Understanding mechanisms of change after conversation-focused therapy in aphasia

Objective: Conversation therapy in aphasia is a complex but effective type of intervention aimed at changing the linguistic and non-linguistic behaviors of persons with aphasia and/or their conversational partners. Recent studies have examined the experimental effects of conversation-based intervention and found significant change in targeted conversation strategies used by people with aphasia during therapy contexts. This investigation examines the generalization of therapy effects to naturally occurring conversations outside therapy. Method: The current study uses a conversation analysis framework to examine the generalization of this change to conversations between a person with aphasia and their spouse. Results: Conversation analysis revealed changes in the sequential environment of various strategies that were targeted in conversation-based intervention. Most notably, there was a change in the flexibility and deployment of gesture type and the act of writing as a means of achieving mutual understanding. Discussion: This study adds to the growing body of evidence supporting conversation-based interventions. Qualitative analysis of conversation provides important information on a client’s response to intervention and the generalization of targeted strategies to everyday contexts. Conclusion: Given the nature of complex, collaborative, and unplanned conversation, qualitative approaches allow clinicians and researchers to better understand why clients deploy strategies of interest at various junctures. These types of analyses are vital for understanding if and how meaningful life participation is achieved after skilled intervention.