Empowering agency in aphasia: Topic initiation (Leaman et al., 2022)

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 S1. People with aphasia cognitive and self-reported communication scores.

Supplemental Material S2. Social Conversation Collection Protocol: Setting the context for a casual conversation.

Supplemental Material S3. Social Conversation Collection Protocol: Utterance-by-utterance decision-making.

Supplemental Material S4. Partner session fidelity rating form.

Supplemental Material S5. TI mechanisms: Distribution and rate of simultaneous use by each conversation dyad condition.

Leaman, M. C., Archer, B., & Edmonds, L. A. (2022). Toward empowering conversational agency in aphasia: Understanding mechanisms of topic initiation in people with and without aphasia. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-21-00049