Interaction-focused intervention for acquired language disorders: Facilitating mutual adaptation in couples where one partner has aphasia

Abstract

This paper discusses the implementation and evaluation of an interaction-focused intervention single case study for a couple where one partner has aphasia. Drawing on conversation analytic research, naturally occurring conversations of the couple at home pre-and post-intervention were collected and analysed. Analysis of the speaker with aphasia's topic initiating turns in the pre-intervention conversation showed that in each case a feature of the attempt was that the speaker had difficulty in getting the topic initiation accepted and established. Drawing on conversation analytic work on topic initiations in normal conversation, intervention focused on training the couple to co-produce these topic initiating turns of the speaker with aphasia in a collaborative and step-by-step manner. Post-intervention, there was evidence that the couple were now using this new method, albeit in a slightly different way to that worked on in the intervention sessions. Drawing on work into adaptation by speakers with aphasia and their conversation partners, these results are discussed in terms of a process of mutual adaptation by the couple.

Professionals’ perspectives on delivering conversation therapy in clinical practice

“…CP training in particular has a robust evidence base (Simmons-Mackie et al, 2010;Simmons-Mackie, Raymer, & Cherney, 2016;Turner & Whitworth, 2006), and the Royal College of Physicians Intercollegiate Stroke Working Party (2016) recommends it as an approach to enhance participation in social interaction for people with aphasia. Individual case studies provide early evidence that direct training of the person with aphasia(PWA) alongside their CP can also achieve positive change (see Beeke et al, 2015;Wilkinson, Lock, Bryan, & Sage, 2011). It is clear from the literature that despite a robust evidence base, conversation therapy research studies vary in implementation (Simmons-Mackie et al, 2010, 2014, and there is no "coherent synopsis" of conversation therapy research studies' findings (Simmons-Mackie et al, 2014, p. 511).…”

An interaction-focused intervention approach to training everyday communication partners: a single case study

“…While many interaction-focused intervention studies have involved the therapist working with the PWA and the significant other together as a dyad (Beeke et al, 2011;Burch et al, 2002;Wilkinson et al, 1998Wilkinson et al, , 2010Wilkinson et al, , 2011, this study adds to the smaller number of studies (e.g., Booth & Perkins, 1999;Booth & Swabey, 1999;Lock et al, 2001) where intervention involved the therapist working with the significant other in the absence of the PWA. The intervention for the significant other was delivered as part of a group intervention for three people who were each significant others of people with aphasia.…”

“…The significant other's initiation of, and engagement in, pedagogic activity can be viewed as a form of interactional adaptation (Wilkinson et al, 2011). That is, it can be a type of behaviour that she/he was not engaging in any significant way before their spouse/family member/friend became aphasic, but instead has emerged in response to that person now being aphasic, typically in an attempt to assist the PWA.…”

“…Finally, it can be noted that while a common means of delivering interaction-focused intervention is by means of a speech and language therapist/pathologist (SLP) working with an individual dyad, often through visiting them at home (e.g., Beeke, Maxim, Best, & Cooper, 2011;Burch, Wilkinson, & Lock, 2002;Wilkinson et al, 1998Wilkinson et al, , 2010Wilkinson et al, , 2011, other methods of delivering intervention have also been used. For example, intervention can be delivered to a group of communication partners of people with aphasia (Booth & Perkins, 1999;Booth & Swabey, 1999;Lock, Wilkinson, & Bryan, 2001), although even in this setting the intervention aims and delivery are typically individualised to a large extent.…”

“…In the study by Wilkinson, Lock, Bryan, and Sage (2011), for example, the significant other was encouraged to respond in a certain way when the PWA signalled she was attempting to initiate a new topic, that is, he would provide her with the time and opportunity to do this by, for example, using continuers, such as "mm hm. "…”