Recipient participation in conversations involving participantswith fluent or non-fluent aphasiaMinna Laaksoa and Sisse Godtb

aDepartment of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland;bDepartment of Behavioural Sciences, University of Helsinki, Helsinki, Finland

ABSTRACTThe present study compares the ways in which conversational partnersmanage expressive linguistic problems produced by participants withfluent vs. non-fluent aphasia. Both everyday conversations with familymembers and institutional conversations with speech-language thera-pists were examined. The data consisted of 110 conversational sequencesin which the conversational partners addressed expressive aphasic pro-blems. Most problems of the speaker with fluent aphasia were locallyrestricted phonological and word-finding errors, which were immediatelyrepaired. In contrast, the sparse expression of the speaker with non-fluentaphasia was co-constructed by conversational partners in long negotia-tion sequences to establish shared understanding. Some differencesbetween recipient participation ineveryday and institutional conversationwere found. The results emphasise the relevance of the nature of theexpressive linguistic problems on participation in interaction. They alsoadd to the clinical knowledge of handling aphasic problems in conversa-tion. This knowledge can be used for developing interaction-focusedintervention.

ARTICLE HISTORYReceived 1 December 2015Accepted 4 August 2016

KEYWORDSAphasia type; co-construction; familymembers; other-repair;speech-language therapists

Introduction

The objective of the present study is to compare the ways in which participants manageexpressive linguistic problems related to fluent conduction aphasia and non-fluent agrammaticaphasia in institutional and everyday settings. In general, conversations involving participantswith aphasia (PWAs) are characterised by frequent expressive linguistic problems and efforts toresolve the problems in extended conversational sequences (e.g. Laakso & Klippi, 1999; Milroy& Perkins, 1992). In problem-solving sequences both PWAs and their interlocutors participatein clarifying meanings and establishing shared understanding. However, collaborative partici-pation may differ between family members and speech-language therapists (SLTs) (Lindsay &Wilkinson, 1999; Laakso, 2015). Besides the difference in everyday and institutional participa-tion roles, the type of aphasia may also influence the participation of the interlocutors: fluentproduction with frequent linguistic errors may call upon different collaborative actions thannon-fluent and linguistically sparse production.

Conversational speech shows adaptations to the underlying linguistic deficits characteristicof the type of aphasia. In fluent conduction aphasia, speech is frequently distorted byphonemic paraphasias (sound errors) and efforts to repair the problem by approximating

CONTACT Minna Laakso [email protected] Department of Psychology and Speech-Language Pathology,University of Turku, Assistentinkatu 7, Turku, FIN-20014, Finland.

CLINICAL LINGUISTICS & PHONETICS2016, VOL. 30, NO. 10, 770–789http://dx.doi.org/10.1080/02699206.2016.1221997

© 2016 Taylor & Francis

the right sound (Bartha & Benker, 2003; Kohn, 1984). Due to the underlying phonologicaldeficit, word-retrieval difficulties and word searching occur. In addition, speakers withconduction aphasia may try to overcome word-finding problems with circumlocutory para-phrasing or by using easily retrievable but semantically weak lexical items (e.g. Helasvuo,Laakso, & Sorjonen, 2004). In non-fluent agrammatic aphasia speech is characterised by theomission of grammatical morphemes, incomplete and incorrect syntactic constructions, andshort utterances (Menn, O’Connor, Obler, & Holland, 1995). As the underlying syntacticdeficit impairs verb and sentence production, speakers with agrammatic aphasia often resortto telegraphic speech style by producing single-word utterances that are mostly uninflectednouns (Heeschen & Schegloff, 1999). One adaptation in conversation is the fronting of nounphrases to the beginning of the turn, so that the speakers overuse left dislocation in their turnconstruction (Beeke, Wilkinson, & Maxim, 2003). Furthermore, the meaning of the turn mayemerge bit by bit by producing sequentially adjacent items without tying them together bygrammatical means (Beeke, Wilkinson, & Maxim, 2007; Heeschen & Schegloff, 1999). Inshort, the two types of aphasia, fluent conduction aphasia and non-fluent agrammatic aphasia,have different (phonological vs. syntactic) underlying deficits that manifest in dissimilar waysin linguistic expression in conversation.

In the present study, the main focus is on the recipient-initiated next turn actions thataim to manage expressive linguistic problems produced by the PWA in a prior turn. Inconversation analysis (CA), expressive problems are characterised as trouble sources thatcan be managed by self- or other-initiated repair. PWAs are not as efficient in self-repairing their own speech as is common in ordinary conversation (cf. Laakso, 1997:130–140). Thus other-initiated actions by the interlocutors become more emphasised.Other-initiated repair can be accomplished in many ways, including asking questions(such as ‘what’, ‘who’, etc.), repeating the trouble source, or by offering candidate under-standings for the recipient to confirm or reject (Schegloff, 2007: 101). In ordinary everydayconversation the recipients usually do not directly correct the original speaker, as self-repair is preferred over other-correction (Schegloff et al., 1977). However, in asymmetricinteractions (e.g. between adults and children) it is common that the more competentinterlocutors are active in resolving the problems and do other-correct (Norrick, 1991).Also in connection with aphasia, co-participants are active and tend to provide candidatewords to resolve e.g. word searching (Laakso & Klippi, 1999; Oelschlaeger & Damico,2000). However if the PWA has non-fluent speech, the interlocutors often co-constructthe sparse talk by adding meaning and extending the agrammatic elements into fullutterances (Goodwin, 1995; Heeschen & Schegloff, 1999). Interlocutors also interpretembodied phenomena such gestures, gaze and facial expressions in co-constructing themeaning of aphasic utterances (e.g. Beeke et al., 2013; Goodwin, 2003; Klippi, 2015;Laakso, 2014). Besides interpretation, conversational partners may use an open-formatother-initiation of repair (e.g. ‘what’ or ‘sorry’) which returns the speaking turn to thePWA (Barnes, 2016). In such cases the PWAs may have difficulties in resolving theproblem. The partners may also resist participating in problem solving (e.g. Aaltonen &Laakso, 2010; Barnes & Ferguson, 2015). However, resistance is not the focus of thepresent study as it analyses collaborative recipient actions.

In collaborative participation, some differences between everyday and institutionalconversational partners have been found. When compared to encounters with every-day interlocutors, the interaction with representatives of a medical institution (e.g. an

CLINICAL LINGUISTICS & PHONETICS 771

SLT in health care) is usually more goal oriented and has special constraints as towhat are the appropriate conversational actions (for medical interaction, see e.g.Heritage & Maynard, 2006). These constraints may result in differences in an SLT’sactions in conversation with a PWA as compared to a conversation between everydayconversation partners. Indeed, differing repair patterns in spouse vs. SLT conversa-tions of PWAs have been found: The spouses tend to repeatedly correct the PWAs’production errors even after the meaning has been recovered, whereas the SLTs avoidcorrection (Lindsay & Wilkinson, 1999). In addition, significant others are found tooffer collaborative completions to word searches, whereas SLTs tend to ask questionsor offer candidate understandings longer than one word (Laakso, 2015). However,thus far, very few studies have compared recipient-initiated repair activities in institu-tional and home conversations of the same PWAs. Furthermore, to our knowledge,the influence of different types of aphasias on recipient participation has not beencompared.

The purpose of the present multiple-case study is to compare the relevance of theaphasia type (fluent vs. non-fluent) to the non-aphasic interlocutors’ management ofexpressive linguistic problems in conversation. The research focus is on recipient-initiatedactions. Everyday vs. institutional conversational partners are also compared. The researchquestions are as follows:

● What kind of expressive linguistic problems and problem-handling sequences man-ifest in conversations involving PWAs with fluent vs. non-fluent aphasia?

● Are the recipient-initiated problem-handling practices of the non-aphasic interlocu-tors different in conversations with:

● participants with fluent vs. non-fluent aphasia?● family members vs. SLTs?

Data and method

Conversations and participants

The data consisted of four videotaped conversations (see Table 1). In these conversationsthere were two kinds of conversational partners, family members and SLTs, in interactionwith participants with two different kinds of aphasia, Lauri (L) with conduction aphasiaand Kalevi (K) with agrammatic aphasia. L conversed at home both with his young adult

Table 1. Conversations and participants.Conversation Participants Location Duration

Conversation 1 L (fluent speaker), L’s home, on the living room couch 00:40:00 hoursT and A(two grandsons)

Conversation 2 L (fluent speaker), L’s home, on the living room couch 00:41:16 hoursSLT-L

Conversation 3 K (non-fluent speaker), K and E’s home at the kitchen table duringafternoon coffee

00:34:11 hours

E (the wife)Conversation 4 K (non-fluent speaker), SLT-K University clinic 00:27:01 hoursTotal 02:22:18 hours

Note. SLT-L = Speech-language therapist working with L; SLT-K = Speech-language therapist working with K.

772 M. LAAKSO AND S. GODT

grandsons (T and A), and with his SLT (SLT-L). K interacted at home with his wife (E)and at the university clinic with his SLT (SLT-K). Pseudonyms are used and name initialsof all participants have been changed to anonymise them. All participants gave in writingtheir informed consent to take part in the study and the principles of research ethics werecarefully followed in gathering and analysing the data. The data belong to a larger researchproject examining the management of problems of speaking and understanding in aphasicconversation (Academy of Finland, grant no 49250).

The conversations of L lasted approximately 40 minutes each, whereas K’s conversa-tions lasted about 30 minutes each. The conversations were digitally videotaped on aMiniDV tape with an additional microphone. The PWAs and their family members chosea time and place where they usually interacted (e.g. a regular visit or an afternoon coffee)and the cameraman (researcher or research assistant) came to videotape that. Theparticipants were asked to interact in the way they ordinarily would. The cameramanwas present in the beginning and end of (and occasionally during) the videotaping whenhandling the camera was necessary. As both PWAs were receiving speech and languagetherapy via a university clinic, they were asked to converse with their SLTs during atherapy session. No specific instructions concerning the conversations were given. Thesesessions were videotaped by the participating SLTs.

Both PWAs were retired males with chronic aphasia (see Table 2). They both had auniversity degree. L (a former CEO) was a 79-year-old man who had suffered an infarc-tion of the left medial cerebral artery 5 years ago. The infarction had left him withmoderately severe conduction aphasia, and he had had several periods of speech andlanguage therapy. L’s language production was fluent but paraphasic with many phonemicand some semantic errors. He also displayed trouble with word-finding and recurrentlysearched for words. K (a former dentist) was a 65-year-old man who had suffered aninfarction of the left medial cerebral artery 29 years ago. The infarction had left him withsevere Broca’s aphasia, and he had had intensive speech and language therapy during thefirst year following his infarct and shorter periods after that. K’s language production wasnon-fluent and agrammatic consisting mainly of uninflected nouns.

In conversation, L was able to use language in various ways for initiating and respond-ing (including questions, answers, comments and narrative turns), whereas K’s commu-nicative actions were mainly responsive to the interlocutors’ actions.

Transcription and analysis

The video material was analysed as Windows Media files. First the conversations weretranscribed according to conversation analytic notation (Atkinson & Heritage 1984: ix–xvi).

Table 2. Background data of the participants with aphasia.

ParticipantLesion

localizationDuration of

illness DiagnosisAphasia type

(BDAE)BNTscore

Severity of aphasia(BDAE)

L, male, 79 years MCA 5 years CVA Conduction/fluent 34/60 3K, male, 65 years MCA 29 years CVA Broca/non-fluent 17/60 2

Note. MCA = medial cerebral artery, CVA = cerebrovascular accident, BDAE = Boston Diagnostic Aphasia Examination(Goodglass & Kaplan, 1983; Finnish version Laine, Niemi, Tuomainen & Koivuselkä-Sallinen, 1997); BNT = Boston NamingTest (Kaplan, Goodglass, Weintraub & Segal, 1983; Finnish version Laine, Koivuselkä-Salllinen, Hänninen & Niemi, 1997);BDAE severity scale 1 = most severe, 5 = mildest).

CLINICAL LINGUISTICS & PHONETICS 773

Along with speech, embodied actions such as hand gestures were described in small capitalswithin double parentheses on a separate line below the utterance they co-occurred with. Forthe sake of clarity, the data extracts include embodied actions only if they are relevant for thepresent analysis. In the data extracts (see example 1), an English translation is provided (inbold face) alongside the original transcription (in italics). When of analytic interest, the talkof each person is depicted in three lines consisting of the original Finnish, an English word-by-word gloss (see glossing symbols in the Appendix), and an English translation. In thegloss line, unintelligible word forms are marked with question marks and, if possible, targetsof these word forms in curly brackets (see line 02 in example 1):

The results were obtained through CA paying special attention to repair organisation(Sacks, 1992; Schegloff et al, 1977). First, all instances where any of the speakers orientedto a section of a conversation as problematic were identified. These problem handlinginstances were divided into sequences by topical organisation. Out of these topicalsequences a total of 72 sequences were such where the non-aphasic interlocutors, i.e.the recipients of the PWAs’ talk, indicated the previous turns of the PWAs as problematic.These were referred to as negotiation sequences. During this preliminary analysis, it wasobservable that the negotiation sequences in conversations involving the two men weredifferent. The conversations of the fluent speaker allowed for a turn-by-turn analysis ofrepair organisation while in the conversations of the non-fluent speaker separate repairsequences were not easily identifiable. Thus, the initial 27 negotiation sequences of thefluent speaker were further analysed for local repair phenomena, and altogether 65 repairsequences of two or more turns during which the problem was dealt with were identified(see Table 3). In connection with non-fluent aphasia, problem handling manifested inalmost all conversational turns of the participants without clearly identifiable repairsequences, and could only be investigated at a broader topical sequential level. Thus,forcing the 45 topical negotiation sequences of the non-fluent speaker into more conciserepair sequences was not appropriate. The sequences analysed accordingly consisted of110 problem-handling sequences in total (see Table 3).

Results

The nature of expressive linguistic problems in conversations of participants withfluent vs. non-fluent aphasia

The trouble sources of the speaker with fluent aphasia were identified either as word search(see example 2; cf. also Goodwin & Goodwin 1986) or as a problem of general intelligibility(see example 3, cf. also Damico et al., 2008), when a clear word search was not present but

(1) Example of the transcription, glossing and translation ofdata extracts.

01 L: onko se- tuo- (.) hh .mt Ville kertonuis-Q he that 1nameM tell-PPChas he- that- (.) hh .mt Ville told you

02 minkälaista se on (0.5) amer- amerissa- (-)what.sort.of-PAR it is {army}-INEwhat it is like (0.5) in the a- ar- (-)

774 M. LAAKSO AND S. GODT

something in the turn was unintelligible enough to stop the flow of conversation, and ledto a subsequent repair initiation in the next turn by the interlocutor. In the followingexample (2), a word search occurs (lines 01–05). The fluent speaker L is talking with histwo grandsons (A and T) about global politics. On line 01, L starts a new topic and endsup trying to produce a place name in Africa:

L’s utterance on lines 01–05 includes many search markers such as pauses (three of themextending to one second, see lines 02, 04, 05), comments on his own knowledge or abilityto find the word: ‘I don’t know what it is’, (line 01) and attempts at approximating thephonemic structure of the target words (lines 02–05). On line 06 his grandson A offers hissuggestion for the searched word, Eritrea. It is noteworthy that A’s suggestion phonemi-cally resembles L’s last attempt at the word. Due to the nature of his aphasia L is able toproduce expression referring to a place (‘there’, line 03) and phonemic approximations ofthe place name (lines 04–05), which may make it easier for the recipient to offer a

Table 3. Analysed problem handling (repair and negotiation) sequences.Conversation Sequences

Conversation 1 29 repair sequences(L, grandsons)

Conversation 2 36 repair sequences(L, SLT)

Conversation 3 29 negotiation sequences(K, wife, cameraman)

Conversation 4 16 negotiation sequences(K, SLT)

Total 110

(2) Word search. (The possible targets of erroneous or cut-off word forms arein curly brackets in the gloss line. If no target can be traced the word ismarked with a question mark on the gloss line.)

01 L: Mmm se:(.) en tiiä- (.) en tiiä hh mikä se onit NEG-1 know-INF NEG-1 know-INF what it is

Mmm it:(.)I don’t know-(.)I don’t know hh what it is

02 e- e- e: e::len kaks (a: h eutrah (1.3){eilen=yesterday} two ?e- e- e: {yesterday} two (a: h eutrah (1.3)

03 epron hh)(0.7).HH sielä hh ö: (0.5).mt lasa hh? there ?

epron hh)(0.7).HH there hh uh: (0.5).mt lasa hh

04 lasarin hhh (1.0).hhh apessiina (.) apessiina hh? {Abessiinia=Abyssinia} {Abyssinia}

lasarin hhh (1.0).hhh {Abyssinia} (.){Abyssinia}hh

05 (1.0) vedutrea hh{Eritrea}

(1.0) {vedutrea} hh

06 A: Eritrea niinkö.Eritrea PRT-Q (appr. you mean)you mean Eritrea.

07 L: Nii.PRTRight.

CLINICAL LINGUISTICS & PHONETICS 775

candidate interpretation. Grandson’s candidate is formulated as a polar question with theinferencing particle niin (its meaning here as an independent clausal unit corresponds to‘right’) and the question clitic -kö, which is then confirmed as correct by L.

Example (3) illustrates the other characteristic trouble source by speaker L, a problemof general intelligibility (see lines 04–05). L is talking with his SLT (SLT-L) about theheating system in his house. In the beginning of the sequence, SLT-L asks which heatingsystem the house has (line 01):

On line 02, L responds without problems that his house has district heating, a heatingsystem in which a centralised plant using gas or oil delivers heating for a whole townsuburb. From line 04 onwards L begins to expand his original response but is not able tocontinue his utterance to an understandable completion. Instead, after describing thedistrict heating as ‘it burns somewhere’, he only produces some cut-off attempts atwords (line 05). In overlap with L’s attempts the SLT-L starts to process the trouble byoffering her candidate understanding (line 06). Using the particle niin (here in turn-initialposition appr. ‘I see’), SLT-L’s candidate ‘somewhere far away’ is formulated as inferen-cing from L’s prior talk about district heating (‘far-heat’, line 02) rather than on thephonemic structure of L’s cut-off attempts on line 05. It is also produced as a completionto fit L’s utterance: ‘it burns somewhere’ – ‘somewhere far away’. However, as the exactnature of the expression L was striving at remains unintelligible, he only acknowledgesSLT-L’s candidate resolution with ‘mmm’ (line 07).

In sum, the expressive problems in the turns of the speaker with fluent conductionaphasia were regularly phonemically distorted words that were cut off to search for abetter approximate. In some cases, the cut-off attempts provided information for therecipient to interpret the word and offer a specific candidate (example 1). In the othercases, the recipients produced more general interpretations based on L’s prior talk(example 2). L’s expressive problems were thus specific occurrences amongst otherwiseunderstandable conversation that could be treated with specific recipient-initiated repair

(3) Problem of general intelligibility.

01 SLT-L: Onko tässä niinku öljy vai sähkölämmitys tässä-is-Q here-INE PRT(like)oil or electric heating here-INEIs it like oil or electric heating system in here-

02 L: Se on kaukolämpö.it is disctrict.heating (literally: ‘far-heat’)It is district heating.

03 SLT-L: Kaukolämpö [joo.District heating [yeah.

04 L: [Nii.(0.8) se palaa(2.0)jossakiPRT it burn-3 somewhere[Right.(0.8) it burns(2.0)somewhere

05 (tapah- (.) [ve-){tapahtua=happen} ?(hap- (.) [ve-)

06 SLT-L: [Nii jossain kaukana.PRT somewhere far.away[I see somewhere far away.

07 L: Mmm.

776 M. LAAKSO AND S. GODT

practices. The participation structure of the repair sequences in L’s conversations mani-fested as follows:

(1) There is an identifiable problem in the turn of the fluent aphasic speaker.(2) The recipient offers a candidate resolution in the next turn.(3) The PWA confirms/rejects the repair.

On the contrary, in the conversations of the non-fluent speaker almost all speaking turnsof the PWA were problematic due to his limited linguistic expression. Most of K’s turnscould be characterised as minimal expression which led to a telegraphic construction of aturn (see example 4, lines 04–05). In this example the non-fluent speaker K is talking withhis wife (E) about his hobby, photography:

In example (4), the wife introduces a new topic to the conversation by asking a question (line01). The non-fluent speaker K responds to the question minimally with an affirmative particlejoo ‘yes’, and does not develop the topic any further (line 02). His turn thus provides the mostminimal possible answer to E’s question. On line 3, the wife then develops the topic by asking afollow-up question. To this question K responds with a more extended answer that he constructsin telegraphic style (lines 04–05; cf. Beeke et al., 2003; Heeschen & Schegloff 1999). He starts witha clausal construction joo mutta toi (‘yes but that’), cuts it off and pauses for almost 5 seconds.After the pause he produces isolated words: the elements of K’s turn are adjacent, separated withpauses, but do not form a clear clausal structure. He frequently uses the pronoun toi ‘that’ forprojecting that there is more to come, as toi is used as a modifier to a noun (cf. Helasvuo et al.,2004). Most of the words he uses are not inflected, and finally he is able to say his main point, ‘25pictures’, although without a clear sentence structure its meaning is hard to interpret. However,

(4) Minimal expression and telegraphic construction of a turn.

01 E: Onks valokuvia viel tekemättä.is-Q photograph-PL-PAR still do-INFAre there still photographs to develop.

02 K: Joo.Yes.

03 E: Otit sä sielt Matin synttäreilt kuvia.Take-2-PST you there-ABL 1nameF-GEN birthday-ABL picture-PL-PARDid you take pictures at Matti’s birthday party.

04 K: Joo mutta toi- (4.7)aa vaitta toi- (2.8) iso toi-PRT but that ? that big thatYes but that-(4.7.) ah vaitta that-(2.8) big that-

05 (3.0)kaksikymmentä (.) viisi (1.5) kuvaa.twenty five picture-PAR

(3.0)twenty (.) five (1.5) pictures.

06 E: Jäi ottamatta.leave-PST take-INFWere not taken.

07 K: Ei (1.7) mutta toi,no but thatNo (1.7) but that,

08 (8.4)

CLINICAL LINGUISTICS & PHONETICS 777

E offers a completion to K’s telegraphic construction (line 06). In this way she co-constructs K’sutterance into a full sentence: ‘Yes but twenty five pictures were not taken’. K, however, rejectsher interpretation (line 07), and the negotiation continues.

In sum, the expressive linguistic problems of the PWA with non-fluent aphasia were moreextensive affecting most of his speaking turns. As a consequence, the participation structure ofthe negotiation sequences in these conversations manifested as follows:

(1) The non-aphasic speaker presents a question or new topic and a response isexpected; the turns are speech eliciting in nature.

(2) The speaker with non-fluent aphasia produces a response which results in troublebecause of sparse expression.

(3) The non-aphasic speaker co-constructs the utterance supplying a fuller grammaticalstructure; the turns are interpretative in nature.

(4) The negotiation continues until mutual understanding is satisfactorily reached orattempts thereof are renounced.

In the following, we will illustrate further these different participatory structures within theconversations of fluent vs. non-fluent participants. We will focus on the methods employed bythe recipients to address the trouble emerging from expressive linguistic difficulties. First, we willanalyse and compare the family members’ and SLT’s next turn repair actions in the conversa-tions of the participant with fluent aphasia. Second, we will look at the family member’s andSLT’s actions in the conversations of the participant with non-fluent aphasia.

Recipient actions in conversations of the participant with fluent aphasia

As shown earlier, the trouble sources of the fluent speaker proved to be more local. As aconsequence, they were solved by relatively uncomplicated next turn repair actions. Example(5) illustrates a paraphasic word search, the most common expressive problem in the con-versation between the fluent speaker L and his two grandsons (A and T) (see lines 01–04). Tresponds to the search with a word candidate (line 05; for a similar practice see e.g.Oelschlaeger & Damico, 2000):

(5) Offering a word candidate.

01 L: Nii. (2.4) .mt joo hh .mt (3.2).mt hh (on hh nä hh)right yeah is ?Right. (2.4) .mt yeah hh .mt (3.2).mt hh (has hh nä hh)

02 (1.5) .mt (1.8) onko se- tuo- (.) hh .mt Villeis-Qhethat 1nameM(1.5) .mt (1.8) has he- that- (.) hh .mt Ville

03 kertonu minkälaista se on (0.5) amer- amerissa- (-)tell-PPC what.sort.of-PAR it is {army}-INEtold you what it is like (0.5) in the a- ar- (-)

04 amer[(—){armeija=army}ar [(—)

778 M. LAAKSO AND S. GODT

In example (5), the fluent speaker L asks a question about a mutual relative (lines 01–04).On lines 03–04 he runs into word finding difficulty in completing his turn and cannotreach the correct form of the word. However, at the end of a grammatical construction hisword search is suggestive enough for T, one of the grandsons, to come up with a wordcandidate, and so on line 05, T joins the search in overlap by offering the word tocomplete L’s turn. The close relationship between the participants and the family mem-ber’s shared knowledge on the topic may also make it easier to offer a word candidate. Theword candidate is approved by L who repeats it (line 06). This example works to exemplifyhow a linguistic difficulty, a word search, can quite directly and immediately be fixed inorder to move forward in the conversation much like what would happen in an ordinaryconversation between non-aphasic speakers (cf. Goodwin & Goodwin, 1986).

Besides word candidates, direct other-corrections were common in fluent conversations(see example 6). Here L and his two grandsons (T and A) are talking about the boys’prospective matriculation examinations. An unmodulated other-correction typical ofeveryday interaction (cf. Haakana & Kurhila, 2009) occurs on line 03:

In commenting how the boys must prepare themselves for the exams, L unsuccessfullyapproximates the word prepata ‘prime’ with a cut-off attempt preta- and a further formperetal (line 01). L is already beginning to move on in making his comment (line 02) whenA, the other grandson, corrects (line 03) the paraphasic form in overlap with L who isfinishing his turn. Although A’s turn is a direct other-correction, it is not treated as

05→ T: [Armeijassa.=army-INE

[In the army.=

06 L: =Armeijassa.army-INE=In the army.

(6) Other-correcting.

01 L: Teidän pitää- (1.1) nyt sitte- (.) preta- peretalyou-PL-GEN must now then {prime} {prime}So you need to-(1.1) now- then- (.) pri- pirem

02 eng[lang-Englishfor Engl-

03 → A: [Prepata.prime-INF

[prime.

04 L: Nii.PRTRight.

05 A: Joo.PRTYes.

06 T: Ni:i.PRTRight.

CLINICAL LINGUISTICS & PHONETICS 779

problematic by L who confirms it (line 04). The other-correction makes up a minimalinsertion sequence (lines 03–04), after which the conversation returns to its progressionand L’s comment on lines 01–02 receives its response from both boys (lines 05-06).

The above-mentioned direct problem-handling methods (i.e. word candidates andother-corrections) were characteristic next turn repairs in the conversation between Lwith fluent aphasia and his grandsons. These frequent other-repairs did not appear to beconsidered problematic although there is a preference for self-repair in conversation(Schegloff et al., 1977). On the contrary, direct other-repair resolved the trouble effectivelyand permitted the participants to develop the topic instead of focusing on repair.

However, the participation of the SLT differed from the family members to someextent. In example (7) L and his SLT are talking about the funny name of L’s residentialarea. Instead of directly correcting, the SLT offers a display of her understanding as a fullsentence (lines 05–06):

On lines 01‒03, L comments that if he were better able to talk, he would do somethingregarding the name. L’s turn includes pauses and attempts at self-repair and the end of theturn (line 03) is hard to understand. The SLT does not readily respond (line 04), afterwhich she first acknowledges L’s turn and then offers her formulation (lines 05–06) of thegist of L’s meaning for L to confirm or reject, resembling rephrasing formulations used inpsychotherapy (cf. Weiste & Peräkylä, 2013) which offer the therapist’s version of theclient’s description. The SLT’s formulation is produced as a summarising sentence, not asa single word as were the word candidates of the grandsons. On line 07, L indicates thatthe SLT’s formulation is correct by approving it. In contrast to the direct methods of thetwo grandsons, the SLT’s approach seems more indirect and subtle. She does not interruptthe turn of L by offering immediate corrections (instead she responds after a pause).Giving time and not instantly assuming the floor may reflect the rehabilitative elements ofspeech-language therapy. Not taking the floor at the first possible place seems to

(7) Offering candidate understanding.

01 L: °juu,° (1.3) jos minä olisin paremmin (0.6) puhu-yeah if I are-1-CON good-COMP speak°yeah,° (1.3) if I was better (0.6) at speak-

02 puhumaan niin (.) menisin- menisin sinne joskus (.)speak-INF so go-1-CON go-1-CON there sometimespeaking (.)I would go- I would go there sometime (.)

03 heh heh (1.2) vähä (käy käy-) (.) Pönttölä.a little fit fit place-name

heh heh (1.2) a little (fit fit-) (.) Pönttölä.

04 (1.3)

05 → SLT-L: Mmm. (.)pyrkisit vaikuttammaan ettätry-2-CON influence-INF that

Mmm. (.)you would try to influence on

06 → muutetaan nimi.change-PAS DEF namechanging the name.

07 L: Niin? (0.8)PRTYeah? (0.8)

780 M. LAAKSO AND S. GODT

encourage the speaker with aphasia to resolve the trouble on his own. In this way sheallows the preferred self-repair to take place. In therapy other-correction may be experi-enced as dispreferred. The SLT’s multi-word response also models sentence-level expres-sion for the aphasic speaker.

Recipient actions in conversations of the participant with non-fluent aphasia

In contrast to the easily identified, isolated trouble sources in fluent conduction aphasiaand the immediate next turn resolution thereof, in non-fluent aphasia, trouble permeatesthe conversation, leaving the non-aphasic speaker responsible for co-constructing a mean-ing for the turns. In example (8), K with non-fluent aphasia is talking with his wife (E)about their plans for the day in a form of a ‘hint-and-guess’ sequence where questions,interpretations and guesses by the non-aphasic participant alternate with the answers andhints by the PWA (cf. Laakso & Klippi, 1999). The wife starts the topic by informing Kwhat she is going to do in the evening (lines 01–02):

(8) Co-constructing ‘hint-and-guess’ sequence.

01 E: No kuule (1.2) mä lähden nyt sitte tänä iltanaPRT hear-2-IMP I go-1 now then this-ESS evening-ESSWell you (1.2) I’m going to go draw in pencil

02 piirtämään.draw-INFtonight.

03 K: Jaaha?PRTI see?

04 E: Mmmhm?

05 K: Minä toi khhh kauppa toi (.) leh- toi lehti?I that store that {magazine} that magazineI that khhh store that (.) mag- that magazine?

06 E: Nii?So?

07 K: Ja ((coughs)) kir- kirje (.) kirja.

and {letter} letter bookAnd ((coughs)) let- letter (.) book.

08 → E: (Oo sun) mitä Tekniikan maailman vai?you-GEN what magazine.name-GEN or

(Oh your) World of Technology or which one?

09 K: Joo.Yes.((K LOOKS AWAY FROM E))

10 → E: Vaiko Tietokonelehti.Or-Q magazine.nameOr Computer Magazine.

11 K: £Joo se toih-£yeah it that

£Yes this that-£

CLINICAL LINGUISTICS & PHONETICS 781

The new topic the wife introduces is met with K’s short response (line 03), and the wifeencourages K to expand with a minimal interrogative Mmmhm? (line 04). As a result, Kproduces a telegraphic-style utterance ‘I – store – magazine’ (line 05). In this slot, hisutterance is interpretable as commenting what he himself is going to do later. Again thewife invites K to continue with an inquiring minimal response (line 06). K continues byadding elements ‘and letter book’ (line 07) which do not clarify the meaning of his priorturn. The wife proceeds to offer a name of a magazine, and a ‘hint and guess’ sequencebegins (line 08). The wife’s interrogative guess-type turns alternate with K’s hint-typeanswers until line 16 where K utters a crucial hint ‘America’ which is followed by thewife’s final candidate, Computer Magazine (line 17). The wife’s single word offers resemblethe word candidates the grandsons used to resolve word searches in the fluent data. Thesequence then ends with acknowledging closing turns (lines 18–19). There is an interestingdetail on lines 08–09 where K seems to accept the wife’s first word candidate as correct. Oncloser inspection K’s turn on line 09 is hesitant in tone and he does not direct his gaze to hiswife to confirm his verbal message. In the light of this conflicting information the wife,perhaps having adapted to the aphasic difficulties manifested in their conversations, is ableto see that the current word candidate may not have been correct and proceeds to offeralternatives that seem to be based on her prior knowledge on magazines her husband usuallybuys. Another potential display of the couple’s adaptation to the husband’s disability is howthe wife chooses to begin negotiating the meaning of K’s turns on lines 05 and 07. Sheignores the letter and book K has mentioned but instead targets the name of the magazinewhich she treats as the most crucial bit of information regarding the topic. Her actionresembles the behaviour of the two grandsons in the fluent speaker data in that it seems toaim at as effortless solution as possible in order to further the topic of conversation.Interpreting K’s turns in their entirety might have led into a prolongation of the negotiation.

The dissimilarity in everyday vs. institutional recipient participation was not as explicit in thenon-fluent speaker conversations as in the fluent data. In the non-fluent data, the SLT co-constructs the talk of K in a way that resembles the wife’s actions in the home conversation.However, whereas the wife initiates conversational topics by commenting, the SLT tries to elicit

12 → E: £Vai molemmat.££Or both.£

13 K: £Yksi.££One.£

14 → E: Kumpi.whichWhich one.

15 (1.2)

16 K: Se (.) ((coughs)) Amerikka toi,it America thatIt (.) ((coughs)) America that,

17 → E: Tietokonelehti.magazine nameComputer Magazine.

18 K: Mmm,

19 E: Joo. (1.5)Yeah. (1.5)

782 M. LAAKSO AND S. GODT

and prompt conversation by asking questions, which is a practice typically employed by SLTs(cf. Silvast, 1991). In example (9), the non-fluent speaker K and SLT-K are talking about K’shobbies:

(9) Speech elicitation, prompting and co-constructing a ‘hint-and-guess’ sequence.

01 SLT-K: Mt entäs sitte siitä- (.) sä har- sanoit että säwhat about then it-ELA you say-2-PST that youWhat about that then- (.) you take- you said that you

02 harrastat sitä valokuvausta. (.)take-2.an.interest.in it-PAR photographing-PARtake an interest in photographing. (.)

03 kerro siitä. (1.8) sul on kameroita. (.)tell-IMP it-ELA you-ADE is camera-PL-PARtell me about that. (1.8) you’ve got cameras. (.)

04 montakin.many-CLImany too.

05 K: Joo.PRTYes.

06 (2.5)

07 SLT-K: Minkälaisia.what.kind-PL-PARWhat kind.

08 (2.1)

09 K: Vanha toi- (1.9) kaksikymmentä- ei kolmekymmentä-

Old that twenty no thirtyOld that- (1.9) twenty- no thirty-

10 ei: neljäkymmentä vuotta toi- (1.6) heh vanhat.no forty year-PAR that old-PLNo: forty years that- (1.6) heh old.

11 → SLT-K: Oot sitäkin harrastanuare-2 it-PAR-CLI take.an.interest-PPCYou have taken an interest in that

12 → nelkyt vuotta.forty year-PARfo forty years.

13 K: Joo.PRTYes.

14 → SLT-K: Valokuvausta [myöskin.photographing-PAR too-CLIPhotographing [as well.

15 K: [Joo. (.) joo.PRT PRT[Yes. (.) yes.

16 → SLT-K: Onko sulla kameraa siltä ajalta.is-Q you-ADE camera-PAR it-ABL time-ABLDo you have a camera from that period.

17 K: Joo.PRTYes.

CLINICAL LINGUISTICS & PHONETICS 783

In example (9) on lines 01–04, the SLT introduces a new topic, K’s hobby of photography, intothe conversation. The SLT’s question ‘do you have many cameras’ is met with a minimalaffirmation by K (line 05). The conversation does not progress and the SLT follows up withanother question ‘what kind of cameras’ (line 07), which prompts K to a telegraphic expression‘old – twenty – thirty – forty – years old’ (lines 09–10). From lines 11–12, the SLT interprets andco-constructs the meaning of K’s turn. As K confirms, the SLT goes on by asking furtherquestions to which K responds (lines 13–21). On line 22, the SLT produces one final question inthe topical sequence, K responds minimally and the topic is closed by weak mutual agreement(lines 24–25). In the sequence there are SLT’s turns that demonstrate speech elicitation whichmay serve a specific speech therapy purpose but as a whole the sequence makes up a ‘hint-and-guess’ sequence where K’s hint/answer turns follow the SLT’s guess/question turns much likewhat could be seen in the conversation between K and his wife. Similarly as with fluent data, theSLT’s questions are formulated as full sentences, not as single word candidates. However, theSLT’s lack of shared background knowledge may affect her co-constructive turns.

Summary of the results

Due to the differences in linguistic deficits the overall structures of the fluent and non-fluentaphasic conversations turned out to be distinct. This difference was reflected both in the wayaphasic expressive trouble appeared in these conversations and how it was managed. The mostsignificant difference in the participation of the interlocutors proved to be that specific repairphenomena were present in the fluent conversations while the non-fluent conversations were co-constructive in nature. In the fluent conversations the non-aphasic participants were able toaddress specific, less obtrusive trouble sources, most typically word searches and phonemicparaphasias, quite directly and most of the time successfully with little interruption to the flow of

18 → SLT-K: Se- (.) nelkyt vuotta vanha.it forty year-PAR oldThat- (is)(.) forty years old.

19 K: Joo. (.) lapset ja toi- (.) ja toi- (.) joo.

PRT child-PL and that and that yeahYes. (.)children and that- (.)and that-(.) yes.

20 → SLT-K: Et sä et itse käytä enää sitä.that you NEG-2 self use-PAS anymore it-PARSo you don’t use it yourself anymore.

21 K: Ei. (.) ei se toi-no no it thatNo. (.) no it that-

22 → SLT-K: Mut onks se kuitenkin käyttökelpoinen periaatteessa.but is-Q it anyway usable principle-INEBut it still works in principle.

23 K: Joo?PRTYes?

24 SLT-K: [Mmm?

25 K: [°Joo.°PRT

[°Yes.°

784 M. LAAKSO AND S. GODT

the conversation. In the non-fluent conversations the non-aphasic participants continuouslyinterpreted and co-constructed the turns of the participant with non-fluent aphasia. The primaryaction in the non-fluent conversations thus became the turn-by-turn co-construction of mean-ing in an attempt to establish some level of mutual understanding.

In the data of the fluent aphasic speaker, the SLT and the grandsons used differing practicesin handling the emerging trouble. The most direct single-word methods of repair (such as other-corrections and single word candidates) were used more by family members than by the SLT. Incontrast, the practices used by the SLT were less direct and in the form of complete sentences(such as candidate understandings of the prior turn and summaries of a longer sequence)instead of single-word turns. In the non-fluent data both the wife and the SLT worked towardsshared understanding by co-constructing ‘hint-and-guess’ sequences. The co-construction ofmeaning seemed to vary little with regard to the interlocutor. However, with the SLT speechelicitation activities seemed more prominent and the SLT formed her guesses and questions ascomplete sentences.

In sum, the results of the present study suggest two kinds of conclusions. First, the type ofaphasia seems to have a significant impact on the emerging participation structure of theconversation and on the practices the recipients employ to manage the problems (i.e. repair vs.co-construction). Second, the participation of the family members and the SLTs seems to bedissimilar in certain ways.

Discussion

It has been noted in previous research that the deteriorated linguistic competence of speakerswith aphasia renders aphasic conversation asymmetric which in turn gives rise to specificinteractional phenomena. Such typical features include the emphasised role of non-aphasicspeakers in the management of trouble in communication (see e.g. Bloch & Beeke, 2008;Heeschen & Schegloff, 1999; Oelschlaeger & Damico, 2000; Milroy & Perkins, 1992) and theprolongation of the repair sequences that appear in order to solve such trouble (see e.g. Laakso& Klippi, 1999; Lindsay & Wilkinson, 1999; Laakso, 2003). The results of this multiple-casestudy support the findings of the emphasised role of the non-aphasic interlocutors. However,our comparative approach revealed some differences in recipient participation depending onthe type of aphasia: the principal participatory approach of handling trouble in the fluentspeaker data was repair while in the non-fluent data it was co-construction.

Contrary to previous studies of aphasic conversation (e.g. Laakso & Klippi, 1999), prolongedsequential repair was not found in connection with chronic fluent conduction aphasia. Inparticular in the conversations with family members, the expressive aphasic problems werehandled immediately and rather effortlessly in the next turn following the problem. On theother hand, the prolongation of the negotiation sequences and the role of the non-aphasicspeaker were especially prominent in the non-fluent data. Thus, the findings of this studyconcur with previous studies that have investigated severe (e.g. Goodwin, 1995) and non-fluentagrammatic (e.g. Heeschen & Schegloff, 1999) aphasias. In the non-fluent data, initiatingconversation in the first place required the active participation of the non-aphasic speaker.However, with the support of the interlocutor the non-fluent speaker was able to contribute tothe conversation at hand. The non-aphasic participants viewed the speaker with non-fluentaphasia as a competent conversationalist and for the most part truly strived to interpret, suggestand create meaning for his turns. The same has been observed by Goodwin (1995). The way

CLINICAL LINGUISTICS & PHONETICS 785

Heeschen & Schegloff (1999) describe the aphasic telegraphic style mobilizing the non-aphasicspeaker to act as an active collaborator and interpreter in re-forming the aphasic telegraphicutterances was also evidenced by the current study.

The current data may reinforce the conclusions that the nature of participation betweenfamily members and SLTs is different (see e.g. Lindsay & Wilkinson, 1999; Perkins, 1995).The present observations are analogous also with Laakso (2015) in that—just like ineveryday conversations in general—the essential aspiration in the family conversation isto promote the topical flow of the conversation by managing the trouble as efficiently aspossible. Instead the participation of the SLTs seems less efficient. The SLTs’ lack of sharedknowledge on the PWAs’ life as compared with the relatives may also influence theaccuracy of their interpretive actions. The SLTs’ indirect sentence-level practices resemblethose found by Lindsay and Wilkinson (1999). In fluent speaker data, the family membersuse more direct methods than the SLT to deal with the trouble, much like the promptword candidates described by Oelschlaeger & Damico (2000). Also noteworthy is thatdirect other-correction is not dispreferred, contrary to the prior findings of Perkins (1995)and Wilkinson (1995) on English aphasic conversation.

Limitations, further research, and clinical implications

The results suggest that there may be different conversational participatory structures wherethe type of aphasia may be one of the dividing factors. It is nonetheless best assumed thatthe variation is substantial even within one aphasia type which is why a dichotomy merelybased on aphasia fluency should probably be considered cautiously (cf. Helasvuo, Klippi, &Laakso, 2001). The differences in the chronicity and severity of aphasia in our data may playa role and deserve further study. In our study, due to the nature of his conduction aphasia,the fluent speaker was less severely impaired in his expression than the speaker with non-fluent agrammatic aphasia. If possible, future studies could examine conversations involvingparticipants with similarly severe but qualitatively different aphasias. Our findings alsosuggest that further research directed at everyday conversations along with the institutionalsettings is essential. Varying settings and co-participants may lead to different displays of thecommunicative competence of the PWA. Thus, examining only one setting may give alimited view on the possibilities for participation the PWA has.

The findings imply that clinical professionals should increasingly use videotaped everydayinteractions as well as therapy data in evaluating the language and communication of peoplewith aphasia. Systematic study of recipient-initiated repair actions in naturally occurringinteraction gives research-based knowledge that can be used in training conversationpartners, which has become an increasingly common approach in aphasia rehabilitation(for a review of such training approaches, see e.g. Simmons-Mackie, Savage, & Worrall,2014; Turner & Whitworth, 2006; Wilkinson, 2010). Future studies should explore the use ofnext turn repair practices in clinical partner training. The differences in repair practicescould be taken into consideration in partner training: one might want to train moreimmediate repair practices in connection with fluent conduction aphasias, whereas inconnection with non-fluent agrammatic aphasia the approach might be more on co-con-struction, elicitation and assisting augmentative and alternate communication methods,

786 M. LAAKSO AND S. GODT

such as pictorial support. With detailed case studies we can accumulatively form a larger,systematic database within which training outcomes can be observed.

Declaration of interest

The authors declare no conflicts of interest.

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Appendix

Principles and abbreviations used in glossing (modified from Sorjonen, 2001).

In the gloss, morphemes have been separated from the root with a hyphen.

The case endings are referred to by the following abbreviations:

Other abbreviations:

Case Abbreviation Approximate meaning

Genitive GEN possessionPartitive PAR partitivenessInessive INE ‘in’Elative ELA ‘out of’Adessive ADE ‘at, on’Ablative ABL ‘from’

Abbreviation Meaning

1 First person ending2 Second person ending1NAME First nameCLI CliticCON ConditionalCOMP ComparativeINF InfinitivePL PluralPRT ParticlePST Past tense (imperfect)Q Interrogative clitic

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