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A case series examination of interaction-focused therapy for aphasia
[Thesis]. Manchester, UK: The University of Manchester; 2014.
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Abstract
This study reports the application and outcomes of Conversation Analysis (CA)-motivated interaction-focused therapy for a case series of eight couples managing the impact of aphasia on their conversations. It builds on previously reported interaction-focused therapy case studies (e.g. Lock, Wilkinson, & Bryan, 2001, Wilkinson, Bryan, Lock & Sage, 2010; Wilkinson, Lock, Bryan & Sage, 2011). Therapy was individualised for each couple, based on CA findings, but taking account of language, cognitive and self-reported disability assessments, and the couples' own observations during informal interviews.The participating couples were beyond the spontaneous recovery period for aphasia and presented with different types (e.g. Wernicke's, Broca's, Anomic) and severities of aphasia. Each couple video-recorded at least 80 minutes of baseline conversation at home, over eight recordings of ten minutes or more. Another eighty minutes were recorded immediately post-therapy, and again three months later. Results were evaluated by comparing pre- and post-therapy data, with the maintenance data used to evaluate whether changes were sustained three months after therapy ended.The findings indicated that four couples implemented behavioural changes following interaction-focused therapy. There was no systematic evidence of change in the other four couples' data. Reasons for successful and unsuccessful outcomes are hypothesised, including resistance to changing adaptations that mask aphasic difficulties, despite the loss of communicative effectiveness these adaptations may cause. Preliminary analysis of linguistic and cognitive assessment data has not revealed any patterns that can be related to response to therapy, but more work is warranted to further explore this data.New findings include two interaction-focused therapy targets: 1) eye gaze by people with aphasia to stall/mobilise help with repair from their partners, and 2) facilitating the person with aphasia to gain the floor more regularly by beginning a turn in the partner's turn space. Other new findings are the use of CA to assess aphasic comprehension impairments, the effectiveness of environments of possible occurrence (Schegloff, 1993) as a measure for evaluating success in interaction-focused therapy studies, and benign pedagogics. The study identified some areas for future research, including the development of an interview to elicit attitudes and beliefs about managing aphasia, as these seemed to influence response to therapy. Clinical applications have been suggested in terms of when this form of therapy may be relevant and for whom it might be expected to prove beneficial.
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