Aphasiology For Peer Review Only A novel treatment targeting the exchange of new information within storytelling for people with non-fluent aphasia and their partners Journal: Aphasiology Manuscript ID: Draft Manuscript Type: Paper Date Submitted by the Author: n/a Complete List of Authors: Carragher, Marcella; East Lancashire Hospitals Trust, Speech and language therapy non-fluent aphasia, interactive storytelling, information exchange, Keywords: generalisation URL: http://mc.manuscriptcentral.com/paph Email: [email protected] Page 1 of 61 Aphasiology 1 2 3 A novel treatment targeting the exchange of new information within storytelling 4 5 for people with non-fluent aphasia and their partners 6 7 8 9 10 11 12 Marcella CARRAGHER a 13 14 For Peer ReviewKaren SAGE b Only 15 16 Paul CONROY c 17 18 19 20 a 21 East Lancashire Teaching Hospitals, England 22 23 b School of Psychological Sciences, University of Manchester 24 25 c Neuroscience and Aphasia Research Unit, University of Manchester 26 27 28 29 30 31 32 Contribution to a special edition of Aphasiology 33 34 35 36 Word count: 6,519 37 38 39 40 41 42 43 Acknowledgements: This work is supported by a Research Bursary from the Stroke 44 45 Association (TSA JRTF 2009/01). We are grateful to the participants with aphasia 46 47 48 and their families for their time, effort and enthusiasm in taking part in the study. This 49 50 work would not have been possible without the support of speech and language 51 52 therapists who cascaded information about the study to potential participants. 53 54 55 56 57 58 59 60 URL: http://mc.manuscriptcentral.com/paph1 Email: [email protected] Aphasiology Page 2 of 61 1 2 3 Abstract 4 5 6 7 Background : Therapy for people with aphasia (PWA) can encompass a wide range of 8 9 10 aims and methodologies, from targeting the linguistic impairment, to strategic 11 12 compensation to optimise communication, interaction and vocational rehabilitation. 13 14 AcrossFor treatment type,Peer one unifying Review area of interest relates toOnly the generalisation of 15 16 behaviours targeted in therapy to untrained tasks and contexts, particularly those 17 18 19 related to everyday communication. Therefore, aphasia rehabilitation ultimately has a 20 21 social goal of optimising the communication of the person with aphasia (PWA) within 22 23 their typical environment. One important aspect of everyday communication relates to 24 25 conveying new information and telling anecdotes/stories. Measures of transactional 26 27 28 success in storytelling have previously demonstrated reliability and validity as an 29 30 analytical method. 31 32 33 34 Aim : The study aimed to extend previous work on transactional success in storytelling 35 36 to a programme of therapy targeting both the PWA and the communication partner 37 38 39 (CP). 40 41 42 43 Methods and procedures : Four participants with chronic non-fluent aphasia and their 44 45 CPs were recruited and a novel dual-focus treatment was administered. For the PWA, 46 47 48 therapy targeted storytelling using the principles of ‘thinking for speaking’ and story 49 50 grammar. For the partner, therapy drew on the principles of conversation coaching to 51 52 increase facilitative behaviours within storytelling to aid the construction of shared 53 54 understanding. Quantitative measures were used to investigate effects of treatment in 55 56 novel storytelling tasks for the group and within a single case study. 57 58 59 60 URL: http://mc.manuscriptcentral.com/paph2 Email: [email protected] Page 3 of 61 Aphasiology 1 2 3 4 5 Outcomes and results : There were numerical gains in information exchange for three 6 7 of four couples, where the conversation partner displayed improved understanding of 8 9 10 the PWQ’s story, and a decrease for one couple. Evidence of likely direct effects of 11 12 therapy across both simple and complex storytelling was consistent for two of the four 13 14 couples.For The single Peer case study suggested Review change consistent withOnly the aims of the 15 16 treatment programme. 17 18 19 20 21 Conclusions : The method of dual-focused therapy and outcome measurement outlined 22 23 in this paper offers promise for targeting an important aspect of everyday 24 25 communication in a standardised task. Potential for future investigation is discussed. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 URL: http://mc.manuscriptcentral.com/paph3 Email: [email protected] Aphasiology Page 4 of 61 1 2 3 Key words : non-fluent aphasia; interactive storytelling; information exchange; 4 5 generalisation 6 7 8 9 10 11 12 13 14 For Peer Review Only 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 URL: http://mc.manuscriptcentral.com/paph4 Email: [email protected] Page 5 of 61 Aphasiology 1 2 3 1 Introduction 4 5 Therapy for people with aphasia (PWA) encompasses a wide range of aims and 6 7 methodologies, from targeting the linguistic impairment (Carragher, Sage, & Conroy, 8 9 10 2013), communication compensation (Hopper, Holland, & Rewega, 2002), interaction 11 12 (Beeke, Maxim, Best, & Cooper, 2011) and vocational rehabilitation (Morris, 13 14 Franklin,For Menger, &Peer GD, 2011). Across Review these treatment approaches, Only one unifying 15 16 area of interest relates to the generalisation of behaviours targeted in therapy to 17 18 19 untrained tasks and contexts, particularly those related to everyday communication. 20 21 But how should we measure the effects of treatment on everyday communication? 22 23 24 25 One option relates to the collection and analysis of naturally occurring conversation 26 27 28 data. Certainly, conversation has been observed to be the most common type of daily 29 30 communication for PWA and matched healthy control participants (Davidson, 31 32 Worrall, & Hickson, 2003). Yet capturing evidence of quantitative change in 33 34 conversation has proved difficult, not least because no standardised, quantitative 35 36 measure of conversation exists (Beeke et al., 2011). Moreover, the high demands of 37 38 39 time and skill needed to carry out qualitative analysis of conversation present 40 41 challenges for service delivery in busy clinical settings (Bradley & Douglas, 2008). 42 43 44 45 From a broader perspective, everyday communication is multifaceted encompassing 46 47 48 both interaction and transaction (Davidson et al., 2003). One solution might be to use 49 50 the naturally occurring transactional opportunities in everyday communication to 51 52 target treatment and to capture evidence of change. Transactional communication 53 54 encompasses various types of discourse genre – conversation, expository, procedural 55 56 (Armstrong, 2000). Within transactional communication, conveying new information 57 58 59 60 URL: http://mc.manuscriptcentral.com/paph5 Email: [email protected] Aphasiology Page 6 of 61 1 2 3 has central role. It is problematic to measures transactional success within 4 5 conversation for a number of reasons: lack of external criteria on which to judge 6 7 transactional success (Ramsberger & Rende, 2002); potential lack of clarity regarding 8 9 10 a speaker’s target word or meaning (Armstrong, 2000); potential for a dissociation 11 12 between the information expressed by the speaker and how this is understood by the 13 14 conversationFor partner Peer (Ramsberger &Review Rende, 2002); as well asOnly the opportunity for 15 16 speakers to draw on shared knowledge which may not be expressed explicitly. Thus, 17 18 19 in order to measure transactional success, it is necessary to use a context that shares 20 21 similarities to conversation but, crucially, offers potential for externally-set criteria 22 23 and standardisation. One such context is storytelling, which offers a broad scope in 24 25 which to base outcome measurement and treatment: 26 27 28 • Social perspective: storytelling is a means of self-expression (McAdams, 29 30 2001), displaying and experiencing an evolving identity (Bierren, Kenyon, 31 32 Ruth, Shroots, & Svendson, 1996), engaging with others and passing on life 33 34 experience (Randall, 2001). Storytelling is a way in which we make sense of 35 36 the world, particularly during challenging life transitions and traumatic events 37 38 39 (Riessman, 1993). 40 41 • Clinically valid: PWA engage in significantly less storytelling in daily life 42 43 compared to healthy controls (Davidson et al., 2003). Thus the powerful 44 45 benefits of storytelling as a way of engaging with others and as a means of 46 47 48 coping are beyond the reach of a population who could benefit from this social 49 50 activity. This suggests that storytelling is a clinically valid context for 51 52 treatment and outcome measurement. 53 54 • Linguistic perspective: production of narrative or storytelling encompasses 55 56 57 skills of macrolinguistics (e.g., the planning and sequencing of information 58 59 60 URL: http://mc.manuscriptcentral.com/paph6 Email: [email protected] Page 7 of 61 Aphasiology 1 2 3 within a structured framework and tailored towards the listener’s perspective) 4 5 and mircolinguistics (i.e., semantic and syntactic aspects of production) which 6 7 resonate throughout many language production activities in daily life 8 9 10 (Whitworth, 2010). There is growing evidence from therapy literature of the 11 12 need to explicitly support PWA to generalise the skills developed within 13 14 Fortherapy sessions Peer to everyday Review communication (Whitwor Onlyth, 2010; Carragher, 15 16 Sage, & Conroy, 2013).