People with non-fluent aphasia initiating actions in everyday conversation with familiar conversation partners: resources for participation

Abstract

ABSTRACT Background: Conversation is central to building and maintaining relationships. Thus, it is unsurprising that people with aphasia and their familiar conversation partners often desire improved conversational ability. However, to facilitate real-world communication, focusing on improving aphasic language difficulties is not enough. We also need a comprehensive understanding of how social actions are accomplished in everyday aphasic conversation, including the means of participation people with aphasia possess. Aims: To investigate the in-situ participation of people with non-fluent aphasia by analysing how they bring up, i.e., initiate, issues of importance to them in home-based authentic conversations with their familiar conversation partners. Methodology: Using conversation analysis, we examined 6 hours of video-recorded everyday conversations of two dyads, each consisting of a person with severe/moderate Broca’s aphasia and their spouse. We analysed 89 instances of the persons with aphasia initiating talk and how these initiations were produced, where in the conversation such initiations appeared, and what the initiations accomplished socially. Outcomes & Results: We identified two descriptive groupings of initiations by the persons with aphasia: formulaic initiations, and initiations striving for propositional content. Formulaic initiations were used in unproblematic ways to accomplish social actions like offerings, or to assess or summarize a topic after it has lapsed. Such initiations are considered important in building social cohesion. Most initiations strived for propositional content, i.e., entailed a content word, or an attempt to produce one. Such initiations were regularly intertwined with multimodal and material resources usually resulting in recognizable social actions like topic initiation irrespective of whether they included an identifiable content word or not. However, the achievement of topic initiation was crucially dependent on interactional work by the spouse. Finally, we discovered a difference in the sequential environment of propositional initiations between the dyads as only one of the spouses regularly provided slots for the person with aphasia to initiate talk. Conclusions: Our analysis revealed persons with Broca’s aphasia participated in conversation through initiations relying on formulaic language and initiations striving for propositional content. The latter demonstrated the pronounced multimodality and interactivity of aphasic conversation. Our findings highlight the significance of the conversation partner’s skills to facilitate the person with aphasia to initiate talk. Thus, our results imply the importance of providing conversation partner training to promote participation in aphasia.