Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
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Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
LT in health care) is usually more goal oriented and has special constraints as to what are the appropriate conversational actions (for medical interaction, see e.g. Heritage & Maynard, 2006). These constraints may result in differences in an SLT’s actions in conversation with a PWA as compared to a conversation between everyday conversation partners. Indeed, differing repair patterns in spouse vs. SLT conversations of PWAs have been found:
The spouses tend to repeatedly correct the PWAs’ production errors even after the meaning has been recovered, whereas the SLTs avoid correction (Lindsay & Wilkinson, 1999). In addition, significant others are found to offer collaborative completions to word searches, whereas SLTs tend to ask questions or offer candidate understandings longer than one word (Laakso, 2015).
However, thus far, very few studies have compared recipient-initiated repair activities in institutional and home conversations of the same PWAs. Furthermore, to our knowledge, the influence of different types of aphasias on recipient participation has not been compared.
The purpose of the present multiple-case study is to compare the relevance of the aphasia type (fluent vs. non-fluent) to the non-aphasic interlocutors’ management of expressive linguistic problems in conversation. The research focus is on recipient-initiated actions. Everyday vs. institutional conversational partners are also compared. The research questions are as follows:
- What kind of expressive linguistic problems and problem-handling sequences man- ifest in conversations involving PWAs with fluent vs. non-fluent aphasia?
- Are the recipient-initiated problem-handling practices of the non-aphasic interlocu- tors different in conversations with:
- participants with fluent vs. non-fluent aphasia? ● family members vs. SLTs?
Data and method
Conversations and participants
The data consisted of four videotaped conversations (see Table 1). In these conversations there were two kinds of conversational partners, family members and SLTs, in interaction with participants with two different kinds of aphasia, Lauri (L) with conduction aphasia and Kalevi (K) with agrammatic aphasia. L conversed at home both with his young adult
Table 1. Conversations and participants. Conversation Participants Location Duration
Conversation 1 L (fluent speaker), L’s home, on the living room couch 00:40:00 hours T and A (two grandsons)
Conversation 2 L (fluent speaker), L’s home, on the living room couch 00:41:16 hours SLT-L
Conversation 3 K (non-fluent speaker), K and E’s home at the kitchen table during afternoon coffee
00:34:11 hours
E (the wife) Conversation 4 K (non-fluent speaker), SLT-K University clinic 00:27:01 hours Total 02:22:18 hours
Note. SLT-L = Speech-language therapist working with L; SLT-K = Speech-language therapist working with K.
772 M. LAAKSO AND S. GODT
grandsons (T and A), and with his SLT (SLT-L). K interacted at home with his wife (E) and at the university clinic with his SLT (SLT-K). Pseudonyms are used and name initials of all participants have been changed to anonymise them. All participants gave in writing their informed consent to take part in the study and the principles of research ethics were carefully followed in gathering and analysing the data. The data belong to a larger research project examining the management of problems of speaking and understanding in aphasic conversation (Academy of Finland, grant no 49250).
The conversations of L lasted approximately 40 minutes each, whereas K’s conversa- tions lasted about 30 minutes each. The conversations were digitally videotaped on a MiniDV tape with an additional microphone. The PWAs and their family members chose a time and place where they usually interacted (e.g. a regular visit or an afternoon coffee) and the cameraman (researcher or research assistant) came to videotape that.
The participants were asked to interact in the way they ordinarily would. The cameraman was present in the beginning and end of (and occasionally during) the videotaping when handling the camera was necessary. As both PWAs were receiving speech and language therapy via a university clinic, they were asked to converse with their SLTs during a therapy session. No specific instructions concerning the conversations were given. These sessions were videotaped by the participating SLTs.
Both PWAs were retired males with chronic aphasia (see Table 2). They both had a university degree. L (a former CEO) was a 79-year-old man who had suffered an infarc- tion of the left medial cerebral artery 5 years ago. The infarction had left him with moderately severe conduction aphasia, and he had had several periods of speech and language therapy. L’s language production was fluent but paraphasic with many phonemic and some semantic errors.
He also displayed trouble with word-finding and recurrently searched for words. K (a former dentist) was a 65-year-old man who had suffered an infarction of the left medial cerebral artery 29 years ago. The infarction had left him with severe Broca’s aphasia, and he had had intensive speech and language therapy during the first year following his infarct and shorter periods after that. K’s language production was non-fluent and agrammatic consisting mainly of uninflected nouns.
In conversation, L was able to use language in various ways for initiating and respond- ing (including questions, answers, comments and narrative turns), whereas K’s commu- nicative actions were mainly responsive to the interlocutors’ actions.
Transcription and analysis
The video material was analysed as Windows Media files. First the conversations were transcribed according to conversation analytic notation (Atkinson & Heritage 1984: ix–xvi).
Table 2. Background data of the participants with aphasia.
Participant Lesion
localization Duration of
illness Diagnosis Aphasia type
(BDAE) BNT score
Severity of aphasia (BDAE)
L, male, 79 years MCA 5 years CVA Conduction/fluent 34/60 3 K, male, 65 years MCA 29 years CVA Broca/non-fluent 17/60 2
Note. MCA = medial cerebral artery, CVA = cerebrovascular accident, BDAE = Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983; Finnish version Laine, Niemi, Tuomainen & Koivuselkä-Sallinen, 1997); BNT = Boston Naming Test (Kaplan, Goodglass, Weintraub & Segal, 1983; Finnish version Laine, Koivuselkä-Salllinen, Hänninen & Niemi, 1997); BDAE severity scale 1 = most severe, 5 = mildest).
CLINICAL LINGUISTICS & PHONETICS 773
Along with speech, embodied actions such as hand gestures were described in small capitals within double parentheses on a separate line below the utterance they co-occurred with. For the sake of clarity, the data extracts include embodied actions only if they are relevant for the present analysis. In the data extracts (see example 1), an English translation is provided (in bold face) alongside the original transcription (in italics).
When of analytic interest, the talk of each person is depicted in three lines consisting of the original Finnish, an English word- by-word gloss (see glossing symbols in the Appendix), and an English translation. In the gloss line, unintelligible word forms are marked with question marks and, if possible, targets of these word forms in curly brackets (see line 02 in example 1):
The results were obtained through CA paying special attention to repair organisation (Sacks, 1992; Schegloff et al, 1977). First, all instances where any of the speakers oriented to a section of a conversation as problematic were identified. These problem handling instances were divided into sequences by topical organisation. Out of these topical sequences a total of 72 sequences were such where the non-aphasic interlocutors, i.e. the recipients of the PWAs’ talk, indicated the previous turns of the PWAs as problematic. These were referred to as negotiation sequences.
During this preliminary analysis, it was observable that the negotiation sequences in conversations involving the two men were different. The conversations of the fluent speaker allowed for a turn-by-turn analysis of repair organisation while in the conversations of the non-fluent speaker separate repair sequences were not easily identifiable. Thus, the initial 27 negotiation sequences of the fluent speaker were further analysed for local repair phenomena, and altogether 65 repair sequences of two or more turns during which the problem was dealt with were identified (see Table 3).
In connection with non-fluent aphasia, problem handling manifested in almost all conversational turns of the participants without clearly identifiable repair sequences, and could only be investigated at a broader topical sequential level. Thus, forcing the 45 topical negotiation sequences of the non-fluent speaker into more concise repair sequences was not appropriate. The sequences analysed accordingly consisted of 110 problem-handling sequences in total (see Table 3).
Results
The nature of expressive linguistic problems in conversations of participants with fluent vs. non-fluent aphasia
The trouble sources of the speaker with fluent aphasia were identified either as word search (see example 2; cf. also Goodwin & Goodwin 1986) or as a problem of general intelligibility (see example 3, cf. also Damico et al., 2008), when a clear word search was not present but
Example of the transcription, glossing and translation of data extracts.
01 L: onko se- tuo- (.) hh .mt Ville kertonu is-Q he that 1nameM tell-PPC has he- that- (.) hh .mt Ville told you
02 minkälaista se on (0.5) amer- amerissa- (-) what.sort.of-PAR it is {army}-INE what it is like (0.5) in the a- ar- (-)
Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
774 M. LAAKSO AND S. GODT
something in the turn was unintelligible enough to stop the flow of conversation, and led to a subsequent repair initiation in the next turn by the interlocutor. In the following example (2), a word search occurs (lines 01–05). The fluent speaker L is talking with his two grandsons (A and T) about global politics. On line 01, L starts a new topic and ends up trying to produce a place name in Africa:
L’s utterance on lines 01–05 includes many search markers such as pauses (three of them extending to one second, see lines 02, 04, 05), comments on his own knowledge or ability to find the word: ‘I don’t know what it is’, (line 01) and attempts at approximating the phonemic structure of the target words (lines 02–05). On line 06 his grandson A offers his suggestion for the searched word, Eritrea. It is noteworthy that A’s suggestion phonemically resembles L’s last attempt at the word. Due to the nature of his aphasia L is able to produce expression referring to a place (‘there’, line 03) and phonemic approximations of the place name (lines 04–05), which may make it easier for the recipient to offer a
Table 3. Analysed problem handling (repair and negotiation) sequences. Conversation Sequences
Conversation 1 29 repair sequences (L, grandsons)
Conversation 2 36 repair sequences (L, SLT)
Conversation 3 29 negotiation sequences (K, wife, cameraman)
Conversation 4 16 negotiation sequences (K, SLT)
Total 110
Word search. (The possible targets of erroneous or cut-off word forms are in curly brackets in the gloss line. If no target can be traced the word is marked with a question mark on the gloss line.)
01 L: Mmm se:(.) en tiiä- (.) en tiiä hh mikä se on it NEG-1 know-INF NEG-1 know-INF what it is
Mmm it:(.)I don’t know-(.)I don’t know hh what it is
02 e- e- e: e::len kaks (a: h eutrah (1.3) {eilen=yesterday} two ? e- e- e: {yesterday} two (a: h eutrah (1.3)
03 epron hh)(0.7).HH sielä hh ö: (0.5).mt lasa hh ? there ?
epron hh)(0.7).HH there hh uh: (0.5).mt lasa hh
04 lasarin hhh (1.0).hhh apessiina (.) apessiina hh ? {Abessiinia=Abyssinia} {Abyssinia}
lasarin hhh (1.0).hhh {Abyssinia} (.){Abyssinia}hh
05 (1.0) vedutrea hh {Eritrea}
{vedutrea} hh
06 A: Eritrea niinkö. Eritrea PRT-Q (appr. you mean) you mean Eritrea.
07 L: Nii. PRT Right.
CLINICAL LINGUISTICS & PHONETICS 775
candidate interpretation. Grandson’s candidate is formulated as a polar question with the inferencing particle niin (its meaning here as an independent clausal unit corresponds to ‘right’) and the question clitic -kö, which is then confirmed as correct by L.
Example (3) illustrates the other characteristic trouble source by speaker L, a problem of general intelligibility (see lines 04–05). L is talking with his SLT (SLT-L) about the heating system in his house. In the beginning of the sequence, SLT-L asks which heating system the house has (line 01):
On line 02, L responds without problems that his house has district heating, a heating system in which a centralized plant using gas or oil delivers heating for a whole town suburb. From line 04 onwards L begins to expand his original response but is not able to continue his utterance to an understandable completion. Instead, after describing the district heating as ‘it burns somewhere’, he only produces some cut-off attempts at words (line 05). In overlap with L’s attempts the SLT-L starts to process the trouble by offering her candidate understanding (line 06).
Using the particle niin (here in turn-initial position appr. ‘I see’), SLT-L’s candidate ‘somewhere far away’ is formulated as inferencing from L’s prior talk about district heating (‘far-heat’, line 02) rather than on the phonemic structure of L’s cut-off attempts on line 05. It is also produced as a completion to fit L’s utterance: ‘it burns somewhere’ – ‘somewhere far away’. However, as the exact nature of the expression L was striving at remains unintelligible, he only acknowledges SLT-L’s candidate resolution with ‘mmm’ (line 07).
Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
In sum, the expressive problems in the turns of the speaker with fluent conduction aphasia were regularly phonemically distorted words that were cut off to search for a better approximate. In some cases, the cut-off attempts provided information for the recipient to interpret the word and offer a specific candidate (example 1). In the other cases, the recipients produced more general interpretations based on L’s prior talk (example 2). L’s expressive problems were thus specific occurrences amongst otherwise understandable conversation that could be treated with specific recipient-initiated repair
Problem of general intelligibility.
01 SLT-L: Onko tässä niinku öljy vai sähkölämmitys tässä- is-Q here-INE PRT(like)oil or electric heating here-INE Is it like oil or electric heating system in here-
02 L: Se on kaukolämpö. it is disctrict.heating (literally: ‘far-heat’) It is district heating.
03 SLT-L: Kaukolämpö [joo. District heating [yeah.
04 L: [Nii.(0.8) se palaa(2.0)jossaki PRT it burn-3 somewhere [Right.(0.8) it burns(2.0)somewhere
05 (tapah- (.) [ve-) {tapahtua=happen} ? (hap- (.) [ve-)
06 SLT-L: [Nii jossain kaukana. PRT somewhere far.away [I see somewhere far away.
07 L: Mmm.
776 M. LAAKSO AND S. GODT
practices. The participation structure of the repair sequences in L’s conversations mani- fested as follows:
Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
There is an identifiable problem in the turn of the fluent aphasic speaker. (2) The recipient offers a candidate resolution in the next turn. (3) The PWA confirms/rejects the repair.
On the contrary, in the conversations of the non-fluent speaker almost all speaking turns of the PWA were problematic due to his limited linguistic expression. Most of K’s turns could be characterised as minimal expression which led to a telegraphic construction of a turn (see example 4, lines 04–05). In this example the non-fluent speaker K is talking with his wife (E) about his hobby, photography:
In example (4), the wife introduces a new topic to the conversation by asking a question (line 01). The non-fluent speaker K responds to the question minimally with an affirmative particle joo ‘yes’, and does not develop the topic any further (line 02). His turn thus provides the most minimal possible answer to E’s question. On line 3, the wife then develops the topic by asking a follow-up question. To this question K responds with a more extended answer that he constructs in telegraphic style (lines 04–05; cf. Beeke et al., 2003; Heeschen & Schegloff 1999).
He starts with a clausal construction joo mutta toi (‘yes but that’), cuts it off and pauses for almost 5 seconds. After the pause he produces isolated words: the elements of K’s turn are adjacent, separated with pauses, but do not form a clear clausal structure. He frequently uses the pronoun toi ‘that’ for projecting that there is more to come, as toi is used as a modifier to a noun (cf. Helasvuo et al., 2004). Most of the words he uses are not inflected, and finally he is able to say his main point, ‘25 pictures’, although without a clear sentence structure its meaning is hard to interpret. However,
Minimal expression and telegraphic construction of a turn.
01 E: Onks valokuvia viel tekemättä. is-Q photograph-PL-PAR still do-INF Are there still photographs to develop.
02 K: Joo. Yes.
03 E: Otit sä sielt Matin synttäreilt kuvia. Take-2-PST you there-ABL 1nameF-GEN birthday-ABL picture-PL-PAR Did you take pictures at Matti’s birthday party.
04 K: Joo mutta toi- (4.7)aa vaitta toi- (2.8) iso toi- PRT but that ? that big that Yes but that-(4.7.) ah vaitta that-(2.8) big that-
Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
05 (3.0)kaksikymmentä (.) viisi (1.5) kuvaa. twenty five picture-PAR
(3.0)twenty (.) five (1.5) pictures.
06 E: Jäi ottamatta. leave-PST take-INF Were not taken.
07 K: Ei (1.7) mutta toi, no but that No (1.7) but that,
08 (8.4)
CLINICAL LINGUISTICS & PHONETICS 777
E offers a completion to K’s telegraphic construction (line 06). In this way she co-constructs K’s utterance into a full sentence: ‘Yes but twenty five pictures were not taken’. K, however, rejects her interpretation (line 07), and the negotiation continues.
In sum, the expressive linguistic problems of the PWA with non-fluent aphasia were more extensive affecting most of his speaking turns. As a consequence, the participation structure of the negotiation sequences in these conversations manifested as follows:
The non-aphasic speaker presents a question or new topic and a response is expected; the turns are speech eliciting in nature.
The speaker with non-fluent aphasia produces a response which results in trouble because of sparse expression.
The non-aphasic speaker co-constructs the utterance supplying a fuller grammatical structure; the turns are interpretative in nature.
The negotiation continues until mutual understanding is satisfactorily reached or attempts thereof are renounced.
In the following, we will illustrate further these different participatory structures within the conversations of fluent vs. non-fluent participants. We will focus on the methods employed by the recipients to address the trouble emerging from expressive linguistic difficulties. First, we will analyse and compare the family members’ and SLT’s next turn repair actions in the conversa- tions of the participant with fluent aphasia. Second, we will look at the family member’s and SLT’s actions in the conversations of the participant with non-fluent aphasia.
Recipient actions in conversations of the participant with fluent aphasia
As shown earlier, the trouble sources of the fluent speaker proved to be more local. As a consequence, they were solved by relatively uncomplicated next turn repair actions. Example (5) illustrates a paraphasic word search, the most common expressive problem in the con- versation between the fluent speaker L and his two grandsons (A and T) (see lines 01–04). T responds to the search with a word candidate (line 05; for a similar practice see e.g. Oelschlaeger & Damico, 2000):
Offering a word candidate.
Non-Aphasic Interlocutors’ Management of Expressive Linguistic Problems
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