Aphasic Conversation Research Articles

First saying and second saying in aphasic conversations

Objective: This present study investigates first and second saying in aphasic conversations to demonstrate the ability of qualitative methodologies (in this case conversation analysis) to study the ways in which persons with aphasia achieve conversation success through verbal repetition in the form of first and second sayings. Method: For this explorative case study, the author drew on data from AphasiaBank, a multimedia database of discourse samples gathered from individuals with aphasia and from healthy controls. Using the framework of conversation analysis, the author discusses its position, composition, and action. Results: We demonstrated the role of the practice of recycling elements of one’s own prior utterances in building socially meaningful action, presenting an image of the speaker with aphasia as someone who is competently and confidently managing throughout her impairment. Discussion: The author discusses the potential of conversation analytical techniques as tools to study the complex phenomenon of conversation as the primary vehicle for human social action. Conclusion: Through the study of ‘first saying and second saying’ in aphasic conversation, this study contributes to our understanding of how persons with aphasia strategically employ their limited linguistic resources to negotiate meaning and social action.

Clinical Linguistics: Analysis of Mapping Knowledge Domains in Past, Present and Future.

Across the world, many infants, children, adults, and elderly people are reported with many types of disorders and disabilities that damage, delay, or impede typical language development and/or use. Speech–language pathologists and other relevant clinicians are responsible for diagnosing, assessing, and rehabilitating these conditions. In nearly all types of disorders or disabilities that affect language, clinical linguistics plays a significant role in their study, diagnosis, and evaluation. This study provides a thorough analysis of the field of clinical linguistics. Data from Scopus, WOS, and Lens were used between 1981 and 2022. The documents included in the analysis were 1685, 1628, and 2677 articles published between 1981 and 2022 in clinical linguistics in Scopus, WOS, and Lens, respectively. For the purpose of assessing the development and impacts of the field of clinical linguistics, we used eight bibliometric and eight scientometric indicators. As part of the study, the results summarized the top contributors to clinical linguistics in terms of production size by year, country, university/research centre, journal, publisher, and author. The impact of the examined evidence on clinical linguistics was visualized and tabulated in the form of visual networks, citation counts, burst, cooccurrence, centrality, and sigma factors that are helpful in identifying the main influencers in clinical linguistics. A few examples of clinical linguistics patterns that are being explored extensively by researchers include cleft palate speech with model theories, visual feedback, motor speech disorders with instrumental analysis, acoustic analysis to understand conversational breakdown, nonlinear phonological theory, aphasic conversation in atypical interaction, and diagnostic markers in functional segments. There are also phonological disorders, William Syndrome, and the use of ultrasound, which may be considered potential clusters of clinical linguistics. A key contribution of this paper is highlighting the importance of clinical linguistics as well as its integration with linguistics, speech–language pathology, neurolinguistics, psycholinguistics, neuroscience, cognitive sciences, psychology, and psychometrics.

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

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.

Collaborative participation in aphasic conversation before and after intensive language-action therapy

ABSTRACTThis study applies conversation analysis to compare everyday conversation samples between a person with aphasia (PWA) and a familiar communication partner (CP) before and after intensive language-action therapy (ILAT). Our analysis concentrated on collaborative repair sequences with the assumption that impairment-focused therapy would translate into a change in the nature of trouble sources, which engender collaborative repair action typical of aphasic conversation. The most frequent repair initiation technique used by the CP was candidate understandings. The function of candidate understandings changed from addressing specific trouble sources pre-ILAT to concluding longer stretches of the PWA’s talk post-ILAT. Alongside with these findings, we documented a clinically significant increase in the Western Aphasia Battery’s aphasia quotient post-ILAT. Our results suggest that instead of mere frequency count of conversational behaviours, examining the type and function of repair actions might provide insight into therapy-related changes in conversation following impairment-focused therapy.

Intervening With Conversation Analysis in Speech and Language Therapy: Improving Aphasic Conversation

In this review, I discuss conversation analytic informed intervention for aphasia, a language disorder acquired following brain damage. As well as describing this form of intervention and outlining features of the studies produced over the last 15 to 20 years that provide evidence of its effectiveness, I discuss some features of this approach that may be of relevance to interventionist conversation analysis more generally. Data are in British English and in Swedish with English translation.

Parole reprise comme réparation conversationnelle dans le cadre de l'aphasie

Repairs are common to deal with problems in ordinary conversation and even more frequent when language and communication disorders disturb interaction. So, speech and language therapists who work with aphasic patients and their families are often faced with repairs. Referring to theory and clinical observations, we try to describe, analyze and understand this process, first in ordinary conversation and then in aphasic conversation. Finally, we describe how this mechanism can be used through two communication therapies.

Multimodality in aphasic conversation

The use of gestures is one of the reasons for which some aphasics communicate better than they speak. For these aphasics as well as their partners, multimodality becomes a resource for the successful management of interaction. However, the successful employment of gesture implies multiple practices of adaptation, since there are important differences between gesture use in non-impaired and impaired aphasic interaction. In non-impaired faceto- face interaction, gestures mostly accompany language and support and influence its interpretation in various ways. Only rarely do gestures, body movements and the manipulation of artifacts take the lead, and even more rarely do they replace language entirely (Goodwin 1986, Heath 1982, 1992, Melinger & Levelt 2004). Under conditions of severe non-fluent aphasia (as described here), gestures therefore are used for functions which they cannot easily fulfill. In the absence of language, gestures become a substitute (Goodwin 2000, 2003 and 2006a, b). This uncoupling of gestural communication from language usually results in complex and often lengthy collaborative sequences in which the participants set out to co-construct what the aphasic “gesturer” means, with the non-impaired speakers providing, in a way, the missing speech for the linguistically impaired speaker (cf. Damico et al. 2008, Goodwin 2000, 2003, 2006). As we will show, these processes of coconstruction are encumbered not by the aphasics’ deficient gestures, but rather the semiotic nature of gesturing itself. We will discuss examples of successful and unsuccessful gestural communication in aphasics and suggest some reasons why gestural communication fails sometimes, but why it helps in other cases. Our observations lend support to the idea that therapy has to respect the semiotic characteristics of gesturing and the interactional practices necessary for their management in order to enhance the successful employment of the visual modality.

Halting Aphasic Interaction. Creation of Intersubjectivity and Spousal Relationship in Situ

This article discusses a communicative phenomenon that is relatively less studied: getting stuck in an aphasic conversation. Although aphasia as a medical and linguistic condition has been widely examined, the more social and participatory aspects of the symptom are not so well-known. Aphasia forms a threat to the emergence of a shared understanding, as well as to the experience of being in the shared, i.e., in the intersubjective, social world. In our analysis, we closely explore how understanding is constructed in the sequential organization of conversation. We use two data corpora when analysing the halting interaction. In our data, we detected two kinds of interactive halts that emerged in connection with aphasic word searching. First, 'real halts' were caused by the aphasic person's inability to find correct words and the co-participants were also not able to resolve the problem. Second, 'exam halts' occurred when the co-participant did not provide the missing words despite knowing what the aphasic speaker was trying to say. We discuss how this halting phenomenon is linked with the notions of intersubjectivity and face-work and conclude that real halts are more directly caused by the aphasic condition, whereas exam halts reflect the spousal relationship in the form of face-work.

Prosodic contextualization of minimal responses to yes/no-questions in aphasic talk-in-interaction: A descriptive single-case study of a Norwegian aphasic speaker

The article explores aspects of the role of prosody as a contextualization cue in aphasic conversation through auditory and acoustic analysis of an aphasic speaker's use of pitch variation in responses to closed yes/no-requests. The results reveal two prosodic realizations of ‘yes’ and ‘no’ contextualizing different kinds of responses: a flat realization with no prolongation and minimal pauses, signalling decisiveness, and a realization with movement in pitch, prolongation and preceding pauses, signalling indecisiveness. The analysis also shows how the aphasic uses a particular realization manipulatively for interactional purposes. The study illustrates the vital role that seemingly unimportant details play in the co-constructive process of creating meaning in interaction. The results indicate an area of competence that seems undisturbed in this speaker.

Conversation and Brain Damage (review)

Reviewed by: Conversation and brain damage ed. by Charles Goodwin Liang Chen Conversation and brain damage. Ed. by Charles Goodwin. Oxford: Oxford University Press, 2003. Pp. x, 314. ISBN 0195129539. $65 (Hb). This volume deals with how people with brain damage communicate. The eleven chapters are arranged into four parts. Part 1: ‘General perspectives’. Charles Goodwin (3–20) presents an introduction of conversation analysis (CA) and of the rest of the book. Emanuel A. Schegloff (21–55) shows the discourse/pragmatic competence of split-brain patients through a detailed [End Page 526] analysis of video episodes of interaction between such patients and the therapist. CA research on conduct in interaction is claimed to produce promising results ‘at one of the more exciting growth points of human self-knowledge’ (47), if researchers treat people with communicative disorders as contributing participants of talk-in-interaction and integrate the study of ‘disordered talk’ with that of ‘ordinary talk by ordinary folks in ordinary (for them) settings’ (45). Part 2: ‘Making meaning together’. Ray Wilkinson, Suzanne Beeke, and Jane Maxim (59–89) examine how speakers with fluent aphasia construct turns at talk using linguistic resources (e.g. lexical items, word order, fronting of noun phrases) that they might have used premorbidly. Charles Goodwin (90–116) focuses on a severely aphasic patient’s extensive use of gesture in a single extended sequence. He shows how gesture can be used to ‘build socially meaningful action’ and questions the validity of ‘assessments of competence based purely on the ability to produce language’ (110). Anu Klippi (117–43) examines meaning construction in aphasic group interactions involving collaborative efforts of both the aphasic patients and the therapists. Participants are found to resort to different linguistic resources, gestures, and situational contexts to achieve mutual understanding. Part 3: ‘Repair’. Lisa Perkins (147–62) shows that in aphasic conversation quick repair is preferred and repair work is a socially sensitive event. The analysis of aphasic discourse ‘highlights the fundamentally collaborative nature of conversation’ and ‘provides the aphasia therapists with a tool to identify precisely how interlocutors are negotiating aphasia’ (160). Through an examination of collaborative construction of repair in conversations involving two Finnish speakers with Wernicke’s aphasia, Minna Laakso (163–88) finds that presence or lack of active coparticipation and shared knowledge directly affect the speed and success rate of repair. Jan Anward (189–210) presents a detailed comparison of two retellings of the same story by a Swedish woman with Wernicke’s aphasia. The second one is more successful than the first because the story becomes ‘tellable and meaningful in the current situation’ (208). Through an analysis of single and alternative guess sequences in aphasic conversation, Mary L. Oelschlaeger and Jack S. Damico (210–27) find that aphasic speakers and their conversational partners work together to resolve word searches. The collaborative coparticipation provides evidence for the social organization of aphasic conversations and for regarding communicative competence as interactional competence. It also reveals the need for a ‘more sociolinguistic perspective in aphasia treatment’ (223). Part 4: ‘Interaction and assessment’. Claus Heeschen and Emanuel A. Schegloff (231–82) call for a paradigm shift from a medical (cognitive-experimental) approach to a sociolinguistic (conversational-analytic) approach to aphasia. They argue that testing with aphasics and other neurologically affected subjects should involve ‘naturally occurring conduct—including (perhaps preeminently) conduct in interaction’ (269) and should consider what they can do as well as what they can not do. Gail Ramsberger and Lise Menn (283–303) also argue for a social perspective to the assessment of communicative success in aphasia. They show that CA techniques may provide ‘an objective, ecologically valid measure of therapeutic outcome’ (301). In sum, I agree with the editor that the papers in this volume might help to change ‘how people with aphasia are perceived and treated in society’, and thus go beyond their ‘theoretical contributions and therapeutic relevance’ (18). Liang Chen University of Louisiana, Lafayette Copyright © 2005 Linguistic Society of America

A closer look at the 'hint and guess' sequences in aphasic conversation

The focus of this article is to examine in more detail the collaborative nature of aphasic conversation. In particular, collaborative efforts can be seen in such situations where aphasic problems, such as word searching, emerge. These problems have traditionally been studied as a cognitive process of an aphasic individual. The aim is to demonstrate that in aphasic conversation word search is a visible activity which often initiates a collaborative problem-solving sequence, traditionally called a 'hint and guess sequence. As the special practices by which this collaboration is accomplished are relatively unknown, the 'hint and guess sequences of both fluent and non-fluent aphasic speakers have been analysed in detail. The main findings suggest that these sequences have a regular structure of four distinct phases that are quite similar irrespective of the type of aphasia.

Sequentiality as a problem and resource for intersubjectivity in aphasic conversation: analysis and implications for therapy

Investigations of non-aphasic conversation have displayed the importance of sequentiality in the meaning and understanding of utterances in conversation. Sequentiality refers to the way in which an utterance is constructed so as to display its relation to the immediately preceding utterances and to make expectable a certain type of utterance in the following turn. As such, it has been shown to be a central resource for participants in achieving intersubjectivity, or a state of mutual understanding, in conversation. In this paper, sequentiality in aphasic conversation is investigated. It is found that aphasia can disrupt the speaker s ability to display the sequential properties of utterances in conversation and can, therefore, be an important reason why certain aphasic turns can be difficult for hearers to understand. However, aphasic speakers are also shown to be able to use the sequential context of earlier turns as a resource to aid communication by referring deictically to prior utterances. It is suggested that these findingshave clinical importance in assessing functional language use and planning therapy. In particular, it is noted that these conversational problems may require a different approach to the types of therapy employed for disorders at the word and sentence level. Some ways in which a more interactionally focused therapy may target these problems are discussed.

Exploring conversation analysis as an assessment tool for aphasia: the issue of reliability

This paper describes an investigation of the temporal reliability of analyses of collaborative repair in aphasic conversation. Whilst it has been proposed that conversation analysis has a useful contribution to make to the assessment of aphasia, assessment methods which use natural interaction as a basis for analysis have been assumed to lack reliability because of variability in conversation in contrast to the standardization across assessments possible with formal assessments. This issue was addressed through comparison of quantitative and qualitative analyses of collaborative repair in dyadic conversations recorded on four different occasions between eight people with aphasia and their relatives. Quantitative results revealed significant within-participant variation in the quantity of collaborative repair occurring in the conversations but between-participant variation was of much greater magnitude. The findings of the qualitative analysis indicated reliability in the interactional challenges experienced as a consequence of aphasia, with consistency in the nature of trouble sources giving rise to collaborative repair work across the participants four conversations. The findings also indicated reliability in the interactional mechanisms employed to deal with trouble sources, with consistency across the participants four conversations in the resolution of collaborative repair. The implications of the findingsfor the use of conversation analysis as an assessment tool to motivate intervention and to measure change over time are discussed.

Introduction

There are a growing number of investigations of aphasia using ethnomethodological conversation analysis (CA). This introduction outlines the importance of investigating aphasic conversation and the potential attraction of CA as a method of analysis. CA is defined and its main areas of analytic investigation outlined. The distinctive methodology of the approach is summarized and discussed in terms of four principles: analysis is participantdriven; assumption that conversation is orderly; importance of sequential context; and wariness of quantification.

Spontaneous verbal repetition: A social strategy in aphasic conversation

This study investigated the spontaneous verbal repetition of a person with aphasia during conversation. Research questions were: Does repetition occur as a spontaneous verbal behaviour? How is repetion effectively used? What are the motivations for its use? A person with aphasia and his wife video recorded eight of their naturally occurring conversations which were subsequently transcribed and sequenced into turns-at-talk. Frequency of repetition and the sequential organization of conversation sequences containing repetition were analysed. Repetition was a frequent behaviour, occurring an average of 8% of the time for all conversations. Repetition was effectively used to meet the social needs of the conversation relating to displays of uncertainty, agreement, alignment and acknowledgement. Motivations for repetition related to its use as a compensatory strategy to overcome specific language barriers and to establish perceptions of conversational proficiency.

Interpersonal aspects of aphasic conversation

This paper presents preliminary work which explores some of the theoretical issues and methodological usefulness of the systemic-functional approach to the analysis of interpersonal aspects of aphasic conversation. Results are presented for the analysis of natural and elicited conversation samples for five mildly aphasic individuals. The results highlight the diverse resources of language which remain accessible to aphasic individuals, and indicate the potential of this approach to describe strengths and weaknesses in how interpersonal meanings are expressed within communicative contexts.

Repair strategies in aphasic discourse; towards a collaborative model

This paper proposes a collaborative model of repair in aphasic discourse, derived from the procedures of conversation analysis (CA). First, it is suggested that relative to other pragmatic orientations CA can offer a particularly illuminating and practically useful perspective on aphasic discourse. Repair strategies are then examined, first in relation to normal conversation then in relation to aphasic conversation' where one or more of the participants is aphasic. Next, Clark and Schaefer's CA-style model of conversational organization (1 987, 1989) is outlined, with attention to its relevance to the organization of repair in aphasic conversation. Finally, we apply this model in an analysis of some aphasic conversational sequences where the collaborative negotiation of repair is particularly evident.