Steven Bloch

The Understandability of AAC: A Conversation Analysis Study of Acquired Dysarthria

In this paper, an analysis of augmentative and alternative communication (AAC) system use by two adults with acquired dysarthria in conversation with their partners at home is presented. The qualitative methodology of Conversation Analysis (CA) is used to describe a particular type of AAC activity that was utilized during conversations by speakers with dysarthria for whom natural speech was still the primary modality. The two main findings were (a) that AAC was regularly used by speakers with dysarthria to attempt self-repairs of communication problems identified by their non-dysarthric partners; and (b) that AAC turns during self-repair activities were typically treated as intelligible but not fully understandable. It is suggested that CA can serve as a useful tool in dysarthria/AAC assessment and for the tailoring of AAC interventions to everyday conversational practices between people with dysarthria and their conversation partners.

Co-Constructed Talk in the Conversations of People with Dysarthria and Aphasia.

This paper uses the methodology of conversation analysis (CA) to examine the practice of co‐constructed turn and utterance production in impaired communication. An investigation of the conversations between two family dyads, featuring one person with dysarthric speech and one with aphasic language, reveals one way in which single turns and utterances are produced through the collaborative activities of two people in interaction. Such a practice is shown to operate without problems for the participants or the need for explicit acceptance by the speakers. It is proposed that co‐construction in disordered speech and language is one way in which communicative competence is accomplished. By drawing attention to similarities in the consequences of dysarthria and aphasia in everyday interaction, it is suggested that researchers and clinicians might profitably look across disorder‐specific boundaries.

Acquired dysarthria in conversation: Identifying sources of understandability problems

BACKGROUND Acquired progressive dysarthria is traditionally assessed, rated, and researched using measures of speech perception and intelligibility. The focus is commonly on the individual with dysarthria and how speech deviates from a normative range. A complementary approach is to consider the features and consequences of dysarthric speech as it is produced as a turn-at-talk in everyday interaction and in particular the ways in which this talk may be identified by its recipient as problematic to understand. AIMS To investigate how dysarthric turns-at-talk in everyday conversation may be problematic to understand. Further, to describe how recipients of dysarthric talk identify the source of problematic understandings to the dysarthric speaker. METHODS & PROCEDURES Video data of natural conversation from two dyads were selected for this paper. The dyads were video-recorded at home, at 3-monthly intervals, over a maximum period of 18 months. Using the methods of conversation analysis a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the recipients of dysarthric talk, through the use of other-initiations of repair, identified some element of that talk as problematic. OUTCOMES & RESULTS This work shows how a recipient of a dysarthric talk turn in everyday conversation goes about displaying the problematicity of that turn to its speaker. Whilst displaying that a problem exists with a prior turn, the recipient may have difficulty in knowing what that problem actually is. CONCLUSIONS & IMPLICATIONS It is proposed that clinicians and researchers should consider the effects of dysarthric speech in interaction. Specifically, the nature of dysarthric troubles and the practices used to signal understanding problems as they occur in everyday interaction should be fully explored. This consideration may have relevance for clinical assessment and intervention.

Anticipatory other-completion of augmentative and alternative communication talk: a conversation analysis study.

Purpose. The study described here investigates the practice of anticipatory completion of augmentative and alternative communication (AAC) utterances in progress. The aims were to identify and analyse features of this practice as they occur in natural conversation between a person using an AAC system and a family member. Method. The methods and principles of Conversation Analysis (CA) were used to video record conversations between people with progressive neurological diseases and a progressive speech disorder (dysarthria) and their family members. Key features of interaction were identified and extracts transcribed. Four extracts of talk between a man with motor neurone disease/amyotrophic lateral sclerosis and his mother are presented here. Results. Anticipatory completion of AAC utterances is intimately related to the sequential context in which such utterances occur. Difficulties can arise from topic shifts, understanding the intended action of an AAC word in progress and in recognising the possible end point an utterance. Conclusions. The analysis highlights the importance of understanding how AAC talk works in everyday interaction. The role of co-participants is particularly important here. These results may have implications for both AAC software design and clinical intervention.

Survey of UK speech and language therapists’ assessment and treatment practices for people with progressive dysarthria

BACKGROUND Dysarthria knowledge is predominantly impairment-based. As a result, speech and language therapists (SLTs) have traditionally adopted impairment-focused management practices. However, guidance for best practice suggests that SLTs should consider the client holistically, including the impact of dysarthria beyond the impairment. AIMS To investigate the current assessment and treatment practices used by UK SLTs with clients with progressive dysarthria and to identify whether these satisfy the needs of SLTs in their everyday practice. To investigate the extent to which they consider oromotor abilities, intelligibility, functional communication, participation and interaction to be important regarding assessment and treatment decisions. To explore whether management decisions are affected by level of clinical experience or settings in which SLTs work. METHODS & PROCEDURES An online survey of UK SLTs working with adults with progressive dysarthria. OUTCOMES & RESULTS A total of 119 SLTs completed the survey. Respondents considered that targeting the levels of impairment, activity and participation are important in the management of clients with progressive dysarthria, as recommended by clinical guidelines and recent research. However a particularly high proportion of respondents reported the use of impairment-based assessments. Respondents reported lacking the necessary tools to target interaction in assessment and intervention. The intervention that respondents use with clients varies according to the progressive disorder and dysarthria severity. There is evidence for a trend that less experienced SLTs and those working predominantly in hospital-based settings focus on the impairment, whereas more SLTs with more experience and those based in predominantly community-based settings look beyond the impairment. CONCLUSIONS & IMPLICATIONS The values held by SLTs match guideline recommendations for best practice, however the clinical reality is that the assessment of progressive dysarthria remains predominantly impairment-focused. New tools need to be developed and integrated into practice to target interaction in assessment and intervention, to reduce the gap between best practice recommendations and clinical reality. Ongoing research into the effectiveness of SLT intervention with clients with progressive dysarthria is required to guide clinical management decisions.

Acquired dysarthria in conversation: Methods of resolving understandability problems

BACKGROUND People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such problems are likely to impact on both the person with dysarthria and those with whom they interact. If this is the case then we may ask questions not just about the nature of these problems but how it is that such problems are dealt with by participants when they occur. AIMS To investigate ways through which problems resulting from dysarthria in everyday conversation are resolved by participants. Further, to examine some of the features of repair resolution, particularly where understanding of self-repair attempts themselves prove difficult. METHODS & PROCEDURES Video data of natural conversation from two dyads were selected for this paper. One dyad features a 58 year-old man with multiple sclerosis and moderate intelligibility problems, the other a 79 year-old woman with motor neurone disease with mild to moderate intelligibility problems. Both elected to be recorded in conversation with their spouses. The dyads were video-recorded at home with no researcher present. Using the methods of Conversation Analysis (CA) a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the participants resolve problems in the understanding of dysarthric speech. OUTCOMES & RESULTS It is shown how some problems resulting from dysarthria in conversation can be resolved relatively quickly, particularly where a specific element of a prior turn is highlighted by the recipient as problematic. In other instances, the recipients understanding problem may be more global. These result in longer repair sequences in which problematic elements are addressed individually. Such a resolution method is ultimately successful but may also be characterised by additional understanding problems. These findings draw attention to an important distinction between intelligibility and understandability. CONCLUSIONS & IMPLICATIONS It is concluded that problems resulting from dysarthria in conversation can require extensive repair work involving both parties. This has implications for the assessment of dysarthria in everyday conversation and also the promotion of intervention strategies that encompass the activities of both participants when dealing with dysarthria in interaction. These findings may be usefully employed in informing both direct clinical work and through training those who work with this client group and their significant others.

Semantic trouble sources and their repair in conversations affected by Parkinson's disease

Background It is known that dysarthria arising from Parkinsons disease may affect intelligibility in conversational interaction. Research has also shown that Parkinsons disease may affect cognition and cause word-retrieval difficulties and pragmatic problems in the use of language. However, it is not known whether or how these problems become manifest in everyday conversations or how conversation partners handle such problems. Aims To describe the pragmatic problems related to the use of words that occur in everyday conversational interaction in dyads including an individual with Parkinsons disease, and to explore how interactants in conversation handle the problems to re-establish mutual understanding. Methods & Procedures Twelve video-recorded everyday conversations involving three couples where one of the individuals had Parkinsons disease were included in the study. All instances of other-initiated repair following a contribution from the people with Parkinsons disease were analysed. Those instances involving a trouble source relating to the use of words were analysed with a qualitative interaction analysis based on the principles of conversation analysis. Outcomes & Results In 70% of the instances of other-initiated repair the trouble source could be related to the semantic content produced by the individual with Parkinsons disease. The problematic contributions were typically characterized by more or less explicit symptoms of word search or use of atypical wording. The conversation partners completed the repair work collaboratively, but typically the non-impaired individual made a rephrasing or provided a suggestion for what the intended meaning had been. Conclusions & Implications In clinical work with people with Parkinsons disease and their conversation partners it is important to establish what type of trouble sources occur in conversations in a specific dyad. It may often be necessary to look beyond intelligibility and into aspects of pragmatics to understand more fully the impact of Parkinsons disease on everyday conversational interaction.

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.

Problematic topic transitions in dysarthric conversation

Abstract Purpose: This study examined the nature of topic transition problems associated with acquired progressive dysarthric speech in the everyday conversation of people with motor neurone disease. Method: Using conversation analytic methods, a video collection of five naturally occurring problematic topic transitions was identified, transcribed and analysed. These were extracted from a main collection of over 200 other-initiated repair sequences and a sub-set of 15 problematic topic transition sequences. The sequences were analysed with reference to how the participants both identified and resolved the problems. Result: Analysis revealed that topic transition by people with dysarthria can prove problematic. Conversation partners may find transitions problematic not only because of speech intelligibility but also because of a sequential disjuncture between the dysarthric speech turn and whatever topic has come prior. In addition the treatment of problematic topic transition as a complaint reveals the potential vulnerability of people with dysarthria to judgements of competence. Conclusion: These findings have implications for how dysarthria is conceptualized and how specific actions in conversation, such as topic transition, might be suitable targets for clinical intervention.

AAC Practices in Everyday Interaction

It is almost 30 years since the publication of Arlene Kraat ’ s state-of-the-art report on communicative interaction involving people provided with communication aids (Kraat, 1985). Kraat ’ s crucial report highlighted the diversity of approaches used to investigate social interactions, and for the fi rst time drew attention to many core features and concepts that characterize social interaction in the AAC fi eld, such as the co-construction of aided contributions, the impact of the communication partner, and the infl uence of technology on interaction. While the years immediately following Kraat ’ s publication saw only gradual developments in AAC-related social interaction research, by default the enduring relevance of social interaction as a defi ning outcome of AAC provision has precipitated a continuing need for research in this area. This special issue brings together a collection of papers concerned specifi cally with the everyday practices of social interaction involving adults and children with communication disabilities. Common to each paper is the use of conversation analysis (CA; Sidnell, 2010) as an empirical and inductive method used to establish how participants organize various facets of interaction. Each paper provides a summary of CA ’ s practices, but readers unfamiliar with these methods are strongly advised to read fi rst Higginbotham and Engelke ’ s informative primer on the principles and practices of talkin-interaction research. Higginbotham and Engelke discuss the methodological roots of talk-in-interaction research, before providing a tutorial on undertaking micro-analysis of naturally occurring interactions. Defi ning the scope of the AAC fi eld is far from straightforward, particularly in the context of interpersonal interaction research. The papers in this special issue embrace a rich defi nition of AAC that incorporates formal communication aid systems (e.g., voice output communication aids), conventional semiotic systems (e.g., handwriting) as well as unaided resources (e.g., gesture), and includes commonplace objects (e.g., teaching materials). While the breadth of communicative modalities considered is varied, each paper emphasizes how they are integrated within a diverse multimodal ecology of interactive resources that are deployed and co-ordinated by participants to accomplish their interpersonal interactions. As such, AAC is conceptualized (and realized) as an inherently interpersonal business, incorporating the co-ordinated actions of all active participants in interaction. For example, Nor e n and colleagues examine the use of communication aid technology, focussing on how the physical practices of touchscreen AAC use can have material consequences for the interaction, that is how, in the moment-by-moment unfolding of the interaction, the very act of pointing to the touch screen, and the hierarchical organization of vocabulary on the device, impact on how the interaction develops. The use of communication aid technology also frames Clarke and colleagues ’ examination of turn exchange. Here the authors provide a focused examination of ways in which two children orient to and manage speaker transfer from an ongoing VOCA-mediated contribution to the next turn by the child with natural speech. This analysis of the deceptively straightforward activity of speaker transfer sheds light on issues related to delays in conversational interaction, and the use of eye gaze as an interactional resource. Bloch and Clarke address a longstanding but underresearched area of AAC that concerns the use of handwriting in interaction as a low-tech AAC system. The authors examine ways in which handwritten contributions to conversation may be delivered and received in interactions between people with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) and their signifi cant others. The analysis of unaided iconic gesture in interaction is also under-represented in AAC research. In this special issue, Wilkinson examines the uses and limitations of iconic gesture as an interactive