Made available in DSpace on 2017-06-01T18:24:20Z (GMT). No. of bitstreams: 1 Andrea_Ferraz.pdf: 824960 bytes, checksum: dd32468b3f4b82d29d5e72b2c7592be5 (MD5) Previous issue date: 2007-05-03 / Nowadays, the brazilian speech therapy clinic, with autistics, is still dominated by the use of corrective and normative procedures, aiming at communication basically. Moving away from the positivism s point of view and adopting the subjectivism ideas (that values the particular), beyond the language conception as a mean of action and the dialogic game as a joint construction of meanings, this research investigated the role of the verbal-linguistic resources, prosodics and paralinguistics in the construction of the autistic child language, in the speech therapy clinic. Specifically, this study had the objective of searching the conversation marks basically the interactionals and the catenation ones, the vowels prolongations, intonations, rhythm and vocal pitches alterations, the cinesic, the tacesic, the prosemic, the correction, the paraphrasing, the repetition, the pause, the hesitation, the interruption and the silence. It was also verified the incidence of these resources en the relation between the autistic child and the speech therapist. The participants of the study were two speech therapists and their patients, among eight and twelve years old, with autism diagnostic, characterized, in this research, as 1 and 2 diade. The data collection was done weekly, through video recorders, gotten during the speech therapy sections. The data were analyzed by means of the video recorders transcriptions, with basis in the discursive fragments, in agreement to the purposes of the Conversation Analysis. The results demonstrated the role played by the resources in the dialogic interactions in the therapists speech turns and in their patients turns. It was observed an equilibrium in the use of the resources by the speech therapists and an inaquality with prevalence of paralinguistic resources by the patients. This study noticed the use of babbling or echolalia by the patients, considering the relation with the repetitions (essencial resource to the speech). With the intention of establish a contrast between the resources, it was required a detailed overlook from the video recorders, and, later, an analisys about the echolalia behavior all along the interactions analysed. As a conclusion, the verbal-linguistic resources, prosodics and paralinguistics were current during the díades interactions. The balanced use of the resources envolved, as the observed in the therapists speech turn, allowed a better speech constructuion. It was also evidenced the imediatism existent in the face-to-face interaction, and that it is very hard to certify the difference between the echolalia or babbling and the repetition. Therefore, this difficulty suggests that both must be meaned in the therapy process, allowing big discursive possibilities to the speakers. / Nos dias atuais, a clínica fonoaudiológica brasileira, com pacientes autistas, ainda permanece impregnada do uso de procedimentos corretivos/normativos, visando fundamentalmente à comunicação. Assumindo um afastamento dessa percepção objetivista, segmentada e comportamentalista, e adotando uma concepção mais subjetiva (onde se valoriza o particular) de linguagem como forma de ação e do jogo interacional como uma construção conjunta da significação, investigou-se, nesse estudo o papel dos recursos lingüísticos verbais, prosódicos e paralingüísticos na construção da linguagem da criança autista, na clínica fonoaudiológica. Especificamente, esta pesquisa teve como objetivo investigar o papel dos aspectos lingüísticos verbais (marcadores conversacionais basicamente interacionais e seqüenciadores), lingüísticos prosódicos (alongamentos vocálicos, entonações, alterações no ritmo, alterações na altura vocal) e paralingüísticos (a cinésica, a tacêsica, a proxêmica, a correção, o parafraseamento, a repetição, a pausa, a hesitação, a interrupção e o silêncio) na construção da linguagem da criança autista. Verificou-se, também, como objetivos específicos, a incidência do uso de elementos lingüísticos verbais, lingüísticos prosódicos e paralingüísticos na relação fonoaudiólogo/criança autista na prática fonoaudiológica. Os participantes do estudo foram duas fonoaudiólogas e seus pacientes, de 08 e 12 anos, com diagnóstico de autismo, caracterizados nesse estudo como díade 1 e 2. A coleta de dados foi feita semanalmente, através de gravações de vídeo dos atendimentos fonoaudiológicos. Os dados foram interpretados com base na transcrição das gravações de vídeo, e nos recortes discursivos, como propostos pela Análise da Conversação. Os resultados mostraram o papel desempenhado pelos recursos lingüísticos verbais, prosódicos e paralingüísticos nas interações dialogadas, tanto nos turnos das terapeutas como nos turnos dos sujeitos. Observou-se um equilíbrio na utilização dos recursos pesquisados nos turnos das terapeutas e um desequilíbrio, como maior prevalência de utilização dos recursos paralingüísticos nos turnos dos sujeitos. De forma complementar, verificou-se a ocorrência de ecolalias nos turnos das crianças. Tendo em vista sua semelhança com as repetições, recurso fundamental na elaboração do texto falado, recorreu-se à observação minuciosa das gravações de vídeo, no intuito de se estabelecer uma diferenciação entre tais recursos. Percebeu-se que, nas crianças autistas pesquisadas, a diferenciação entre a repetição e a ecolalia centrava-se em três características nas emissões ecolálicas: ausência de contato visual, atividade motora constante e reprodução fiel de recursos como alongamento vocálico, entonação e alteração de tom. Como conclusão, percebeu-se que os recursos lingüísticos verbais e prosódicos desempenharam o papel de articular os segmentos do discurso, destacar aspectos importantes do texto falado, facilitar a compreensão, orientar o interlocutor durante a interação, traduzir o estado emocional dos interactantes e facilitar o acesso ao significado do discurso. Os recursos paralingüísticos operaram no processamento do texto falado, na organização do pensamento dos interactantes, na delimitação dos tópicos, na ênfase, e chamaram a atenção de forma decisiva na manutenção da interação. Destaca-se, ainda, que a utilização equilibrada dos recursos estudados, como observada nos turnos das terapeutas, permitiu uma melhor formulação do texto falado. Constatou-se, também, que, diante do imediatismo da interação face a face, é extremamente difícil estabelecer a diferença entre a ecolalia e a repetição, sugerindo, portanto, que ambas devam ser significadas no processo terapêutico, permitindo ao seu usuário maiores possibilidades discursivas

Philosophiae Doctor - PhD / This thesis investigated the education support services provided by occupational therapists, physiotherapists and speech and language therapists in the Western Cape Province of South Africa. Changes in the education policy in South Africa to an inclusive education system have major implications for the way therapists provide support. Therapists have been challenged to move from a medical model of support with a focus on highly specialised treatment for a small number of individual learners with disabilities, to a systemic and health promoting model which focuses on support for the education system, including all learners, teachers and parents. The aim of this research was to develop an appropriate and integrated approach for therapists to support schools within an inclusive and health promoting schools framework in South Africa. Participatory action research using quantitative and qualitative methodology was used. Two surveys were conducted in the Western Cape Province. The first was a survey of all therapists to determine who was working with pre-school and school-aged learners and where. The second survey was of all therapists working in special schools and a small number of private practitioners to identify the roles of the therapists in providing direct and indirect support. In two of the seven education districts in the province, focus group discussions were held with 45 teachers from special and ordinary schools, and 21 parents of school-aged learners - to identify the support they needed. Workshops, incorporating focus groups, were also held with the therapists to, firstly, identify the support they needed to give to learners, teachers, parents and the education system and, secondly, to identify the competencies they needed to give this support. The data from the surveys were subjected to simple descriptive statistical analysis. These analyses reveal that therapists have a very wide range of roles relating to direct support, including: assessment, intervention with individual learners and learners in groups, and evaluation. Interventions include the development of hearing, speech and communication skills; skills for activities of daily living; life skills; home management skills; work related skills; motor function skills; and play and leisure skills. Therapists from different disciplines frequently provide the same type of support. Indirect support provided includes support for the schools system, teachers and parents. Thirty six percent of the therapists in this study want to increase the proportion of time they spent on indirect support. The study also revealed that multidisciplinary collaboration and teamwork were Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training poorly developed. Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training. Parents in this study indicated that they need access to education and support for their children, including direct support for their children; effective means of communicating with their children; specific competencies to facilitate caring for their children; emotional support; advocates to work with them in support of their children addressing environmental physical and attitudinal barriers, and developing a supportive community; and supportive relationships with therapists.

Among Swedish speech and language pathologists there is a need for extended knowledge of existing treatment methods for aphasia. Currently, there is an ongoing process to develop clinical guidelines for aphasia rehabilitation. Therefore, a knowledge base is needed, including a description of existing treatment methods, their theoretical foundation and evidence base. The aim of the present study was to compose an evidence-based summation of treatment methods for auditory comprehension disorder in people with aphasia. A systematic literature search was conducted using the following databases: PubMed, PsycINFO, Cochrane Library, CINAHL and Speechbite. Additionally, several studies were found by manual searches. Twenty-three articles were chosen and assessed. A total of 13 different treatment methods were described. Most of the included studies had a poor quality and few participants. The majority of the treatment methods were found to have an insufficient evidence base, with the exception of CIAT and Hand-action observation treatment. They were found to have moderate and limited evidence. Most of the included studies have shown a significant improvement of auditory comprehension following speech and language therapy. Although, for speech and language pathologists to be able to choose a specific treatment method based on evidence, larger studies with higher quality will be needed. / Bland svenska logopeder finns behov av utökad kunskap om vilka specifika metoder som finns för behandling av afasi. För närvarande pågår ett arbete med att ta fram kliniska riktlinjer för afasi. Syftet med studien var att ta fram ett evidensbaserat kunskapsunderlag med en beskrivning av olika metoder för behandling av hörförståelse hos personer med afasi. Resultatet av den aktuella studien ämnas användas till arbetet med de kliniska riktlinjerna. En systematisk litteratursökning genomfördes i databaserna PubMed, PsycINFO, Cochrane Library, CINAHL samt Speechbite. Utöver detta handsöktes ytterligare artiklar. Sammanlagt 23 artiklar kvalitetsgranskades och evidensstyrkan för varje metod bedömdes enligt SBU:s beskrivning av GRADE-systemet. I kunskapsunderlaget presenteras sammanlagt 13 olika behandlingsmetoder för behandling av hörförståelse. De flesta av de ingående studierna hade en bristande studiekvalitet med lågt antal deltagare. Majoriteten av behandlingsmetoderna bedömdes ha otillräcklig evidens, med undantag för CIAT och Hand-action observation treatment som bedömdes ha måttlig respektive begränsad evidens. De ingående studierna har övervägande visat att logopedisk behandling ger ett signifikant förbättrat resultat på hörförståelse. Större behandlingsstudier med bättre kvalitet behövs dock för att kliniska logopeder ska kunna välja en behandlingsmetod framför en annan på en evidensbaserad grund.

The diploma thesis is oriented on special education. The main goal is to find out and describe whether and how is speech and language therapy established in regular kindergartens at the foothills of Orlické mountains. The work is divided into five chapters, four of them are theoretical and the fifth chapter is a practical one. The first chapter is focused on the way how the preschool education is organised in the Czech Republic. It describes the legislation system, clarifies the system of curricular documents established in our republic and mainly the framework educational program for preschool education. The second chapter describes the preschool-child ontogenesis including all aspects of his/her personality and it also depicts the child-speech ontogenesis. The third chapter is focused on the main types of impaired communication ability of preschool children. The fourth chapter is focused on the speech therapy intervention provided in the Czech Republic. The fifth chapter presents combined research, within which the qualitative method of dialogue and the quantitative method of questionnaire were used, together with non-structured observation and comparative analysis among kindergartens. The chapter defines the research goals and used methods, sets the hypotheses and the research sample. In...

Research examining bilinguals who stutter (BWS) is limited; in particular there are few studies that have considered examining features of speech motor control in BWS. The present study was designed to examine features of speech motor control in bilingual speakers of Mandarin and English. Speech motor control was examined through the acoustic analysis of speaking rate, voice onset time (VOT) and stuttering adaptation. Participants ranged from age between 9 and 27 years. Upon completion of a language dominance questionnaire, two BWS participants were found to be English dominant and three were Mandarin dominant. Each BWS participant was matched to age/sex matched control participants (BWNS). Results for the BWS participants found more stuttering in the less dominant language based on a measure of percentage of syllables stuttered. All of the BWS participants demonstrated stuttering adaptation and there was no significant difference in the amount of adaptation for Mandarin and English. There was no difference found between BWS and BWNS for speaking rate and VOT. In spite of the similarity between BWS and BWNS, speaking rate in Mandarin appeared to be faster compared to English. These findings suggest that speech motor control in BWS and BWNS are similar and current application of these findings to the clinical setting is discussed.

Det saknas logopediskt bedömningsmaterial normerat för flerspråkiga barn, och kunskapen om dessa barns typiska tal- och språkutveckling är begränsad hos logopeder i Sverige. Detta leder till över- och underdiagnostisering av språkstörning. Denna studie syftar till att undersöka svensk-engelsktalande barns narrativer (berättelser). Dessa analyseras kvantitativt och kvalitativt, både makrostrukturellt (story grammar) och mikrostrukturellt (lingvistiska mått). Även narrativ förståelse undersöks och jämförs med produktion. Studiens deltagare är 16 simultant flerspråkiga svensk-engelsktalande barn i åldern 6-7 år, som går i förskoleklass eller i första klass. Narrativerna eliciteras med hjälp av två bildsekvenser ur ett bedömningsmaterial framtaget av en forskningsgrupp inom COST Action IS0804. Bedömningsmaterialet innehåller även förståelsefrågor till bildsekvenserna, och bakgrundsfrågor för vårdnadshavare att fylla i. Resultaten visar inga skillnader i makrostruktur mellan svenska och engelska, vilket tyder på att narrativ förmåga inte nödvändigtvis är språkbunden. Jämförelser mellan förståelse och produktion av utvalda story grammar-komponenter visar dock en tydlig skillnad. Förståelsen för en karaktärs mål (story grammar-komponenten goal), vad karaktären vill uppnå, är etablerad hos de flesta deltagarna trots att produktionen av goal är begränsad. Till skillnad från makrostrukturen, skiljer sig mikrostrukturen åt i narrativerna. De engelska narrativerna är både längre och mer komplexa än de svenska. Skillnaderna mellan barn i förskoleklass och i första klass är dessutom stor, både makro- och mikrostrukturellt. Detta tyder på att mycket händer i barns språkliga och narrativa utveckling i tidig skolålder. Tvärspråkligt inflytande förefaller vara en naturlig del av den typiska språkutvecklingen hos simultant flerspråkiga barn. / There are no standardised tests for assessing bilingual children’s speech and language development, and the knowledge about these children’s typical language development is limited amongst speech and language therapists in Sweden. Studies have shown that this can lead to misdiagnosis of language impairment in these children. The aim of this study is to investigate the narratives of Swedish-English speaking children. Analysis is made, both quantitatively and qualitatively, regarding the macrostructure (story grammar) and the microstructure (linguistic measurements) of the narratives. Narrative comprehension is also examined, and compared with the produced narratives. The participants are 16 simultaneously bilingual Swedish-English speaking children, aged 6-7 years and either attending preschool class or first grade in the Swedish education system. The narratives are elicited using two different sets of pictures from an assessment material designed by a research group within COST Action IS0804. The assessment material also contains comprehension questions and a form for carers to fill in, regarding the children’s linguistic backgrounds. The results in this study show no macrostructural differences between the Swedish and the English narratives, which indicates that narrative ability is not necessarily language dependent. There is a clear difference between the comprehension and production of selected story grammar components. Despite the limited production of characters’ goals in the narratives, the participants appear to have established the comprehension of this story grammar component. The microstructural analysis of the narratives shows that the English narratives are both longer and more complex than the Swedish ones. There are differences between participants attending Swedish preschool class and participants attending Swedish first grade, with regards to both macrostructure and microstructure. The differences indicate that language and narrative ability is increasing between the ages of 6 and 7. Crosslinguistic influence appears to be a natural part of typical language development in simultaneously bilingual children.

Behovet av tolkar inom hälso- och sjukvården har ökat i takt med att antalet flerspråkiga individer ökar i dagens samhälle. Detta medför högre krav på sjukvården att upprätthålla kvalitén på god hälso- och sjukvård för alla. Logopeder kommer ofta i kontakt med flerspråkiga personer och är då i många av fallen i behov av tolkar vid utredningar eller behandlingar. I dagsläget finns det endast ett fåtal studier tillgängliga som beskriver de utmaningar i ett samarbete med logoped, som kan upplevas ur tolkens perspektiv. Syftet med studien är därmed att undersöka tolkars roll och få fram deras perspektiv av logopedisk utredning och behandling av flerspråkiga personer. Ökad kunskap om tolkens perspektiv skulle kunna tydliggöra de utmaningar och välfungerande arbetssätt som kan finnas och bidra till att förstärka samarbetet mellan tolk och logoped.Materialet för studien består av enkätsvar från 209 tolkar som arbetar i olika delar av Sverige. Information om tolkarna sammanställdes i tabeller för att kunna ge en överblick över bakgrundsinformation samt svar på ett antal fasta frågor om deras perspektiv och erfarenheter av tolkning inom logopediska aktiviteter. Många av de fasta frågorna hade också möjlighet till fritextsvar, vilket i hög grad utnyttjades av de tolkar som besvarade enkäten. Fritextsvarenanalyserades med tematisk analys. Resultatet påvisade att många av tolkarna överlag upplevde samarbetet med logopederna som positivt, men att det finns förbättringsområden. Det främst förekommande området var att tolkarna upplevde att logopederna inte hade tillräcklig kunskap över hur tolkarna bör utföra sitt yrke (utifrån yrkesetiska principer). En förbättrad förståelse förvarandras professioner skulle kunna öka den ömsesidiga förståelsen i samarbetet mellan tolk och logoped. Att kunna få ta del av de material som ska användas innan ett besök hos logopeden för att kunna förbereda sig, är något som tolkarna angav skulle kunna förbättra deras egen prestation och på så sätt även bidra till ökad patientsäkerhet. / The need for interpreters in health care has increased as the number of multilingual individuals increases in today´s society. This entails greater demands on healthcare services to maintain a high quality of healthcare for all. Speech therapists often encounter multilingual people and are then in many cases in need of interpreters during assessments or interventions. Currently, there are only a few studies available that describe challenges that may occur in collaborationsbetween interpreters and speech and language therapist, viewed from the interpreters’perspective. The purpose of this study is thus to investigate the role of interpreters and emphasise their perspective on speech and language therapy activities (e.g. assessment and intervention) for multilingual people. Increased knowledge of the interpreters’ perspective may reveal challenges, as well as identify well-functioning working methods that exist. Results of the study may contribute to strengthening the collaboration between interpreters and speech and language therapists.The material for the study consists of questionnaire responses from 209 interpreters from different parts of Sweden. To provide a comprehensive overview of their answers,information about the interpreters was compiled in tables. Free text answers were an accompanying option to many of the fixed questions. The interpreters' free text answers were analysed using thematic analysis. Overall, the results showed that many of the interpreters perceived the collaboration with the speech therapists as positive, but that there are areas for improvement. The most commonly addressed area was that the interpreters felt that the speech therapists did not have sufficient knowledge of how interpreters are required to perform their profession (by oath of conduct). An improved understanding of each other's professions might increase the degree of satisfaction in the collaboration between interpreter and speech and language pathologist. Getting access to the materials that are to be used for assessment or intervention, before the appointment to be interpreted, would provide the interpreter with a fair chance to prepare appropriately. This is something that a majority of the interpreters in the present study pressed would improve their own performance and thus also increase patient safety.

L'aphasie est un trouble acquis du langage qui cause des difficultés de communication pouvant affecter la compréhension et l'expression. Lorsque l'aphasie survient par suite d’un accident vasculaire cérébral, des difficultés importantes de communication sont initialement constatées, puis une amélioration graduelle dans les semaines et les mois qui suivent. Toutefois, pour certaines personnes, l’aphasie peut rester sévère un an, l’aphasie est alors considérée comme chronique. L'une des manifestations les plus courantes de l'aphasie est l'anomie - un manque de mots. Un nombre croissant d'études se penchent sur l'impact de la thérapie sur l'aphasie chronique et ont montré une amélioration du langage après plusieurs années. Des thérapies sont développées et étudiées en anglais, mais peu d’écrits scientifiques décrivent les effets des thérapies spécifiques et formalisées en français. Le but du présent travail doctoral est d'examiner les effets comportementaux et d’explorer les substrats neurologies du protocole Analyse des Composantes Phonologiques (ACP) ainsi que l’influence des facteurs individuels sur les gains chez dix-huit personnes vivant avec une aphasie chronique. Ainsi, la thèse comporte trois articles qui abordent, chacun, des facettes différentes des effets de l’ACP. Dans le premier article, les effets comportementaux de l’ACP sont explorés ainsi que le rôle des facteurs individuels sur la réponse à l’intervention. Le deuxième considère l’effet de l’ACP sur la connectivité fonctionnelle du cerveau, tout en considérant l’effet des facteurs individuels. Enfin, le troisième article s’intéresse à la réponse par suite de l’intervention ACP en considérant les facteurs individuels du bilinguisme et des caractéristiques neuroanatomiques comme la localisation des lésions et l’épaisseur corticale. L'ensemble de résultats démontre une amélioration significative de la dénomination des noms parmi les dix-huit participant·e·s inclus·e·s. Par ailleurs, cette amélioration a été mesurée sur des mots non-traités, ce qui reflète un effet de généralisation. Par surcroit, cette amélioration se maintient à trois mois et six mois après la fin de l’intervention. L’âge, la sévérité de l’anomie et la présence d’une apraxie de la parole sévère influencent les gains mesurés. Les analyses neurofonctionnelles de connectivité fonctionnelle au repos auprès de dix participant·e·s montrent une meilleure intégration des réseaux visuels et langagiers, associés lors d’une tâche de dénomination des noms. Les changements de connectivité observés dépendent de la sévérité de l'aphasie. Plus spécifiquement, l’intégration interhémisphérique et au sein de l’hémisphère droit est plus importante chez les personnes ayant une aphasie plus légère. Finalement, être bilingue influence aussi les gains observés par suite du protocole Analyse des Composantes Phonologiques. Les personnes bilingues s’améliorent davantage, cet avantage est associé une épaisseur corticale supérieure dans l’hémisphère droit comparativement aux personnes monolingues. Ces données préliminaires suggèrent que les changements comportementaux observés résultent de la combinaison des composantes phonologiques et orthographiques de l'intervention, et que l’intervention requiert et entraîne les fonctions exécutives. Les données cueillies dans le cadre de cette thèse sont prometteuses en ce qui concerne les effets bénéfiques de l’Analyse des Composantes Phonologiques en français. Plus précisément, les gains mesurés auprès d’un échantillon présentant des symptômes variés, la généralisation et le maintien supportent l’utilisation de ce protocole d’intervention auprès de personnes francophones. Il est à noter que la taille du groupe étudié est modeste, mais les méthodologies complémentaires et la convergence des résultats avec les données existantes dans les écrits scientifiques et à travers les méthodes d'étude de cette thèse (niveaux comportemental et neurofonctionnel) justifient des études subséquentes pour mieux comprendre les mécanismes d'action et l’influence des facteurs individuels sur les gains. / Aphasia is an acquired language disorder that causes communication difficulties that can affect understanding and expression. When aphasia occurs following a stroke, significant communication difficulties are initially noted, followed by gradual improvement over the following weeks and months. However, for some people, the aphasia may remain severe after a year even when recovery has been seen, in which case the aphasia is considered chronic. One of the most common symptoms in aphasia is anomia - a difficulty finding and saying words. A growing number of studies are looking at the impact of speech and language therapy on chronic aphasia and have shown improvement in language after several years. Therapies are developed and studied in English, but little scientific literature describes the effects of specific, formalized therapies in French. The purpose of the present doctoral work is to examine the behavioural effects and to explore the neurological substrates of the Phonological Component Analysis (PCA) protocol as well as the influence of individual factors on gains in 18 adults living with chronic aphasia. Thus, the dissertation consists of three articles, each of which addresses different facets of the effects of PCA. In the first article, the behavioural effects of PCA are explored as well as the role of individual factors on the response to the intervention. The second considers the effect of PCA on resting-state functional brain connectivity, while considering the effect of individual factors. Finally, the third paper looks at the response to the PCA intervention by considering the individual factors of bilingualism and neuroanatomical characteristics associated such as cortical thickness, and also lesion location. The overall results show a significant improvement in naming among the eighteen participants included in the thesis. Moreover, this improvement was measured on untreated words, which reflects a generalization effect and was maintained at three and six months after the end of the intervention. Age, severity of impairment and the presence of severe apraxia of speech influenced the measured gains. Neurofunctional analyses of resting-state functional connectivity in ten participants showed improved integration of the visual and language networks, associated during a naming task. The connectivity changes observed depend on the severity of the aphasia. More specifically, interhemispheric and right hemisphere integration is greater in individuals with milder aphasia. Finally, being bilingual also influences the gains observed following the Phonological Component Analysis protocol. Bilinguals improved more, and this advantage was associated with greater cortical thickness in frontal regions of the right hemisphere compared to monolinguals. These preliminary data suggest that the observed behavioural changes result from the combination of the phonological and orthographic components of the intervention, and that the intervention requires and trains executive functions. The data collected in this thesis show promise for the beneficial effects of Phonological Component Analysis in French. Specifically, the gains, generalization, and maintenance measured in a sample of adults living with aphasia displaying varied symptoms support the use of this intervention protocol with French speakers. It should be noted that the size of the study group is modest, but the complementary methodologies and the convergence of the results with existing data in the scientific literature and through the study methods of this thesis (behavioural and neurofunctional levels) justify subsequent studies to better understand the mechanisms of action and the influence of individual factors on gains.

Healthcare professionals such as speech and language therapists are expected to change their practice throughout their career. However, from a practice perspective, there is a lack of knowledge around what practice change is, what it really takes, and why there are different trajectories. Consequently, therapists, managers and commissioners lack empirical evidence on which to base decisions about enabling practice change. In addition, intervention researchers lack basic sociological research around implementation that could inform their research designs, reporting and impact. This case-based sociological inquiry, underpinned by critical realist assumptions, was designed to address this knowledge gap. It includes a two-stage qualitative synthesis of 53 (then 16) studies where speech and language therapists explained the work of their practice in depth, and a primary qualitative study focused on one professional jurisdiction, children with speech sound difficulties (SSD). Forty two speech and language therapists from three NHS areas and independent practice in Scotland participated in individual interviews or self-organised pairs or focus groups to discuss in depth how and why they had changed their practice with these children. A variety of comparative methods were used to detail, understand and explain this particular aspect of the social world. The resulting theory of SSD practice change comprises six configured cases of practice change (Transforming; Redistributing; Venturing; Personalising; Delegating; Refining) emerging from an evolving and modifiable practice context. The work that had happened across four key aspects of this context (Intervention; Candidacy; Caseload; Service) explained what made each case possible, and how practice had come to be one way rather than another. Among its practical applications, the theory could help services plan more realistic practice change. In addition, the inductively developed layered model of SSD intervention change has the potential to contribute to speech and language therapy education as well as methodological discussions around complex interventions.

Personer med afasi lider ofta av sina språkliga svårigheter och upplever dem som ett allvarligt problem. När förmågan till effektiv kommunikation genom talat språk inte räcker till kan ett Alternativt och Kompletterande Kommunikationssätt (AKK) behövas. Det möjliggör att personen, förutom med tal, kommunicerar med till exempel bilder, gester eller tecken. Proceduren att välja ett passande AKK är komplicerad och det händer att ett hjälpmedel som inte passar individens behov sätts in av logoped, eller att ett hjälpmedel inte sätts in alls. För att utveckla och förbättra möjligheten att avgöra om och i så fall vilket hjälpmedel som bör användas har Lasker och Garrett utvecklat bedömningsverktyget The Multimodal Communication Screening Test for persons with Aphasia (MCST-A). Denna studies huvudsyfte var att översätta MCST-A till svenska. Studien delades upp i tre delar; 1) översättning och anpassning av MCST-A till svenska, 2) prövning av översättningen på personer utan afasi samt 3) en första testning på personer med måttlig till grav kronisk afasi där deras resultat på MCST-A jämfördes med en skattning av deras förmåga att kommunicera med AKK i vardagen. Översättningen och anpassningen ledde till en fungerande version på svenska. Resultatet från testningen på personer med afasi går i linje med tidigare forskning, där resultatet på MCST-A speglar personers skattade förmåga att kommunicera med AKK i vardagen. MCST-A kan således vara ett användbart instrument för att avgöra om och på vilken nivå ett hjälpmedel kan användas av en person med afasi. Det är dock inte möjligt att dra en generaliserbar slutsats utifrån denna studies resultat då urvalet var begränsat. / Individuals with aphasia often suffer from their language difficulties and experience them as a serious problem. When the ability to communicate effectively through spoken language is insufficient, an Augmentative and Alternative Communication (AAC) may be required. This allows the person, in addition to speech, to communicate with for example pictures, gestures or body language. The procedure for choosing a suitable AAC is complicated, sometimes an aid that doesn’t suit the needs of the individual is provided by speech-language pathologists and sometimes an aid isn’t provided at all. In order to develop and improve the ability to determine if and what aids should be used, Garrett and Lasker developed the assessment tool The Multimodal Communication Screening Test for Individuals with Aphasia (MCST-A). The main purpose of this study was to translate MCST-A into Swedish. The study was divided into three parts; 1) translation and adaptation of MCST-A to Swedish, 2) testing the translation on persons without aphasia, and 3) a first test on persons with moderate to severe chronic aphasia, where their results on MCST-A were compared with an estimate of their ability to communicate with AAC in daily life. The translation and adaptation led to a working version in Swedish. The results from the persons with aphasia is in line with previous research, where the results on MCST-A reflects the estimated ability to communicate with AAC in their daily lives. Thus, MCST-A can be a useful tool to determine whether if and on what level aids can be used by a person with aphasia. However, it’s not possible to draw a generalizable conclusion based on the results of this study as the sample was small.