. Moreover, the SLP discussed with the couple how to manage frustration in conversation in day-to-day interaction. In order to measure the effects of the intervention, the couple participated in two types of conversations, one was relatively free and the other was more argumentative in

Service encounter interactions of people living with moderate-to-severe post-stroke aphasia in their community

ABSTRACT Background: Access to the community is recognised as a need as well as a right for people living with a disability, including people living with aphasia (PLWA). Although studies have shown factors that hinder or support participation of PLWA, few examined naturally occurring interactions outside the home. Aims: This qualitative study aimed to describe the structure of natural interactions occurring between people with aphasia and individuals at the checkout in service encounters. Methods and Procedure: Six participants with moderate-to-severe expressive post-stroke aphasia were video-recorded during commercial interactions within their community environment. Data collection took place in grocery stores, supermarkets, restaurants, drug stores, coffee shops, specialised shops, and a movie theatre. A total of 20 commercial interactions were analysed using conversation analysis. Outcomes and Results: The interactions between PLWA and checkout assistants during payment were characterised by a sequence of four communication stages based on mutual agreement of (1) their availability for the commercial transaction, (2) the item(s) that would be purchased, (3) the price, and (4) the fact that the interaction was over. The second and third parts of the sequence were more challenging in terms of physical access to the desired item(s) or its representation in stage two and access to a visual display of the price in stage three influenced the communication accessibility of the stores. Conclusions: The present findings suggest that PLWA can successfully participate in interactions involving the purchase of goods, even if aphasia is severe, as these interactions are structured by communication and four stages of mutual agreement. During rehabilitation, speech–language pathologists could help prepare PLWA to carry out commercial transactions in self-selected shops to support active community participation post-rehabilitation.