EFFECTS OF GRAPHIC TOPIC-SETTERS ON CONVERSATIONS WITH SEVERELY APHASIC COMMUNICATORS

Kathryn L. Garrett, Ph.D., CCC-SLP Duquesne University, Pittsburgh, PA

Christine Huth, MS CFY Allegheny Intermediate Unit, Pittsburgh, PA

A poster presentation at the ASHA 2000 Convention, Washington, D.C.

Abstract: In this single subject experiment, a communicator with severe aphasia conversed with partners about a personal event and a current event in baseline, graphic topic-setter, and instructional conditions. Dependent variables included exchanges per topic, participant initiations, successful exchanges, modality, and elapsed topic time. Qualitative ratings were also obtained.

Background/Review of the Literature: Persons with severe aphasia have significant difficulty with language expression across communication modalities. Consequently, they typically cannot share adequate amounts of specific information to sustain in-depth topical conversations. Reports indicate that tangible or graphic representations of topics or events can facilitate nonspeaking communicators’ ability to convey specific, relevant information during conversational interactions (Beukelman & Mirenda, 1998; Hunt, Alwell, & Goetz, 1991; Musselwhite, 1990). Anecdotal evidence of the success of these “remnants” also has been described for a few individuals with aphasia (Beukelman, Yorkston, & Dowden, 1985; Garrett & Beukelman, 1992; Weiss & Ho, 1997). However, no systematic investigations of the efficacy of this strategy have been conducted to date. Moreover, the ability of persons with aphasia to acquire purposeful use of graphic contextual materials in response to a treatment protocol has not been researched. Finally, it is not known whether communicators with severe aphasia can generalize their use of contextual communication strategies to interactions with unfamiliar partners.

Purpose: This investigation examined: 1) the impact of graphic contextual support on the communicative behavior an individual with severe expressive aphasia; 2) the ability of the participant to learn to purposefully use graphic context in conversations given specific instructional intervention; and 3) the generalization of these skills across conversational partners.

Methods: A modified single subject (ABAC)/return to baseline research design was utilized in this project. Data were collected, transcribed, and analyzed from one participant with severe aphasia (S.D.) across three conditions (baseline, context-only, instructional), two conversational tasks (discussion of recent personal events and current news events), and two conversational partners. The subject was a 72-yer-old male, one year post a thrombotic left CVA with a diagnosis of moderate-to-severe Broca’s aphasia with co-existing apraxia of speech. 8 sessions (2 baseline, 4 context only, and 2 return-to-baseline) of conversational data were obtained and transcribed with the first conversational partner. 16 sessions (3 baseline, 4 context only, 3 return-to-baseline, 4 context + instruction, and 2 return-to-context only) were collected and transcribed with the second conversational partner, for a total of 24 sessions. Personal event topics were selected through interviews with the spouse and current event topics through the headlines in the newspaper. Topics were represented through key word outlines prepared in accordance with pre-set criteria. The participants were instructed to talk as long as they could about the topics or any alternative topics. Each interaction was videotaped. In the instruction session, “rules” for the conversation were introduced and the participant rehearsed the conversation with the primary investigator prior to data collection. Sample current event topics were: Steelers game, Payne Stewart’s airplane, Last game in old Pitt stadium, Bonfire log collapse. Sample personal event topics were: family wedding, visit to stroke support group, lunch with a friend.

Quantitative measures derived from session transcriptions included: turns, exchanges, turns/exchange ratio, initiations, successfulness, modality, and elapsed time per topic. Additionally, all participants rated their own communicative competence, partner’s competence, comfort with the communication technique, and enjoyment of communication technique. Data were initially plotted by individual sessions in accordance with a single subject analysis technique. However, inherent variability (perhaps because of the uniqueness of each topic) caused any potential effect to be obscured. To compensate for variability, quantitative data on turns, exchanges, initiations, etc, were averaged by condition/topic and graphed.

Data Summarization: Results showed that the aphasic participant (S.D.) demonstrated an increase in the number of participant turns and total turns from baseline to context to instructional conditions across both partners. Initiations approximately doubled for current event context and context + instruction conditions across both partners. Less of an effect was seen with the personal event topic although increases initiations were noted. S.D. was much more successful when context was available during interactions with partner one. However, increases were very slight for partner two. Experimental observations that partner one was a less skilled interpreter were supported empirically as there was more of a treatment effect with regard to turns and successfulness with partner one than partner two. However, context allowed S.D. to initiate more readily, which in turn changed the participant’s role in the interactions with both partners. In addition, effect of the topics was also noted. The length of the interaction as measured in seconds and/or number of turns, was typically greater for the personal event. However, when context was available, there was a more pronounced increase in the initiations for the current event.

Results: These data suggest that the presence of tangible, contextual information does influence the conversational interactions of people with aphasia and their communication partners. The first participant appeared to initiate more, and interactions were, in general, more successful when context was available. S.D. quickly learned to utilize contextual information to initiate or add information to a topical conversation. By pointing to semantically specific information, he extended topical interactions across both partners as measured by increases in turns and time. The nature of the interactions changed across conditions from clinician-dominated to shared roles as initiator. Interaction effects were observed between partners, topics, and condition. Although participants did not rate their interactions differently, analysis of conversational content, both descriptively and via mathematical means, suggested that participants were better able to co-construct conversations when pictures or key words were available to supplement the natural communication signals of the communicator with aphasia. Further quantitative analysis is warranted to determine the significance of the effects, and whether meaningful interactions exist among the variables such as referential acts, successfulness, and contingent partner responses.

CURRENT EVENT TOPIC DATA
Partner 1	Time (secs0	# Exch.	# Ss turns	Turns/exch	% SS inits	%success
Ave A	119	8.75	14.25	2.7	.26	.46
SD	37.4	3.69	6.5	.53	.05	.18
Ave B	148	10	22.5	3.6	.47	.90
SD	21.5	2.31	5.07	.39	.09	.13
Partner 2	Time (secs0	# Exch.	# Ss turns	Turns/exch	% SS inits	%success
Ave A	189.2	9.17	28.7	6.35	.29	.82
SD	62.15	3.31	12.03	3.06		.13
Ave B	166	14.83	31.7	3.79	.49	.88
SD	27.7	2.4	6.95	.82		.09
Ave C	254.5	15	50	5.54	.48	.88
SD	131.17	2.9	20.58	1.15		.01

4.49

PERSONAL EVENT TOPIC DATA
Partner 1	Time (secs0	# Exch.	# Ss turns	Turns/exch	% SS inits	%success
Ave A	179	9.5	25.3	4.51	.39	.59
SD	66.82	3.87	6.8	.82	.03	.18
Ave B	199.75	9.25	32.25	5.76	.48	.80
SD	47.8	2.22	6.6	1.14	.15	.15
Partner 2	Time (secs0	# Exch.	# Ss turns	Turns/exch	% SS inits	%success
Ave A	212.2	9.83	35	7.46	.44	.77
SD	81.97	4.83	16.46	3.82	.22	.16
Ave B	284.5	14.83	43.83	5.63	.47	.86
SD	38.35	4.12	12.54	.79	.08	.06
Ave C	212	15.67	51	6.14	.46	.86
SD	126.2	3.21	4.58	1.49	.04	.13

Clinical application/ future directions: The presence of visual or tangible context appears to immediately change the nature of interactions between people with severe expressive aphasia and their communication partners. Interactions are characterized by increased quantity of communication turns and exchanges, increased communicator initiations and increased overall successfulness of the exchange. Teaching communicators to reference specific information within some form of visual or tangible context (e.g. newspaper article, remnant) could be an easily implemented clinical intervention strategy for transitional (from partner dependent to self-initiating) communicators with severe expressive aphasia.

This research was supported in large part by a 1998 ASHA Foundation New Investigator Research Award.