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The article focuses on rehabilitation of people with aphasia. Topics discussed include treatment of entrenched communication problems resulting from impaired comprehension and fluent yet semantically empty speech with neologisms and jargon; improving patients quality of life; and offering effective communication support to people with aphasia.

Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a complex behavioural intervention is in the early stages of development and evaluation. Aims: This article aims to evaluate an intervention that targeted a PWA and their conversation partner (CP), a dyad, as equals in a novel conversation therapy for agrammatic aphasia, using both quantitative and qualitative evidence of change. The intervention aimed to increase the insight of a dyad into facilitator and barrier conversation behaviours, to increase the understanding of the effect of agrammatism on communication, and to support each speaker to choose three strategies to work on in therapy to increase mutual understanding and enhance conversation. Methods & Procedures: Quantitative and qualitative methods are used to analyse multiple pre-therapy and follow up assessments of conversation for two dyads. Outcomes & Results: Results show that one person with severe and chronic agrammatic aphasia was able to select and practise strategies that led to qualitative and quantitative changes in his post-therapy conversations. The other PWA showed a numerical increase in one of his three strategies post therapy, but no significant quantitative change. Although both CPs significantly reduced barrier behaviours in their post-therapy conversations, neither showed a significant increase in the strategies they chose to work on. For one CP, there was qualitative evidence of the use of different turn types. Conclusions: Individually tailored input from a speech and language therapist can assist some people with chronic agrammatism to develop conversational strategies that enhance communication. Outcomes are influenced by the severity and extent of language deficits affecting, for example, single word writing. In terms of behaviour change for CPs, it appears that it may be easier to reduce barrier behaviours rather than to increase the use of facilitatory strategies. The results have implications for collaborative goal setting with clients undergoing conversation therapy. [ABSTRACT FROM AUTHOR]

This article reports an intervention in the conversations between a man with chronic aphasia, Barry, and his wife, Louise (both names are pseudonyms). Preintervention analysis revealed the potential of writing as a resource for turn construction. Intervention consisted of enabling Barry to use writing to produce more complete turns at talk, thereby increasing the likelihood of mutual understanding, and encouraging Louise to modify her responses to Barry’s turns and thus enhance his interactional potential. Quantitative analysis revealed that Barry significantly increased his use of writing after intervention, but there was no change in other trained strategies. Louise eradicated correct production sequences (designed to elicit the correct production of a word despite her knowing the target) but did not implement trained strategies. In conclusion, individually tailored input underpinned by Conversation Analysis principles can alter the conversational behavior of a person with aphasia. It appears easier for a conversation partner to reduce unhelpful behaviors than to adopt facilitatory strategies. Data are in British English. [ABSTRACT FROM AUTHOR]

The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement. This is followed by examples of sequences occurring in the talk of two of these speakers that result in different, and more limited, turn construction opportunities, namely 'test' questions asked in order to initiate a new topic of talk, despite the conversation partner knowing the answer. The contrast between extended turns and test question sequences illustrates the effect of interactional context on aphasic turn construction practices, and the potential of less than optimal sequences to mask turn construction skills. It is suggested that the interactional motivation for test question sequences in these data are to invite people with aphasia to contribute to conversation, rather than to practise saying words in an attempt to improve language skills. The idea that test question sequences may have their origins in early attempts to deal with acute aphasia, and the potential for conversation partnerships to become 'stuck' in such interactional patterns after they may have outlived their usefulness, are discussed with a view to clinical implications. [ABSTRACT FROM AUTHOR]

In this article a conversation analytic approach is used to investigate the form and use of enactment by speakers with agrammatic aphasia in talk-in-interaction. Enactment here refers to the employment by participants of direct reported speech and/or other behavior such as the use of gesture/body movement and/or prosody to iconically depict some aspects of reported scenes or events. The enactment of these speakers is notable in terms of the distinctive grammatical practices within which it is regularly produced (e.g., without any reporting verb such as say) and a reliance on kinesic enactment and simple lexical forms produced as seconds, i.e., reactions or second pair-part responses such as oh, no, and oh no. It is argued that enactment and other instances of iconicity within interaction as produced by these aphasic speakers are examples of interactional methods adopted by them in order to formulate actions and events in talk using the limited lexical and grammatical resources at their disposal, and some similarities to other types of language use such as child language and pidgins are noted. [ABSTRACT FROM AUTHOR]

Historically, agrammatism, a symptom of Broca's aphasia, has been associated with dysprosody, on account of speakers' slow, halting, and effortful speech. Almost all investigations of this phenomenon use experimental methods (reading, repetition). Thus, little is known about how prosody is used by speakers with agrammatism and understood by their interlocutors in everyday conversations. This paper takes an interactional approach to prosody, using Conversation Analysis to explore everyday conversations between three speakers with agrammatism and their family members/friends, recorded in the home. A distinct prosodic pattern is revealed in their talk, whereby non-final words in an agrammatic utterance are produced with mid-level or minor rising pitch, and final words with a prominent pitch excursion. The analysis shows that conversation partners orient to terminal pitch movement as a signal of turn completion. Conversely, they do not take the floor when pitch signals continuation, despite significant pausing and severe grammatical disruption. Thus, prosody appears to function to regulate turn taking in the same way as it does in typical (non-language disordered) conversation. For these three speakers, intact prosodic skills appear to compensate for impaired grammatical ability, by packaging a series of haltingly produced words into an utterance, the meaning of which is responded to by the conversation partner as the sum of its agrammatic parts. [ABSTRACT FROM AUTHOR]

A Japanese-speaking stroke patient with disrupted phonology but relatively good semantics was severely impaired in nonword reading, with better preserved and imageability-modulated word-reading in both kanji and kana. This basic similarity of reading in the two Japanese scripts was accompanied by the following differences: (i) distinct error patterns (prominent semantic errors for kanji vs. phonological errors for kana); (ii) a more pronounced imageability effect for kanji; and (iii) a remarkable pseudohomophone advantage for kana. The combination of deep dyslexia for kanji and phonological dyslexia for kana in a single patient suggests that these are not two distinct reading disorders. [ABSTRACT FROM AUTHOR]

Current approaches to assessing agrammatism use data from restricted contexts, such as picture description and story telling tasks. There is evidence in the conversation analysis literature to suggest that conversational grammar may differ markedly from the grammar of such elicited language samples. The disparity between conversational and test grammar suggests that it is possible for the form of an agrammatic utterance to be motivated by the context in which it occurs. Thus, behaviours previously considered to be symptoms of agrammatism may be adaptations to talking in different environments. This study analyses two distinctive test response forms made by two agrammatic speakers, and discusses whether they might be strategic adaptations to testing rather than symptoms of impairment. [ABSTRACT FROM AUTHOR]

Background: Although research into agrammatism has done much to characterise the nature of the underlying disorder, most studies have analysed elicited, task-based data. As a result, little is known about the grammar that people with agrammatism use in everyday talk with habitual conversational partners. There is evidence in the Conversation Analysis (CA) literature to suggest that conversational grammar may not mirror the grammar of elicited language samples. Aims: To explore the notion that conversation and task-based data do not necessarily reveal the same grammatical phenomena, addressing the following questions: (1) What resources does a speaker with agrammatism make use of in order to construct a turn at talk? (2) Is the conversational grammar of a speaker with agrammatism organised in a systematic way? (3) What is the relationship between patterns of turn construction in conversation and the grammatical characteristics of output elicited by decontextualised language tests? Methods & Procedures: A videotaped conversation between an agrammatic speaker and his adult daughter is analysed using CA. Four recurring turn construction formats are described and illustrated with extracts. Background information on the client presents the results of picture-naming and sentence production tests. Outcomes & Results: There is great variation between the grammar of conversation and test data. Test results reveal a severe problem with verb access and sentence construction, with ability declining sharply as the number of verb arguments increases. However, the speaker deploys interactional alternatives to standard grammatical structures, and it is possible for him to recount events without explicit articulation of verbs and argument structures, using a combination of talk and mime. Only a minority of his conversational utterances are concerned with recounting events - commenting, assessing, and reasoning are highly prevalent. Conclusions: Conversation and sentence-level tests provide complementary but essentially different information about grammatical ability. This implies that assessment of conversational grammar should become a routine part of any investigation of agrammatism in order to gain a more complete picture of an individual's ability to impose structural order on their talk, and to explore implications for successful interaction with others. Currently, approaches to assessment and intervention over-emphasise events. In conversation, other actions such as giving an opinion are just as prevalent. Findings suggest a mismatch between what appears problematic on testing and what is treated as problematic by the interactants in conversation, and that intervention might profitably seek to address grammatical difficulties that have a basis in interaction. [ABSTRACT FROM AUTHOR]

Previous research on work after stroke has used quantitative methods and a medical model approach to identify factors that influence return to work. This study uses an inclusive, qualitative methodology (focus groups) to begin to explore stroke survivors' own perspectives about what helps and hinders paid or voluntary work after stroke. The research was conducted in partnership with Different Strokes, a British organisation of stroke survivors. Five focus group discussions were held with 37 stroke survivors and 12 of their supporters. Data was analysed using an adapted Framework approach to identify themes within and across individuals and groups. Factors representing barriers to or enablers of work were identified in four key themes: rehabilitation process, employer agency, social structural and personal. The study found evidence of social oppression via infrastructure, institutional structures and practices, and some individuals' attitudes. Alongside this, some supportive individuals, practices and strategies were identified. [ABSTRACT FROM AUTHOR]

This paper uses the methodology and analytical findings of conversation analysis to investigate the notion that a phasic grammar may be understood at least partly in the context of the demands of turns at talk in conversation. An investigation of the conversation of an English-speaking person with aphasia reveals two distinct grammatical phenomena, and it is suggested that their use may be interactionally motivated by the need to take a relatively unproblematic turn at talk despite the constraints of non-fluent aphasia. The grammatical patterns that are revealed by this analysis look considerably diffrerent from those elicited by standard methods of data sampling. The possibility that interactional grammatical phenomena are not visible in the language data elicited by clinical assessments is raised. This question is addressed via an in-depth comparison of the same speaker's interactional and elicited grammar in a linked article. It is suggested that the tool of conversation analysis provides researchers with a new and fruitful approach to the study of grammatical abilities in aphasia. [ABSTRACT FROM AUTHOR]

This paper investigates the grammatical difficulties of an English-speaking person with non-fluent aphasia using clinical assessments based on picture description and story telling, The same individual's conversation grammar which was investigated in detail in a linked article is reviewed here. and the notion that interactional grammatical phenomena may not necessarily be visible in elicited language data is explored. Data analysis shows that the aphasic speaker's grammar looks considerably different in the context of clinical assessment than it does in conversation. Analysis of elicited grammar reveals that the majority of utterances produced are subject-verb-object (SVO) type sentences, whereas prior analysis of conversation data indicated patterns of interactional grammatical phenomena that differ from such sentence types. It is suggested that language tests and conversation provide complementary but essentially different information about grammatical abilities. The clinical implications of this finding are discussed. [ABSTRACT FROM AUTHOR]

Explores the use of context in aphasia as a manifestation of systematic adaptation to the environment of everyday conversation. Use of conversation analysis approach; Discussion through video data of two people with acute aphasia; Language of speakers with aphasia.

The article focuses on rehabilitation of people with aphasia. Topics discussed include impact of Better Conversations with Aphasia, a conversation therapy programme on current practice by Great Britain speech and language therapists; improving patients quality of life; and reducing barriers to conversation at the group level.