Implementing and evaluating aphasia therapy targeted at couples' conversations: A single case study

Abstract

Background: In recent years conversation has become an area of interest for aphasia therapy, with several studies using conversation analysis (CA) to target and evaluate therapy. Most of these studies have focused on the main conversation partner of the person with aphasia, and in particular have targeted the partner's pedagogic behaviours in relation to the person with aphasia. Evaluations of therapy have primarily taken the form of qualitative analyses of change in conversational behaviours. Aims: This single-case intervention study aims to advance research into interaction-focused intervention for aphasia in the following ways: by targeting intervention at the person with aphasia and the main conversation partner as a couple; by focusing on conversational behaviours where the person with aphasia can be seen to be restricted by the conversational actions of the conversation partner, in particular by recurrent questioning using closed questions and yes/no interrogatives; and by using a novel combination of qualitative and quantitative approaches to evaluate the intervention. Methods Procedures: CA was used to target and evaluate interaction-focused intervention for a couple where one partner has aphasia. Evidence for change was evaluated using qualitative and quantitative evidence of change in conversational behaviours; evidence from naive raters of pre- and post-intervention conversation extracts; and interview/other feedback from the conversation partner. Outcomes Results: There was evidence that the intervention had changed the couple's conversational behaviours. In particular, the conversational behaviours of the non-aphasic partner were in general less restricting for the person with aphasia in that she was now using fewer questions and more instance of other types of turns, such as paraphrases. Following intervention the person with aphasia had also changed in that he was now producing turns that had more sentences, or attempts at sentences, and which developed the topic of talk across several of his turns. Conclusions: The study provides evidence that directly targeting the conversational behaviours of the person with aphasia and/or a main conversational partner can produce positive change, and can achieve this in a way that is ecologically valid. In particular, it highlights the usefulness of targeting conversational behaviours that are proving to be maladaptive for the participants. It provides further evidence that creating change in the non-aphasic partner's conversational behaviour may facilitate change in the person with aphasia's conversational and linguistic performance

Communication therapy for people with aphasia and their partners (APPUTE)

“…A person with aphasia and his or her conversation partner collaborate in constructing the messages in a conversation (Goodwin, 1995;Klippi, 1996). This observation has led to rehabilitation methods where the couples receive guidance on how to strengthen their successful communication strategies and to avoid less successful ones (Booth & Swabey, 1999;Wilkinson et al, 2010). Breakdowns can occur in a conversation with people with aphasia (Booth & Perkins, 1999).…”

“…Severe aphasia is a chronic condition that makes even everyday communication difficult if some changes are not made in the way conversations are constructed between a person with aphasia and his or her communication partner (Simmons-Mackie, Raymer, Amstrong, Holland, & Cherney, 2010;Wilkinson, Bryan, Lock, & Sage, 2010). There are different approaches to achieve this aim.…”

“…For example, conversation analysis-based interventions focus on spontaneous communication and conversation (Booth & Swabey, 1999;Wilkinson et al, 1998Wilkinson et al, , 2010 but in APPUTE, the focus is on specific communication tasks. In APPUTE, as well as in the Promoting Aphasics' Communicative Effectiveness method (PACE) (Davis, 2005;Davis & Wilcox, 1985) and Conversational Coaching (Hopper, Holland, & Rewega, 2002), the clients decide which means and strategies of communication they use and which suit them best.…”

Managing Problems of Acceptability Through High Rise-Fall Repetitions

“…Beeke et al 2014;Lock et al 2001;Wilkinson 1999Wilkinson , 2014. While this research has led to the development of training materials that have been shown to lead to significant changes in the behaviour of partners of PWA, family members or volunteers (Wilkinson et al 2010;Beeke et al 2011), there is much less conversationfocused research looking at the interactions between healthcare professionals and PWA, although there is a wealth of conversation analytic research into the structure of interactions involving other patient populations (e.g., Elsey et al 2015;Plug, Sharrack & Reuber 2009;Stivers 2005a, b;Toerien, Shaw & Reuber 2013).…”

Interaction-focused intervention for acquired language disorders: Facilitating mutual adaptation in couples where one partner has aphasia

“…These changes included an increase in the average length of the aphasic speaker's verbal utterances in conversation from one word to three words. In a study by Wilkinson, Bryan, Lock, and Sage (2010) changes to the manner in which the spouse of a man with aphasia initiated sequences (e.g., through yes/no questions) and responded to her husband resulted in changes in the man with aphasia's linguistic and interactional behaviour. These changes included the aphasic speaker increasing the number of turns in conversation in which he produced, or attempted to produce, one or more sentences, and also taking a more active role in developing topic.…”