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

Abstract

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.ac.uk/. Eight people with chronic agrammatic aphasia, and their regular conversation partners participated in the tailored 8 week program involving significant video feedback. We explored changes in: (i) conversation facilitators (such as multi-modal turns by people with aphasia); and (ii) conversation barriers (such as use of test questions by conversation partners). The outcome of intervention was evaluated directly by measuring change in video-recorded everyday conversations. The study employed a pre-post design with multiple 5 minute samples of conversation before and after intervention, scored by trained raters blind to the point of data collection. Group level analysis showed no significant increase in conversation facilitators. There was, however, a significant reduction in the number of conversation barriers. The case series data revealed variability in conversation behaviors across occasions for the same dyad and between different dyads. Specifically, post-intervention there was a significant increase in facilitator behaviors for two dyads, a decrease for one and no significant change for five dyads. There was a significant decrease in barrier behaviors for five dyads and no significant change for three dyads. The reduction in barrier behaviors was considerable; on average change from over eight to fewer than three barrier behaviors in 5 minutes of conversation. The pre-post design has the limitation of no comparison group. However, change occurs in targeted conversational behaviors and in people with chronic aphasia and their partners. The findings suggest change can occur after eight therapy sessions and have implications for clinical practice. A reduction in barrier behaviors may be easier to obtain, although the controlled case series results demonstrate a significant increase in conversation facilitators is also possible. The rehabilitation tool is available online and video technology was central to delivering intervention and evaluating change.

“I don’t know”: a usage-based approach to familiar collocations in non-fluent aphasia

“…To illustrate functional patterns of IDK usage, representative examples of IDK functions were selected and analysed further, using existing conversation analytic (CA) transcriptions from Carragher et al (2013) and Best et al (2016). Appendix 3 includes information on CA transcription symbols used in these extracts.…”

“…Dyads 1-8 took part in a study by Carragher, Sage, & Conroy (2013), and dyad 9 in a study by Best et al (2016) 1 . Background information on all dyads is summarized in Table 1.…”

“…Participants gave written informed consent to long term storage of their data. Ethical approval was granted by NHS IRAS ethics (Carragher et al, 2013) and NHS Cambridgeshire 1 Research Ethics Committee (Best et al, 2016). (Table 1 near here) 1 Dyad 2 in Best et al Kaplan, Goodglass, & Weintraub, 2001), used for assessing lexical retrieval for dyads 1-8; for dyad 9, the percentage reflects an average across three baselines of the OANB (Druks & Masterson, 2000) noun subset.…”

“…All conversations were recorded in the dyads' home under instruction to videotape a conversation at a time of day and on a topic of the dyad's choosing. Conversations were transcribed as part of prior studies by Carragher et al (2013) and Best et al (2016), or by the first author of the current project where additional untranscribed samples existed. Sampling consisted of 5-to 25-minute segments where the participant with aphasia was in conversation with a family member.…”

The impact of Better Conversations with Aphasia on current practice by UK speech and language therapists

“…They then jointly set goals to practise up to three facilitatory behaviours in coached conversation tasks with the speech and language therapist (SLT). There is evidence of the effectiveness of BCA, namely a significant reduction in barriers to conversation at the group level, and for some PWAs and their CPs, a significant increase in facilitatory conversation behaviours (Best et al 2016). The online resource provides SLTs with access to the BCA intervention programme and training materials including videos showing BCA therapy being delivered, guidance on goal-setting and outcome measurement, and advice from experienced SLTs.…”