Ray Wilkinson

Intervening With Conversation Analysis in Speech and Language Therapy: Improving Aphasic Conversation

In this review, I discuss conversation analytic informed intervention for aphasia, a language disorder acquired following brain damage. As well as describing this form of intervention and outlining features of the studies produced over the last 15 to 20 years that provide evidence of its effectiveness, I discuss some features of this approach that may be of relevance to interventionist conversation analysis more generally. Data are in British English and in Swedish with English translation.

Living With Semantic Dementia: A Case Study of One Family’s Experience

Semantic dementia is a variant of frontotemporal dementia and is a recently recognized diagnostic condition. There has been some research quantitatively examining care partner stress and burden in frontotemporal dementia. There are, however, few studies exploring the subjective experiences of family members caring for those with frontotemporal dementia. Increased knowledge of such experiences would allow service providers to tailor intervention, support, and information better. We used a case study design, with thematic narrative analysis applied to interview data, to describe the experiences of a wife and son caring for a husband/father with semantic dementia. Using this approach, we identified four themes: (a) living with routines, (b) policing and protecting, (c) making connections, and (d) being adaptive and flexible. Each of these themes were shared and extended, with the importance of routines in everyday life highlighted. The implications for policy, practice, and research are discussed.

Conversation and aphasia: advances in analysis and intervention

The papers in this special issue share two major features in common. First, in each case, the research presented takes as its main focus of attention conversational interactions involving one or more persons with aphasia. In some cases, these are interactions between a person with aphasia (PWA) and someone in a professional relationship to them, such as a speech and language therapist (SLT)/pathologist. In others, they take the form of conversations between people with aphasia and those with whom they interact most in their daily domestic lives, such as their spouse, other family members, or friends. Second, the research in each of the papers draws on the methods and findings of one particular approach, Conversation Analysis (CA) (Sidnell, 2010; ten Have, 2007). This shared orientation results in commonalities across the papers in terms of what types of interactional data are collected, how those data are collected and represented (in particular, in terms of data transcription), and which aspects of these data are analysed and how. In some of the papers, the analysis is used as the basis for planning and targeting an intervention, which is then implemented with possible changes postintervention evaluated by again collecting and analysing interactional data. Reporting on research carried out in the UK, Finland, Sweden, the USA, Australia, and South Africa, the papers here bear testimony to the continued growth of a body of work which draws on CA to provide insights into the nature of aphasia and of aphasic interaction (i.e., interaction that involves one or more persons with aphasia). In addition, as is amply demonstrated here, the use of this approach within aphasiology has been highly productive in generating research which involves the targeting, implementation, and evaluation of intervention in order to improve conversations for people with aphasia and their everyday conversational partners (Wilkinson, 2010; Wilkinson & Wielaert, 2012). Indeed, this growth in intervention studies constitutes one of the main advances that has taken place within the field since the publication of the previous special issue on Conversation Analysis and Aphasia in this journal (Hesketh & Sage, 1999).

Adapting to conversation with semantic dementia : using enactment as a compensatory strategy in everyday social interaction

BACKGROUND Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. AIMS To examine the everyday conversation, at home, of an individual with semantic dementia. METHODS & PROCEDURES A 71-year-old man with semantic dementia and his wife were given a video camera and asked to record natural conversation in the home situation with no researcher present. Recordings were also made in the home environment, with the individual with semantic dementia in conversation with a member of the research team. Conversation analysis was used to transcribe and analyse the data. Recurring features were noted to identify conversational patterns. OUTCOMES & RESULTS Analysis demonstrated a repeated practice by the speaker with semantic dementia of acting out a diversity of scenes (enactment). As such, the speaker regularly used direct reported speech along with paralinguistic features (such as pitch and loudness) and non-vocal communication (such as body posture, pointing and facial expression) as an adaptive strategy to communicate with others in conversation. CONCLUSIONS & IMPLICATIONS This case shows that while severe difficulties may be present on neuropsychological assessment, relatively effective communicative strategies may be evident in conversation. A repeated practice of enactment in conversation allowed this individual to act out, or perform what he wanted to say, allowing him to generate a greater level of meaningful communication than his limited vocabulary alone could achieve through describing the events concerned. Such spontaneously acquired adaptive strategies require further attention in both research and clinical settings in semantic dementia and analysis of interaction in this condition, using conversation analysis, may be helpful.

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.

Life story resources in dementia care: a review

PURPOSE Life story work has a relatively long tradition in the caring sciences and is recognised as an important component of dementia care and practice. However, to date, there has not been a review of accessible life story resources. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH Following a systematic approach to identification and inclusion, 11 life story resources were reviewed to ascertain areas of commonality and divergence between the materials. FINDINGS The authors were able to group the analysis under eight areas and at the end of this process, it was uncertain if life story work is a formal staff intervention or an informal activity that people with dementia and their families could engage in. Resources also varied in terms of whether the life story information was organised in a chronological way, or with topics of interest/discussion or with a combination of both. Life story evaluation and its impact on the life of the person with dementia is in need of development. PRACTICAL IMPLICATIONS Across the resources the authors identified four reasons to do life story work which the authors have named as: emotional connections; interactional connections; building new connections and practical care connections. SOCIAL IMPLICATIONS There was limited guidance aimed at helping people with dementia to develop and compile their own life story. ORIGINALITY/VALUE This paper provides new insights into the usefulness, future directions and content of life story resources in dementia care. It will be of interest to those in health and social care as well as people living with dementia.

Speaker Transfer in Children's Peer Conversation: Completing Communication-aid-mediated Contributions

Abstract Managing the exchange of speakers from one person to another effectively is a key issue for participants in everyday conversational interaction. Speakers use a range of resources to indicate, in advance, when their turn will come to an end, and listeners attend to such signals in order to know when they might legitimately speak. Using the principles and findings from conversation analysis, this paper examines features of speaker transfer in a conversation between a boy with cerebral palsy who has been provided with a voice-output communication aid (VOCA), and a peer without physical or communication difficulties. Specifically, the analysis focuses on turn exchange, where a VOCA-mediated contribution approach completion, and the child without communication needs is due to speak next.

Gestural depiction in acquired language disorders: on the form and use of iconic gestures in aphasic talk-in-interaction.

Abstract This paper uses conversation analysis to investigate the form and use of iconic gestures by a man with severe Broca-type aphasia in interaction with his speech and language therapist. Deconstructing iconic gestures into the different types of methods used to produce them, the paper analyzes how these gestures can depict certain entities, such as actions or types of people, in ways that may be understandable to the recipient. It is also observed that these iconic gestures can constitute gestural contributions, which not only communicate certain semantic meanings, but also accomplish social actions, such as answering or repairing. The implications of this analysis for our understanding of compensatory behavior in aphasia, and of augmentative and alternative communication in social interaction more generally, are discussed.

Problems with the understandability of aphasic talk: mentions of persons as a trouble source in interaction

Background: In this single case study we draw on conversation analytic methods and findings to investigate how a speaker with aphasia produces mentions of persons within conversation and how these mentions are regularly treated by the speaker’s recipient as difficult to understand. As well as names, mentioning persons can involve other types of linguistic forms including category terms (such as “father”, “baby”, and “scanner girl” which are used in this data set) and pronouns. Mentioning can also involve different forms of action in relation to the mentioned person (e.g., referring to someone versus describing someone). Recurrently in this data set the recipient uses other-initiation of repair to display problems in understanding which particular individual is being mentioned by the person with aphasia (PWA) and what action is being signified in relation to that person. Aims: To investigate in what ways the PWA’s mentioning of persons in conversation leads to displays of problematic understanding for the recipient, and to investigate possible factors involved in the problematic nature of this speaker’s person mentions. Methods & Procedures: The PWA was assessed on tests of language and executive functioning and was recorded in conversation with a research speech and language therapist. The conversational data were transcribed and analysed using conversation analytic methods. The PWA was also assessed on a battery of language and executive function tests. Outcomes & Results: We analyse four instances within one continuous episode of conversation where the mention of a person by the PWA results in a difficulty for the recipient in understanding which particular person is being mentioned. It is also evident that a difficulty in understanding one person mention can impact negatively on the recipient’s ability to understand other, linked, person mentions. On some occasions the linguistic forms used by the PWA to signify particular people did not appear to be well chosen in terms of taking into account the knowledge state of the recipient and how she would recognise who was being mentioned. The PWA’s talk also led to difficulties for the recipient in recognising what kind of mentioning (e.g., referring or describing) the PWA was engaged in at particular points in the conversation. Conclusions: While problems with the retrieval of names are a well-attested feature of aphasia, this paper focuses on the broader area of mentioning persons in conversation, and analyses the previously little-researched phenomenon of how person mentions produced by a PWA can be difficult to understand. It is suggested that this PWA’s pattern of producing mentions of person that are difficult to understand may be linked to her profile of executive function deficits as well as linguistic deficits.

Combining music and life story to enhance participation in family interaction in semantic dementia: a longitudinal study of one family’s experience

Abstract Background: Semantic dementia is a rarer dementia, classified as a type of frontotemporal dementia and a variant of primary progressive aphasia. Studies examining conversation in this condition and interventions to enhance participation in family life present as gaps in the research literature. Methods: Working with one family on a longitudinal basis, this study used conversation analysis and narrative analysis to provide a detailed assessment of communication . This information was used to design an individually tailored life story intervention to facilitate family interaction: a co-produced life story music DVD. Results: This intervention offered the family a resource that allowed the person with semantic dementia to display areas of retained competence and enhanced participation in interaction in a way that was not typically present in everyday conversation. Conclusions: It is argued that fostering greater opportunities for such in-the-moment connections is an important goal for intervention, particularly when language may be significantly compromised.