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Psychology and Speech-Language Pathology Discussion Assignment
Recipient participation in conversations involving participants with fluent or non-fluent aphasia Minna Laaksoa and Sisse Godtb
A Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland; b Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
ABSTRACT The present study compares the ways in which conversational partners manage expressive linguistic problems produced by participants with fluent vs. non-fluent aphasia. Both everyday conversations with family members and institutional conversations with speech-language therapists were examined.
The data consisted of 110 conversational sequences in which the conversational partners addressed expressive aphasic problems. Most problems of the speaker with fluent aphasia were locally restricted phonological and word-finding errors, which were immediately repaired.
In contrast, the sparse expression of the speaker with non-fluent aphasia was co-constructed by conversational partners in long negotiation sequences to establish shared understanding. Some differences between recipient participation in everyday and institutional conversation were found. The results emphasize the relevance of the nature of the expressive linguistic problems on participation in interaction. They also add to the clinical knowledge of handling aphasic problems in conversation. This knowledge can be used for developing interaction-focused intervention.
ARTICLE HISTORY Received 1 December 2015 Accepted 4 August 2016
KEYWORDS Aphasia type; co- construction; family members; other-repair; speech-language therapists
Introduction
The objective of the present study is to compare the ways in which participants manage expressive linguistic problems related to fluent conduction aphasia and non-fluent agrammatic aphasia in institutional and everyday settings. In general, conversations involving participants with aphasia (PWAs) are characterised by frequent expressive linguistic problems and efforts to resolve the problems in extended conversational sequences (e.g. Laakso & Klippi, 1999; Milroy & Perkins, 1992).
In problem-solving sequences both PWAs and their interlocutors participate in clarifying meanings and establishing shared understanding. However, collaborative participation may differ between family members and speech-language therapists (SLTs) (Lindsay & Wilkinson, 1999; Laakso, 2015). Besides the difference in everyday and institutional participation roles, the type of aphasia may also influence the participation of the interlocutors: fluent production with frequent linguistic errors may call upon different collaborative actions than non-fluent and linguistically sparse production.
Conversational speech shows adaptations to the underlying linguistic deficits characteristic of the type of aphasia. In fluent conduction aphasia, speech is frequently distorted by phonemic paraphasia’s (sound errors) and efforts to repair the problem by approximating
CONTACT Minna Laakso minna.laakso@utu.fi Department of Psychology and Speech-Language Pathology, University of Turku, Assistentinkatu 7, Turku, FIN-20014, Finland.
CLINICAL LINGUISTICS & PHONETICS 2016, VOL. 30, NO. 10, 770–789 http://dx.doi.org/10.1080/02699206.2016.1221997
© 2016 Taylor & Francis
the right sound (Bartha & Benker, 2003; Kohn, 1984). Due to the underlying phonological deficit, word-retrieval difficulties and word searching occur. In addition, speakers with conduction aphasia may try to overcome word-finding problems with circumlocutory para- phrasing or by using easily retrievable but semantically weak lexical items (e.g.
Helasvuo, Laakso, & Sorjonen, 2004). In non-fluent agrammatic aphasia speech is characterized by the omission of grammatical morphemes, incomplete and incorrect syntactic constructions, and short utterances (Menn, O’Connor, Obler, & Holland, 1995). As the underlying syntactic deficit impairs verb and sentence production, speakers with agrammatic aphasia often resort to telegraphic speech style by producing single-word utterances that are mostly uninflected nouns (Heeschen & Schegloff, 1999).
One adaptation in conversation is the fronting of noun phrases to the beginning of the turn, so that the speakers overuse left dislocation in their turn construction (Beeke, Wilkinson, & Maxim, 2003). Furthermore, the meaning of the turn may emerge bit by bit by producing sequentially adjacent items without tying them together by grammatical means (Beeke, Wilkinson, & Maxim, 2007; Heeschen & Schegloff, 1999). In short, the two types of aphasia, fluent conduction aphasia and non-fluent agrammatic aphasia, have different (phonological vs. syntactic) underlying deficits that manifest in dissimilar ways in linguistic expression in conversation.
In the present study, the main focus is on the recipient-initiated next turn actions that aim to manage expressive linguistic problems produced by the PWA in a prior turn. In conversation analysis (CA), expressive problems are characterised as trouble sources that can be managed by self- or other-initiated repair. PWAs are not as efficient in self- repairing their own speech as is common in ordinary conversation (cf. Laakso, 1997: 130–140).
Thus other-initiated actions by the interlocutors become more emphasised. Other-initiated repair can be accomplished in many ways, including asking questions (such as ‘what’, ‘who’, etc.), repeating the trouble source, or by offering candidate under- standings for the recipient to confirm or reject (Schegloff, 2007: 101). In ordinary everyday conversation the recipients usually do not directly correct the original speaker, as self- repair is preferred over other-correction (Schegloff et al., 1977).
However, in asymmetric interactions (e.g. between adults and children) it is common that the more competent interlocutors are active in resolving the problems and do other-correct (Norrick, 1991). Also in connection with aphasia, co-participants are active and tend to provide candidate words to resolve e.g. word searching (Laakso & Klippi, 1999; Oelschlaeger & Damico, 2000). However if the PWA has non-fluent speech, the interlocutors often co-construct the sparse talk by adding meaning and extending the agrammatic elements into full utterances (Goodwin, 1995; Heeschen & Schegloff, 1999).
Interlocutors also interpret embodied phenomena such gestures, gaze and facial expressions in co-constructing the meaning of aphasic utterances (e.g. Beeke et al., 2013; Goodwin, 2003; Klippi, 2015; Laakso, 2014). Besides interpretation, conversational partners may use an open-format other-initiation of repair (e.g. ‘what’ or ‘sorry’) which returns the speaking turn to the PWA (Barnes, 2016). In such cases the PWAs may have difficulties in resolving the problem. The partners may also resist participating in problem solving (e.g. Aaltonen & Laakso, 2010; Barnes & Ferguson, 2015). However, resistance is not the focus of the present study as it analyses collaborative recipient actions.
In collaborative participation, some differences between everyday and institutional conversational partners have been found. When compared to encounters with every- day interlocutors, the interaction with representatives of a medical institution (e.g. an
CLINICAL LINGUISTICS & PHONETICS 771
SLT in health care) is usually more goal oriented and has special constraints as to what are the appropriate conversational actions (for medical interaction, see e.g. Heritage & Maynard, 2006). These constraints may result in differences in an SLT’s actions in conversation with a PWA as compared to a conversation between everyday conversation partners. Indeed, differing repair patterns in spouse vs. SLT conversations of PWAs have been found:
The spouses tend to repeatedly correct the PWAs’ production errors even after the meaning has been recovered, whereas the SLTs avoid correction (Lindsay & Wilkinson, 1999). In addition, significant others are found to offer collaborative completions to word searches, whereas SLTs tend to ask questions or offer candidate understandings longer than one word (Laakso, 2015). However, thus far, very few studies have compared recipient-initiated repair activities in institutional and home conversations of the same PWAs. Furthermore, to our knowledge, the influence of different types of aphasias on recipient participation has not been compared.
The purpose of the present multiple-case study is to compare the relevance of the aphasia type (fluent vs. non-fluent) to the non-aphasic interlocutors’ management of expressive linguistic problems in conversation. The research focus is on recipient-initiated actions. Everyday vs. institutional conversational partners are also compared. The research questions are as follows:
Data and method
Conversations and participants
The data consisted of four videotaped conversations (see Table 1). In these conversations there were two kinds of conversational partners, family members and SLTs, in interaction with participants with two different kinds of aphasia, Lauri (L) with conduction aphasia and Kalevi (K) with agrammatic aphasia. L conversed at home both with his young adult
Table 1. Conversations and participants. Conversation Participants Location Duration
Conversation 1 L (fluent speaker), L’s home, on the living room couch 00:40:00 hours T and A (two grandsons)
Conversation 2 L (fluent speaker), L’s home, on the living room couch 00:41:16 hours SLT-L
Conversation 3 K (non-fluent speaker), K and E’s home at the kitchen table during afternoon coffee
00:34:11 hours
E (the wife) Conversation 4 K (non-fluent speaker), SLT-K University clinic 00:27:01 hours Total 02:22:18 hours
Note. SLT-L = Speech-language therapist working with L; SLT-K = Speech-language therapist working with K.
772 M. LAAKSO AND S. GODT
grandsons (T and A), and with his SLT (SLT-L). K interacted at home with his wife (E) and at the university clinic with his SLT (SLT-K). Pseudonyms are used and name initials of all participants have been changed to anonymise them. All participants gave in writing their informed consent to take part in the study and the principles of research ethics were carefully followed in gathering and analysing the data. The data belong to a larger research project examining the management of problems of speaking and understanding in aphasic conversation (Academy of Finland, grant no 49250).
The conversations of L lasted approximately 40 minutes each, whereas K’s conversa- tions lasted about 30 minutes each. The conversations were digitally videotaped on a MiniDV tape with an additional microphone. The PWAs and their family members chose a time and place where they usually interacted (e.g. a regular visit or an afternoon coffee) and the cameraman (researcher or research assistant) came to videotape that. The participants were asked to interact in the way they ordinarily would.
The cameraman was present in the beginning and end of (and occasionally during) the videotaping when handling the camera was necessary. As both PWAs were receiving speech and language therapy via a university clinic, they were asked to converse with their SLTs during a therapy session. No specific instructions concerning the conversations were given. These sessions were videotaped by the participating SLTs.
Both PWAs were retired males with chronic aphasia (see Table 2). They both had a university degree. L (a former CEO) was a 79-year-old man who had suffered an infarc- tion of the left medial cerebral artery 5 years ago. The infarction had left him with moderately severe conduction aphasia, and he had had several periods of speech and language therapy. L’s language production was fluent but paraphasic with many phonemic and some semantic errors. He also displayed trouble with word-finding and recurrently searched for words. K (a former dentist) was a 65-year-old man who had suffered an infarction of the left medial cerebral artery 29 years ago. The infarction had left him with severe Broca’s aphasia, and he had had intensive speech and language therapy during the first year following his infarct and shorter periods after that. K’s language production was non-fluent and agrammatic consisting mainly of uninflected nouns.
In conversation, L was able to use language in various ways for initiating and respond- ing (including questions, answers, comments and narrative turns), whereas K’s commu- nicative actions were mainly responsive to the interlocutors’ actions.
Transcription and analysis
The video material was analysed as Windows Media files. First the conversations were transcribed according to conversation analytic notation (Atkinson & Heritage 1984: ix–xvi).
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Excellent Quality 95-100%
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Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
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Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
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Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
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Psychology and Speech-Language Pathology Discussion Assignment |
Psychology and Speech-Language Pathology Discussion Assignment