Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia

Figures & data

Table

Case example: A client is attending their appointment in the multidisciplinary memory disorders clinic. When the consultant neurologist asks, “and how have you been?”, the client responds with “Losing my way a little”. The neurologist responds to this by moving on to the next question. The speech and language therapist/pathologist, who knows the client well, interjects and asks, “What do you mean by ‘losing your way a little’?”. The client explains that he has been quite depressed and having suicidal thoughts. This led to a review of the medications being prescribed. Had this been overlooked, or perhaps interpreted literally as suggesting the client was having navigational difficulties today, then this might have resulted in a significant issue not being addressed. Attending to a person’s language can be extremely helpful in deepening understanding of a person’s current perspectives, needs, and priorities. It was several clinical experiences like that outlined above, which inspired the researchers to explore metaphor use amongst people with PPA, their families and the therapists working with them.

Table 1: Participant demographic details

Living with PPA dataset (n=21)
male: female	9:12
PwPPA	7
CPs	14
	(of these 5 = dyads)
CPs relationship to PwPPA (n=14)
Wife	6
Husband	5
Daughter	3
PPA variant (dyads were counted twice for each participant)
nfvPPA	10
svPPA	5
lvPPA	5
mixed PPA	1
Years since diagnosis	2.25 (range 1-7)
SLTs (n=15)
male:females	0:15
Mean years as SLT/P	22.6 (range 1.5-45)
Mean no. of PPA patients seen over career clinically	141 (range 0-350+)
Mean no. of PPA patients seen over career for research	52 (range 0-200)

Notes: NB: PwPPA = people with primary progressive aphasia, CP = care partner, nfvPPA = nonfluent agrammatic variant primary progressive aphasia, svPPA = semantic variant primary progressive aphasia, lvPPA = logopenic variant primary progressive aphasia, SLT/P = speech and language therapist/pathologist

Table 2: Overview of data extraction

Stage 1	Stage 2	Stage 3	Stage 4	Stage 5
AV read the entire transcript to familiarise themselves with the content.	In the context of each lexical unit, the researcher, AV, identified if there was a more basic contemporary meaning in other contexts than the one in the given context. If yes then the text was marked as metaphorical.	Metaphorical language was extracted and collated into a table.	25% of transcripts were read by a second researcher (either LR or DH), and data extracted in accordance with stages 2 and 3.	AV compared extracted data for consistency. The research team, comprising AV, JC, LR and DH, met regularly to discuss metaphor extractions and interpretation of metaphorical language to ensure critical reflexivity.

Table 3: Categories and number of metaphors identified across the data sets

Data collection:	Type of metaphor (n=number of metaphors)
Data collected from people with PPA and their families - 131	Living with PPA – 45 (of these 6 were generated by PwPPA)
	Caring for a person with PPA – 37 (of these 5 were generated by PwPPA)
	Speech and language therapy – 49 (of these 2 were generated by PwPPA)
	Relationship with SLT/P - 7
	Access to services – 13 (of these 1 was generated by a PwPPA)
Data collected from SLT/Ps - 106	Delivering speech and language therapy to people with PPA - 57
	Relationships with people with PPA - 27
	Access to services - 17

Notes: NB: PPA = primary progressive aphasia SLT/P = speech and language therapists/pathologists

Figure 1. Different metaphors used by participants to describe their experiences depending on variant of PPA and time since diagnosis.

NB: italicized and * = metaphors generated by PwPPA, vPPA = logopenic variant primary progressive aphasia, svPPA = semantic variant primary progressive aphasia, nfvPPA = nonfluent agrammatic variant primary progressive aphasia.

Figure 2. Case example accompanied with suggested responses using six-steps to illustrate how to respond to metaphorical language

NB: PPA = primary progressive aphasia