Improving conversation in acquired language disorders: 
An interaction-focused intervention - PowerPoint Presentation

Slide1

Improving conversation in acquired language disorders: 
An interaction-focused intervention approach in aphasia therapy

Ray WilkinsonNeuroscience and Aphasia Research Unit University of Manchester

ALF,

Nyborg Strand, March 2012Slide2

Overview of presentation

1. Why focus aphasia assessment therapy on conversation?2. Conversation analysis methods and areas of investigation in aphasia:Data collection, transcription and analysisAnalysing repair, turns and sequences, topic and how they are affected by aphasia3. Interaction-Focused Therapy4. Implementing and evaluating Interaction-Focused Therapy:

Two aphasia therapy case studies

5. Current and future research directions and clinical issues

Slide3

Conversation

The most prevalent use of spoken language and communication in daily life (Davidson, Worrall and Hickson, 2003)Therefore, conversation important as target for therapy and as place where improvement after therapy should be evident‘conversation is…..a vehicle through which selves, relationships and situations are talked into being’ (Schiffrin, 1988)Therefore, conversation relevant not only to language and communication, but also psychsocial issues of how

personal identity

and relationships are constructed and managed Slide4

Conversation differs from other types of aphasia language and communicative assessments

Utterances in conversation are produced:as part of a social interaction: involves at least two people; PWA having to produce utterance in response to what other has just said; having to understand and speak at same timeonline and under time pressure: little time for utterance planning or productionmatter: conversation used to produce actions (eg requests, jokes etc.); errors and delays affect actions and one’s identity

We can’t predict conversational problems and abilities from testing

(Wilkinson, 1995; Beeke

et al., 2003)

To see how PWA copes in conversation, we need to assess conversation Slide5

Conversation: An interaction-focused approach in aphasia assessment and therapy

Using Conversation Analysis approach (Sidnell, 2010): Focus on conversation features eg:Turns and sequencesRepairTopicMethodological features: Data collection: naturally-occurring conversational dataData transcription: capture features of how speakers talkData analysis: how do speakers collaborate turn by turn to

produce talk which is meaningful for each other?; how do they show to each other

eg (a) how they interpret what an utterance means; (b) that something is problematic for them to understand Slide6

Uses of an interaction-focused approach for aphasia

Assessment and therapy planning: allows insight into how people with aphasia (PWA) and their main significant others (SO) communicate spontaneously and in the home environment; allows insight into how they are adapting to conversation with aphasia; what the problems or limitations areTherapy implementation: allows individualised therapy to be carried out with the dyad (PWA & SO) together to change conversational patterns of behaviour; allows therapy to be targeted at real problems or limitations experienced by the dyad in daily lifeTherapy evaluation: allows investigation of whether improvement has occurred in real language use and communication at home in daily life activitiesSlide7

Assessing communication at home: Pedagogic activity

you know what I mean I think they’ve joined upyou’ve got no id- it’s and now it drives me mad because I- so she said I can go- if I come to (2.3) San-tander

Say it again

San San



tan der

San-der San tan  Sand



(2.0)

San-tan

San-don’t it’s driving me mad!

( )

no leave itSlide8

Pedagogics: ‘

McFlurry’

no leave it (0.4) but then (0.5) I can go (1.6)what did you have the other day?

what?d’you know on F- on eh (1.7)

Thu

rsday

yeah Thursday (0.4) when we drove,I went to- I know I know

w

hat



was it

I know I-wait a minute (0.6) we went we ate, we ate? something and I went (0.9) oh god I went eh wait a minute (.) I went by myself (1.1) with the car (.) and we went and I said (0.4) oh god (0.4)

MacFru

- (7.2) Mac

please could I have



you said





please



could I have (.) a (1.6) Mac (16.1)



Fruly



its not

Fruly

(1.3) MacFruly nearly (1.3) Mac (1.2)fu-fu-fuMac (2.0) Furry MacFurryMcFlurry Slide9

Pedagogics: ‘Hamburger’

McFlur

- McFlurry

. yeah and one (.)

hambur

-

hambe- ham han (1.1) ham



ham-

bury

b

u



r-



bu

-

(1.8)

hamburg

-

burgy

,

burger.

hamburger ham burger

b

ut what did you get the McFlurry (.) which one did you getwith smarties

yeah

((

both laugh

))

smarties

! ((laughs))yeahyeah no I had it it was goodcos before you used to say ‘the dots’dots!((both laugh)) Slide10

Also found in German aphasic conversation

(Bauer & Kulke, 2004) and Dutch aphasic conversation (Wielart & Wilkinson, 2012)Pedagogic behaviour - aims to help aphasic speaker learn/practise language; but also has social costs: Focuses attention on aphasic speaker’s incompetenceTakes over as the topic and slows conversation downOften, but not always, creates negative emotion in aphasic speaker eg embarrassment, emotional upset

Pedagogic

behaviour: a common feature of aphasic conversation

(

Wilkinson et al., 1998; Booth & Perkins, 1999; Lindsay & Wilkinson, 1999; Turner & Whitworth, 2006

) Slide11

Pedagogic

behaviour in this dyad’s talk:Engaged in relatively frequentlyAppears generally emotionally unproblematic for them/for PWA – in fact often a source of humour/laughterPWA sometimes initiates the pedagogic activitythe SO temporarily takes on role of teacher/trainer but this shift in social roles seems unproblematicThis is not always the case and can often be a target for therapySlide12

Pedagogic

behaviour as problematic: Connie & Sam

did you paint that thing today?

(1.0)yes (0.4) uhm (0.3) wheel barrow

yeah

uhm (.) I can't (0.3) paint itwhy's that?eh lef hands.what hand?

lef

hands

.

lef:

T

lef

–t

hand

you're saying- you're saying lef: you're not putting the ‘t’ at the

end (0.2

) lef

t

.

lef:-

t

lef:-

t

you're missing the ‘t’ (0.3) lef

t

lef

(.) hands (0.3) I can't (hear) it

((

sounds and looks upset

))

yes but you tried didn't you? you try.mm ((laughs))(1.5)Slide13

Connie and Sam: pedagogic

behaviour as maladaptive form of repair behaviour and as target for therapy (Lock, Wilkinson &Bryan, 2001; see also Booth & Perkins, 1999: Turner & Whitworth, 2006)Couple report they engage in these behaviors regularly – to give Connie practice at saying wordsBut as seen in example:Leads to negative emotions (eg upset) on occasionTakes over as topic – slows down conversationProlonged focus on Connie’s inability to say ‘simple’ word

Conversation analysis research on repair in normal conversation (

Schegloff, 2000):Preference for self completion of repair

Preference for repair to be short

Issues of competence and ‘face’Slide14

Adaptation by dyads in turns and sequences:

Test Questions (Lock et al., 2001; Bauer & Kulke 2004)what jobs was you doing?....what did you do in oil?....what do I do for a living?... what do

I do on a computer?

i.e. method of having a ‘conversation’, especially with people with severe aphasiabut not a real exchange of information; highlights inability; limited and controlling form of talk

Slide15
Slide16

Targeting improved

aphasic conversation: Four approaches (Wilkinson, 2010)InterventionApproach Data collectionData analysis pre/post TxFocus of conversation -related TxSlide17

Targeting improved

aphasic conversation: Four approaches (Wilkinson, 2010)InterventionApproach Data collectionData analysis pre/post TxFocus of conversation -related TxImpairment-focused (Hickin

et al. 06)

Conversation between PWA and SO or professionalWord retrieval within conversationImpairment-word finding difficultiesSlide18

Targeting improved

aphasic conversation: Four approaches (Wilkinson, 2010)InterventionApproach Data collectionData analysis pre/post TxFocus of conversation -related TxImpairment-focused (Hickin

et al. 06)

Conversation between PWA and SO or professionalWord retrieval within conversationImpairment-word finding difficulties

Communication-focused

(Conversational Coaching: Holland et al, 02)

Communication task with PWA and SOMain concepts of a story communicated during taskVerbal and non-verbal communication strategies used by PWA and SOSlide19

Targeting improved

aphasic conversation: Four approaches (Wilkinson, 2010)InterventionApproach Data collectionData analysis pre/post TxFocus of conversation -related TxImpairment-focused

(Hickin et al. 06)

Conversation between PWA and SO or professionalWord retrieval within conversationImpairment-word

finding difficulties

Communication-focused

(Conversational Coaching: Holland et al, 02)Communication task with PWA and SOMain concepts of a story communicated during taskVerbal and non-verbal communication strategies used by PWA and SO

Psychosocial-focused

(Supported

Conversation:

Kagan

et al. 01)

Interview

between PWA and a volunteer

Message exchange and social interactive skills of participants using (M)SCA and (M)PCA

Volunteer’s skills in acknowledging and revealing the competence of PWASlide20

Targeting improved

aphasic conversation: Four approaches (Wilkinson, 2010)InterventionApproach Data collectionData analysis pre/post TxFocus of conversation -related TxImpairment-focused (Hickin

et al. 06)

Conversation between PWA and SO or professionalWord retrieval within conversationImpairment-word finding difficulties

Communication-focused

(Conversational Coaching: Holland et al, 02)

Communication task with PWA and SOMain concepts of a story communicated during taskVerbal and non-verbal communication strategies used by PWA and SOPsychosocial-focused

(Supported

Conversation:

Kagan

et al. 01)

Interview

between PWA and a volunteer

Message exchange and social interactive skills of participants using (M)SCA and (M)PCA

Volunteer’s skills in acknowledging and revealing the competence of PWA

Interaction-focused

SPPARC: Lock et al, 01)

Conversation

between PWA and SO

Impact of aphasic impairments on conversation (

eg

repair,

turns

etc

) and how PWA and SO adapt in conversation

Behaviours

used by the PWA and SO to deal with aphasic impairments in conversation (

turms

, repair

etc)Slide21

Therapy Case Study 1: Dealing with limited choice of actions within turns and sequences

(Wilkinson, Bryan, Lock & Sage, 2010, Aphasiology)LenAge: 66; left CVA 18 months priorBroca’s type aphasia and verbal apraxiaHemiplegia: able to walk with care, write with non-preferred handRetired head teacherJane (wife)Retired teacherSlide22

Comprehensive Aphasia Test: Cognition

Pre treatment

Ravens CPM

8/12

Pyramids & Palm Trees

6/10

Verbal fluency

4

Verbal recognition

10/10

Ideomotor apraxia

7/12

Picture description

5/10

Arithmetic

5/6Slide23

Cognition

Pre treatment

Post treatment

Ravens CPM

8/12

8/12

Pyramids & Palm Trees

6/10

8/10

Verbal fluency

4

5

Verbal recognition

10/10

10/10

Ideomotor apraxia

7/12

6/12

Picture description

5/10

6/10

Arithmetic

5/6

4/6

Comprehensive Aphasia Test: CognitionSlide24

Language

Pre treatment

Auditory comprehension (SW)

24/30

Written comprehension (SW)

26/30

Auditory comprehension (S)

11/16

Written comprehension (S)

10/16

Repetition (SW)

8/32

Noun naming

9/48

Reading (SW)

7/48

Comprehensive Aphasia Test: LanguageSlide25

Language

Pre treatment

Post treatment

Auditory comprehension (SW)

24/30

22/40

Written comprehension (SW)

26/30

24/30

Auditory comprehension (S)

11/16

13/16

Written comprehension (S)

10/16

15/16

Repetition (SW)

8/32

6/32

Noun naming

9/48

10/48

Reading (SW)

7/48

4/48

Comprehensive Aphasia Test: LanguageSlide26

Pre-intervention CAT Picture Description

`a man asleep and the (ray) is…it.. ah cup (dik, cots, frot) cat goin in the (blefa) the gates are falling and recorder it on.. a plant'. Slide27

Conversation

Analysis Profile for People with Aphasia (CAPPA: Whitworth, Perkins & Lesser, 1997)Changes in couple’s report of regained pre-morbid patterns:Slide28

Len and Jane: Assessment and InterventionAssessment 1Conversation recorded (15 mins)Language assessmentsCAPPA interview8 weeks rest Assessment 2Conversation recorded (9 mins

)

CAPPA interview8 weeks intervention (1-2

hrs

, 1 per week)

Assessment 3Conversation recorded (37 mins)Language assessments

CAPPA

interviewSlide29

Question-answer sequences:

Research from normal conversation(Schegloff, 2007)Questions constrain next speakerQuestions are first-pair parts (FPPs): normative expectation that an answer will be produced and be in line with the question askedQuestioner temporarily controls the conversation and the Q-A sequence - unless answerer does something extra, questioner can speak again (and maybe start a new sequence) Slide30

Yes-no questions

(Raymond, 2003)Y-N questions particularly constrain the answererAn expectation that an answer will contain a ‘yes’ or a ‘no’ (this may end up being answers full contribution)Answerer may not answer with a ‘yes’ or a ‘no’ but this will be noticeable (why avoiding it?) and may entail more linguistic workExample of ‘positionally sensitive grammar’ (Schegloff 1996) ie where an utterance comes in conversation can affect its formSlide31

Conversation:

Pre-intervention 1

did you have a good walk?(4.5) did you enj

oy your walk?yeswas it very hot?

yes.

did you

see anybody?(0.5) uh: no. yeah, (1.9) man with a dog.you saw the man with the dog uhm (.)whats his name. not Bob. cant remember what his name is. right. was he going for a

wa

lk with the dog?

n

o

o

h



right



he’s

coming back.

he was coming

do

wn,



right.



yeah

and

uhm

you didn’t see Gwyn or

Edna?(0.2) y:es,Slide32

Sequence

s in Len and Jane’s conversation: Pre-interventionSlide33

Sequence

s in Len and Jane’s conversation: Pre-interventionTurn 1 by JaneTypically produces questions in the form of:yes-no questions (eg ‘did you have a good walk’?) 2) ‘closed’ questions which demanded specific answers (

eg

‘who did you see?’)Slide34

Sequence

s in Len and Jane’s conversation: Pre-interventionTurn 1 by JaneTypically produces questions in the form of:yes-no questions (eg ‘did you have a good walk’?) 2) ‘closed’ questions which demanded specific answers (

eg

‘who did you see?’)Turn 2 by

Len

Typically uses the minimum form to answer the question:

-answers Y-N questions with a ‘yes’ or ‘no’

-answers closed/’

wh

-’ questions with minimal information required (‘two’)

Very few sentences

/attempted sentences, despite their use in tests (here only ‘he’s coming back’)Slide35

Sequence

s in Len and Jane’s conversation: Pre-interventionTurn 1 by JaneTypically produces questions in the form of:yes-no questions (eg ‘did you have a good walk’?) 2) ‘closed’ questions which demanded specific answers (

eg

‘who did you see?’)Turn 2 by

Len

Typically uses the minimum form to answer the question:

-answers Y-N questions with a ‘yes’ or ‘no’

-answers closed/’

wh

-’ questions with minimal information required (‘two’)

Very few sentences

/attempted sentences, despite their use in tests (here only ‘he’s coming back’)

Turn 3 by Jane

Jane’s responses typically

take the form of another question, launching a new sequenceSlide36

Example

2: the ‘best’ section in the pre-intervention conversation as chosen unanimously by three blind ratersMore sentence forms by Len, but still the general patterns of sequence and topic seen in Extract 1:Slide37

Pre-intervention Ex 2a

so when I went ehm (0.4) to the hospital with Nana this morning (0.8) what did you do

I went eh (0.4) wa ge gu walkyou went for a walk (0.4) ehm (0.4) what time did you get up

(6.0) eh (se woo) (1.3) wah (0.6) t-t- tu before eight o’clock?

(0.7) yes ((

nods

)) got up before eight o’clock (0.8) right and em (0.4) did you do your breakfast or did Anthony do it for you ooh I

did

it

you did it right did you make yourself a cup of tea

ye:s

((

nods

))

g

ood

ooh (.) and I made (.) Anthony (.) cup of (.) teaSlide38

Pre-intervention 2a cont.

you made Anthony a cup of tea heh heh (.) did you take it up

noheh heh heh okay so he came down 

for his cup of tea yeah(0.5) so (.) what did you do then(1.4) went out for a walkyou went out for a walk (0.4) ehm (.) where did you go

ooh (.) I-I (0.8) I: (0.6) went (.)

to: (.) the: (0.7)

right did you go up as far as Southgate? y-ah! ((points)) y-no

you went to the end of Blag



don’s Lane?



ye:s ((

nods

)) ye:s

right okay you went to the end of Blagdon’s



Lane



yeah (0.4) and I came back>

and you came backSlide39

Len and Jane pre-intervention: Sequence and topic

Len is almost constantly in the role of ‘answerer’Len is interactionally passive and responsive. His role in relation to determining the content, direction, and topical development of these two conversations is a minimal oneIt is Jane who constantly takes the initiating actions - asking questions, initiating and developing the topics of talkSlide40

Intervention Aims: Discussed and worked with

with the coupleJane: make greater use of other forms to initiate sequences rather than yes/no and closed questions

(b)

Jane: respond to some of Len’s answers with a repeat or paraphrase of his turn, or with a

minimal agreement

(such as

‘mm hm’) rather than with

another

question

(c

) Len

:

use

the extra opportunities for talk

that

Jane

’

s

changes in

behaviour provide in

order to contribute more to the conversation Slide41

Interaction-focused intervention process

R

aise

participants’ awareness of a conversational behaviour in general

Using

handouts

adapted from those used in the SPPARC, Jane introduced to findings about turns and sequences (such as questions and answers) different types

of questions

the

constraining effects

of questions on

the

recipientSlide42
Slide43

Interaction-focused intervention process

2. R

aise

participants’ awareness of own patterns of

conversation

Jane shown video clips of her question behaviours with Len and this discussed with herJane given handouts which included examples of her different types of questions and

their effect

on Len’s

responsesSlide44

Interaction-focused intervention process

3. Strategies for change

Jane asked to read written

versions of a range of questions she had used and decide which type of question each was (i.e

. yes

/

no question etc.)Jane encouraged to use different types of turns athome to initiate sequences (i.e., different types of questions, statement forms instead of questions etc) and to respond with paraphrases and minimal turns

In forms of: role plays, homework tasks to monitor herself and elicit her feelings about changesSlide45
Slide46

Post-

intervention tell me about your walk.

(2.0) I eh (1.9) I’ve eh (4.7) I (0.7) eh walked past the (0.5) cemetery (1.1) I saw Gwyn(1.1) you walked (.) past the cemetery (.) you s

aw Gwyn saw Gwyn(0.5) and he (was) (0.7) coming downGwyn was coming down.

yeah. (0.5) and he have

bwocks

with him (0.9) a with eh- (0.4) him (1.0) ehhe had a box with him NO::: a bag.

,

he had a



bag

with him right?





ye:s



(1.2) and he was (2.1) going out (0.5) t-to, (2.2) to eh, (2.6) ) oh anyone

oski

the (0.3) eh (0.5)

kower

but eh lays and he- and (0.5) he was (0.7) eh s: saying (0.6) eh par eh oohSlide47

Post-intervention cont.

(0.9) at eh (1.1) ooh

(1.5) eh he had a bag with him was he going shopping?

n

o

coming home from the



shops.



no he was (0.9) he (wa) (ts) (0.9) and he (wat) (.) talked to me about the Wales?

he talked to



you-



yeah

he talked to you about Wales (.) right?

Slide48

Sequence

s in Len and Jane’s conversation: Post-interventionSlide49

Sequence

s in Len and Jane’s conversation: Post-interventionTurn 1 by JaneNow initiating sequences with forms other thn questions eg a topic-eliciting statement (‘tell me about your walk’)Slide50

Sequence

s in Len and Jane’s conversation: Post-interventionTurn 1 by JaneNow initiating sequences with forms other thn questions eg a topic-eliciting statement (‘tell me about your walk’)

Turn 2 by Len

Regularly consisting of sentences or attempted sentences – sometimes 2 or more sentences in a turn

Taking active role in conversation:

-actively developing, and in charge of, topic

-correcting JaneSlide51

Sequence

s in Len and Jane’s conversation: Post-interventionTurn 1 by JaneNow initiating sequences with forms other thn questions eg a topic-eliciting statement (‘tell me about your walk’)

Turn 2 by Len

Regularly consisting of sentences or attempted sentences – sometimes 2 or more sentences in a turn

Taking active role in conversation:

-actively developing, and in charge of, topic

-correcting Jane

Turn 3 by Jane

Responses

regularly take non-question forms esp. repeats and paraphrases

Generally very ‘other-oriented’

ie

oriented to Len’s talkSlide52

Sequence

s in Len and Jane’s conversation: Post-interventionTurn 1 by JaneNow initiating sequences with forms other than questions eg a topic-eliciting statement (‘tell me about your walk’)Turn 2 by Len

Regularly consisting of sentences or attempted sentences – sometimes 2 or more sentences in a turn

Taking active role in conversation:

-actively developing, and in charge of, topic

-correcting Jane

Turn 3 by Jane

Responses

regularly take non-question forms esp. repeats and paraphrases

Generally very ‘other-oriented’

ie

oriented to Len’s talk

Turn 4 by Len

Produces

another turn developing his topicSlide53

Quantitative comparisons of samples pre-interventionSlide54

Quantitative comparisons of samples pre and post-interventionSlide55

Conversation post

-intervention: Speech and language therapists’ ratings Could the changes we had identified using Conversation Analysis be identified by others who had not undertaken the close analysis?

Could 15 naive

SLTs select from two samples of conversation which sample is taken from the pre-Intervention video and which is from the

post-.

Was there

a difference between the two samples on the behaviours identified.Slide56

Method:

Take sample of post-intervention conversation showing changesSelect best section from pre-intervention conversations for comparison (chosen unanimously by three naïve raters)15 SLTs took part in ratings Average time since qualification: 11.2 yearsAverage number of years working with aphasia: 9.6 yearsSlide57

Task 1: which sample is pre-intervention and which post-intervention?

Extracts presented as ‘green’ and ‘harlequin’SLTs shown the two extracts twice (g;h;g;h)Make decision on which extract is pre, which post and comment whySlide58

Task 2: Observations of specific

behavioursTreatment described to SLTsSLTs given written transcripts of the extractsGiven description of behaviours with codesWatched extracts twice (h;h;g;g) and marked down when behaviours evidentSlide59

Results: Task 1- which sample is pre-treatment and which post-treatment?

14 out of the 15 SLPs correctly identified green extract as occurring post-treatmentSlide60

Task 2: Proportion behaviours observed pre-interventionSlide61

Task 2: Proportion behaviours observed post- interventionSlide62

Conversation post-treatment: Jane

’s perception‘The main difference in Len’s conversation since last June is that he now uses sentences daily instead of one word requests or answers. Len speaks to our son and my mother and his weekly telephone call to his brother is much less of a chore for Len. He attempts more conversation with friends.When Sarah first set up the recorder and stated that she wanted us to record our conversation my heart dropped. We had no conversation as I understood it. I would talk to Len constantly and apart from making sure that he understood me, I was content to leave it at that. Slide63

When Len needed to tell me something we played

‘twenty questions’ until I understood his needs. When we studied the tape we were both very surprised to see that Len was able to answer some questions. He gained in confidence through this experience and has gone from strength to strength.The initial sounds are sometimes wrong but Len is forming complete sentences, in his head, and attempts to talk in complete sentences. Len finds it easier to initiate a conversation relating to his needs…..’Slide64

In this study….

Couple had mutually adapted in a way which ‘worked’ for them to some extent: - Jane gets Len to talk by asking easy questions where the form is easy for him eg Y-N questions - Len’s linguistic limitations are not exposed ie little delay /errors/repairBut this adaptation was at a large cost: - Len very passive in conversation and contributing only minimally to topic developmentThe intervention provided them with choices ie can do other actions in conversation except very restricted Q-A-Q-ANotably, Len’s language output changed (was encouraged to be used) in conversation, even though it was Jane who was most targeted in intervention (cf. Simmons-Mackie et al., 2005)Slide65

Therapy case study 2: Improving PWA’s ability to produce successful topic initiations

(Wilkinson, Lock, Bryan & Sage, 2011, IJSLP)Connie 36Left CVA 14 months previouslyAgrammaticPhonemic and semantic paraphasiasMild dysarthriaGood comprehensionProfession: ex-catering

manager

Sam (spouse)

38

Profession: manager

in a service industrySlide66

Interaction-focused therapy for Connie & Sam

Collect recordings of couple at home and carry out testsConversation assessment: pre-and post intervention and plan intervention RepairTopicTurns and sequences10 minutes transcribed and analysed Interaction-focused intervention: four 2-hour sessions with the couple together at homeSlide67

Comprehensive Aphasia Test:

Disability Questionnaire for ConnieKey: lower the score, lower the perceived disabilitySlide68

Topic initiation in normal conversation

Can occur almost imperceptibly within turns.But other topic initiations are ‘boundaried’ ie marked to be heard as disjunctive to what has just been talked aboutSuccessful topic change is a collaborative and mutual phenomenon eg: -one speaker announces some news (‘oh I saw John last night’) -other speaker aligns with this news/new topic (‘oh really?’)It is important that topic initiating turns are recognizable as such-often using ‘prefatory discontinuity markers’ eg ‘anyway’,‘ well’ etc -separates off the new topic from the old ie makes it disjunctiveAlso speakers mark when current topic winding down (eg by repeating/returning to words used at the start of the topic)

-ie

current topic is marked as winding down, new one may be expected Collaborative work between two speakers Slide69

Topic initiations by Connie: Pre-intervention

Connie initiates topic three times in the pre-intervention conversation dataBut each time the topic initiation is problematiceg Sam has difficulty in understanding Connie’s topic initiating turnsSlide70

Pre-intervention Ex. 1

stop off in California (0.8) on the way there- in (.) New York

on the way there..

hhh ehm (1.4) eh feberi

February

.

no::! (0.6) farerifamily.yeah. (1.2) fami

ly

.

fabi

,

fa:mi:ly

.

fa:mi:

ly

.

that’s it. (0.3) family. your family in A-America. (0.5)



we’ll see them.



no:::!

family?

(1.5) ((

C looks crossly at S

))

sorry (.) I’m (.) mistaken

fabawi

(1.3)

fa:mi:ly

.=yeah, Jimmyyeah. (0.7) and they’re going.no:: ((looks frustrated))go on< go on sorry sorry go on

eh Jimmy...Mary…Slide71

Pre-intervention Ex.

2and it's ten past eleven (2.0) and I just feel tired (.)

I'll have a shower now (.) (scuse) I just keep yawning

((yawns)) have a shower (.) go to bed and get up again.ehm rea:d

my:

boo:ks

: (1.5)sorry  ( ) rea:d

my:

boo:ks

:

read your book?

mm

where's your book?

((

C picks up homework book

))Slide72

Summary of Connie’s topic initiations pre-intervention

All three topic initiations were initially unsuccessfulProblem for Sam in understanding/hearing them: - not only dysarthric/agrammatic problems but some evidence he does not always recognize them AS topic initiating turns Psychosocial consequences: Sam’s difficulties in understanding Connie are evident, often over several turns/triesFactor: Connie’s design of these turns, and not marking them clearly enough as topic initiations – not getting Sam’s attention eg no use of ‘prefatory discontinuity markers’Slide73

Intervention for topic initiation difficulties

1 of Connie and Sam’s 4 intervention sessions focused on topicRaising awareness of topic initiations in general - normal topic initiation discussed using SPPARC handouts 2. Raising their awareness of their own patterns of topic initiations - using Connie and Sam’s videos - ie highlighting Connie’s topic initiations appear ‘out of the blue’ and therefore hard for Sam to understand - currently done as quite unilateral by Connie rather than collaborative3. Strategies for change -Connie to draw Sam’s attention to topic initiation with ‘alerters’ eg

‘anyway’ -if Sam recognizes this as topic initiation, he should collaborate with it

(eg through using a continuer such as ‘mm hm’)-what currently done unilaterally by one to be done collaboratively by twoSlide74

Topic initiations by Connie: Post-intervention

In similar length of

analysed

conversation (9 mins), 5 topic initiations by Connie using this new methodBut not ‘anyway’ etcRather: Temporal phrase (‘tomorrow morning’) + pause

(

ie

space for Sam to recognize this is a new topic and produce a continuer to facilitate her to continue)Slide75

Post-intervention Ex. 1

((talking to ‘

Soots’, the cat))

shower leaking (0.3) Soots (0.3) shower’s leaking.(2.7)mm (0.9)((talking to cat)) lay down.(5.8)

ehm (.) ((

lip smack

)) (2.0) eh:: (.) ((lip smack)) (1.3) next Thursday, (2.3) mm hm



eh



te

n o’clock, (0.3) a m

,

(0.4)



mm hm



(0.4)

ehm (.) meet (.) cous-ins

.

(1.9)

meet?

the cousins (.)

Stanst-ead

air-port.

I thought it was

Fri

day you were going.

no! (0.6) Thursday.Slide76

Post-intervention Ex.

2I’m only gonna go (.) two weeks. (2.4) a day to get there (n) a day to get back (2.8)

it’s a long way. (0.9) s- (0.9) it’s a day out-two days out your life on an aeroplane,

((shrugs)) mm so what?(6.5) ((

lip smack

)) ehm, (.) ((

lip smack)) tomorrow?=mm hm,(0.8) morning, (0.4) e:leven o’clock,

mm hm

nom

eni

(.) h- (.)

hos

pital,

.



mm

hm



m

i

d

i

s

ex

hos

pital,

((

nods

))

ehm: (0.5) ((lip smack)) f-ehm, ((tuts)) (1.2) heh

heh

heh

John

John (

(laughs)).Slide77

Post-intervention Ex.

3well I’m glad you’re

gonna go (0.6) with your cousins ‘n (2.3) good holiday

eh ((lip smack)) ehm ((

lip smack

)) (0.8)

las:t (1.0) no. (.) you- mm ((lip smack)) l- (3.5) ((lip smack)) this morning,

((

head nod

))

‘

raine

phone me (0.9) Aus

tral

ia.

yeah ((

yawns

))

ehm

guess what

(1.0) what

(1.5) you



and me



she’s moving back (1.0)

no

(.) you and I,

you mean you and me

((

both laugh))ehm god-par-ents. (1.2) godparents.yeah. (0.8) only if we go there.

yeah

you and I yeahSlide78

Summary of topic initiation intervention

New method is idiosyncratic, but successful for this coupleConnie’s temporal phrase with rising intonation + pause successfully marked this turn as new topic, discontinuous with prior talkIt also enagaged Sam as a co-constructor of the topicIe topic initiation as collaborative and step-by-stepNew method involves mutual adaptation – new behaviours for Connie’s topic initiations by both members of the coupleAll Connie’s topic initiations using this method were understood by Sam – no repair and highlighting of Connie’s impairments Slide79

Summary of topic initiation intervention

This method slightly different to what was trained

Where does this temporal phrase method come from?Slide80

Use of temporal phrase pre-intervention

she used to

lick them to death didn’t she. (.) licked them to

death awwh::

ehm

((

lip smack)) (.)uh (1.1) ((lip smack)) nine years ago .

hh

ehm

(.) ((

lip smack

)) (0.2) the

do

g (0.3) eh died a heart attack

awwh



that was your



alsatian



yeah



yeahSlide81

Maintenance of use of method: 23 months after post-intervention assessment

yeah that

’s all I been doing

part from (0.2) bit a decorating (0.8) umm (1.0) yeah tuh (0.2) July no- June um (0.2)

tuh

three tier wedding cake (0.2)

I make itare you? yeah (0.3)

brilliant

Slide82

Use of interaction-focused therapy in clinical practice

Some publications in professional literature about using this therapy approach in clinical practice (Niewenhuis, 2005; Volkmer, 2006; Waters, 2007)With other client groupsIn different settings eg hospitalRun as group therapy vs couples therapyTime issues & resource issuesSlide83

Conclusions

Now a growing evidence base that aphasia therapy can change how PWA and SOs have conversations in the home environment (see Wilkinson & Wielaert, 2012, for an overview)This means a change not only in terms of improved communication and language use, but also supporting couples to adapt to having conversations with aphasia i.e. psychosocial improvementFuture work involves examining the role of impairment-focused therapy in changing conversation, and in expanding how interaction-focused therapy is used both in research and clinical practice Slide84

ray.wilkinson@manchester.ac.uk