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Background: Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. Aims: To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Outcomes & Results: Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment. Conclusions & Implications: This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice.

Purpose: Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self-rated communicative participation during goal-setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self-rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. Methods: Nine PwA and nine control patients without aphasia rated their experience of communication during a goal-setting meeting. Thirty-eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal-setting meetings. Results: The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self-rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. Conclusion: Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self-ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self-reported experience, since awareness might influence results.

Background: An individual's ability to make autonomous decisions is fundamental to self-determination. The presence of neurological pathology, for example, aphasia, and its associated difficulties with language and/or cognition, may affect an individual's capacity to make decisions, or their ability to reveal their capacity to make decisions. Decision-making by persons with aphasia (PWA) can be enhanced when communication partners are trained and if communication supports are provided, for example, supports that reduce the linguistic and cognitive demands of the task, and/or that facilitate expression. Aims: The main aim of this review is to identify the types of decisions for which persons with post-stroke aphasia receive support, the communication partners involved in supporting decision-making by PWA and the communication strategies implemented to support decision-making by PWA. Methods & Procedures: A multifaceted search strategy was used. Specific keywords were used to search seven electronic databases. Hand-searches of two journals, as well as ancestral searches of the reference lists of selected articles was also performed. Through the application of predefined selection criteria, 16 journal articles, spanning from 1998 to 2021, were selected from the initial yield of 955 articles for inclusion in this review. Data pertaining to the aims of the study were extracted using a data-extraction form. Outcomes & Results: This review shows that most of the research to date has focused on supporting persons with post-stroke aphasia in decisions pertaining to discharge planning or accommodation, and decisions pertaining to informed consent for participation in research. The communication partners cited most frequently as supporting decision-making by PWA are speech-language pathologists and family members. A range of communication strategies, most of which are components of Supported Conversation Techniques for Adults with Aphasia (SCA™), support decision-making by PWA. The most frequently listed strategies include augmenting information with different modalities, acknowledging the competence of the PWA, thereby inviting initiation and collaboration by the PWA, and the allocation of sufficient time for the decision-making process. Conclusions & Implications: This review presents research trends regarding the support of PWA in decision-making. Future research should focus on the effectiveness of the different strategies identified, and on the support of PWA in the making of a greater variety of complex decisions.

Background: Cognitive-communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole. Methods & Procedures: A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full-text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia. Outcomes & Results: The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) 'identities changing' reflected how interactions within the family systems impacted on identities; (2) 'loss' reflected the grief experienced by families due to changes in communication; and (3) 'developing communication strategies' highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia. Conclusions & Implications: The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family-centred practice as recommended in policy.

Background: Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). Aim: To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. Methods & Procedures: The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. Main contribution: The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. Conclusions & Implications: Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication.

Background: Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties. Aims: This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication--For Persons Who Live with MND (AID-COMp). Methods & Procedures: We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively. Outcomes & Results: For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs. Conclusions & Implications: We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences.

Background: Despite evidence that Communication Partner Training (CPT) can enable health professionals to communicate more effectively with people with aphasia (PWA), an evidence-practice gap exists. To address this, a tailored implementation intervention was developed and trialled to improve health professionals' implementation of communication strategies in a subacute setting. Aims: To explore the outcomes and perceived feasibility, acceptability and potential effectiveness of an iterative CPT implementation intervention on multidisciplinary healthcare professionals' communication with PWA. Methods & Procedures: The CPT implementation intervention was delivered to two groups of healthcare professionals (n = 6 and 7) approximately 6 months apart. The intervention underwent two iterations targeting emerging barriers to implementation success, with Group 2 receiving a modified version of the Group 1 intervention. A concurrent qualitative process evaluation was conducted to understand key factors determining implementation outcomes. Quantitative outcomes were recorded at baseline and 3-month follow-up, including the Measure of Skill in Supported Communication (MSC), a customized behavioural determinants survey mapped to the Theoretical Domains Framework (TDF) and the Organizational Readiness for Change survey. Focus groups and semi-structured interviews were conducted with health professional participants and the speech-language therapist trainer to explore perceptions of feasibility, acceptability and potential effectiveness. Content analysis was used to analyse the qualitative data, with categories and themes generated. Outcomes & Results: The Group 2 implementation intervention was adapted based on feedback and reflections from Group 1 participants to incorporate more time for practice interactions and discussion during training, individual follow-up sessions and provision of accessible resources to aid communication attempts. There were greater improvements seen in the Group 2 outcomes on both the MSC and the TDF survey, suggesting that the iterative tailoring of the intervention was successful in addressing the barriers to change and led to improved implementation. The difference between the group's outcomes may also partly be explained by the impact of organizational readiness, which decreased during Group 1's implementation period. Despite similar themes emerging from the stakeholder perspectives in both groups (training factors, implementation facilitators, implementation barriers, and changes in knowledge and practice), these diverted in ways which served to explain the different implementation outcomes. Conclusions & Implications: An iteratively adapted CPT implementation intervention targeting healthcare professionals' use of supported communication strategies was feasible and acceptable for most participants. The implementation intervention was potentially effective in changing participants' communication with PWA, particularly for Group 2. Future CPT implementation efforts should continue to incorporate stakeholder input and tailor strategies to the organizational context, and measure whether outcomes are sustained in the long term.

Background: Impairments in social communication are ubiquitous after moderate to severe traumatic brain injury (TBI). Most attempts to quantify these impairments have been descriptive rather than theoretically motivated. We propose that Relevance Theory provides a framework for characterizing social communication limitations after TBI and linking these problems to underlying cognitive impairments. Aims: This study asked how adult speakers with and without TBI used specific linguistic forms in social communication. We selected three linguistic markers that convey thoughts and feelings of the speaker and which are intended to influence the same in the listener: propositional attitude verbs, the discourse marker "like" and the quotative "like." Methods & Procedures: Ten adults with moderate to severe TBI and 12 healthy adults completed 5-min casual conversations with student researcher partners as part of a larger research study. Conversations were transcribed and analysed for the frequency of the three linguistic markers, corrected for total words in the transcript. Outcomes & Results: Participants in the TBI group used discourse marker "like" significantly less than participants in the healthy comparison group (0.75% and 2.06% of total words, respectively; p = 0.05, d = -0.43) and showed less variety in functions of "like." The use of propositional attitude verbs and quotative "like" was not affected by TBI. Conclusions & Implications: Expression of propositional attitude seems largely preserved after TBI. Relevance Theory may provide a helpful framework (1) to interpret subtle quantitative and qualitative differences that contribute to social conversation problems of adults with TBI; and (2) to elucidate relations among the social communication signs and symptoms and underlying cognitive impairments.

Background: This study is a longitudinal follow-up to prior work examining the important pragmatic skill of communication repair (i.e., the ability to respond effectively to a request for clarification of an unclear message) across three neurodevelopmental disabilities in which language skills are impaired: fragile X syndrome with and without autism spectrum disorder (FXS-ASD; FXS-O), idiopathic ASD (ASD-O), Down syndrome (DS) and controls with typical development (TD). Prior work examining communication repair skills at younger ages indicated impairments in boys with FXS-ASD and ASD-O, with females performing comparably with each other across groups. Aims: To characterize communication repair skills in young individuals with FXS-ASD, FXS-O, ASD-O, DS and TD, across groups and over development. A secondary aim included documenting sex differences in FXS (with and without ASD) and DS. Methods & Procedures: Sixty young individuals with FXS-ASD (49 males, 11 females), 38 with FXS-O (13 males, 25 females), 38 with ASD-O (males only), 42 with DS (21 males, 21 females) and 41 with TD (21 males, 20 females) participated in the study, with a subsample reported on here who were retested at a second time point 2.7 years later on average. Participants completed a structured, picture-based task designed to assess the ability to repair breakdowns in communication. Participants' responses were compared across groups and sexes at the second time point, and interpreted with respect to previously published (Time 1) findings. Outcomes & Results: Key findings included that, with age, male groups (including those with FXS-ASD and ASD-O, who showed difficulty at Time 1) performed more comparably, decreasing their use of inappropriate responses, in spite of relatively little change observed in general cognitive or structural language abilities in the clinical groups. However, girls with FXS and DS became more non-responsive with age, and differences between boys and girls with FXS-ASD emerged over time as well. Conclusions & Implications: Findings suggest that impairments in a critical pragmatic skill--the ability to repair communication breakdown--show significant change with age across three neurodevelopmental disabilities, with important sex-specific patterns. These developments were often observed in spite of a relative plateau in cognitive and language growth, suggesting that repair skills may be more malleable and therefore an excellent target for intervention. Findings not only inform the nature of pragmatic impairment across groups but also can importantly inform clinical practice, suggesting that clinicians should monitor pragmatic skills such as repairs throughout development and also consider the role of sex in clinical efforts.

Background: To manage conversational breakdowns, individuals with hearing loss (HL) often have to request their interlocutors to repeat or clarify. Aims: To examine how middle-aged hearing aid (HA) users manage conversational breakdowns by using open-class repair initiations (e.g., questions such as "sorry," "what" and "huh"), and whether their use of repair initiations differs from their normally hearing interlocutors. Methods & Procedures: Eighteen 45-64-year-old adults with acquired mild to moderate HL participated in the study. The participants were videotaped in everyday interactions at their homes and workplaces and in clinical encounters with hearing health professionals. Interactions were transcribed and open-class repair initiations of participants with HL and their interlocutors were identified using conversation analysis. The frequencies of initiations were analyzed statistically between the groups, and the contexts and structure of repair sequences dealing with communication breakdown were analyzed. Outcomes & Results: Before acquiring HA the participants with HL reported intense use of open-class repair initiation. After HAs were acquired, there was no statistically significant difference in the frequency of open-class repair initiations between HA users and their interlocutors. The most common means for open-class repair initiation in the data was interrogative word "mitä" ('what'). Vocalization "hä" ('huh'), apologetic expression "anteeksi" ('sorry') and clausal initiations (e.g., 'what did you say'/'I didn't hear') occurred less often. Open-class repair initiations emerged in contexts where they typically occur in conversation, such as topical shifts, overlapping talk and action, background noise, and disagreements. When used, open-class repair initiations most often led to repetition by the interlocutor, which immediately repaired the conversational breakdown. Long clarification sequences with multiple repair initiations did not occur. Conclusions & Implications: Participants with mild to moderate HL using hearing amplification initiate open-class repair similarly to their normally hearing conversational partners when the frequency, types, contexts and structure of repair are considered. The findings diminish the stigma related to HL, HAs and the use of open-class repair. The findings suggest that HA amplifies hearing successfully in everyday conversation when the level of HL is mild to moderate. However, the evidence for the benefit of HAs remains indirect.

Background: Previous research has shown that speakers with aphasia rely on enactment more often than non-brain-damaged language users. Several studies have been conducted to explain this observed increase, demonstrating that spoken language containing enactment is easier to produce and is more engaging to the conversation partner. This paper describes the effects of the occurrence of enactment in casual conversation involving individuals with aphasia on its level of conversational assertiveness. Aims: To evaluate whether and to what extent the occurrence of enactment in speech of individuals with aphasia contributes to its conversational assertiveness. Methods & Procedures: Conversations between a speaker with aphasia and his wife (drawn from AphasiaBank) were analysed in several steps. First, the transcripts were divided into "moves," and all moves were coded according to the systemic functional linguistics (SFL) framework. Next, all moves were labelled in terms of their level of conversational assertiveness, as defined in the previous literature. Finally, all enactments were identified and their level of conversational assertiveness was compared with that of non-enactments. Outcomes & Results: Throughout their conversations, the non-brain-damaged speaker was more assertive than the speaker with aphasia. However, the speaker with aphasia produced more enactments than the non-brain-damaged speaker. The moves of the speaker with aphasia containing enactment were more assertive than those without enactment. Conclusions & Implications: The use of enactment in the conversations under study positively affected the level of conversational assertiveness of the speaker with aphasia, a competence that is important for speakers with aphasia because it contributes to their floor time, chances to be heard seriously and degree of control over the conversation topic.

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices. Methods & Procedures: Thirty-seven UK SLTs completed an online questionnaire, eight of whom attended a follow-up focus group. A clinical consistency scale was applied to the questionnaire data and tasks that were most consistently used were explored in the focus group and analyzed using a primarily deductive thematic data analysis approach. Outcomes & Results: Three key CST findings arose: (1) the rarity with which SLTs focus equally and explicitly on both communication partners' strategies; (2) SLTs' differing understandings of CST terminologies and concepts and underuse of formal assessment; and (3) the absence of video feedback. Conclusion & Implications: This study's survey findings suggest that conversation partners not only receive half the amount of CST given to people with aphasia but also play a more passive learning role when they are present. This is an interesting point to consider when the current evidence base contains stronger evidence for the effectiveness of conversation partner CST over other CST approaches, it being described as an effective method that may be maintained over time.

Background: Nonverbal communication deficits are characteristic of autism spectrum disorder (ASD) and have been reported in some later-born siblings of children with ASD (heightened-risk (HR) children). However, little work has investigated gesture as a function of language ability, which varies greatly in this population. Aims: This longitudinal study characterizes gesture in HR children and examines differences related to diagnostic outcome (ASD, language delay, no diagnosis) and age. Methods & Procedures: We coded communicative gesture use for 29 HR children at ages 2 and 3 years during interactions with a caregiver at home. Outcomes & Results: Children in the ASD group produced fewer gestures than their HR peers at 2 years, though large individual differences were observed within each subgroup at both ages. In addition, reliance on particular types of gestures varied with age and outcome. Both ASD and language delay children exhibited a pattern of reduced pointing relative to their no diagnosis peers. Conclusions & Implications: Similarities and differences exist between communication in HR infants with language delay and their HR peers, reinforcing our understanding of links between verbal and nonverbal communication in populations at risk for language delay.

Background: Features of dysarthria associated with Parkinson's disease (PD), such as low volume, variable rate of speech and increased pauses, impact speaker intelligibility. Those affected report restricted interactional participation, although this area is under explored. Aims: To examine naturally occurring instances of problems with intelligibility that resulted in multiple attempts at repair in order to consider repair initiation strategies that might restrict or enhance participation. Methods & Procedures: Thirteen people with PD (PwPD) video-recorded over 10 h of informal conversation data in their home setting involving familiar conversation partners (CPs). Using a conversation analytic (CA) approach, and drawing on an existing typology of repair initiators (RIs) for everyday talk-in-interaction and their relative power to locate a turn's repairable element, the design and ordering of RIs used by CPs was addressed, alongside their local consequences. Outcomes & Results: CPs tended to increase the specificity of their RIs in line with the existing typology, progressing from open class forms (e.g. "mm?") to more specific forms (e.g. questions/partial repeats). Repeated open class repair initiators (OCRIs) were used where PD speakers' self-repair attempts provided limited information. Sometimes, however, specificity was increased too soon, before enough syntactic knowledge was gleaned, which resulted in an extended repair sequence. Where one OCRI followed another, the second always took a different form: lexically or in terms of prosodic/non-verbal features. RI forms not described in the existing typology were also identified, such as "prompts to modify speech" (e.g. "Speak louder") and repeating/rephrasing the original first pair part (e.g. question), and their effectiveness examined. Conclusions & Implications: First steps are presented towards the design of a communication intervention promoting the efficient resolution of repair to moderate social withdrawal and increase participation for this client group. Future research will need to explore the feasibility and acceptability of such a resource.

Background: A communicative disability interferes with the affected person's ability to take active part in social interaction, but non-disabled communication partners may use different strategies to support communication. However, it is not known whether similar strategies can be used to compensate for different types of communicative disabilities, nor what factors contribute to the development of a particular approach by communication partners. Aims: To develop a set of categories to describe the strategies used by communication partners of adults who have problems expressing themselves due to neurogenic communicative disabilities. The reliability of assessment was a particular focus. Methods & Procedures: The material explored consisted of 21 video-recorded everyday conversations involving seven couples where one spouse had a communicative disability. Three of the dyads included a person with dysarthria and anomia related to later stages of Parkinson's disease, while four of them included a person with stroke-induced aphasia involving anomia. First a qualitative interaction analysis was performed to explore the strategies used by the communication partners when their spouses had problems expressing themselves. The strategies were then categorized, the reliability of the categorizations was explored and the relative frequency of the various strategies was examined. Outcomes & Results: The analysis of the conversational interactions resulted in a set of nine different strategies used by the communication partners without a communicative disability. Each of these categories belonged to one of three overall themes: No participation in repair; Request for clarification or modification; and Providing candidate solutions. The reliability of the categorization was satisfactory. There were no statistically significant differences between diagnoses in the frequency of use of strategies, but the spouses of the persons with Parkinson's disease tended to use open-class initiations of repair more often than the spouses of the persons with aphasia. Conclusions & Implications: The types of strategies used by spouses of persons with neurogenic communicative disabilities seem to be more strongly associated with individual characteristics of communicative ability than with the type of disorder involved. The set of categories developed in this study needs to be trialled on larger groups of participants, and modified if and as necessary, before it can be regarded as a valid system for the description of such strategies in general. Once this has been done it may become a useful instrument in the assessment of the strategies used by communication partners of individuals with communicative disabilities.

Background: Previous research suggests that speakers are especially likely to produce manual communicative gestures when they have relative ease in thinking about the spatial elements of what they are describing, paired with relative difficulty organizing those elements into appropriate spoken language. Children with specific language impairment (SLI) exhibit poor expressive language abilities together with within-normal-range nonverbal IQs. Aims: This study investigated whether weak spoken language abilities in children with SLI influence their reliance on gestures to express information. We hypothesized that these children would rely on communicative gestures to express information more often than their age-matched typically developing (TD) peers, and that they would sometimes express information in gestures that they do not express in the accompanying speech. Methods & Procedures: Participants were 15 children with SLI (aged 5;6-10;0) and 18 age-matched TD controls. Children viewed a wordless cartoon and retold the story to a listener unfamiliar with the story. Children's gestures were identified and coded for meaning using a previously established system. Speech-gesture combinations were coded as redundant if the information conveyed in speech and gesture was the same, and non-redundant if the information conveyed in speech was different from the information conveyed in gesture. Outcomes & Results: Children with SLI produced more gestures than children in the TD group; however, the likelihood that speech-gesture combinations were non-redundant did not differ significantly across the SLI and TD groups. In both groups, younger children were significantly more likely to produce non-redundant speech-gesture combinations than older children. Conclusions & Implications: The gesture-speech integration system functions similarly in children with SLI and TD, but children with SLI rely more on gesture to help formulate, conceptualize or express the messages they want to convey. This provides motivation for future research examining whether interventions focusing on increasing manual gesture use facilitate language and communication in children with SLI.

Background: Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful. Aims: The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature. Methods & Procedures: Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies. Outcomes & Results: Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD. Conclusions & Implications: Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.

Background & Aims: A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours. Methods & Procedures: A 55-year-old man with chronic agrammatism and his wife took part in eight weekly sessions of conversation therapy, adapted from Supporting Partners of People With Aphasia in Relationships and Conversation (SPPARC). Language and conversation were assessed before and after therapy, and the couple's views on conversation and disability were elicited. Conversation analysis was used to analyse: (1) pre-therapy conversation patterns, (2) how the PWA engaged and learned during therapy and the forms of facilitation that aided this process, and (3) qualitative change in post-therapy conversation behaviour. Outcomes & Results: After therapy, the PWA showed increased insight and acceptance of the use of strategies such as writing and drawing in the face of conversational difficulty. However, use was prompted by his wife and was rarely spontaneous. Conclusions & Implications: This single case study suggests that conversation training based around an experiential learning process is able to engage a PWA directly in learning about the effects of aphasia on conversation. Key facilitators were self-study via video and experience of practising conversation whilst receiving online feedback from a speech and language therapist. However, increased insight did not automatically change conversation behaviour. Although he better understood the effects of his aphasia on conversations with his wife, learning stopped short of the ultimate goal of the conversation training programme; the spontaneous use of strategies worked on in therapy when faced with conversation breakdown. One explanation may be that limited cognitive flexibility lead to problems with switching from one strategy to another. (Contains 3 notes, 2 figures, 7 extracts, and 5 tables.)

Background: Aphasiologists often research, assess and treat linguistic impairment and its consequences for daily life separately. Studies that link the language used by people with aphasia to routine communicative activities may expand the linguistic forms treated as relevant for successful communication by people with aphasia. Previous research has suggested that initiating topics in conversation can be problematic for people with aphasia, but it has not been widely investigated. Aims: This paper uses Conversation Analysis to examine how a person with aphasia initiated topics in everyday conversation. It describes the utility of "and"-prefacing for topic initiation. Methods & Procedures: A person with chronic aphasia ("Valerie") was recruited to participate and was video-recorded speaking with four conversation partners. Approximately 3.5 h of recordings were collected, and transcribed according to conversation analytic conventions. Topic initiations in this data set were identified and analysed using conversation analytic procedures. Outcomes & Results: It was found that topic initiations often led to trouble, and that Valerie recurrently used and-prefaced turns when initiating topics (e.g. "and how was your turkey?"). This paper argues that "and"-prefacing was an advantageous method for initiating topics because it smoothed the conversational discontinuities that this action creates. Conclusions & Implications: These findings are consistent with previous observations about the hazardousness of topic initiation for people with aphasia. Valerie's use of and-prefacing suggests that conjunctions and other turn prefaces may be useful for promoting successful communication by people with aphasia during everyday conversation. Future investigation should identify if and how other people with aphasia use turn prefacing when initiating topics, and whether this changes over time. (Contains 5 extracts, 3 tables, and 3 notes.)

Background: Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. Aims: To examine the everyday conversation, at home, of an individual with semantic dementia. Methods & Procedures: A 71-year-old man with semantic dementia and his wife were given a video camera and asked to record natural conversation in the home situation with no researcher present. Recordings were also made in the home environment, with the individual with semantic dementia in conversation with a member of the research team. Conversation analysis was used to transcribe and analyse the data. Recurring features were noted to identify conversational patterns. Outcomes & Results: Analysis demonstrated a repeated practice by the speaker with semantic dementia of acting out a diversity of scenes (enactment). As such, the speaker regularly used direct reported speech along with paralinguistic features (such as pitch and loudness) and non-vocal communication (such as body posture, pointing and facial expression) as an adaptive strategy to communicate with others in conversation. Conclusions & Implications: This case shows that while severe difficulties may be present on neuropsychological assessment, relatively effective communicative strategies may be evident in conversation. A repeated practice of enactment in conversation allowed this individual to act out, or perform what he wanted to say, allowing him to generate a greater level of meaningful communication than his limited vocabulary alone could achieve through describing the events concerned. Such spontaneously acquired adaptive strategies require further attention in both research and clinical settings in semantic dementia and analysis of interaction in this condition, using conversation analysis, may be helpful.

Background: To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. Aims: To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. Methods & Procedures: Semi-structured interviews were conducted with four women and seven men with chronic aphasia (n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. Outcomes & Results: Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. Conclusions & Implications: The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed. (Contains 4 tables.)

Background: One of the most disabling consequences of aphasia is the way it excludes the person from conversation. A number of studies have attempted to tackle this problem by training the conversational partners of aphasic people. This study offers an evaluation of this approach. Aims: Six volunteers were trained in conversing with people with moderate or severe aphasia. The study aimed to evaluate whether training changed the volunteers' knowledge about aphasia and their interactions with aphasic people. It also explored whether changes in the volunteers were matched by improved participation of the aphasic people in conversation. Methods & Procedures: Volunteers were recruited from an aphasia group in Milton Keynes. They were trained as a group over three sessions (9 hours in total). The training drew on the techniques of Kagan (1998, 1999). It included presentation of information using different media, group discussions, viewing of videos and role play. The course aimed to improve (1) the volunteers' understanding of the nature of aphasia, (2) the volunteers' knowledge about communication strategies to use with aphasic people and (3) the skills of the volunteers in supporting aphasic people in conversation. An additional aim was to increase the aphasic subjects' participation in conversation. Two evaluation methods were employed. Specially designed questionnaires were administered before and after training to evaluate the volunteers' knowledge and understanding. Volunteers were also videotaped in conversation with aphasic people before and after training. The videos were rated by speech and language therapists, using nine-point rating scales, derived from Kagan (1999). Outcomes & Results: Significant improvements were seen on the questionnaire scores and in ratings of the volunteers' videos. The rating gains were attributed to the training course, since baseline scores were stable and improvements only occurred after the training period. There were comparable gains in the participation of the aphasic subjects, which again occurred after training. Conclusions: The study demonstrates that a short training course can change the knowledge and practice of experienced volunteers. The findings have implications for teaching generic skills to volunteers working with aphasic people. (Contains 5 tables, 1 figure and 2 notes.)

Background: An individual's ability to make autonomous decisions is fundamental to self‐determination. The presence of neurological pathology, for example, aphasia, and its associated difficulties with language and/or cognition, may affect an individual's capacity to make decisions, or their ability to reveal their capacity to make decisions. Decision‐making by persons with aphasia (PWA) can be enhanced when communication partners are trained and if communication supports are provided, for example, supports that reduce the linguistic and cognitive demands of the task, and/or that facilitate expression. Aims: The main aim of this review is to identify the types of decisions for which persons with post‐stroke aphasia receive support, the communication partners involved in supporting decision‐making by PWA and the communication strategies implemented to support decision‐making by PWA. Methods & Procedures: A multifaceted search strategy was used. Specific keywords were used to search seven electronic databases. Hand‐searches of two journals, as well as ancestral searches of the reference lists of selected articles was also performed. Through the application of predefined selection criteria, 16 journal articles, spanning from 1998 to 2021, were selected from the initial yield of 955 articles for inclusion in this review. Data pertaining to the aims of the study were extracted using a data‐extraction form. Outcomes & Results: This review shows that most of the research to date has focused on supporting persons with post‐stroke aphasia in decisions pertaining to discharge planning or accommodation, and decisions pertaining to informed consent for participation in research. The communication partners cited most frequently as supporting decision‐making by PWA are speech–language pathologists and family members. A range of communication strategies, most of which are components of Supported Conversation Techniques for Adults with Aphasia (SCA™), support decision‐making by PWA. The most frequently listed strategies include augmenting information with different modalities, acknowledging the competence of the PWA, thereby inviting initiation and collaboration by the PWA, and the allocation of sufficient time for the decision‐making process. Conclusions & Implications: This review presents research trends regarding the support of PWA in decision‐making. Future research should focus on the effectiveness of the different strategies identified, and on the support of PWA in the making of a greater variety of complex decisions. WHAT THIS PAPER ADDS: What is already known on the subject: PWA have the right to be given the opportunity to participate in personally relevant decision‐making through all stages of life. Research has shown that decision‐making can be enhanced with trained communication partners and if supports are provided that reduce the linguistic and cognitive demands of the task, and that support the expressive abilities of PWA. What this study adds to existing knowledge: This scoping review is the first to synthesize the findings of research regarding the types of decisions for which persons with post‐stroke aphasia receive support, the communication partners supporting PWA in making these decisions and the communication strategies implemented to support decision‐making by PWA. What are the potential or actual clinical implications of this work?: Clinicians working with PWA may be sensitized to the role they can play in supporting decision‐making by PWA, the current state of the literature regarding types of decisions that may need to be supported, communication partners who can provide such support and communication strategies that may be helpful in this regard. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) is a rare neurodegenerative brain disorder characterized by declining language ability. There is currently no way to reverse or slow the course of the progressive brain degeneration, nor is there a cure for PPA. Throughout the course of the disease, any treatment must therefore be palliative in nature and should be designed to manage symptoms and improve the quality of life of the affected person. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people with PPA written from the perspective of those living with this condition. Aims: I have a clinical diagnosis of the nonfluent/agrammatic variant of PPA (nfvPPA), supported by imaging. In this report I discuss my experience of the progressive loss of language and communication skills, and detail the challenges I have been facing. I also describe how my quality of life has been enhanced by the early initiation of treatment focusing on communication strategies targeted to my specific impairments and designed to support my individual interests and goals. Methods & Procedures: I was fortunate to obtain an early diagnosis from a cognitive neurologist experienced with PPA. From the onset of my language difficulties, I have received excellent personalized care from a multidisciplinary medical team including speech–language pathologists, a cognitive neurologist and other doctors. Main Contributions: My life during the early stage of nfvPPA has been enriched by personalized care focused on supporting the particular activities, interests and goals that are most important and meaningful to me. As my disease has progressed, I have benefited from an evolving range of strategies and adaptations targeted to the specific deficits in the areas of speaking, writing and reading that I have been facing at any given time. In addition, I have adopted methods to enhance the benefit of these language‐directed strategies. And I have been employing evidence‐based approaches that improve general brain health and thereby indirectly support my language. Conclusions & Implications: My experience represents a model for the personalized care of people in the early stage of nfvPPA. WHAT THIS PAPER ADDS: What is already known on the subject: There is minimal information in the medical literature describing the subjective experience of a person with PPA. There is little information in the medical literature about strategies to make meaningful improvements to the quality of life of people in the early stage of PPA. What this paper adds to existing knowledge: I have a clinical diagnosis of nfvPPA, supported by imaging. In this paper I give a first‐person account of my experience of the progressive loss of language and communication skills, and I detail the challenges I have been facing. I describe how my quality of life during the early stage of nfvPPA has been enhanced by an evolving range of strategies and adaptations tailored to my speech and language deficits as they have arisen. These compensatory strategies have focused on supporting the particular activities, interests and goals that are most important and meaningful to me. What are the potential or actual clinical implications of this work?: The description of my subjective experience of the progressive loss of language and communication skills offers insight for speech–language pathologists, neurologists and other professionals involved in the clinical care of people in the early stage of nfvPPA. My experience represents a model for the personalized clinical care of people in the early stage of this disorder. [ABSTRACT FROM AUTHOR]

Background Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims To investigate UK SLTs' current CST practices. Methods & Procedures Thirty-seven UK SLTs completed an online questionnaire, eight of whom attended a follow-up focus group. A clinical consistency scale was applied to the questionnaire data and tasks that were most consistently used were explored in the focus group and analyzed using a primarily deductive thematic data analysis approach. Outcomes & Results Three key CST findings arose: (1) the rarity with which SLTs focus equally and explicitly on both communication partners' strategies; (2) SLTs' differing understandings of CST terminologies and concepts and underuse of formal assessment; and (3) the absence of video feedback. Conclusion & Implications This study's survey findings suggest that conversation partners not only receive half the amount of CST given to people with aphasia but also play a more passive learning role when they are present. This is an interesting point to consider when the current evidence base contains stronger evidence for the effectiveness of conversation partner CST over other CST approaches, it being described as an effective method that may be maintained over time. [ABSTRACT FROM AUTHOR]

Background Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful. Aims The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature. Methods & Procedures Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies. Outcomes & Results Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD. Conclusions & Implications Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD. [ABSTRACT FROM AUTHOR]

Background: To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. Aims: To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. Methods & Procedures: Semi-structured interviews were conducted with four women and seven men with chronic aphasia ( n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. Outcomes & Results: Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. Conclusions & Implications: The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed. [ABSTRACT FROM AUTHOR]