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Title:Targeting collaborative referencing in aphasia: evidence from a mixed methods treatment study
Author(s):Devanga, Suma Ramesh
Doctoral Committee Chair(s):Hengst, Julie A.
Doctoral Committee Member(s):Duff, Melissa C.; Johnson, Cynthia J.; Prior, Paul
Department / Program:Speech & Hearing Science
Discipline:Speech & Hearing Science
Degree Granting Institution:University of Illinois at Urbana-Champaign
Subject(s):Social approach
Barrier task
Aphasia intervention
Single-case experimental design
Patient-reported outcome measures
Communication confidence
Conversational synchrony
Distributed communication theory
Functional outcomes
Abstract:The current study integrates the distributed communication theory (Hengst, 2015) with the social philosophies of interventions for aphasia with the aim of investigating the communicative changes in four individuals with chronic aphasia and their clinician-partners during the study sessions (both during the treatment, and during probe conditions), as well as outside of the study sessions. Adopting an overarching interpretive case study design and an embedded multiple-probe single-case experimental design, this mixed methods study combines qualitative ethnographic methodologies (e.g., observations, interviews, patient-reports), discourse analysis procedures (e.g., collaborative referencing), and quantitative experimental methodologies (e.g., multiple-probes) to understand the different dimensions of the process and effects of treatment. Data collection included 108 videotaped study sessions with 27 sessions completed by each of the four participant pairs that consisted of the following: (a) 2 pre-treatment sessions (b) 5 baseline sessions (c) 15 barrier treatment protocol (BTP; Hengst, Duff & Dettmer, 2010) sessions with 5 weekly treatment probes, and (d) 5 maintenance sessions. The baseline, treatment probe and maintenance sessions consisted of 2 dependent variables, a collaborative confrontation naming (CCN) probe of 12 personally relevant probe-cards per session, followed by a 10-minute conversation probe using the mediated discourse elicitation protocol (Hengst & Duff, 2007). Each BTP treatment session (i.e., independent variable) consisted of 6 trials of the collaborative referencing task, during which the client and clinician alternatively took turns to identify and match personally relevant treatment-cards to their numbered boards with a partial-barrier separating them. Two patient-reported outcome measures— communication confidence profile (Babbitt & Cherney, 2010), and conversation profile (Whitworth, Perkins & Lesser, 1997) were also administered during baseline, treatment probe and maintenance sessions. All the treatment sessions and conversation probes were transcribed and coded for discourse analysis. The CCN probes were scored by two independent raters using the adapted PICA scale (Porch Index of Communicative Ability; Porch, 1971); the conversation probes were analyzed for the changes in non-content conversational synchrony (Gupta, 2012) and content-conversational synchrony (e.g., Hengst et al., 2016). Results from the analysis for collaborative referencing revealed that all four participant-pairs successfully completed the 15 barrier treatment protocol sessions, and the findings were consistent with the collaborative referencing model (Clark & Wilkes-Gibbs, 1986) in that, there was a high mean accuracy of card placement of 99.95%, with reduced collaborative effort across trials per card placement, and also with simplification of the initiating referencing expressions across trials and sessions. Extending beyond the model, we found a high number of repetitions of card labels with increased consistency in using agreed-upon labels across participant pairs supporting the findings from Hengst et al., (2010), which suggest that repeated engagement in collaborative referencing serves as the grounds for learning. Results from the analysis of the CCN probe revealed a positive treatment effect on naming with a Tau-U treatment effect size of 0.92 at p<0.0001, indicating a functional relation between the treatment and naming. Analysis of non-content and content conversational synchrony revealed variable results across participant-pairs and across sessions, indicating no functional relation between the treatment and conversational synchrony. Results from the two patient-reported outcome measures showed that there were reports of increased communication confidence and increased conversational participation in diverse activities and situations, indicating a positive impact of the treatment outside of the study sessions, in the everyday lives of the four participants. Consistent with the previous literature on barrier treatment protocol, this study found successful collaborative referencing and verbal learning of references within treatment sessions in all four participant pairs. More strikingly, the results indicated that the treatment effects were generalized to a clinical naming task, and also that the patient reports indicated a significant impact of the treatment on the communicative lives of individuals with aphasia. This research highlights the use of communicative engagement as a therapy tool for aphasia, with clinical implications regarding both assessment and management of neurogenic communication disorders. They also point to the potential benefits of using patient-reported outcome measures and discourse analysis measures to design and study novel treatment approaches to better meet the real-life communication goals.
Issue Date:2017-04-11
Rights Information:Copyright 2017 Suma Devanga
Date Available in IDEALS:2017-08-10
Date Deposited:2017-05

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