Background: Conversation is the archetypal mode of communication. As a process it draws on numerous skills,
and predispositions, adapting to dynamic contexts and coordinated in highly sophisticated ways for successful
interaction. The combination of these abilities with contextual variables coalesces uniquely to represent what this
research proposes to be conversational intelligence. It is argued here that high levels of conversational
intelligence rest to a large degree on executive functions (EF) which are steadily becoming more widely
acknowledged and researched within the communication domain. The impairment of EF in neurologically
injured individuals has significant, though as yet undisclosed, repercussions for recovery, response to therapy
and ability to integrate communication skills in every day interactions to support conversational success. This
study incorporates some new approaches to the study of communication disorders following stroke, including
conversation, executive functions and the possibility of pharmacological intervention.
Aims: The aims of this study were to describe in detail the language, executive function and conversational
characteristics of ten individuals who had experienced strokes and to examine the relationships among these
three areas of functioning. In addition, this research investigated the response of these ten participants to
pharmacological therapy on a one month trial of Leviteracetam (LEV).
Methods and Procedures: Ten individuals who had suffered single incident strokes were recruited from local
community and rehabilitation facility referrals. All ten participated in a four stage randomised, double blind
investigation including baseline, active, placebo and withdrawal phases. At each stage participants underwent
testing on an EF battery and were recorded having conversations with familiar interlocutors. In addition,
significant others completed a rating scale assessing affective features and behaviours and language testing was
conducted at the baseline phase using the WAB. The language and EF data were scored and the conversations
subjected to Conversation Analysis. For each participant, profiles were created and assessed for interrelationships
between the executive characteristics and conversational features representative of each executive
construct. Repeated measures analysis of variance was conducted on EF data for the four phases of the study to
determine significant pharmacological effects.
Outcomes and Results: The majority of the sample presented with significant EF deficits across most areas
assessed. Two participants presented with essentially intact profiles which were not explained in terms of types
of aphasia or site of lesion. Language results proved to be inconsistently associated with EF deficits, but
conversational features reflected underlying executive strengths or deficits with greater consistency. Two
participants experienced amelioration (though not statistically significant) of interference control during the
active phase, with observable improvements in conversational skill. One participant demonstrated improved
conversation without a change in EF scores. The response to LEV is evaluated with reference to potential
alternatives.
Conclusions: The existence of EF deficits in individuals with stroke is demonstrated. Furthermore, the impact of
these impairments is considerable and observable during naturally occurring conversations, suggesting the
centrality of the EF contribution to conversational intelligence. The lack of association between formal language
test scores and EF impairments argues for the inclusion of more authentic assessment approaches for stroke
patients. The data is explored in terms of specific consequences of different lesion sites on EF and
communication and briefly addresses bilingualism as a potential variable in explaining some of the variations in
the data. Pharmacotherapy is addressed as an important focus of future research protocols. Implications for
assessment and treatment are discussed as well as proposals for future study.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6600 |
| Date | 03 March 2009 |
| Creators | Frankel, Tali |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf, application/pdf, application/pdf |
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