Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods.

Background: Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change.

Aims: To identify mechanisms of change within a conversation therapy for people with aphasia and their partners.

Conversation Therapy with People with Aphasia and Conversation Partners using Video Feedback: A Group and Case Series Investigation of Changes in Interaction.

Conversation therapies employing video for feedback and to facilitate outcome measurement are increasingly used with people with post-stroke aphasia and their conversation partners; however the evidence base for change in everyday interaction remains limited. We investigated the effect of Better Conversations with Aphasia (BCA), an intervention that is freely available online at https://extend.ucl.

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

: 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. : 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.

Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia.

The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement.

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.

Prosody as a compensatory strategy in the conversations of people with agrammatism.

Historically, agrammatism, a symptom of Broca's aphasia, has been associated with dysprosody, on account of speakers' slow, halting, and effortful speech. Almost all investigations of this phenomenon use experimental methods (reading, repetition). Thus, little is known about how prosody is used by speakers with agrammatism and understood by their interlocutors in everyday conversations.

Deep dyslexia for kanji and phonological dyslexia for kana: different manifestations from a common source.

A Japanese-speaking stroke patient with disrupted phonology but relatively good semantics was severely impaired in nonword reading, with better preserved and imageability-modulated word-reading in both kanji and kana. This basic similarity of reading in the two Japanese scripts was accompanied by the following differences: (i) distinct error patterns (prominent semantic errors for kanji vs. phonological errors for kana); (ii) a more pronounced imageability effect for kanji; and (iii) a remarkable pseudohomophone advantage for kana.

Rethinking agrammatism: factors affecting the form of language elicited via clinical test procedures.

Current approaches to assessing agrammatism use data from restricted contexts, such as picture description and story telling tasks. There is evidence in the conversation analysis literature to suggest that conversational grammar may differ markedly from the grammar of such elicited language samples. The disparity between conversational and test grammar suggests that it is possible for the form of an agrammatic utterance to be motivated by the context in which it occurs.

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 speaker's output.

Adapting to conversation as a language-impaired speaker: changes in aphasic turn construction over time.

Using the methodology and findings of conversation analysis, we analyze changes in the talk of a man with aphasia (a language disorder acquired following brain damage) at two points in his spontaneous recovery period in the first months post-stroke. We note that in the earlier conversation (15 weeks post-stroke) two of the turn constructional methods he particularly makes use of are replacement (a form of repair) and extension. By the time of the latter conversation (30 weeks poststroke) these methods are less prevalent, while another repair operation, insertion, is now used in a particular way not seen in the earlier conversation.

Using conversation analysis to assess and treat people with aphasia.

This article gives an overview of the application to aphasia of conversation analysis (CA), a qualitative methodology for the analysis of recorded, naturally occurring talk produced in everyday human interaction. CA, like pragmatics, considers language use in context, but it differs from other analytical frameworks because the clinician is not making interpretations about how an aspect of language should be coded or judging whether an utterance is successful or adequate in terms of communication. We first outline the CA methodology before discussing its application to the assessment of aphasia, principally through the use of two published assessment tools.

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 individual's 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 speaker's grammar looks considerably different in the context of clinical assessment than it does in conversation.

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.