Conversation in Aphasia Across Communication Partners: Exploring Stability of Microlinguistic Measures and Communicative Success

Towards efficient, ecological assessment of interaction: A scoping review of co-constructed communication

BACKGROUND

The complexity of communication presents challenges for clinical assessment, outcome measurement and intervention for people with acquired brain injury. For the purposes of assessment or treatment, this complexity is usually managed by isolating specific linguistic functions or speech acts from the interactional context. Separating linguistic functions from their interactional context can lead to discourse being viewed as a static entity comprised of discrete features, rather than as a dynamic process of co-constructing meaning. The ecological validity of discourse assessments which rely on the deconstruction of linguistic functions is unclear. Previous studies have reported assessment tasks that preserve some of the dialogic features of communication, but as yet, these tasks have not been identified as a distinct genre of assessment. We suggest the term 'co-constructed communication' to describe tasks which are specifically designed to capture the dynamic, jointly produced nature of communication within a replicable assessment task.

AIMS

To identify and summarize how co-constructed communication has been assessed with individuals with non-progressive acquired communication disability regarding task design, measures and psychometric robustness.

METHODS

A scoping review methodology was used to identity relevant studies. Systematic database searches were conducted on studies published before July 2021. Studies in the yield were assessed against eligibility criteria, with 37 studies identified as eligible for inclusion.

MAIN CONTRIBUTION

This is the first time that co-constructed communication has been defined as a genre of discourse assessment for stroke and traumatic brain injury populations. Co-constructed communication has been assessed for 144 individuals with aphasia and 111 with cognitive-communication disability. Five categories of co-constructed communication tasks were identified, ranging in complexity. Variability exists in how these assessment tasks are labelled and measured. Assessment measures require further psychometric profiling, specifically regarding test-retest reliability and validity.

CONCLUSIONS

Co-constructed communication is a discourse genre which offers researchers and clinicians a replicable method to assess language and communication in an experimentally rigorous way, within an ecologically valid context, bridging the gap between experimental and ecological assessment approaches.

WHAT THIS PAPER ADDS

What is already known on this subject Standardized assessments of language skills and monologue offer reliable, replicable ways to measure language. However, isolating language from an interactional context fundamentally changes the behaviour under study. This raises questions about the ecological validity of the measures we routinely use to determine diagnoses, guide treatment planning and measure the success of treatment. What this study adds to the existing knowledge This review highlights studies that conceptualize, and often quantify, interaction by combining experimental rigour and aspects of everyday dialogue. This is the first time this genre of discourse assessment has been identified. We propose the term 'co-constructed communication' to describe this genre and provide an operational definition for the term. What are the practical and clinical implications of this study? Co-constructed communication assessment tasks require refinement, particularly regarding aspects of psychometric robustness. In the future, these tasks offer pragmatic, meaningful ways to capture the effect and impact of aphasia and cognitive-communication disability within interaction.

Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia

PURPOSE

This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning.

METHOD

Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported.

RESULTS

Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up.

CONCLUSIONS

This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.

Analyzing Language in the Picnic Scene Picture and in Conversation: The Type of Discourse Sample We Choose Influences Findings in People With Aphasia

PURPOSE

People with aphasia express that improved conversational discourse is a primary rehabilitation goal. Discourse is usually assessed using monologue, such as a picture description task, but research shows that language in monologue varies from language in everyday conversation. Consequently, we investigated the relationship of language in unstructured conversation and in the picnic scene picture because it is a part of the most often used aphasia battery (Western Aphasia Battery-Revised) and thus is frequently used to inform therapy. Second, because previous research suggests people with severe aphasia may not demonstrate language production variability between types of monologue-level discourse, we evaluated the relationship of severity and the difference in scores between conversation and the picnic scene task.

METHOD

Thirty-four people with mild-to-severe aphasia described the picnic scene and provided a conversation sample. We measured language production and communicative success using seven measures with established psychometrics in conversation/monologue. We conducted correlations to answer the research questions.

RESULTS

Correlations were moderate and weaker for the measures in the two conditions. A strong negative relationship was demonstrated between aphasia severity and global coherence. All other relationships were moderate and weaker for the remaining measures when correlated with aphasia severity (also negative).

CONCLUSIONS

Results are consistent with other studies indicating that language varies in different types of discourse. We conclude that for accurate, meaningful assessment, discourse sampling needs to include the specific type of discourse the individual wishes to address in therapy, because discourse samples and their findings are not interchangeable.

Dyadic Conversation between Mandarin-Chinese-Speaking Healthy Older Adults: From Analyses of Conversation Turns and Speaking Roles

Older adults' daily conversations with other older adults enable them to connect to their surrounding communities and improve their friendships. However, typical aging processes and fluctuations in family caring might cause conversation changes. The purpose of this study was to explore the quantitative contributions of conversation turns (CTs) and speaking roles (SRs) in Mandarin-Chinese-speaking conversation dyads between mutually familiar healthy older adults (HOAs). A total of 20 HOAs aged 65 or over were recruited. Each dyad conversed for ten minutes once a week for five weeks, five sessions per dyad, for a total of 50 sessions. The frequency and percentages of the coded CTs and SRs contributed by each HOA were individually tallied and calculated. Quantitatively symmetrical contributions of CTs and SRs occurred in Mandarin-Chinese-speaking conversation dyads between mutually familiar HOAs. Although typical aging processes might change conversations, both Mandarin-Chinese-speaking HOAs serve as active interlocutors to each other in taking CTs and SRs to co-construct their conversation processes and content in their dyadic conversation. Sufficient knowledge of conversation co-constructions might lead them to have more supportive environments to connect to surrounding communities and improve their friendships.

Conversation as an Outcome of Aphasia Treatment: A Systematic Scoping Review

PURPOSE

Conversation-focused speech-language pathology services are a top priority for people living with aphasia, but little is known about how researchers measure conversation as an outcome of treatment. This scoping review was undertaken to systematically review the evidence regarding the measurement of conversation in aphasia studies and to identify current practices and existing gaps.

METHOD

A systematic literature search was conducted for studies published between January 1995 and September 2019 in multiple electronic databases. Covidence software was used to manage search results, study selection, and data charting processes. Data were extracted from each study and then collated and organized to elucidate the breadth of approaches, tools, or procedures oriented to measuring conversation as an outcome and identify gaps in the existing literature.

RESULTS

The systematic search of the literature resulted in 1,244 studies. A total of 64 studies met inclusion criteria and were included in the review. The review summarizes the various tools and procedures used to measure conversation as an outcome of aphasia intervention, including variations in data collection and analysis procedures. The review also evaluates the quality of conversation measures in terms of psychometric properties and informal measures of validity. There was a total of 211 measures used across the 64 studies.

CONCLUSIONS

While there was no clear measure that was objectively superior, several measures show promise and warrant future exploration. Some of the orientations, conceptualizations, and procedures we have presented can be seen as options that might be included in a future conversation-focused core outcome set.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21514062.

The effect of an aphasia ID card on the processing of language produced by a speaker with nonfluent aphasia

INTRODUCTION

We tested whether aphasia self-disclosure via an aphasia ID card impacts (1) how non-aphasic listeners initially process language produced by a speaker with aphasia and (2) learning of the speaker's error patterns over time.

METHODS

In this eye-tracking experiment, 27 young adults followed instructions recorded by a speaker with nonfluent aphasia while viewing a target picture and a distractor. The Card group (n = 14) was shown a simulated aphasia ID card for the speaker and the No Card group (n = 13) was not. The task was divided into Pre-Observation and Post-Observation blocks. Between blocks, participants observed the speaker making semantic paraphasias. Eye-tracking analyses compared the time course of target advantage (reflecting competition from the distractor picture) and workspace advantage (reflecting attention to task) between groups and blocks.

RESULTS

Pre-Observation, the Card group had a higher target advantage than the No Card group in the post-response window (i.e., after participants had responded), indicating sustained attention to the speaker's language. Across blocks, there was evidence that the Card group (but not the No Card group) learned that the speaker makes semantic paraphasias.

CONCLUSIONS

Aphasia ID cards impacted listeners' processing of language produced by a speaker with nonfluent aphasia. Increased patience and attentiveness may underlie both the Card group's sustained attention to the speaker as well as learning of the speaker's error patterns. Further research should address whether these changes impact communication success between PWA and new conversation partners.

Transactional Success in the Texting of Individuals With Aphasia

PURPOSE

Text messaging is a pervasive form of communication in today's digital society. Our prior research indicates that individuals with aphasia text, but they vary widely in how actively they engage in texting, the types of messages they send, and the number of contacts with whom they text. It is reported that people with aphasia experience difficulties with texting; however, the degree to which they are successful in conveying information via text message is unknown. This study describes the development of a rating scale that measures transactional success via texting and reports on the transactional success of a sample of 20 individuals with chronic aphasia. The relationships between texting transactional success and aphasia severity, texting confidence, and texting activity are explored.

METHOD

Performance on a texting script was evaluated using a three-category rating in which turns elicited from participants with aphasia received a score of 0 (no transaction of message), 1 (partial transaction), or 2 (successful transaction). Internal consistency was assessed using Cronbach's alpha. Interrater reliability was determined using intraclass correlation coefficient and Krippendorff's alpha.

RESULTS

Although preliminary, results suggest adequate internal consistency and strong interrater reliability. Texting transactional success on the script response items was significantly correlated with overall aphasia severity and severity of reading and writing deficits, but there was no relationship between transactional success and texting confidence or overall texting activity.

CONCLUSIONS

This study describes initial efforts to develop a rating scale of texting transactional success and to evaluate the validity of scores derived from this measure. Information from a texting transactional success measure could inform treatment that aims to improve electronic messaging in people with aphasia.

Validation of an Automated Procedure for Calculating Core Lexicon From Transcripts

PURPOSE

The aim of this study was to advance the use of structured, monologic discourse analysis by validating an automated scoring procedure for core lexicon (CoreLex) using transcripts.

METHOD

Forty-nine transcripts from persons with aphasia and 48 transcripts from persons with no brain injury were retrieved from the AphasiaBank database. Five structured monologic discourse tasks were scored manually by trained scorers and via automation using a newly developed CLAN command based upon previously published lists for CoreLex. Point-to-point (or word-by-word) accuracy and reliability of the two methods were calculated. Scoring discrepancies were examined to identify errors. Time estimates for each method were calculated to determine if automated scoring improved efficiency.

RESULTS

Intraclass correlation coefficients for the tasks ranged from .998 to .978, indicating excellent intermethod reliability. Automated scoring using CLAN represented a significant time savings for an experienced CLAN user and for inexperienced CLAN users following step-by-step instructions.

CONCLUSIONS

Automated scoring of CoreLex is a valid and reliable alternative to the current gold standard of manually scoring CoreLex from transcribed monologic discourse samples. The downstream time saving of this automated analysis may allow for more efficient and broader utilization of this discourse measure in aphasia research. To further encourage the use of this method, go to https://aphasia.talkbank.org/discourse/CoreLexicon/ for materials and the step-by-step instructions utilized in this project.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20399304.

"If You Just Stay With Me and Wait…You'll Get an Idea of What I'm Saying": The Communicative Benefits of Time for Conversational Self-Repair for People With Aphasia

PURPOSE

This study investigated the communicative benefits of self-repair during conversation for persons with aphasia (PWAs). Self-repair of trouble sources is an interactional priority that emphasizes autonomy and competence. Of equal importance, conversationalists desire to minimize silences and work together to ensure forward movement (progressivity) of conversation. Simultaneously achieving progressivity and self-repair is challenging in aphasia, and PWAs and their partners often make trade-off decisions between these two activities. Conversation-level aphasia interventions usually focus on supportive techniques that promote participation while maintaining progressivity, effectively favoring progressivity over self-repair. This study evaluates the benefits of an alternative approach that shifts the emphasis to self-repair, thereby highlighting potential trade-off costs of routinely forgoing self-repair to achieve progressivity.

METHOD

Ten people with mild-to-moderate aphasia each held two conversations with two different partners. When trouble sources characterized by silent and/or filled pauses occurred, partners maintained a supportive and engaged stance, allowing PWAs time to self-repair. We analyzed language produced during these "edited turns" using three paradigms considering form, content, and use.

RESULTS

The data yielded 311 edited turns. For form, on average, each edited turn resulted in 3.72 words; for content, most edited turns contained autobiographical information; for use, approximately 40% of edited turns introduced new information, and 40% added to the ongoing topic. The remainder were either ambiguous or comments such as, "I can't think of it."

CONCLUSIONS

When given engaged support and time to self-repair, PWAs contributed meaningful personal information to conversations for approximately 80% of edited turns. Importantly, self-repair often resulted in self-expression that directed the conversation, which is a communicative role critical for empowering agency and identity. This research opens a dialogue about benefits and limitations of approaches that prioritize either progressivity or self-repair and how to balance the two to optimize therapeutic benefits for each individual.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19379738.

What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.

Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia

PURPOSE

This study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success.

METHOD

Twenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success.

RESULTS

All speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success.

CONCLUSIONS

Specific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17699423.

A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia

PURPOSE

Evidence has shown that group conversation treatment may improve communication and reduce social isolation for people with aphasia. However, little is known about the impact of conversation group treatment on measures of discourse. This project explored the impact of conversation treatment on measures of monologic discourse.

METHOD

In this randomized controlled trial, 48 participants with chronic aphasia were randomly assigned to dyadic, large group, or control conditions. Conversation group treatment was provided for 1 hr, twice per week, for 10 weeks. Discourse samples were collected and coded at pretreatment, posttreatment, and 6-week maintenance. There were three narrative tasks: (a) Comprehensive Aphasia Test (CAT) picture description, (b) Cat Rescue Picture, and (c) Cinderella retell. All narratives were coded using the percent correct information units (percent CIUs), the CAT standardized narrative analysis method, and the complete utterance (CU) method.

RESULTS

No significant changes were observed on percent CIU, which was the primary outcome measure. The treated groups demonstrated improvement on aspects of the CU method following treatment, whereas the control group did not. Significant changes were observed for other CIU measures and the CAT standardized narrative analysis in both the treated and control groups.

CONCLUSIONS

The results suggest that the CU measures were more sensitive to the effects of conversation treatment in monologic discourse compared to CIU and CAT measures. Changes were more common in absolute rather than relative values, suggesting that conversation treatment impacts the overall amount of language produced rather than efficiency of production.

Assessing Language in Unstructured Conversation in People With Aphasia: Methods, Psychometric Integrity, Normative Data, and Comparison to a Structured Narrative Task

Purpose This study evaluated interrater reliability (IRR) and test-retest stability (TRTS) of seven linguistic measures (percent correct information units, relevance, subject-verb-[object], complete utterance, grammaticality, referential cohesion, global coherence), and communicative success in unstructured conversation and in a story narrative monologue (SNM) in persons with aphasia (PWAs) and matched participants without aphasia (M-PWoAs). Furthermore, the relationship of language in unstructured conversation and SNM was investigated for these measures. Methods Twenty PWAs and 20 M-PWoAs participated in two unstructured conversations on different days with different speech-language pathologists trained as social conversation partners. An 8- to 12-min segment of each conversation was analyzed. Additionally, a wordless picture book was used to elicit an SNM sample at each visit. Correlational analyses were conducted to address the primary research questions. Normative range and minimal detectable change data were also calculated for the measures in both conditions. Results IRR and TRTS were moderate to good for parametric measures and moderate to excellent for nonparametric measures for both groups, except for TRTS for referential cohesion for the PWAs in conversation. Furthermore, in PWAs, a strong correlation was demonstrated for three of eight measures across conditions. Moderate or weaker correlations were demonstrated for three of eight measures, and correlations for two of eight measures were not significant. An ancillary finding was no significant differences occurred for sample-to-sample variability between the two conditions for any measure. Conclusions This study replicates previous research demonstrating the feasibility to reliably measure language in unstructured conversation in PWAs. Furthermore, this study provides preliminary evidence that language production varies for some measures between unstructured conversation and SNM, contributing to a literature base that demonstrates language variation between different types of monologue. Thus, these findings suggest that inclusion of the specific types of discourse of interest to the PWA may be important for comprehensive assessment of aphasia. Supplemental Material https://doi.org/10.23641/asha.16569360.

Measuring Global Coherence in People With Aphasia During Unstructured Conversation

Purpose Global coherence is an essential macrolinguistic discourse skill that speakers use to formulate discourse to convey meaning with maintenance to a topic. When global coherence is poor, the listener's ability to understand how the discourse makes sense as a whole is diminished. Measures exist to evaluate global coherence in people with aphasia during monologue tasks (e.g., picture description). The aim of the current research is to develop such a measure for unstructured conversation and to explore how global coherence is impacted by aphasia during conversation. A global coherence measure for conversation is required because markedly different cognitive and linguistic demands are made for production of different types of discourse. Thus, a structured monologue measure cannot be used with validity for unstructured conversation. To adequately evaluate global coherence during conversation, a measure specific to the demands of conversation is required. Method We adapted the 4-point Global Coherence Scale (Wright & Capilouto, 2012; Wright et al., 2013), a monologue-level measure of global coherence to conversation, resulting in the 4-point Global Coherence Scale in unstructured conversation (GCSconv). We conducted statistical evaluation of the reliability/stability of the 4-point GCSconv in 18 unstructured conversations held by nine people with aphasia. Utterances with low global coherence scores were classified following a recent methodology to describe how breakdown in these utterances contributed to diminished global coherence (Hazamy & Obermeyer, 2019). Results The 4-point GCSconv demonstrated excellent inter/intrarater reliability and test-retest stability. Nonspecific language and off-topic comments contributed most frequently to lowered global coherence. Conclusions Findings suggest the 4-point GCSconv may be a feasible and reliable measure of global coherence in conversation. This measure adds to a core of emerging reliable discourse measures for conversation. As such, it has potential to inform assessment and treatment of everyday conversation and to investigate the relationship of global coherence in structured monologue and unstructured conversation. Supplemental Material https://doi.org/10.23641/asha.12469187.

Evaluating Change in the Conversation of a Person With Mild Aphasia After Attentive Reading With Constrained Summarization-Written Treatment

Purpose The purpose of this project was to evaluate the effect of a discourse-level treatment, Attentive Reading with Constrained Summarization-Written (ARCS-W), on conversational discourse. ARCS-W aims to improve spoken and written output by addressing the cognitive-linguistic requirements of discourse production through constrained summarization of novel material. Method This is an experimentally controlled case study with a single participant, Bill. Three conversation samples were collected at pretreatment, and a single conversation was collected 1 month after treatment. The participant completed 24 ARCS-W treatment sessions, and each session included reading and then summarizing a novel current event article following specific constraints (use lexically precise words, stay on topic, use complete sentences) in speaking and writing. Conversation outcomes evaluated the success of each utterance (1-4 scale), grammaticality, and the proportion of utterances with relevant content (relevant utterances). Additionally, behavioral manifestations of word-finding difficulty were evaluated in conversation. Results Bill improved communicative success at the utterance level based on the minimal detectable change. He also demonstrated reductions in behavioral manifestations of lexical retrieval difficulty based on decreases in the percentage of false starts (e.g., t*, t*), mazes (e.g., uh, s*, um), and abandoned utterances. Bill did not increase the proportion of relevant utterances or grammatical utterances in conversation. Conclusions This case study provides preliminary evidence of the potential impact of ARCS-W treatment in conversation. Additionally, the measures implemented to evaluate conversation represent a promising adaptation of a novel methodology to capture change in conversation. Supplemental Material https://doi.org/10.23641/asha.12375053.

"By the Way"… How People With Aphasia and Their Communication Partners Initiate New Topics of Conversation

Purpose The ability to initiate new topics of conversation is a basic skill integral to communicative independence and agency that is susceptible to breakdown in aphasia (Barnes, Candlin, & Ferguson, 2013), yet this discourse skill has received little research attention. Healthy adults (HAs) follow 3 established patterns of structural organization to cue the conversation partner when an utterance is intended to initiate a new topic (Schegloff & Sacks, 1973; Svennevig, 1999). In addition, speakers have the option to use these mechanisms of topic initiation (TI) individually or in conjunction with one another. Occasionally, speakers do not follow these conversational macrostructure expectations, in which case TI occurs abruptly, referred to as a noncoherent TI (NC-TI; Mentis & Prutting, 1991). Understanding how TI is disrupted by aphasia requires foundational knowledge regarding the relative use/combined use of TI mechanisms and NC-TI in HAs and persons with aphasia (PWAs). The purpose of this study is to investigate how PWAs and their conversation partners initiate new topics of conversation and to determine the relationship between the number of TI methods used and communicative success (CS) in persons with mild aphasia (PWA-Mild) and persons with moderate and severe aphasia (PWA-Mod/Sev). Method Six PWA-Mild and 4 PWA-Mod/Sev engaged in 15-min unstructured conversations with different HA partners. Utterances were coded for types of TI used by both partners and were evaluated for CS using a 4-point scale (Leaman & Edmonds, 2019) for PWAs. Results/Implications PWAs used NC-TI with a much greater frequency than HAs who never used NC-TI. The rate of NC-TI was associated with increased severity of aphasia. HAs and PWA-Mild used cohesion most often as the method for TI, while PWA-Mod/Sev used it least often. CS was moderately positively correlated with the number of methods of TI used in PWA-Mod/Sev. However, no such correlation existed for PWA-Mild; this group achieved a high degree of CS on TI utterances, independent of the number of methods of TI used. Findings include the clinical implication suggesting PWA-Mod/Sev may benefit from simultaneous use of TI mechanisms to achieve better CS during conversation. Supplemental Material https://doi.org/10.23641/asha.9765164.

Revisiting the Correct Information Unit: Measuring Informativeness in Unstructured Conversations in People With Aphasia

Purpose The purpose of this study was to determine whether the correct information unit (CIU) can be reliably applied to unstructured conversational discourse in people with aphasia (PWA). The CIU was developed by Nicholas and Brookshire (1993) to measure word-level informativeness in structured monologue-level discourse and is widely used by clinicians and researchers for this purpose. A case study (Oelschlaeger & Thorne, 1999) investigating the use of the CIU in conversation has suggested potential issues with interrater reliability (IRR), which has discouraged application of the CIU to this discourse context. However, no further research has been conducted to replicate or extend this finding. Given a clinical and research need for reliable linguistic measures appropriate for use in unstructured conversation, revisiting the reliability, stability, and suitability of the CIU is indicated. Method The CIU protocol developed by Nicholas and Brookshire (1993) was modified according to the needs of conversational discourse, resulting in the CIU in conversation (CIUconv) protocol. Two speech-language pathology graduate student research assistants completed training on use of the CIUconv with the 1st author. Sixteen conversations held by 8 PWA (i.e., 2 conversations each) were used as language samples to determine IRR of percent CIU (%CIU) in conversation through use of the CIUconv. Test-retest stability of %CIU as applied per this protocol was then assessed across the 2 conversations collected for each PWA. Results Use of the CIUconv resulted in excellent IRR of %CIU for each research assistant and the 1st author. Likewise, test-retest stability for the measure was excellent. Results were evaluated at both the group and individual levels. Conclusions %CIU demonstrated excellent interrater and test-retest reliability when applied to unstructured conversation using the CIUconv procedure, which was developed to account for expected linguistic characteristics of conversation. These findings suggest that %CIU may be a feasible, reliable measure of informativeness in unstructured conversation in PWA when the CIUconv is used by trained raters.