“Accountability” in interaction-focused intervention for aphasia: a conversation-analytic study of therapeutic effects

ABSTRACT

Background: Aphasia interventions typically require independent practice on the part of people with aphasia. Interaction-focused interventions aim to change patterns in everyday conversation, and require both people with aphasia and their familiar communication partners to implement communication strategies. Little empirical evidence is available on how people with aphasia and their conversation partners practice communication strategies independently.

Aims: This study explores how people with aphasia and their conversation partners attend to intervention goals during independent conversations. It focuses on how people with aphasia are made “accountable” for using communication strategies.

Methods & Procedures: This study employed a descriptive, qualitative design, drawing on single-case conversation analytic methods. Six participants (three people with aphasia, and their respective spouses) recorded communication samples as part of an interaction-focused intervention. About 22 min of these samples were transcribed and analysed using conversation-analytic methods.

Outcomes & results: 27 instances where conversation partners topicalised intervention were analysed. The extracts presented, demonstrate that intervention goals were invoked via a range of communicative acts, including repair initiations, assessments, and directive-like assertions. People with aphasia were treated as responsible for not administering strategies at communicatively relevant moments.

Conclusions: Intervention participants’ displays of “online” reasoning about intervention goals may be practically important for interaction-focused intervention, and warrant further attention. These displays hold potential for better defining therapeutic mechanisms in interaction-focused intervention.

KEYWORDS:

• Aphasia
• interaction
• intervention
• communication partner training

Acknowledgments

The author would like to thank the participants, and acknowledge the contribution of Sophie Toocaram to data transcription.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Of.course, this analysis is also defeasible in the next turn, and may be recontextualised as a more generic problem (e.g., A: pardon?; B: I didn’t mean to swear, sorry; A: No, I just didn’t hear you).

2. Equivalent demographic data for conversation partner participants are incomplete, and not reported. This is not ideal. However, the findings of the present study are not directly reliant on the demographic characteristics of participants (with and without aphasia).

3. It should be noted that Hilton’s goal of “using words other than yes and no when responding” was not included in the outcomes reported in Barnes and Nickels (2017). This is because it was very difficult to unequivocally operationalise for meaningful coding by naïve coders. 

4. A Reviewer queried the decision to focus exclusively on instances where conversation partners invoked intervention goals. There are a number of motivations for this choice. First, as noted earlier, there were few instances where people with aphasia initiated orientation to intervention goals; either their own, or their conversation partner’s. Second, due to their aphasia, the times when they did appear to be orienting to intervention goals were often ambiguous. As a consequence, the data furnished very few—and very few unambiguous—candidate instances for analysis. Finally, the role of routine conversation partners in encouraging or inhibiting strategy use by people with aphasia is a practically and theoretically important topic for interaction-focused intervention.

5. There is an empty chair next to Hilton obscuring what they are looking at on the table. It possible that they are looking at small cueing cards depicting communication strategies, which were prepared for the intervention.

6. It should also be noted that Extract 4 includes transcription of participant gaze in a segment where Gail invokes intervention goals. This is necessary to adequately convey the social actions that participants are accomplishing in this part of the extract. 

Additional information

Funding

This research was funded by a Macquarie University “New Staff” grant entitled “Learning in conversation therapy” awarded to the author.