Helping aphasic patients accomplish greeting exchanges

Implications for stroke care in Thailand


  • Pairote Wilainuch University of the Thai Chamber of Commerce



Aphasia, Conversation Analysis, Wai, Sawatdi, Gesture, Thailand


Background: This study explores greeting exchanges in stroke care, in particular the use of the ‘wai’ gesture.

Method: Seventeen patients with Broca’s aphasia, some family members, six nurses from district public health centers, and four nurses from a district hospital in northern Thailand were given written consent forms for participation. Thirty counseling sessions were video-recorded in patients’ homes and analyzed using conversation analysis. Direct observation and in-depth interview were also used for supplementary data collection.

Results: These showed a patient’s daughter helping her to accomplish a greeting. She was encouraged to use one hand to raise the other hand up. Another patient was only able to raise one hand to conduct the normal ‘wai,’ a potential cause of embarrassment for the patient, as the greeting is always formed by putting the two palms of the hands together. The nurse encouraged him to perform the greeting using one hand through different questions and statements.

Discussion and conclusion: While the ‘wai’ gesture and the spoken greeting ‘sawatdi’ used for social functions plays an important role in stroke counseling, the nursing guidelines in the Barthel Index excluded them in the section on non-verbal communication assessment. This article suggests that they should be taken into account, in order to improve the nursing guidelines to fit the Thai context.

Author Biography

Pairote Wilainuch, University of the Thai Chamber of Commerce

Pairote Wilainuch received a PhD in communication studies from the University of York, UK, and is professor at the University of the Thai Chamber of Commerce. His research interests include conversation analysis, communication on death and dying, medical interaction, marketing communication, business interaction, and public relations.


Aroonmanakun, W. (2005). Thai-English and English-Thai transliteration system: Approaches and development. Bangkok: Thailand Research Fund.

Beeke, S., Wilkinson, R., and Maxim, J. (2001). Context as a resource for the construction of turns at talk in aphasia. Clinical Linguistics & Phonetics, 15(1–2), 79–83. DOI:

Cameron, D. (2006). Working with spoken discourse. London: Sage.

Cooper, R. (2012). Culture shock! Thailand: A survival guide to customs and etiquette (9th ed.). Singapore: Marshall Cavendish.

Daumüller, M., and Goldenberg, G. (2010). Therapy to improve gestural expression in aphasia: A controlled clinical trial. Clinical Rehabilitation, 24, 55–65. DOI:

De Waal, F. (1996). Good natured: The origins of right and wrong in humans and other animals. Cambridge: Harvard University Press. DOI:

Drew, P. (2003). Conversation analysis. In Jonathan A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 132–158). London: Sage.

Duranti, A. (1992). Language and bodies in social space: Samoan ceremonial greetings. American Anthropologist, 94, 657–691. DOI:

Goffman, E. (1967). Interaction ritual: Essays in face to face behavior. Garden City: Doubleday.

Goffman, E. (1971). Relations in public: Microstudies of public order. New York: Harper & Row.

Goodwin, C. (1995). Co-constructing meaning in conversations with an aphasic man. Research on Language and Social Interaction, 28(3), 233–260. DOI:

Goodwin, C. (Ed.) (2003). Introduction. Conversation and brain damage (pp. 3–20). Oxford: Oxford University Press.

Heritage, J. (1984). Garfinkel and ethnomethodology. Cambridge: Polity Press.

Heritage, J., and Maynard, D. W. (2006). Communication in medical care: Interaction between primary care physicians and patients. Cambridge: Cambridge University Press. DOI:

Howard, K. M. (2010). Social relationships and shifting languages in northern Thailand. Journal of Sociolinguistics, 14(3), 313–340. DOI:

Hutchby, I., and Wooffitt, R. (1998). Conversation analysis: Principles, practices and applications. Cambridge: Polity Press.

Iverson, J., and Goldin-Meadow, K. (1998). Why people gesture when they speak. Nature, 396(6708), 228. DOI:

Kendon, A. (1990). Conducting interaction: Patterns of behavior in focused encounters. Cambridge: Cambridge University Press.

Klippi, A. (2003). Collaborating in aphasic group conversation: Striving for mutual understanding. In C. Goodwin (Ed.), Conversation and brain damage (pp. 117–143). Oxford: Oxford University Press.

McLeod, J. (2001). Qualitative research in counselling and psychotherapy. London: Sage. DOI:

McNeilis, K. S. (2001). Analyzing communication competence in medical consultations. Health Communication, 13(1), 5–18. DOI:

McNeill, D. (1992). Hand and mind: What gestures reveal about thought. Chicago: Chicago University Press.

Peräkylä, A. (1995). AIDS counselling: Institutional interaction and clinical practice. Cambridge: Cambridge University Press. DOI:

Peräkylä, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 61(4), 301–320.; DOI:

Peräkylä, A. (2006). Observation, video and ethnography: Case studies in Aids counsellings and greetings. In P. Drew, G. Raymond, and D. Weinberg (Eds.), Talk and interaction in social research methods (pp. 81–96). London: Sage. DOI:

Peräkylä, A. (2013). Epilogue: What does the study of interaction offer to emotional research? In A. Peräkylä and M.-L. Sorjonen (Eds.), Emotion in Interaction (pp. 274–289). Oxford: Oxford University Press. DOI:

Pomerantz, A., and Fehr, B. J. (2011). Conversation analysis: An approach to the analysis of social interaction. In T. A. Van Dijk (Ed.), Discourse studies: A multidisciplinary introduction (2nd ed., pp. 165–190). Thousand Oaks: Sage. DOI:

Poslawsky, I. E., Schuurmans, M. J., Lindeman, E., and Hafsteinsdóttir, T. B. (2010). A systematic review of nursing rehabilitation of stroke patients with aphasia. Journal of Clinical Nursing, 19(1–2), 17–32. DOI:

Powell, L., Amsbary, J., and Mark, H. (2014). The wai in Thai culture: Greeting, status-marking and national identity functions. Journal of Intercultural Communication, 34(1), 7.

Prasat Neurological Institute (2011). Clinical nursing practice guidelines for stroke. Bangkok: Prasat Neurological Institute.

Raymer, A. (2007). Gestures and words: Facilitating recovery in aphasia. ASHA Leader, 12(8). DOI:

Sacks, H. (1975). Everyone has to lie. In B. Blount and M. Sanches (Eds.), Sociocultural dimensions of language use (pp. 57–80). New York: Academic Press.

Scharp, V. L., Tompkins, C. A., and Iverson, J. M. (2007). Gesture and aphasia: Helping hands? Aphasiology, 21(6–8), 717–725. DOI:

Ten Have, P. (1999). Doing conversation analysis: A practical guide. London: Sage.

Tompkins, C. A., Scharp, V. L., and Marshall, R. C. (2006) Communicative value of self cues in aphasia: A re-evaluation. Aphasiology, 20(7), 684–704. DOI:

Wilainuch, P. (2014). Interpersonal communication for rehabilitation and wellbeing between patients after stroke, public health professionals and family members, in Changwat Nan. Bangkok: The Thailand Research Fund.

Wilkinson, R. (2011). Changing interactional behaviour: Using conversation analysis in intervention programmes for aphasic conversation. In C. Antaki (Ed.), Applied conversation analysis: Intervention and change in institutional talk (pp. 32–53). New York: Palgrave Macmillan. DOI:

Wilkinson, R. (2013). Gestural depiction in acquired language disorders: On the form and use of iconic gestures in aphasic talk-in-interaction. Augmentative and Alternative Communication, 29(1), 68–82. DOI:

Wooffitt, R. (2005). Conversation analysis and discourse analysis: A comparative and critical introduction. London: Sage. DOI:

World Health Organization. (2004). The atlas of heart disease and stroke. Geneva: WHO.



How to Cite

Wilainuch, P. . (2021). Helping aphasic patients accomplish greeting exchanges: Implications for stroke care in Thailand. Journal of Interactional Research in Communication Disorders, 11(2), 151–170.