Understanding mechanisms of change after conversation-focused therapy in aphasia

A conversation analysis investigation


  • Jamie H Azios Lamar University
  • Brent E Archer Bowling Green State University
  • Jaime B Lee James Madison University




aphasia, stroke, conversation, treatment, intervention, qualitative


Objective: Conversation therapy in aphasia is a complex but effective type of intervention aimed at changing the linguistic and non-linguistic behaviors of persons with aphasia and/or their conversational partners. Recent studies have examined the experimental effects of conversation-based intervention and found significant change in targeted conversation strategies used by people with aphasia during therapy contexts. This investigation examines the generalization of therapy effects to naturally occurring conversations outside therapy.

Method: The current study uses a conversation analysis framework to examine the generalization of this change to conversations between a person with aphasia and their spouse.

Results: Conversation analysis revealed changes in the sequential environment of various strategies that were targeted in conversation-based intervention. Most notably, there was a change in the flexibility and deployment of gesture type and the act of writing as a means of achieving mutual understanding.

Discussion: This study adds to the growing body of evidence supporting conversation-based interventions. Qualitative analysis of conversation provides important information on a client’s response to intervention and the generalization of targeted strategies to everyday contexts.

Conclusion: Given the nature of complex, collaborative, and unplanned conversation, qualitative approaches allow clinicians and researchers to better understand why clients deploy strategies of interest at various junctures. These types of analyses are vital for understanding if and how meaningful life participation is achieved after skilled intervention.

Author Biographies

Jamie H Azios, Lamar University

Jamie H. Azios, PhD, CCC-SLP is an associate professor in the Speech and Hearing Sciences Department at Lamar University. She has expertise in using qualitative research methodologies to examine the perspectives and interactions of adults with neurogenic communication disorders in various social contexts. Her research interests include co-constructed conversation in aphasia and the impact of communicative environments on social participation and inclusion. She has published articles related to client centeredness, the interactional environments of long-term care facilities, and therapist and client behaviors during social approaches to aphasia intervention. She is an inaugural Tavistock Trust for Aphasia Distinguished Scholar.

Brent E Archer, Bowling Green State University

Brent E. Archer hails from Johannesburg, South Africa. After completing a degree in speech-language pathology and audiology at the University of the Witwatersrand in 2006, Brent worked as a speech-language pathologist and audiologist at rural hospitals, clinics, schools, and kindergartens in the Free State province of South Africa. In 2012, he entered the applied languages and speech sciences PhD program at the University of Louisiana, Lafayette. In his dissertation, Brent used a number of frameworks (systemic functional linguistics, CA, cognitive ethnography) to study facilitated conversation groups for people with aphasia. He was interested in understanding how groups of people with mild to
severe language deficits were able to use each other and resources in the environment to remain effective, competent communicators. In 2016, he obtained his PhD from the University of Louisiana, Lafayette. After graduating, he was appointed as an assistant professor in communication disorders and sciences at Bowling Green State University. Brent’s research interests include aphasiology and bilingualism in clinical populations. In 2020, Brent was chosen as a Tavistock Aphasia Distinguished Scholar.

Jaime B Lee, James Madison University

Jaime B. Lee, PhD, CCC-SLP, is an assistant professor in the Communication Sciences and Disorders Department at James Madison University. She teaches courses in the areas of neurogenic communication disorders and is engaged in clinical research focused on adults with chronic aphasia. She has published on topics such as attention and aphasia, computer-based treatments for aphasia, aphasia group facilitation, and single-case experimental design.


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How to Cite

Azios, J. H., Archer, B. E., & Lee, J. B. (2022). Understanding mechanisms of change after conversation-focused therapy in aphasia: A conversation analysis investigation. Journal of Interactional Research in Communication Disorders, 13(2), 220–243. https://doi.org/10.1558/jircd.21043