THE EFFECTS OF GRAPHIC TOPIC SETTERS ON CONVERSATIONS WITH A SEVERELY APHASIC COMMUNICATOR

1. THE EFFECTS OF GRAPHIC TOPIC SETTERS ON CONVERSATIONS WITH A SEVERELY APHASIC COMMUNICATOR Kathryn L. Garrett, Ph.D., CCC-SLP Duquesne University, Pittsburgh, PA Christine Huth, MS CFY Allegheny Intermediate Unit, Pittsburgh, PA+-

2. Abstract • In this single subject experiment, a commu-nicator with severe expressive aphasia conversed with 2 partners about a personal event and a news 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. Results showed increases in the number of turns, length of time, success-fulness, and ability of the participant to initiate/add novel info in the contextual con-ditions. Topic and Partner effects were noted.

3. Background/Review of the Lit • Previous research showed that communicators with severe aphasia can participate more fully in interactions using the Written Choice Conversational Strategy (Garrett & Beukelman, 1995). However, this strategy does not allow communicators to introduce novel, semantically specific information to a conversational interaction • Tangible context (visual representations of topics, remnants) have been used to stimulate the aphasic communicators to convey novel topical information (Beukelman, Yorkston, & Dowden, 1985; Weiss & Ho, 1997). • However, little specific data are available to analyze the impact of these “external topical aids” on the communication interactions of severely aphasic individuals

4. Purposes of this Study • To investigate how graphic contextual information affects the ability of an individual with severe aphasia to initiate and sustain conversation in the following conditions: • 1) Baseline vs. Context vs. Context+Instruction • 2) across 2 communication partners • 3) Personal Event vs. Current Event

5. Participant Demographics - S.D. • Male, 72 years old, married • 1 year post thrombotic left CVA • Diagnosis of moderate-to-severe Broca’s aphasia with coexisting Apraxia of Speech • Western Aphasia Battery Scores: (Kertesz & McCabe, 1982) • Spontaneous Speech…….. 3.5/20 • Comprehension ………….8.35/10 • Repetition……………….. 1.2/10 • Naming………………….. 2/10 • Overall WAB Aphasia Quotient = 30/100

6. Methods • Design • Modified Single Subject (ABAC) Sequential Design • Partner 1: 2 baseline sessions (A1) 4 graphic context sessions (B1) 2 baseline sessions (A2) 8 sessions total • Partner 2: 3 baseline sessions (A1’) 4 graphic context sessions (B1’) 3 baseline sessions (A2’) 4 instructional sessions (C1’) 2 graphic context sessions (B2’)16 sessions total

7. Methods • Data Collection Procedures • Topic Selection: personal event topic obtained from interview with spouse prior to session; current event from 1st or 2nd headliner story in primary newspaper sections. • Topic Representation: key word outlines prepared for context conditions (see below) in accordance with pre-set criteria (6-8 lines, large print, declarative phrases, etc.) • General Instructions: Talk for as long as you want about …. Or ….. (8 minute cap). Topic presentation was randomly ordered. Each interaction was videofilmed. • Instruction Condition: “Rules” for conversation were introduced (see below); then participant rehearsed the conversation with the primary investigator prior to data collection. Feedback provided to communicator on: opportunities for initiation, adequacy of message, etc.

8. Sample Graphic Topic Setters • Personal EventCurrent Event

9. Current Events Women’s World Cup Soccer Championship Pirates Baseball Game JFK Jr. Plane Crash Kennedy Funeral Drought Emergency in PA John Deere Golf Tournament Bonfire Log Collapse at Texas A & M Personal Events Lunch with Daughter Playing Bingo Wedding of a Family Friend Bowling Visit to Grandkids Aphasia Support Group Meeting Thanksgiving Dinner Christmas Shopping with Wife & Daughter Sample Topics

10. Sample Instructional Chart

11. Methods Continued: • Data Analysis Procedures/Dependent Vars. • Tapes were transcribed and coded for: • Turns • Exchanges (clusters of turns related to a single idea) • Initiations (who initiated - partner or participant?) • Successfulness (was idea conveyed - fully or partially?) • Modality (including referential gestures to topic setter) • Elapsed time per topic • Perceptual Datawere also collected on S.D.’s and partner’s • Own Competence • Partner’s Competence • Comfort with Communication Technique • Enjoyment of Communication Technique.

12. Data Summarization • Data were initially plotted by individual sessions in accordance with single subject analysis techniques • 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 then averaged by condition/topic and graphed (see display) • Descriptive statistics were calculated (see handout) • Inferential (nonparametric analysis) will follow, although independence of data is an issue

13. Results (Overview) • Condition Effects: • Participant Turns and Total Turns increased incrementally from baseline to context to instructional conditions across both partners. • Initiations approx. doubled for current event context and context+instruction conditions across both partners • Less of an effect seen with personal event (although increases in initiations were noted) • S.D. was much moresuccessful when context was available during interactions with partner 1; however, increases were very slight for partner 2

14. Results (Overview cont.) • Partner Effects • Experimental observations that Partner 1 was a less skilled interpreter were supported empirically -- there was more of a tx effect with regard to turns and successfulness with Partner 1 than Partner 2 • However, context allowed S.D. to initiate more readily, which in turn changed the participant’s role in the interactions with both partners.

15. Results (Overview cont.) • Topic Effects • Length of 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 initiations for the current event.

16. Summary and Conclusions • 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 - from clinician-dominated to shared roles as initiator. • Interaction effects were observed between partners, topics, and condition. • Further quantitative analysis is warranted to determine • the significance of the effects • Whether meaningful interactions exist among the variables (e.g., referential acts, successfulness, contingent partner responses)

17. 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, communicator initiations and 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.

18. Acknowledgements • This investigation was supported, in part, by an ASHA 1998 Research Grant for New Investigators • The authors would also like to acknowledge the efforts of the following individuals: the participant and his spouse; graduate students Katrina Dunnewold and Jeannine Christie (experimental partners),and Jen Martonik (graduate research assistant/graph-maker extraordinaire)