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

Abstract

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 couple's 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.

Discourse/Conversation Analysis and Autism Spectrum Disorder

“…Here, discursive approaches have enabled the generation of tools for assessment and intervention that target communication at the level of (at least) the dyad (see Beckley et al 2013). Hence, rather than focusing on the individual with aphasia, this interactional focus has enabled practitioners to work with service users and their friends/family to improve mutual experiences of conversation and understanding of the meaning of certain communication behaviours.…”

Managing Problems of Acceptability Through High Rise-Fall Repetitions

“…This suggests that SLTs do use different structures, and encourage conversations to develop along different trajectories, to the conversations that PWA experience with their partners and carers. This study indicates that more research into the so-called "black box" of therapeutic conversations (Beckley et al, 2013) is clearly warranted.…”

“…The authors seek to examine and measure the effectiveness of a direct therapy on changing the conversational behaviours of two PWA and their partners -it is not only, or mainly, an analysis of the conversational behaviours of the SLT and the PWA. Interestingly, Beckley et al (2013) state that it would be helpful to know more about the structure of clinical interactions. The authors suggest that Conversation Analysis (CA) -a methodology which has a long history of use in aphasiology (e.g.…”

“…A study by Beckley et al (2013), one of the papers included in the Simmons-Mackie et al (2014) review, is an example of the research regarding conversation-focussed therapies. The authors seek to examine and measure the effectiveness of a direct therapy on changing the conversational behaviours of two PWA and their partners -it is not only, or mainly, an analysis of the conversational behaviours of the SLT and the PWA.…”

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

“…This article reports intervention outcomes for a man with agrammatic aphasia, Barry, and his wife, Louise (pseudonyms), who took part in a larger program of conversation training involving eight couples, funded by the Stroke Association (see also Beckley et al, 2013;Beeke et al, 2014). The intervention examined the utility of working directly with a PWA (as well as their CP) on strategy use in conversation.…”