Beginning now: Talk the Talk! #ConversationAnalysis #EMCA for aphasia groups with @AziosSLP
"People with aphasia communicate better than they can speak" - Audrey Holland
"Begin with the end in mind" - Kagan & Simmons-Mackie (2007)
CA can help us appreciate comm competence!

Aphasia conversation groups are powerful spaces for creating communication competence. They are important contexts for shaping language competence and language impairment changes. Natural context; allows for positive identity formation - skilled facilitator helps all of this!

What does a good facilitator do? How conversation works matters. Conversation is always collaborative: it's jointly agreed upon and negotiated before a conversation can be picked up.
Sequential dependency: speakers construct turns based upon what happened in the turn before.

Adjacency pairs: turns are constrained by the preceding turn/sequential dependency
Speakers have a preference for moving things along to establish mutual understanding: progressivity
Speakers have to fix problems that impact understanding: speakers orient towards fixing: repair

What does this mean for our work as clinicians? When we get into facilitating aphasia groups, there's a lot going on and a lot to manage. Are we truly maximising opportunities to ensure and enhance communication competence? Are we doing things to inhibit successful communication?

Clinician behaviours to watch out for:
Asking questions
Topic
Making accommodations
Repair
Purpose and value system

Open vs closed questions constrain turn preferences e.g. yes/no for "do you like ice-cream?". This can support people with more severe forms of aphasia/non-fluent aphasia. This is really highlighted in data on experienced facilitators who use these strategically.

Floor transfer and floor holding sequences (Archer et al, 2020) - when PWA gesture, gaze, point to picture, expert facilitators recognise this as a move to gain the floor and may cast a yes/no question e.g. are you telling us about your grandkids? Facilitator then opens floor.

Not all questions are good questions to ask or are asked in the right way at the right time e.g. round robin (Lee & Azios, 2020) e.g. asking repeated yes/no questions like: "do you like icecream?". We have to be strategic about use of questions, timing and recruiting resources.

Use of test questions: asking questions that you already know the answer. These tend to make people with aphasia perform, and can be disastrous for communication competence. (Beeke et al, 2013) e.g. "What did we see yesterday?" "It's a /b/"... challenging with spouses at times.

Topic is a negotiated and collaborative process
- PWA can negotiate topic in multiple ways.
- Sharing something newsworthy: itemised news inquiries (Lee & Azios, 2020): "How did that doctor visit go last week?"
Great way for facilitators to initiate topics

News announcements are a great way for novice facilitators to initiate topics e.g. sharing information from own life, and asking questions related to potentially shared experience. Be on the look out for this in group members contribution!

Expert facilitators make topic a focus e.g. what do you want to talk about? "Metatopical turns" (Archer et al, 2018). Highlighting equal right of group members to shape the flow and progressivity off conversation in the group.

Making accommodations for PWA
- Visual supports (Lee & Azios, 2020)
- Keywording (Archer et al, 2019)
- Mirrored gestures (Simmons-Mackie & Kagain, 1999)

Inexperienced facilitators can find some of this more challenging - with a heavy orientation towards the supports, the facilitator can miss opportunities to ratify the topic and move things out.

When facilitators mirror gesture used in the preceding turn this supports affiliation and acceptance and promotes communicative competence.

Repair - signals of "trouble sources" often word-finding problems
- uh, hmm, what do you call it, gaze, pauses, closes eyes
during that process sometimes the PWA will find word, but may invite others in to help collaboratively repair the trouble source. This is often non-verbal

Sometimes it's verbal: what do you call it, help me out?
Hint and guess - Laakso & Klippi 1999 - most difficult to solve in initiation of topic sequences as we don't have prior knowledge. Guessers may begin to offer "candidate understandings" e.g. guesses at what the word is.

Skill in engaging successfully in hint and guess sequences is often about timing e.g. Beeke et al, 2015.
These really highlight confidence.

Purpose and value system - embedded vs exposed corrections (Simmons-Mackie & Damico, 2008) e.g. offering the corrected word in the immediate turn that happens after. This can be supportive in a group e.g. where a member uses he to talk about daughter, "yeah she will, won't she?"

Explicit error correction tend to trigger side sequences that are not aligned with goal of enhancing communicative competence.
Acknowledgement and congruent overlap (Simmons-Mackie & Kagan, 1999)

Assuming competence by focusing on content rather than performance (Simmons-Mackie & Elman, 2011)
Explicit purpose and value system:
"Ground rules" - Damico et al, 2015
Self-deprecating humour (Archer et al, 2019)

PWA actions on conversation
- Typical strategies and personally constructed and individualised.

Typical resources - gesture, pantomime, gesture, writing e.g. Beeke et al, 2014
Material resources - newspapers, photos -Tuomenoksa et al, 2021
Verbal resources - lexical self-repair, effective circumlocution, verbal "cueing" (Azios et al, 2020).

Individualised resources
- Discourse markers that people use e.g. "issy" (Simmons-Mackie & Damico, 1996).
People might not even be aware they are using these: an untapped resource that we could exploit as a strength in therapeutically supported environments!

Verbal repetition (Oelschlaeger & Damico, 1998)
Telegraphic speech (Heeschen & Schlegoff, 2003) (not just an impairment!)
Singing (Azios & Archer, 2018)
If a PWA is using an unusual strategy, sit back & observe communicative function. If it's being used frequently, it's working!

Measuring outcomes in conversation:
- Does my therapy "work"?
- Capturing something meaningful (Wallace et al, 2017)
- Strength-oriented vs deficit oriented perspectives

CA looks at micro vs macro level of conversation - how to measure these?
Gesture
Writing
Drawing
Effective circumlocution
Operationalised strategies can be reliably and validly captured - Azios et al 2020

Similar procedures across several CA-based studies (Barnes & Nickels, 2018; Beeke et al, 2011, 2015; Best et al, 2016). Can sample behaviourally over short recordings e.g. 10 minutes.