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

Abstract

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.

What Factors Predict Who Will Have a Strong Social Network Following a Stroke?

“…It may therefore be useful to consider supporting and bolstering friendship circles, for example, through peer-support schemes or aphasia/stroke groups (Brown et al, 2013), adopting a more social approach to therapy (Pound et al, 2000), or exploring therapy approaches such as solution focused brief therapy which may increase confidence to engage socially (Northcott, Burns, Simpson, & Hilari, in press). Conversation partner programmes aimed primarily at spouses (Beeke et al, 2015) could potentially be adapted for supporting close friendships. Still, few research projects have specifically targeted friendship loss in an intervention study for this population.…”

Displays and claims of understanding in conversation by people with aphasia

“…This work, alongside other research by Beeke and colleagues (e.g. Beeke et al 2011Beeke et al , 2014Beeke et al , 2015 thus explores improvements on qualitative and quantitative tests of conversational ability after the employment of conversation-based therapies. The focus of the research is on the interaction between the PWA and their partners, and indeed the conversation-focussed research to date has almost exclusively looked to promote and improve the inclusion of PWA in everyday (rather than clinical)…”

Enhanced patient involvement in Swedish aphasia intervention

“…This intervention is thus not only focused on the individual with aphasia, but also strongly dependent upon the involvement of significant others. Research has demonstrated that individually adapted consultations, based on Conversation Analytical (CA) principles may positively change the communication situation for persons with aphasia (Beeke, Johnson, Beckley, Heilemann, Edwards, Maxim and Best, 2015). This finding gets further support from a research review on CA-informed aphasia interventions (Wilkinson, 2014) highlighting the benefits of this approach in relation to the everyday communication needs of people with aphasia and their significant others.…”