Consequences Of Aphasia Research Articles

The Italian Aphasia Awareness Survey (IAAS): an online questionnaire about the public knowledge of aphasia in Italy, informative findings

ABSTRACT Background: According to surveys conducted in several countries, public awareness and knowledge of aphasia are inadequately low. Persons with aphasia appoint this fact as a relevant environmental barrier. Aims: The present inquiry aims at analyzing the status of awareness and knowledge about aphasia in Italy. Methods & Procedures: An original questionnaire was distributed online through a snowball sampling method on the Italian adult population. Respondents were asked if they had heard of the term “aphasia” and subsequently tested on its definition and clinical characteristics. Similar questions regarding “celiac disease” and “Down syndrome” were asked for comparison. Demographic data and information about the source of knowledge were also recorded. Outcomes & Results: Considering 2172 respondents, 62.4% had heard of aphasia, 58.2% showed definition knowledge while 4.6% complete general knowledge. These rates were lower than those for the other medical conditions. Older age, female gender, higher education, and being a health professional were significantly associated with awareness. The questionnaire highlighted poor knowledge about the social and functional consequences of aphasia. Conclusions: Overall, the rates of aphasia awareness and knowledge were low. Despite health professionals performed better, the level of general knowledge was also poor among these respondents. These preliminary data set the need for further inquiries, undertaking appropriate methodological ameliorations.

Abstract P214: Social Network Analysis of a Community Aphasia Group Pre- And Post-Covid: Implications for Future Planning

Introduction: Among the many negative consequences of aphasia is an altered social network. Social network analysis supports an objective, quantitative evaluation of social networks among individuals with aphasia along with potential impacts of social programming and interventions on an individual’s social network. Social network analysis may also support better understanding of the impact of Covid on individuals with aphasia. Aims: This pilot evaluation utilized social network analysis via R to evaluate the social network characteristics of a community-based aphasia network across a 12-month pre-Covid period. Social network aphasia group data for a standard duration of time pre- and post-Covid were also compared to identify potential social implications of Covid in a population already at higher risk for reduced social interactions. This presentation will also provide fundamental concepts relevant to social network analysis for those interested in pursuing such analysis in further depth. Methods: Twelve months of pre-Covid aphasia group program attendance data were examined using the visNetwork R package. An additional six months of Covid-era time frame data were also analyzed.The primary relationship function of “ a attended b” (where a = individual participant and b = event/setting) was used in the analysis. Multiple social network characteristics were analyzed and displayed including node, edgeness, directionality, weight, and centrality indices across individuals with aphasia, care partners and community members and settings. Results and Conclusions: Network analysis reveals a directed network graph with primarily unidirectional relationships. There is an emergence of several aphasia group participant behavior types, both pre- and post-Covid, relevant for future planning including: communities of individuals who have similar behaviors in terms of type of event attendance; key individuals who are "heavy users" of various services in terms of frequency and breadth of event attendance; and peripheral users who use only one service. Post-Covid social network implications are discussed including supports to mitigate negative impacts of Covid on social network composition.

Comparison of the Effects of Video Modeling and Clinician Modeling on Naming Deficiency in Aphasic Patients

Background: Aphasia is the most frequent disorder that could occur following a stroke. Aphasia has a negative impact on the patient's communication ability through language. One of the common consequences of aphasia is naming deficits that can lead to communication disorders. Therefore, the treatment of aphasia is necessary. The aim of the current study was to investigate the effect of video modeling and clinician modeling on naming skills of patients with chronic aphasia.Materials and Methods: The design of this prospective single subject study was A‑B‑A that performed on four patients with chronic aphasia. participated. This study was administered during three phases including the baseline (three sessions); the intervention (nine sessions); and a follow-up phase (three sessions). The outcome measure was taken in three phases including baseline, intervention, and follow-up. For each patient, the naming score for items modeled by the clinician, the naming score for items modeled video modeling by other, the naming score for self-video modeling, and the reaction time score were recorded.Result: A total of three patients complete the study and one of them refused to continue treatment. The naming score of all modeling types increased in all patients. In the other words, the intervention helped the patients be improved in naming. Also, the results of the reaction time indicated that the video modeling, as well as clinician modeling, could decrease the response time that means the intervention could increase the speed of retrieval processes. Conclusion:In our study, all three types of modeling could improve the naming scores in patients with chronic aphasia. Additionally, the findings demonstrate that the clinician and video modeling might increase mental processing for naming verbally. [GMJ. 2019;8:e1158]

“Who decides what criteria are important to consider in exploring the outcomes of conversation approaches? A participatory health research study”

Background: One of the most devastating consequences of aphasia is the disruption to normal conversation. The Conversation Partner Programme emphasises communicative competence and life participation. Currently there is no recognised system for evaluating this intervention. Following policy imperatives for patient and public involvement, it is important to include service users in the development of evaluation criteria. However, people with aphasia are often excluded from such research and service development initiatives because of their communication disability. This study was designed to include people with aphasia and other key stakeholders as co-researchers in the development of evaluation criteria for a Conversation Partner Programme.Aims: To describe the multi-perspectival co-generation of Conversation Partner Programme evaluation criteria using a participatory research approach.Methods & Procedures: Following a pilot study, the generation and analysis of qualitative data involved a Participatory Learning and Action (PLA) approach based on the interpretive paradigm. Using purposeful sampling participants (n = 20) included: people with aphasia (n = 5); speech and language therapists (n = 5); speech and language therapy graduates and undergraduates (n = 9) and university coordinator (n = 1). Through (n = 18) individual and inter-stakeholder data generation episodes (PLA focus groups and interviews) using participatory techniques (Flexible Brainstorming, Card Sort, Direct Ranking, Seasonal Calendar), evaluation criteria were identified. The principles of thematic analysis guided the co-analysis of data with participants. Data generated in Ireland were presented to an international inter-stakeholder group at Connect, UK, for preliminary exploration of transferability of findings.Outcomes & Results: Conversation Partner Programme evaluation criteria agreed and prioritised by co-researchers in order of importance included: (1) shared understanding of structure, (2) clarity about the programme, (3) agreed evaluation mechanism, (4) linking with other organisations, and (5) feedback. “Shared Understanding of Structure” was ranked the most important criterion and related to the nature and number of participants, opportunities for group meetings, socialising, and stakeholder interaction. “Feedback”, the criterion ranked least important, detailed responsibilities about summarising programme experiences and sharing this information between stakeholders.Conclusions: People with aphasia and other key stakeholders were meaningfully involved in the identification of evaluation criteria for a Conversation Partner Programme. The outcomes of this collaborative work bridge the gap between policy imperatives around involvement and actual practice and will impact the design, delivery, and evaluation of the programme for all stakeholders. Findings will be of interest to professionals in this clinical area and to those exploring innovative methodologies to include marginalised service users, especially people with communication disabilities in research.

Communication difficulties and the use of communication strategies: from the perspective of individuals with aphasia

To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. Semi-structured interviews were conducted with four women and seven men with chronic aphasia (n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed.

“Natural” conversation: A treatment for severe aphasia

Background: Many treatment approaches based on different concepts of aphasia have been proposed. Nowadays two main approaches face each other: the impairment- and the consequences-based approaches. The impairment-based approach draws directly from cognitive neuropsychology and is aimed at improving the linguistic deficit. The consequences-based approach (or functional or psychosocial approach) has its roots in the pragmatic approach and endeavours to reduce the consequences of aphasia in daily living. Aims: The aim of this study is to present a treatment for severe aphasia that partially reconciles the two approaches. It incorporates some principles of the impairment-based approach and utilises them in a “natural” situation that has a direct impact on the daily life of patients with aphasia. Methods & Procedures: The description of the characteristic of a conversation between two normal interlocutors serves to illustrate how a theory of conversation can help guide the clinician's behaviour during “natural” conversation/rehabilitation with a severely aphasic patient. Application of the conversation/rehabilitation treatment is illustrated by the case of Mr I, a global aphasic patient 18 months post-onset who underwent 9 months of treatment. Outcomes & Results: Positive outcome was obtained. Mr I was initially unable to keep in contact with anybody or even understand that others were trying to interact with him. After treatment, his approach to others had substantially changed. He showed interest in what happened around him and was capable of sustaining a conversation if his interlocutors took some simple measures to facilitate his comprehension. Conclusions: The conversation/rehabilitation treatment partly reconciles the impairment- and consequences-based approaches and this study demonstrates that at least for one man with aphasia, Mr I, the treatment was successful.

A qualitative longitudinal case study of a daughter's adaptation process to her father's aphasia and stroke

Background: Aphasia has repercussions on the lives of families who adjust to the new situation of their parent. Most data concerning how family members adapt to aphasia concern spouses, and less so children. However, adult children are likely to encounter specific problems because of the different nature of parent–child relationships. Aims: This study aimed to describe the experience of a daughter's adaptation process to her father's stroke and aphasia during the first year post‐stroke. Methods & Procedures: A qualitative approach was employed to explore the experience of one individual recounted in the context of face‐to‐face interviews. The participant was a 31‐year‐old woman living with her parents at the time her father became aphasic at the age of 60 years. Three interviews were conducted: (1) when her father began outpatient rehabilitation, (2) near the end of outpatient rehabilitation, and (3) three months later. Outcomes & Results: Results revealed that the sources of stress for this participant evolved over time from initial concerns for her father's survival and health, to preoccupations concerning her father's communication and their relationship, and lastly to concerns about how her own life had been altered. In reaction to stress the participant was proactive, obtained information, modified her communication with him, and oversaw his health and treatments. Over time some of the negative consequences diminished and more positive indicators emerged. The strategies the participant employed allowed her to feel she did the right thing, and also she preserved her self‐esteem. However, at the last interview she still suffered from the changes in her relationship with her father and their communication restrictions. Conclusions: The results indicate that the experience of a daughter was an evolving process, involving negative and more positive consequences. The process of adaptation was influenced by the particular life situation of this participant, her perception of stresses, and the types of strategies she employed. These results show that children may be stressed by many changes associated with a stroke, such as communication limitations. When possible, adult children should be included in the rehabilitation process since they provide skills, abilities, and affection in caring for their parent with aphasia. These may contribute to the reduction of overall stress related to a family's adaptation to the consequences of aphasia and stroke.

Application of the ICF in Aphasia

The aim of this article is to describe aphasia using the framework provided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The key constructs of ICF are described in relation to the ultimate goal of intervention in aphasia-maximizing quality of life. Aphasic impairments as well as activity limitations and participation restrictions are discussed. In addition, the impact of contextual factors on the experience of aphasia and participation in life are addressed. Finally, a case example is presented to depict the use of the ICF as an organizational framework for approaching management of impairments and consequences of aphasia.

Development of a procedure to evaluate the contributions of persons with aphasia and their spouses in an interview situation

Background: Although there has been increasing interest in the study of conversations between people with aphasia and their partners, the participation of persons with aphasia in conversation with their spouses in the presence of a third party has not been extensively investigated. Nevertheless, opportunities for such situations are frequent, and therefore provide an interesting opportunity to examine how couples collaborate. This research was supported by grants from Social Sciences and Humanities Research Council of Canada and Les Fonds de la Recherche en Santé du Québec. The participants are gratefully acknowledged. We would like to also thank Christiane Malaborza, Claudia Morin, Ève Nadeau, the speech‐language pathologists, and the associations of people with aphasia who referred many participants to us. We also extend our gratitude to Nina Simmons‐Mackie for helpful comments. Aims: (1) To develop a procedure to analyse conversations that would specifically address the contributions of persons with aphasia and their spouses in an interview situation. (2) To describe spousal contributions in an interview situation, including what preceded and followed these contributions, in a group of couples with a member with aphasia. (3) To verify the inter‐judge reliability of the procedure. Methods & Procedures: Videos of three couples with aphasia in an interview situation were analysed. Contributions of the spouse when the participant with aphasia was clearly speaking with the interviewer, contexts in which spouses contributed, reactions of persons with aphasia, and their participation following contributions were described. Definitions were created, operationalised, tested, and refined on 11 other similar couples in the same interactive situation. Eight other couples were then videotaped and studied. Outcomes & Results: Results revealed that half the contributions produced by the spouse were “repairs” and the other half were “speaking for” behaviours. Most often, contributions were unsolicited. Generally, the person with aphasia approved the spouse's contribution and continued afterwards to take an active part in the conversation. Inter‐judge reliability coefficients varied between 89% and 97%. Conclusions: The procedure employed is representative of situations encountered by couples affected by aphasia. The data collection and analysis methods could be applicable to clinical situations. It is important to consider spousal contributions and their impact on the person with aphasia in conversations when helping couples adjust to the consequences of aphasia.

Managing linguistic incompetence as a delicate issue in aphasic talk-in-interaction: On the use of laughter in prolonged repair sequences

While problems of understandability have been well documented as one consequence of aphasia in talk-in-interaction, the fact that the linguistic limitations associated with aphasia can lead to a speaker producing displays of linguistic incompetence which are treated as delicate and potentially embarrassing has been less investigated. In this paper two methods by which aphasic speakers can be seen to treat their displays of incompetence as delicate are analysed. Both involve treating the non-competence as laughable and are produced within self-initiated repair sequences at a point where the speaker has failed to produce a self-repair despite a prolonged attempt which has markedly delayed the ongoing progressivity of the turn. One method involves the aphasic speaker producing laughter which alone or with a verbal account marks his/her self-repair attempt at that point as having failed. In response, the conversation partners recurrently do not respond to this laughter with laughter of their own. The second method involves the aphasic speaker producing a ‘humorous noticing’ of a repair try which has been produced as an error. In response to these humorous noticings conversation partners regularly laugh. These methods of managing delicate displays of linguistic incompetence are discussed, along with some methods of turn construction used by aphasic speakers which result in such displays of linguistic incompetence being less likely to occur.

Aphasia - an existential loneliness: A study on the loss of theworld of symbols

The aim of this study was to analyse the existential consequences of aphasia and the struggle to regain the ability to communicate. Data were collected by means of interviews, published books and diaries from four women and five men, who varied in type of aphasia and time since cerebral lesion. Data were interpreted in accordance with a lifeworld hermeneutic approach. The findings led to six interpretations, which serve as a base for a comprehensive understanding and which indicate that the intentional, non-verbal act when something is recognized as something is not affected by aphasia. Aphasia affects the world of symbols, which is necessary for interaction with others. It is connected, therefore, with feelings of alienation, inferiority and shame in social settings. Losing one's ability to recognize symbols thus makes it essential to cope with existential loneliness. The outcome, a sense of community or alienation, appears to depend on the quality of interpersonal relations. The results thus demonstrate that interaction and communication are important aspects of professional care giving. Key words: Aphasia, intentionality, symbolization, care giving, lifeworld, hermeneutics, existential loneliness

Do measures of language impairment predict patient‐reported communication difficulty and distress as measured by the Burden of Stroke Scale (BOSS)?

Background: Patient‐reported measures of communication difficulty and communication‐related distress may be used to obtain efficient and valid indices of the functional consequences of aphasia and its treatment on the daily lives of many community‐dwelling stroke survivors. However, they have not been employed to evaluate treatment outcomes or to examine hypotheses specifying their relationship to commonly employed measures of speech and language impairment in persons with aphasia. This work was supported by the VHA Department of Rehabilitation Research and Development Merit Review Program (Project # C2386R), and the VA Pittsburgh Healthcare System's Geriatric Research Education and Clinical Center (GRECC). The authors wish to acknowledge the contributions of Burden of Stroke Scale (BOSS) Phase 2 Field Trial collaborators, Katherine Ross PhD, VAMC Phoenix, and Julie Wambaugh PhD, VAMC Salt Lake City, the assistance of their respective study team members, Steve Larson MA, Rosalea Cameron MA, and Christina Nessler MA, and the assistance of Mary Ann Oakley and Amy Goda. Aims: This study examined whether the Shortened Porch Index of Communicative Abilities, (SPICA) (Disimoni, Keith, & Darley, 1980), 55‐item Revised Token Test (55‐item RTT) (Arvedson, McNeil, & West, 1986), and BDAE Severity Rating Scale (Goodglass, Kaplan, & Barressi, 2001) scores obtained at 3 months post‐onset (MPO) predicted patient‐reported communication difficulty and distress as measured by the Burden of Stroke Scale (BOSS) (Doyle et al., 2004) at 12 MPO. Methods & Procedures: A sample of 37 adults with mild to moderate aphasia (M SPICA %ile = 70.4) were identified from a larger sample (n = 178) of community‐dwelling stroke survivors who participated in a longitudinal investigation designed to examine the psychometric properties of the BOSS. Speech and language data obtained from the sub‐sample of participants with aphasia were retrospectively examined in two sequential regression models in which the 3‐MPO test scores served as the predictor variables of interest, and 12‐MPO BOSS Communication Difficulty and Communication Distress Scores served as dependent variables. Results: Among the speech and language measures examined, only 3‐month BDAE Severity Ratings contributed significantly to the prediction of 12‐month patient‐reported communication difficulty and distress as measured by the BOSS. Conclusions: The findings suggest that performance‐based measures of speech and language impairment such as the SPICA and 55‐item RTT may not accurately predict the day‐to‐day communication difficulty and distress experienced by community‐dwelling stroke survivors with mild to moderate aphasia. Replication of these findings in a prospectively designed study employing a larger more representative sample, and more comprehensive assessment instruments is needed to substantiate the relationship between performance‐based measures of language impairment and patient‐reported communication difficulty and distress in adults with aphasia.

Aphasia – an existential loneliness: A study on the loss of the world of symbols

The aim of this study was to analyse the existential consequences of aphasia and the struggle to regain the ability to communicate. Data were collected by means of interviews, published books and diaries from four women and five men, who varied in type of aphasia and time since cerebral lesion. Data were interpreted in accordance with a lifeworld hermeneutic approach. The findings led to six interpretations, which serve as a base for a comprehensive understanding and which indicate that the intentional, non-verbal act when something is recognized as something is not affected by aphasia. Aphasia affects the world of symbols, which is necessary for interaction with others. It is connected, therefore, with feelings of alienation, inferiority and shame in social settings. Losing one's ability to recognize symbols thus makes it essential to cope with existential loneliness. The outcome, a sense of community or alienation, appears to depend on the quality of interpersonal relations. The results thus demonstrate that interaction and communication are important aspects of professional care giving.

Forum

Background : Focusing treatment for aphasia requires systematic collection and analysis of an individual's biographical, medical, and behavioural data including, ideally, appraisal of his or her health, functioning, and quality of life. Determining treatment outcomes requires methodical indexing of therapeutic effect(s), ranging from a decrease in one or more specific communication impairments to an increase in overall quality of life. Despite the abundance of available measures, current appraisal of aphasia may be insufficient for focusing socially valid treatment and evaluating its outcomes, because most tests were developed without the advantage of a widely accepted, programmatic framework for evaluating the interaction between an individual's health condition and personal factors, and the external factors that represent the circumstances in which he or she lives. Aims : This paper urges incorporation of the World Health Organisation's (WHO) international classifications of functioning, disability, and quality of life into the appraisal of aphasia to facilitate both more meaningful treatment planning, designed to address the entire consequences of aphasia for each individual, and more meaningful comparison of treatment outcomes, within and among healthcare disciplines and providers. Main Contribution : Limitations of the current appraisal of aphasia are listed, and suggestions for using the WHO framework to evaluate existing instruments and develop new measures are provided. Conclusions : If proven applicable, incorporation of the WHO international classifications of functioning, disability, and quality of life into the appraisal of aphasia should facilitate: development of meaningful and practical health policy; methods to assess quality assurance; improved outcome evaluation; and, most importantly, development of socially relevant treatment for people with aphasia.

DiscussionThe case for qualitative case study methodology in aphasia: An introduction

Background: Qualitative research methods are still largely untapped, but research has shown that they are appropriate for capturing the complexity of the psychosocial consequences of aphasia. While “single case” research in various guises has been widely utilised, the qualitative case study research design has had quite limited application to the study of aphasia.Aims: The aim of this paper is to outline the characteristics of the qualitative case study research design and to discuss potential applications of this methodology to research of the psychosocial consequences of aphasia.Main Contribution: An overview of the qualitative case study design is presented. The aspects described include case selection, data collection, data analysis, and methods to enhance trustworthiness.Conclusions: It is concluded that qualitative case study research allows the study of complex communication behaviours in context. Its end product is a holistic and intensive description and interpretation of communication. It can answer questions related to how and why communication changes after intervention programmes that address the psychosocial consequences of aphasia. This methodology appears to offer great promise in making significant contributions to the knowledge base and practice of speech‐language pathology with adults and families with aphasia.

“Speaking for” behaviours in spouses of people with aphasia: A descriptive study of six couples in an interview situation

Background: People with aphasia and their spouses frequently meet professionals to discuss health‐related issues. In this situation, which is often in an interview form, various strategies may be employed by spouses to facilitate communication. One of these strategies is “speaking for” the person with aphasia.Aims: (1) To identify the presence of “speaking for” behaviour, to measure the frequency of the spouses' “speaking for” and “rapid speaking for” behaviours, and to describe what preceded and followed these behaviours for all participating couples. (2) To describe each individual couple's patterns of “speaking for” in relationship to the members' perceptions of conversations before and after the onset of aphasia.Methods & Procedures: Six couples were studied in an interactive situation. Both the spouse with aphasia and the non‐aphasic spouse took turns being asked questions in a systematic way. Each member also participated individually in a semi‐structured interview aiming to obtain information on perceptions of communication before and since the aphasia.Outcomes & Results: Analysis of three‐way conversations revealed that all of the spouses without aphasia in this study used some “speaking for” behaviours. However, there was great variability in the frequency of the behaviours within couples. For some couples, “speaking for” the person with aphasia may reduce that person's ability or willingness to participate in conversations. The findings from the semi‐structured interviews suggest that “speaking for” a person with aphasia may be an integral behaviour for some couples that is consistent with pre‐stroke interaction patterns.Conclusions: It is important to consider the “speaking for” behaviour, the impact of this behaviour, and the pre‐stroke interaction pattern when helping couples adjust to the consequences of aphasia.

Viewing couples living with aphasia as adult learners: Implications for promoting quality of life

Background: Current interventions for addressing the psychosocial consequences of aphasia have been based on professionally driven constructs as opposed to insider accounts of aphasia. An adult learning approach offers the possibility of developing a programme for individuals with aphasia and their families that involves a more holistic and person-centred approach. This approach offers insights about promoting the quality of life of couples living with aphasia. Aims: The primary objective of this paper is to discuss the implications of adopting an adult learning approach in promoting the quality of life of couples living with chronic aphasia. This paper outlines current interventions for addressing the psychosocial consequences of aphasia. It describes an innovative approach of working with couples with aphasia that explicitly integrates adult education principles and strategies. The basic assumption of this approach is that learning begins with the learner, as opposed to the therapist or treatment plan. Main Contribution: The main contribution of this paper is to outline an alternative approach to intervention that is based on an adult learning model. This approach suggests that improving quality of life for couples living with aphasia involves more than simply promoting increased participation in conversation. Placing the learner in the central role results in intervetion goals that encompass emotional and marital issues, as well as communication. Conclusions: The implications of the adult learning approach on promoting quality of life in the area of emotions, marital issues, and communication outcomes are discussed. Implications of this approach on the role of the speech-language pathologist are also examined. Address correspondence to: Riva Sorin-Peters, 190 Winding Lane, Thornhill, Ontario, L4J 5J2, Canada.

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.

Sharing the communicative burden: A conversation-analytic account of aphasic/non-aphasic interaction

This article presents an analysis of conversation between people with linguistic impairment as a consequence of aphasia and their interlocutors. The challenge faced by linguistic-impaired conversationalists in achieving successful interaction provides an insight which highlights the essentially collaborative construction of all communication and the manner in which meanings are progressively negotiated and agreed over an often quite lengthy conversational sequence. In this article, extracts of conversation are used to illustrate the insights granted by the socially oriented, data-driven approach of Conversation Analysis into the process of aphasic interaction. The relative contributions of an analysis of this kind, and the type of analysis provided by Relevance Theory, a cognitively oriented model of communication, are briefly assessed.