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.

Effective writing rehabilitation for people with acquired dysgraphia following a stroke could lead to more opportunities to communicate, reduce isolation and improve quality of life. Previous research has suggested that both impairment-focused spelling therapies and assistive technologies can support writing rehabilitation, although the strength of the evidence is limited. The central aim of this PhD study was to investigate whether a combined approach to writing therapy, including impairment-based therapies and assistive technologies, could improve the email writing of participants with varying severity of acquired dysgraphia. An email writing assessment was developed for outcome measurement and data from 42 control participants were collated to determine the neuro-typical range of email writing performance on this task. A within-participants, multiple case design was used to evaluate the effects of two different approaches to therapy with participants with dysgraphia. In the first study, two impairment-based therapies (uni-modal and multi-modal) were compared with eight participants with dysgraphia and the effects of these on spelling accuracy of treated and untreated words were measured. The functional outcomes (email writing, written picture description, writing frequency and perception of disability) of these therapies were also investigated in a second study. The third study evaluated the effects of training eight participants with dysgraphia (six of whom had participated in the first two studies) to use an assistive writing technology for functional writing. There was a wide range of performance in neuro-typical participants on email writing, with both age and education emerging as determinants of performance. Within the clinical studies, there were no significant differences between uni-modal and multi-modal therapies with respect to spelling accuracy, but these lexical therapies led to significant improvements to accuracy of treated and untreated words, written picture description and word length within emails. Training and use of assistive writing software resulted in significant improvements in spelling accuracy and word length within emails. All participants with dysgraphia showed some responsiveness to intervention. Both impairment-based and compensatory approaches to writing rehabilitation were found to have benefit, although the effects varied across participants and outcome measures. This study has highlighted the need for further research into assessments and therapies for writing in aphasia, specifically focusing on candidacy for specific approaches to writing rehabilitation.

In this project we examine mechanisms of linguistic and non-linguistic control in bilingual patients with aphasia for evidence of domain general cognitive control or domain specific cognitive control on tasks of low complexity and high complexity. Participants include 13 bilingual adults with aphasia and 20 neurologically healthy bilingual adults who are matched on age, years of education and measures of language experience. All participants completed two linguistic control tasks and two non-linguistic control tasks. Results from healthy controls and patients with less severe language impairment revealed that mechanisms of control do not overlap (i.e., indicative of domain specific cognitive control) on low complexity tasks, but do overlap (i.e., indicative of domain general cognitive control) on high complexity tasks, suggesting that as task demands increase, control mechanisms engage. In contrast, for patients with more severe language deficits, results revealed that control mechanism do not overlap on low or high complexity tasks, suggesting that (a) as task demands increase, linguistic and non-linguistic control mechanisms do not engage, thus they function differently compared to healthy participants and less severely impaired patients, and (b) there is a possibility that because patients with severe language deficits have difficulty with accessing lexical representations, this language impairment may supersede their ability to engage in linguistic control. / 2017-10-27T00:00:00Z

This study examined how retelling stories with a variety different background noise conditions affected the communicative experiences of people with aphasia (PWA). Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants participated in a semi-structured interview immediately following the experimental measure where they were asked open-ended questions regarding their experience retelling stories and how those experiences related to their everyday lives. Results revealed three themes related to how participants responded to communicating in noise: (a) cognitive reactions, (b) emotional reactions, and (c) social reactions. The findings suggest that PWA exert more effort when speaking in noise and benefit from supportive communication partners more than control participants. Findings also suggest that PWA who reported a lack of strategies were more likely to adopt maladaptive strategies. Explicit training for communication partners and PWA may help PWA more effectively cope with the challenges of difficult noise situations which may lead to increased confidence and social participation.

The purpose of this study was to examine how varying pause lengths in speech of people with aphasia (PWA) influences listeners' perceptions. The study specifically assesses listeners' perceptions of communicative effectiveness and speaker likability. Speech samples from six people with nonfluent or fluent aphasia were obtained from a previous study conducted by Harmon (2018). The speech samples were modified to create four sets of stimuli, including the original recordings, normalized within utterance pauses, normalized between utterance pauses, and normalized for both within and between utterance pauses. Forty listeners rated each of the speech samples based on the perceived communicative effectiveness and likability using a visual analog scale. Communicative effectiveness and likability ratings were significantly higher for the normalized within utterance and normalized within and between utterance conditions when compared to the baseline and normalized between utterance conditions. Both male and female listeners rated the recordings from nonfluent aphasic speakers lower than recording from speakers with fluent aphasia. Results of the study provide preliminary evidence that pauses in speech of PWA influence listeners' perceptions of communicative effectiveness and likability of the speaker. It is hoped that additional research regarding pause in speech of PWA will be conducted to determine if targeting pause in speech-language therapy will improve the communication of PWA.

This study investigates pause duration between and within utterances in the speech of 20 people with different degrees and types of aphasia: 15 with fluent aphasia and five with nonfluent aphasia. It also examines within utterance pause durations as a function of utterance position. Using aphasia speech samples collected in a previous study by Harmon (2018), Praat acoustic analysis software was used to segment words and periods of pause and measure pause duration within and between utterances. The data were analyzed using descriptive statistics, including pause duration mean, standard deviations, and interquartile range. Speech pauses were also categorized by the percentage of pause durations greater than 250 ms, 500 ms, 750 ms, and one second. Nonfluent aphasia presents higher mean durations of both between and within utterance pauses than fluent aphasia. Speakers with fluent and nonfluent aphasia subtypes exhibit a larger proportion of pauses longer than one second between utterances than within them. Between utterances, there is a positive association between increase in aphasia severity and an increase in pause duration. Within utterances, speech from individuals with moderately severe aphasia have longer mean pause durations than mild or very mild cases. Individuals with both fluent and nonfluent aphasia demonstrate increased pause durations in the initial sentence position. Further research will provide insight into how this compares with typical speech and how these pause patterns affect the communicative effectiveness of the speaker.

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Thesis. 1978. Ph.D.--Massachusetts Institute of Technology. Dept. of Psychology. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND HUMANITIES. / Vita. / Bibliography: leaves 112-118. / Ph.D.

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