Suzanne Beeke

Formulating Actions and Events With Limited Linguistic Resources: Enactment and Iconicity in Agrammatic Aphasic Talk

In this article a conversation analytic approach is used to investigate the form and use of enactment by speakers with agrammatic aphasia in talk-in-interaction. Enactment here refers to the employment by participants of direct reported speech and/or other behavior such as the use of gesture/body movement and/or prosody to iconically depict some aspects of reported scenes or events. The enactment of these speakers is notable in terms of the distinctive grammatical practices within which it is regularly produced (e.g., without any reporting verb such as say) and a reliance on kinesic enactment and simple lexical forms produced as seconds, i.e., reactions or second pair-part responses such as oh, no, and oh no. It is argued that enactment and other instances of iconicity within interaction as produced by these aphasic speakers are examples of interactional methods adopted by them in order to formulate actions and events in talk using the limited lexical and grammatical resources at their disposal, and some similarities to other types of language use such as child language and pidgins are noted.

Grammar without sentence structure: A conversation analytic investigation of agrammatism

Background: Although research into agrammatism has done much to characterise the nature of the underlying disorder, most studies have analysed elicited, task‐based data. As a result, little is known about the grammar that people with agrammatism use in everyday talk with habitual conversational partners. There is evidence in the Conversation Analysis (CA) literature to suggest that conversational grammar may not mirror the grammar of elicited language samples. The data presented in this paper were collected as part of a larger study funded by the Economic and Social Research Council (ESRC), entitled “An investigation of aphasic syntax‐for‐conversation” (ESRC R000222754, Wilkinson, Maxim, & Beeke, 2001). Aims: To explore the notion that conversation and task‐based data do not necessarily reveal the same grammatical phenomena, addressing the following questions: (1) What resources does a speaker with agrammatism make use of in order to construct a turn at talk? (2) Is the conversational grammar of a speaker with agrammatism organised in a systematic way? (3) What is the relationship between patterns of turn construction in conversation and the grammatical characteristics of output elicited by decontextualised language tests? Methods & Procedures: A videotaped conversation between an agrammatic speaker and his adult daughter is analysed using CA. Four recurring turn construction formats are described and illustrated with extracts. Background information on the client presents the results of picture‐naming and sentence production tests. Outcomes & Results: There is great variation between the grammar of conversation and test data. Test results reveal a severe problem with verb access and sentence construction, with ability declining sharply as the number of verb arguments increases. However, the speaker deploys interactional alternatives to standard grammatical structures, and it is possible for him to recount events without explicit articulation of verbs and argument structures, using a combination of talk and mime. Only a minority of his conversational utterances are concerned with recounting events—commenting, assessing, and reasoning are highly prevalent. Conclusions: Conversation and sentence‐level tests provide complementary but essentially different information about grammatical ability. This implies that assessment of conversational grammar should become a routine part of any investigation of agrammatism in order to gain a more complete picture of an individuals ability to impose structural order on their talk, and to explore implications for successful interaction with others. Currently, approaches to assessment and intervention over‐emphasise events. In conversation, other actions such as giving an opinion are just as prevalent. Findings suggest a mismatch between what appears problematic on testing and what is treated as problematic by the interactants in conversation, and that intervention might profitably seek to address grammatical difficulties that have a basis in interaction.

Exploring aphasic grammar 2: do language testing and conversation tell a similar story?

This paper investigates the grammatical difficulties of an English-speaking person with non-fluent aphasia using clinical assessments based on picture description and story telling. The same individuals conversation grammar, which was investigated in detail in a linked article is reviewed here, and the notion that interactional grammatical phenomena may not necessarily be visible in elicited language data is explored. Data analysis shows that the aphasic speakers grammar looks considerably different in the context of clinical assessment than it does in conversation. Analysis of elicited grammar reveals that the majority of utterances produced are subject-verb-object (SVO) type sentences, whereas prior analysis of conversation data indicated patterns of interactional grammatical phenomena that differ from such sentence types. It is suggested that language tests and conversation provide complementary but essentially different information about grammatical abilities. The clinical implications of this finding are discussed.

Redesigning therapy for agrammatism: Initial findings from the ongoing evaluation of a conversation-based intervention study

Abstract Therapy for agrammatism, once only targeted at surface grammar, has begun to demonstrate the benefits of rigorous theoretically motivated therapy aimed at underlying syntax. Whilst there is evidence that grammatical ability in the clinical setting can be improved by such therapies, it has proved hard to detect carryover to everyday conversation in the home. Recent research using a qualitative methodology called Conversation Analysis (CA) has shown that utterances produced by agrammatic speakers in peer conversation differ significantly from those elicited during assessment and therapy tasks. This is because tasks target decontextualized language, isolated from an interactional context of real-life talk about needs, opinions, and experiences. This paper explores the idea that, given this finding, it may be more appropriate, and effective, to provide therapy for agrammatism by targeting the grammar of conversation directly. It outlines a new therapeutic approach based on CA concepts, describes the early development of a valid quantitative measure of change in conversation and presents some qualitative data from one of the first dyads involved in an ongoing therapy study.

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.

Exploring aphasic grammar. 1: A single case analysis of conversation.

This paper uses the methodology and analytical findings of conversation analysis to investigate the notion that aphasic grammar may be understood at least partly in the context of the demands of turns at talk in conversation. An investigation of the conversation of an English-speaking person with aphasia reveals two distinct grammatical phenomena, and it is suggested that their use may be interactionally motivated by the need to take a relatively unproblematic turn at talk despite the constraints of non-fluent aphasia. The grammatical patterns that are revealed by this analysis look considerably different from those elicited by standard methods of data sampling. The possibility that interactional grammatical phenomena are not visible in the language data elicited by clinical assessments is raised. This question is addressed via an in-depth comparison of the same speakers interactional and elicited grammar in a linked article. It is suggested that the tool of conversation analysis provides researchers with a new and fruitful approach to the study of grammatical abilities in aphasia.

Conversation focused aphasia therapy: investigating the adoption of strategies by people with agrammatism.

Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a complex behavioural intervention is in the early stages of development and evaluation. Aims: This article aims to evaluate an intervention that targeted a PWA and their conversation partner (CP), a dyad, as equals in a novel conversation therapy for agrammatic aphasia, using both quantitative and qualitative evidence of change. The intervention aimed to increase the insight of a dyad into facilitator and barrier conversation behaviours, to increase the understanding of the effect of agrammatism on communication, and to support each speaker to choose three strategies to work on in therapy to increase mutual understanding and enhance conversation. Methods & Procedures: Quantitative and qualitative methods are used to analyse multiple pre-therapy and follow up assessments of conversation for two dyads. Outcomes & Results: Results show that one person with severe and chronic agrammatic aphasia was able to select and practise strategies that led to qualitative and quantitative changes in his post-therapy conversations. The other PWA showed a numerical increase in one of his three strategies post therapy, but no significant quantitative change. Although both CPs significantly reduced barrier behaviours in their post-therapy conversations, neither showed a significant increase in the strategies they chose to work on. For one CP, there was qualitative evidence of the use of different turn types. Conclusions: Individually tailored input from a speech and language therapist can assist some people with chronic agrammatism to develop conversational strategies that enhance communication. Outcomes are influenced by the severity and extent of language deficits affecting, for example, single word writing. In terms of behaviour change for CPs, it appears that it may be easier to reduce barrier behaviours rather than to increase the use of facilitatory strategies. The results have implications for collaborative goal setting with clients undergoing conversation therapy.

Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia.

BACKGROUND & AIMS A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours. METHODS & PROCEDURES A 55-year-old man with chronic agrammatism and his wife took part in eight weekly sessions of conversation therapy, adapted from Supporting Partners of People With Aphasia in Relationships and Conversation (SPPARC). Language and conversation were assessed before and after therapy, and the couples views on conversation and disability were elicited. Conversation analysis was used to analyse: (1) pre-therapy conversation patterns, (2) how the PWA engaged and learned during therapy and the forms of facilitation that aided this process, and (3) qualitative change in post-therapy conversation behaviour. OUTCOMES & RESULTS After therapy, the PWA showed increased insight and acceptance of the use of strategies such as writing and drawing in the face of conversational difficulty. However, use was prompted by his wife and was rarely spontaneous. CONCLUSIONS & IMPLICATIONS This single case study suggests that conversation training based around an experiential learning process is able to engage a PWA directly in learning about the effects of aphasia on conversation. Key facilitators were self-study via video and experience of practising conversation whilst receiving online feedback from a speech and language therapist. However, increased insight did not automatically change conversation behaviour. Although he better understood the effects of his aphasia on conversations with his wife, learning stopped short of the ultimate goal of the conversation training programme; the spontaneous use of strategies worked on in therapy when faced with conversation breakdown. One explanation may be that limited cognitive flexibility lead to problems with switching from one strategy to another.

Individual variation in agrammatism: a single case study of the influence of interaction

BACKGROUND Agrammatic speech can manifest in different ways in the same speaker if task demands change. Individual variation is considered to reflect adaptation, driven by psycholinguistic factors such as underlying deficit. Recently, qualitative investigations have begun to show ways in which conversational interaction can influence the form of an agrammatic speakers output. AIMS To explore qualitative patterns of individual variation in the output of a single case, in order to address the following questions: (1) in what ways do grammatical structure, verbs and argument structure differ qualitatively between data samples?; and (2) what is the influence of interaction on the structure of utterances? METHODS & PROCEDURES A man with severe and chronic agrammatism is videotaped completing tests of spoken sentence construction, composite, and cartoon strip picture descriptions and a story telling task. In addition, he independently videotapes a sample of conversation with a family member at home. Analyses of these data draw on cognitive neuropsychological, linguistic and psycholinguistic methodologies as well as the data-driven procedures of conversation analysis. OUTCOMES & RESULTS The qualitative analysis uncovers considerable variation between data sets with respect to grammatical structure, verbs and argument structure. The agrammatic speaker appears more skilled at imposing order on his spontaneous speech than the results of sentence construction tests might predict. Interaction influences his output style. Adaptation is found to be a collaborative process that occurs between two speakers in the quest for mutual understanding, not something that takes place within an individual. CONCLUSIONS It is concluded that an interactional approach to agrammatism has the potential to yield important insights into the characteristics of telegraphic speech and individual variation. The failure of sentence-level tests to capture this individuals skill in producing systematically structured utterances in conversation implies that the assessment of agrammatism could benefit from the additional sampling and analysis of conversational grammar.

Enabling Better Conversations Between a Man With Aphasia and His Conversation Partner: Incorporating Writing Into Turn Taking

This article reports an intervention in the conversations between a man with chronic aphasia, Barry, and his wife, Louise (both names are pseudonyms). Preintervention analysis revealed the potential of writing as a resource for turn construction. Intervention consisted of enabling Barry to use writing to produce more complete turns at talk, thereby increasing the likelihood of mutual understanding, and encouraging Louise to modify her responses to Barry’s turns and thus enhance his interactional potential. Quantitative analysis revealed that Barry significantly increased his use of writing after intervention, but there was no change in other trained strategies. Louise eradicated correct production sequences (designed to elicit the correct production of a word despite her knowing the target) but did not implement trained strategies. In conclusion, individually tailored input underpinned by Conversation Analysis principles can alter the conversational behavior of a person with aphasia. It appears easier for a conversation partner to reduce unhelpful behaviors than to adopt facilitatory strategies. Data are in British English.