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Background: Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change. Aims: To identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy. Methods and Procedures: Data were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in-therapy discussions and post-therapy interviews, which are analysed using Framework Analysis. Outcomes and Results: Seven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers' skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. Conclusions and Implications: These clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research.

Background: Agrammatic speech can manifest in different ways in the same speaker if task demands change. Individual variation is considered to reflect adaptation, driven by psycholinguistic factors such as underlying deficit. Recently, qualitative investigations have begun to show ways in which conversational interaction can influence the form of an agrammatic speaker's output. Aims: To explore qualitative patterns of individual variation in the output of a single case, in order to address the following questions: (1) in what ways do grammatical structure, verbs and argument structure differ qualitatively between data samples?; and (2) what is the influence of interaction on the structure of utterances? Methods & Procedures: A man with severe and chronic agrammatism is videotaped completing tests of spoken sentence construction, composite, and cartoon strip picture descriptions and a story telling task. In addition, he independently videotapes a sample of conversation with a family member at home. Analyses of these data draw on cognitive neuropsychological, linguistic and psycholinguistic methodologies as well as the data-driven procedures of conversation analysis.Outcomes & Results: The qualitative analysis uncovers considerable variation between data sets with respect to grammatical structure, verbs and argument structure. The agrammatic speaker appears more skilled at imposing order on his spontaneous speech than the results of sentence construction tests might predict. Interaction influences his output style. Adaptation is found to be a collaborative process that occurs between two speakers in the quest for mutual understanding, not something that takes place within an individual. Conclusions: It is concluded that an interactional approach to agrammatism has the potential to yield important insights into the characteristics of telegraphic speech and individual variation. The failure of sentence-level tests to capture this individual's skill in producing systematically structured utterances in conversation implies that the assessment of agrammatism could benefit from the additional sampling and analysis of conversational grammar.

Background Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change. Aims To identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy. Methods & Procedures Data were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in-therapy discussions and post-therapy interviews, which are analysed using Framework Analysis. Outcomes & Results Seven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers' skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. Conclusions & Implications These clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research. [ABSTRACT FROM AUTHOR]

Background & Aims A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours. Methods & Procedures A 55-year-old man with chronic agrammatism and his wife took part in eight weekly sessions of conversation therapy, adapted from Supporting Partners of People With Aphasia in Relationships and Conversation (SPPARC). Language and conversation were assessed before and after therapy, and the couple's views on conversation and disability were elicited. Conversation analysis was used to analyse: (1) pre-therapy conversation patterns, (2) how the PWA engaged and learned during therapy and the forms of facilitation that aided this process, and (3) qualitative change in post-therapy conversation behaviour. Outcomes & Results After therapy, the PWA showed increased insight and acceptance of the use of strategies such as writing and drawing in the face of conversational difficulty. However, use was prompted by his wife and was rarely spontaneous. Conclusions & Implications This single case study suggests that conversation training based around an experiential learning process is able to engage a PWA directly in learning about the effects of aphasia on conversation. Key facilitators were self-study via video and experience of practising conversation whilst receiving online feedback from a speech and language therapist. However, increased insight did not automatically change conversation behaviour. Although he better understood the effects of his aphasia on conversations with his wife, learning stopped short of the ultimate goal of the conversation training programme; the spontaneous use of strategies worked on in therapy when faced with conversation breakdown. One explanation may be that limited cognitive flexibility lead to problems with switching from one strategy to another. [ABSTRACT FROM AUTHOR]

Background: Agrammatic speech can manifest in different ways in the same speaker if task demands change. Individual variation is considered to reflect adaptation, driven by psycholinguistic factors such as underlying deficit. Recently, qualitative investigations have begun to show ways in which conversational interaction can influence the form of an agrammatic speaker's output. Aims: To explore qualitative patterns of individual variation in the output of a single case, in order to address the following questions: (1) in what ways do grammatical structure, verbs and argument structure differ qualitatively between data samples?; and (2) what is the influence of interaction on the structure of utterances? Methods & Procedures: A man with severe and chronic agrammatism is videotaped completing tests of spoken sentence construction, composite, and cartoon strip picture descriptions and a story telling task. In addition, he independently videotapes a sample of conversation with a family member at home. Analyses of these data draw on cognitive neuropsychological, linguistic and psycholinguistic methodologies as well as the data-driven procedures of conversation analysis. Outcomes & Results: The qualitative analysis uncovers considerable variation between data sets with respect to grammatical structure, verbs and argument structure. The agrammatic speaker appears more skilled at imposing order on his spontaneous speech than the results of sentence construction tests might predict. Interaction influences his output style. Adaptation is found to be a collaborative process that occurs between two speakers in the quest for mutual understanding, not something that takes place within an individual. Conclusions: It is concluded that an interactional approach to agrammatism has the potential to yield important insights into the characteristics of telegraphic speech and individual variation. The failure of sentence-level tests to capture this individual's skill in producing systematically structured utterances in conversation implies that the assessment of agrammatism could benefit from the additional sampling and analysis of conversational grammar. [ABSTRACT FROM AUTHOR]

Focuses on Speech and Language Therapy (SLT) services for people with dementia in Great Britain. Opportunities provided by the National Service Framework (NSF) for the profession to address the variability and quality in SLT service provision; Elimination of age discrimination; Provision of person-centered care; Promotion of older people's health and independence.

A recently completed evaluation of a one day training package on communication has found evidence of a perceived need for training in both communication and communication impairment among care workers employed by health and social care agencies. This paper is a discussion of the factors that contribute to the delivery of successful workshops to front line care workers. [ABSTRACT FROM AUTHOR]

This paper reviews new theoretical and practical developments in working with partners of people with aphasia and describes the development of a clinician's resource entitled 'SPPARC: Supporting Partners of People with Aphasia in Relationships and Conversation'. It focuses particularly on one part of that resource: the SPPARC Conversation Training Programme, which adapts conversation analysis for clinical use. The paper describes the stages involved in assessing and working on conversation in everyday life. [ABSTRACT FROM AUTHOR]

Discusses a number of initiatives that address training and support of residential care staff to relate to older communication disabled people in Great Britain. Limitations on implementation of staff training and support; High proportions of residents with communication disorders; Care staff's ability to cope with a range of complex communication problems.

Focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. Description of assessment and treatment informed by conversation analysis; Implications for the relation between language and psychosocial issues.