Tangentiality as non-conformity: Responses of participants with right hemisphere damage to questions in clinical interactions

Abstract

Background

People with right hemisphere damage (PwRHD) are often reported to produce tangential or irrelevant utterances. This may be related to their conversational difficulties, including performance in making relevant responses to questions. Clinical interactions represent a major type of communicative activity that PwRHD frequently attend and where they need to answer questions raised by clinicians. So far very little is known about how PwRHD accomplish question–response sequences in such institutional interactions.

Aims

To examine question–response sequences between participants with right hemisphere damage (RHD) and clinicians. To investigate how potentially tangential talk of the former that ensues after the clinicians’ questions may affect their responses to questions in clinical interactions. To identify problems incurred by those utterances as responses and how clinicians utilize conversational practices to manage them.

Methods & Procedures

Drawing on purposive sampling, the study used four recorded interactions between clinicians and participants with RHD as data. The data were transcribed and analysed within the framework of conversation analysis. The study focuses on question–response sequences where participants with RHD produce potentially tangential utterances as responses to questions raised by the clinicians.

Outcomes & Results

Tangential utterances produced by participants with RHD occur either as overall non-conforming answers to the questions (i.e., not conforming to the normative expectations for the action type and/or grammatical form of response in the clinical setting), or non-conforming extension after type-conforming answers. The clinicians often orient to the overall non-conforming answers as problematic and utilize a set of practices to pursue adequate responses.

Conclusions & Implications

The study presents a new approach to understanding tangential talk associated with RHD, framing it as non-conforming answers within question–response sequences. It also describes management practices employed by the clinicians to cope with them. The results add to knowledge about the communication profile of PwRHD, particularly in goal-oriented interactions. They may provide a reference for assessment and intervention for difficulties of PwRHD in accomplishing question–response sequences. The study also suggests that the assessment of conversational behaviours of the clinical group should be placed within wider sequences and specific communicative activities.

WHAT THIS PAPER ADDS

What is already known on the subject

• PwRHD are often reported to produce tangential or irrelevant utterances. They also exhibit differences and challenges in complying with rules in conversational interactions.

What this study adds to the existing knowledge

• By using conversation analysis to examine question–response sequences between PwRHD and clinicians, the study investigates how potentially tangential utterances of the former may affect their responses to questions in clinical interactions. It presents a perspective on tangential talk by describing how PwRHD make non-conforming answers to questions. It also describes clinicians’ management practices of the phenomenon. This study extends the literature addressing conversational behaviours of PwRHDs in institutional interactions.

What are the potential or actual clinical implications of this work?

• The results add to knowledge about the communication profile of PwRHD, especially in terms of accomplishment of the question–answer sequence type. Difficulties in providing conforming answers to questions should be considered as a potential target in assessment and intervention for conversational difficulties of the clinical group. The study suggests assessment of conversational behaviours of PwRHD should be placed within wider sequences and specific communicative activities.