Background: Conversation is central to building and maintaining relationships. Thus, it is unsurprising that people with aphasia and their familiar conversation partners often desire improved conversational ability. However, to facilitate real-world communication, focusing on improving aphasic language difficulties is not enough. We also need a comprehensive understanding of how social actions are accomplished in everyday aphasic conversation, including the means of participation people with aphasia possess. Aims: To investigate the in-situ participation of people with nonfluent aphasia by analysing how they bring up, i.e., initiate, issues of importance to them in home-based authentic conversations with their familiar conversation partners. Methodology: Using conversation analysis, we examined 6 hours of video-recorded everyday conversations of two dyads, each consisting of a person with severe/moderate Broca's aphasia and their spouse. We analysed 89 instances of the persons with aphasia initiating talk and how these initiations were produced, where in the conversation such initiations appeared, and what the initiations accomplished socially. Outcomes & Results: We identified two descriptive groupings of initiations by the persons with aphasia: formulaic initiations, and initiations striving for propositional content. Formulaic initiations were used in unproblematic ways to accomplish social actions like offerings, or to assess or summarize a topic after it has lapsed. Such initiations are considered important in building social cohesion. Most initiations strived for propositional content, i.e., entailed a content word, or an attempt to produce one. Such initiations were regularly intertwined with multimodal and material resources usually resulting in recognizable social actions like topic initiation irrespective of whether they included an identifiable content word or not. However, the achievement of topic initiation was crucially dependent on interactional work by the spouse. Finally, we discovered a difference in the sequential environment of propositional initiations between the dyads as only one of the spouses regularly provided slots for the person with aphasia to initiate talk.

This study applies conversation analysis to compare everyday conversation samples between a person with aphasia (PWA) and a familiar communication partner (CP) before and after intensive language-action therapy (ILAT). Our analysis concentrated on collaborative repair sequences with the assumption that impairment-focused therapy would translate into a change in the nature of trouble sources, which engender collaborative repair action typical of aphasic conversation. The most frequent repair initiation technique used by the CP was candidate understandings. The function of candidate understandings changed from addressing specific trouble sources pre-ILAT to concluding longer stretches of the PWA's talk post-ILAT. Alongside with these findings, we documented a clinically significant increase in the Western Aphasia Battery's aphasia quotient post-ILAT. Our results suggest that instead of mere frequency count of conversational behaviours, examining the type and function of repair actions might provide insight into therapy-related changes in conversation following impairment-focused therapy.

Background: In everyday conversations, a person with aphasia (PWA) compensates for their language impairment by relying on multimodal and material resources, as well as on their conversation partners. However, some social actions people perform in authentic interaction, proposing a joint future activity, for example, ordinarily rely on a speaker producing a multi-word utterance.

Aivoverenkiertohäiriö (AVH) aiheuttaa usein pitkäaikaisia tai pysyviä toimintarajoitteita, kuten vaikeuksia liikkumisessa, itsestä huolehtimisessa ja kommunikaatiossa. Nyt raportoitava tutkimus on Kelan AVH:n sairastaneille järjestämien kuntoutuskurssien toimivuutta selvittävän tutkimuksen osatutkimus. Tämän tutkimuksen tarkoituksena oli selvittää Kelan painokevennetyn kävelyn, käden tehostetun käytön ja kommunikaatioon painottuvien AVH-kuntoutuskurssien osallistujien tavoitteiden asettamista ja tavoitteiden toteutumista. Tutkimukseen osallistui 49 AVH-kuntoutujaa, joista 14 osallistui painokevennetyn kävelyn, 16 käden tehostetun käytön ja 19 kommunikaatioon painottuvalle AVH-kurssille. Tutkimuksessa analysoitiin GAS-menetelmällä laaditut Omat tavoitteeni -lomakkeet. Kokonais- ja osatavoitteista analysoitiin niiden merkitykselliset käsitteet, jotka sillattiin ICF-luokitukseen. Sillatuista ICF-aihealueista tarkasteltiin sekä frekvenssejä eri kurssimuodoissa että kokonais- ja osatavoitteiden asettumista ICF-luokituksen eri luokitusportaille. Tavoitteiden saavuttamista arvioitiin GAS-menetelmän T-lukuarvon avulla. Lomakkeelle kirjatut kokonaistavoitteet olivat painokevennetyn kävelyn ja käden tehostetun käytön AVH-kursseilla suoritusten ja osallistumisen tavoitteita, kommunikaatioon painottuvalla AVH-kurssilla ne siltautuivat myös ruumiin/kehon toimintoihin. Kokonaistavoitteiden siltaukset painottuivat ICF-luokituksessa interventioiden painotusten mukaisesti kävelyyn, yläraajan käyttöön ja kommunikaatioon. Muutamista lomakkeista kokonaistavoite puuttui kokonaan ja osassa tavoite oli niin yleisellä tasolla, että se siltautui osa-alueelle suoritukset ja osallistuminen. Osatavoitteet asettuivat pääosin hierarkkisesti siten, että osatavoite oli kokonaistavoiteen kanssa joko samalla tai tarkemmalla ICF-luokitusportaan tasolla. Joissakin tapauksissa kokonaistavoite ja osatavoite/-tteet eivät kohdanneet. Muutama kokonais- tai osatavoite sisälsi kaksi merkityksellistä käsitettä, mikä näkyi sekä siltauksessa että oli saattanut vaikeuttaa tavoitteen saavuttamisen arviointia. Puolet painokevennetyn kävelyn ja käden tehostetun käytön AVH-kurssilaisista ja 79 prosenttia kommunikaatioon painottuvalle AVH-kurssille osallistujista saavutti tai ylitti kuntoutuksen tavoitteet. Konkreettisten ja saavutettavien sekä loogisesti etenevien tavoitteiden asettaminen edellyttää lisäkoulutusta GAS:n käyttöön. Tavoitteiden siltaus ICF-luokitukseen auttaa jäsentämään millä toimintakyvyn osa-alueella ja/tai tarkemmalla toimintakyvyn aihealueella kuntoutujan kanssa työskennellään. AbstractRehabilitation goals and their linking to the ICF in subjects with strokeStroke often causes long-term or permanent functional limitations, such as difficulties in moving, taking care of oneself, and communicating. This study forms a part of a wider research project evaluating stroke rehabilitation courses organized by The Social Insurance Institute of Finland. The purpose of this article is to investigate how participants of courses focused on body weight supported walking training, constraint-induced movement therapy for upper limbs and communication set goals, and how these goals are realized. The study included 49 subjects with stroke, of whom 14 participated in body weight supported walking training, 16 in constraint-induced movement therapy for upper limbs, and 19 in communication-focused courses. The goals set by the participants using Goal Attainment Scaling (GAS) method were analyzed. The overall and specific goals were analyzed for their relevant concepts, and they were mapped to the ICF classification. Of the mapped ICF categories, both frequencies within the three course formats and the setting of overall and specific goals for different classification stages of the ICF classification were examined. The achievement of the goals was assessed using the T-value of the GAS method. In rehabilitation courses focused on body weight supported walking training and constraint-induced movement therapy for upper limbs, the overall goals were mapped to the activities and participation. In the communication-focused course they were additionally mapped to body functions. The mapping of the overall goals in the ICF classification focused on walking, upper limb use, and communication, in line with the course priorities. In a few of the cases the overall goals were not set, and in some cases the goal was so general that it was mapped to the activities and participation component. The specific goals were mainly hierarchical, so that theys were on the same or more precise level than the overall goal of the ICF classification. In some cases, the overall goal and the specific goal(s) did not match. A few overall or specific goals contained two relevant concepts, which affected the mapping and may have made it difficult to assess the achievement of the objective. Half of the participants with body weight supported walking training, constraint-induced movement therapy for upper limbs, and 79% of the participants in the communication-focused rehabilitation achieved or exceeded their rehabilitation goals. Setting concrete and achievable and logically progressing goals requires additional training in the use of GAS method. The benefit of mapping the goals to the ICF classification is that it helps analyzing in which functional area, and/or the more specific functional sub-area, is the focus of the rehabilitation. The study highlights the importance of setting rehabilitation goals with people recovering from stroke. The study identified areas of development, that could be used to clarify and structure the joint work of the rehabilitee and the rehabilitation professional in goal-setting and achievement. The results can be generalized to the target group of subjects that have experienced a sudden brain injury as adults, especially to subjects with stroke. Keywords: stroke, rehabilitation, goals, GAS, ICF