Topic maintenance in non-fluent aphasia conversation

A training program in strategies for communication partners

Authors

  • Estibaliz Terradillos Complutense University of Madrid
  • Teresa Simón Complutense University of Madrid
  • Ramón López-Higes Complutense University of Madrid

DOI:

https://doi.org/10.1558/jcs.29236

Keywords:

aphasia, conversation analysis, conversation therapy, conversational partner, conversational strategies, topic maintenance

Abstract

Background: Studies on communication partner training programs for persons with aphasia reveal improvements in the conversation partners’ communication skills. This article explores the strategies for topic maintenance developed by the conversational partners of three people with non-fluent aphasia before and after an intervention on conversational strategies.

Method: We used conversation analysis to examine video-recorded samples of everyday conversations (pre- and post-treatment and follow-up) between three couples. The assessment for topic management was performed with Conversation Analysis Profile for People with Aphasia (CAPPA). The intervention was conducted over a period of five weeks. The partners were trained to use strategies for better topic maintenance (multiple-choice, multimodality, and message verification). At six weeks post-therapy, a third recording was made.

Results: After the intervention, changes in topic maintenance were observed. The use of strategies is related to the pre-existing context and the presence of visual support.

Discussion/Conclusion: Individuals with non-fluent aphasia and their conversation partners engage in multimodal conversations and benefit from the use of strategies to overcome barriers to understanding, leading them to maintain a conversational topic.

Author Biographies

  • Estibaliz Terradillos, Complutense University of Madrid

    Estibaliz Terradillos is a speech and language pathologist with 24 years of experience in the neurological field. She holds a PhD (2024) from the Faculty of Psychology at the Complutense University of Madrid. Her thesis regards conversation partner training in aphasia. She works as an Associate Lecturer at the Complutense University of Madrid, where she is also the Head of teaching at the Speech Therapy Clinic of the Faculty of Psychology. Her publications include Guía de intervención logopédica en las afasias (with Professor Ramón López-Higes, 2016, Síntesis).

  • Teresa Simón, Complutense University of Madrid

    Teresa Simón is Lecturer in Speech and Language Pathology at the Complutense University of Madrid. She holds a PhD from the Complutense University of Madrid in the programme of Language Intervention (2011) and a Master in Research Methodology in Health and Behavioural Sciences. She has worked for eight years as a speech pathologist in clinical settings. Between 2009 and 2019, she was a lecturer at the University of Castilla-La Mancha. She is co-editor and secretary of the Journal of Research in Speech and Language Therapy and author of more than twenty articles, books, and chapters in the field of ageing, language disorders, clinical linguistics, and research methods.

  • Ramón López-Higes, Complutense University of Madrid

    Ramón López-Higes is Professor in the Department of Experimental Psychology at the Complutense University of Madrid (UCM). He started his scientific career in 1990 after obtaining a Spanish government research grant (FPI program). His doctoral thesis was distinguished with the UCM’s extraordinary prize. Dr. López-Higes has conducted studies about sentence comprehension. He joined the Cognitive Neuroscience research group, has led two competitive coordinated projects, and now is codirecting a new research project. He was the president of Asociación Española de Logopedia, Foniatría y Audiología (AELFA). He was also vice dean of SLP in the faculty of Psychology (UCM) and director of the Department of Cognitive Processes. He is co-author of more than sixty high-impact publications (books and papers). 

References

Aaltonen, T., & Laakso, M. (2010). Halting aphasic interaction: creation of intersubjectivity and spousal relationship in situ. Communication & Medicine, 7(2), 115–126. https://doi.org/10.1558/cam.v7i2.95

Archer, B., Tetnowski, J., Freer, J. C., Schmadeke, S., & Christou-Franklin, E. (2018). Topic selection sequences in aphasia conversation groups. Aphasiology, 32(4), 394–416. https://doi.org/10.1080/02687038.2017.1413705

Auer, P., & Bauer, A. (2011). Multimodality in aphasic conversation: Why gestures sometimes do not help. Journal of Interactional Research in Communication Disorders, 2(2), 143–215. https://doi.org/10.1558/jircd.v2i2.215

Barnes, S. E., Candlin, C. N., & Ferguson, A. (2013). Aphasia and topic initiation in conversation: A case study. International Journal of Language & Communication Disorders, 48(1), 102–114. https://doi.org/10.1111/j.1460-6984.2012.00186.x

Beckley, F., Best, W., & Beeke, S. (2017). Delivering communication strategy training for people with aphasia: What is current clinical practice?. International Journal of Language & Communication Disorders, 52(2), 197–213. https://doi.org/10.1111/1460-6984.12265

Beeke, S., Beckley, F., Johnson, F., Heilemann, C., Edwards, S., Maxim, J., & Best, W. (2015). Conversation focused aphasia therapy: Investigating the adoption of strategies by people with agrammatism. Aphasiology, 29(3), 355–377. https://doi.org/10.1080/02687038.2014.881459

Beeke, S., Sirman, N., Beckley, F., Maxim, J., Edwards, S., Swinburn, K., & Best, W. (2013). Better Conversations with Aphasia: An e-Learning Resource. UCLeXtend. https://extend.ucl.ac.uk/

Beeke, S., Wilkinson, R., & Maxim, J. (2007). Individual variation in agrammatism: A single case study of the influence of interaction. Journal of Language & Communication Disorders, 42(6), 629–647. https://doi.org/10.1080/13682820601160087

Beeke, S., Wilkinson, R., & Maxim, J. (2009). Prosody as a compensatory strategy in the conversations of people with agrammatism. Clinical Linguistics & Phonetics, 23(2), 133–155. https://doi.org/10.1080/02699200802602985

Best, W., Maxim, J., Heilemann, C., Beckley, F., Johnson, F., Edwards, S. I., Howard, D., & Beeke, S. (2016). Conversation therapy with people with aphasia and conversation partners using video feedback: A group and case series investigation of changes in interaction. Frontiers in Human Neuroscience, 10, 562. https://doi.org/10.3389/fnhum.2016.00562

Blonder, L. X. (2000). Language use. In S. E. Nadeau, L. J. Rothi & B. Crosson (Eds.), Aphasia and language: Theory to practice (pp. 284–295). Guilford Press.

Button, G., & Casey, N. (1985). Topic nomination and topic pursuit. Human Studies, 8(1), 3–55. https://doi.org/10.1007/BF00143022

Caute, A., Dipper, L., & Roper, A. (2021). The City Gesture Checklist: The development of a novel gesture assessment. International Journal of Language & Communication Disorders, 56(1), 20–35. https://doi.org/10.1111/1460-6984.12579

Clark, H. H. (1996). Using language. Cambridge University Press. https://doi.org/10.1017/CBO9780511620539

Clough, S., & Gordon, J. K. (2020). Fluent or nonfluent? Part A. Underlying contributors to categorical classifications of fluency in aphasia. Aphasiology, 34(5), 515–539. https://doi.org/10.1080/02687038.2020.1727709

Cruice, M., Blom Johansson, M., Isaksen, J., & Horton, S. (2018). Reporting interventions in communication partner training: A critical review and narrative synthesis of the literature. Aphasiology, 32(10), 1135–1166. https://doi.org/10.1080/02687038.2018.1482406

Damico, J., Tetnowski, J., Lynch, K., Hartwell, J., Weill, C., Heels, J., & Simmons-Mackie, N. (2015). Facilitating authentic conversation: An intervention employing principles of constructivism and conversation analysis. Aphasiology, 29(3), 400–421. https://doi.org/10.1080/02687038.2014.945388

Doedens, W. J., & Meteyard, L. (2022). What is functional communication? A theoretical framework for real-world communication applied to aphasia rehabilitation. Neuropsychology Review, 32(4), 937–973. https://doi.org/10.1007/s11065-021-09531-2

Gallardo, B. (1993). La transición entre los turnos conversacionales: Silencios, solapamientos e interrupciones. Contextos (21–22), 189–220.

Gallardo, B., & Moreno, V. (2005). Afasia no fluente. Materiales y análisis pragmático (Vol. 2 del Corpus PerLA). Universitat de Valencia. https://www.uv.es/perla/GallardoyMOrenoVol2.AfNoFluente.pdf

Goodglass, H., Kaplan, E., & Barresi, B. (2000). Boston diagnostic aphasia examination (3rd ed.). Lippincott Williams & Wilkins.

Hayes, A. F., & Krippendorff, K. (2007). Answering the call for a standard reliability measure for coding data. Communication Methods and Measures, 1, 77–89. https://doi.org/10.1080/19312450709336664

Hazamy, A. A., & Obermeyer, J. (2020). Evaluating informative content and global coherence in fluent and non-fluent aphasia. International Journal of Language & Communication Disorders, 55(1), 110–120. https://doi.org/10.1111/1460-6984.12507

Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G. H. Lerner (Ed.), Conversation analysis. Studies from the first generation (pp. 13–31). John Benjamins Publishing Company.

Johnson, F. M., Best, W., Beckley, F. C., Maxim, J., & Beeke, S. (2017). Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods. International Journal of Language & Communication Disorders, 52(3), 374–387. https://doi.org/10.1111/1460-6984.12279

Kistner, J., Marshall, J., & Dipper, L. T. (2020). The influence of conversation parameters on gesture production in aphasia. Clinical Linguistics & Phonetics, 34(8), 693–717. https://doi.org/10.1080/02699206.2019.1692075

Kitzinger, C. (2013). Repair. In J. Sidnell, & T. Stivers (Eds.), The handbook of conversation analysis (pp. 229–256). Wiley-Blackwell.

Krippendorff, K. (2004). Reliability in content analysis: Some common misconceptions and recommendations. Human Communication Research, 30(3), 411–433. https://doi.org/10.1111/j.1468-2958.2004.tb00738.x

Laakso, M., & Godt, S. (2016). Recipient participation in conversations involving participants with fluent or non-fluent aphasia. Clinical Linguistics and Phonetics, 30(10), 770–789. https://doi.org/10.1080/02699206.2016.1221997

Laakso, M., & Klippi, A. (1999). A closer look at the ‘hint and guess’ sequences in aphasic conversation. Aphasiology, 13(4), 345–363. https://doi.org/10.1080/026870399402136

Leaman, M. C., & Archer, B. (2022). “If you just stay with me and wait…You’ll get an idea of what I’m Saying”: The communicative benefits of time for conversational self-repair for people with aphasia. American Journal of Speech-Language Pathology, 31(3), 1264–1283. https://doi.org/10.1044/2022_AJSLP-21-00199

Leaman, M. C., & Edmonds, L. A. (2019). Revisiting the correct information unit: Measuring informativeness in unstructured conversations in people with aphasia. American Journal of Speech-Language Pathology, 28(3), 1099-1114. https://doi.org/10.1044/2019_AJSLP-18-0268

Lock, S., Wilkinson, R., Bryan, K., Maxim, J., Edmundson, A., Bruce, C., & Moir, D. (2001). Supporting partners of people with aphasia in relationships and conversation (SPPARC). International Journal of Language & Communication Disorders, 36(S1), 25–30. https://doi.org/10.3109/13682820109177853

Manzo, J. F., & Blonder, L. X. (1995). The social-interactional organisation of narrative and narrating among stroke patients and their spouses. Sociology of Health & Illness, 17(3), 307–327. https://doi.org/10.1111/1467-9566.ep10933323

Oelschlaeger, M. L., & Damico, J. S. (2003). Word searches in aphasia: A study of the collaborative responses of communicative partners. In C. Goodwin (Ed.), Conversation and brain damage (pp. 211–227). Oxford University Press.

Perkins, L., Crisp, J., & Walshaw, D. (1999). Exploring conversation analysis as an assessment tool for aphasia: The issue of reliability. Aphasiology, 13(4–5), 259–281. https://doi.org/10.1080/026870399402091

Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking in conversation. Language, 50(4), 696–735. https://doi.org/10.2307/412243

Sage, K., & Terradillos, E. (2016). Terapia funcional para la persona con afasia: ¿en qué consiste?, In M. T. Martín-Aragoneses & R. López-Higes. (Eds.), Claves de la logopedia en el siglo XXI (pp. 231–249). UNED.

Saldert, C., Jensen, L. R., Blom Johansson, M., & Simmons-Mackie, N. (2018). Complexity in measuring outcomes after communication partner training: alignment between goals of intervention and methods of evaluation. Aphasiology, 32(10), 1167–1193. https://doi.org/10.1080/02687038.2018.1470317

Schegloff, E. A. (1979). The relevance of repair to syntax-for-conversation. In T. Givón (Ed.), Discourse and syntax (pp. 261–286). Brill.

Schegloff, E. A. (1992). Repair after next turn: The last structurally provided defense of intersubjectivity in conversation. American Journal of Sociology, 97(5), 1295–1345. https://doi.org/10.1086/229903

Schegloff, E. A. (2007). Sequence organization in interaction. A primer in conversation analysis. Cambridge University Press.

Schegloff, E. A., Jefferson, G., & Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53(2), 361–382. https://doi.org/10.2307/413107

Sidnell, J., & Stivers, T. (Eds). (2013). The handbook of conversation analysis. Wiley-Blackwell.

Simmons-Mackie, N., & Damico, J. S. (1997). Reformulating the definition of compensatory strategies in aphasia. Aphasiology, 11(8), 761–781. https://doi.org/10.1080/02687039708250455

Simmons-Mackie, N., Raymer, A., & Cherney, L. R. (2016). Communication partner training in aphasia: An updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(12), 2202–2221. https://doi.org/10.1016/j.apmr.2016.03.023

Simmons-Mackie, N., Savage, M. C., & Worrall, L. (2014). Conversation therapy for aphasia: A qualitative review of the literature. International Journal of Language & Communication Disorders, 49(5), 511–526. https://doi.org/10.1111/1460-6984.12097

Tuomenoksa, A., Beeke, S., & Klippi, A. (2022). People with non-fluent aphasia initiating actions in everyday conversation with familiar conversation partners: Resources for participation. Aphasiology, 36(5), 575–598. https://doi.org/10.1080/02687038.2020.1852518

Wallace, S. J., Isaacs, M., Ali, M., & Brady, M. C. (2022). Establishing reporting standards for participant characteristics in post-stroke aphasia research: An international e-Delphi exercise and consensus meeting. Clinical Rehabilitation, 37(2), 199–214. https://doi.org/10.1177/02692155221131241

Whitworth, A., Perkins, L., & Lesser, R. (1997). Conversation analysis profile for people with aphasia. Whurr Publishers.

Wilkinson, R. (1999). Sequentiality as a problem and resource for intersubjectivity in aphasic conversation: Analysis and implications for therapy. Aphasiology, 13(4–5), 327–343. https://doi.org/10.1080/026870399402127

Wilkinson, R. (2010). Interaction-focused intervention: A conversation analytic approach to aphasia therapy. Journal of Interactional Research in Communication Disorders, 1(1), 45–68. https://doi.org/10.1558/jircd.v1i1.45

Wilkinson, R. (2011). Changing interactional behaviour: Using conversation analysis in intervention programmes for aphasic conversation. In C. Antaki (Ed.), Applied conversation analysis (pp. 32–53). Palgrave Macmillan.

Wilkinson, R. (2014). Intervening with conversation analysis in speech and language therapy: Improving aphasic conversation. Research on Language and Social Interaction, 47(3), 219–238. https://doi.org/10.1080/08351813.2014.925659

Wilkinson, R. (2019). Atypical interaction: Conversation analysis and communicative impairments. Research on Language and Social Interaction, 52(3), 281–299. https://doi.org/10.1080/08351813.2019.1631045

Wilkinson, R., & Wielaert, S. (2012). Rehabilitation targeted at everyday communication: Can we change the talk of people with aphasia and their significant others within conversation?. Archives of Physical Medicine and Rehabilitation, 93(1), S70–S76. https://doi.org/10.1016/j.apmr.2011.07.206

Wilkinson, R., Lock, S., Bryan, K., & Sage, K. (2011). Interaction-focused intervention for acquired language disorders: facilitating mutual adaptation in couples where one partner has aphasia. International Journal of Speech-Language Pathology, 13(1), 74–87. https://doi.org/10.3109/17549507.2011.551140

Wright, H. H., Capilouto, G. J., & Koutsoftas, A. (2013). Evaluating measures of global coherence ability in stories in adults. International Journal of Language & Communication Disorders, 48(3), 249–256. https://doi.org/10.1111/1460-6984.12000

Downloads

Published

2024-08-07

Issue

ADVANCE ACCESS TO FORTHCOMING ARTICLES

Section

Articles

How to Cite

Terradillos, E. ., Simón, T., & López-Higes, R. (2024). Topic maintenance in non-fluent aphasia conversation: A training program in strategies for communication partners. Journal of Connected Speech. https://doi.org/10.1558/jcs.29236