A collaborative approach for treating conversational narratives: An aphasia treatment case study

conversational narratives;aphasia;intervention;barrier game;kernel narratives;communication confidence

Schwimmer, Natasha Hannah ; Channell, Marie, ; ,Ishikawa, Keiko ; Hengst ; Julie A.

关键词: conversational narratives;    aphasia;    intervention;    barrier game;    kernel narratives;    communication confidence;   

Others  :  https://www.ideals.illinois.edu/bitstream/handle/2142/101587/SCHWIMMER-THESIS-2018.pdf?sequence=1&isAllowed=y

美国|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

The current study aims to understand the ability of a 15-session, collaborative intervention to support conversational narrative telling between an individual with moderately-severe, chronic aphasia, Mr. Lee, and a clinician partner.This study merges lines of research from the social-learning-based barrier game intervention (Hengst 2003, 2008; Hengst, Duff, & Dettmer, 2010) and research characterizing conversational narrative use by individuals with aphasia (Pratzel, 2008).Utilizing an interpretive case-study design, this study incorporates ethnographic methods of data collection for discourse analysis, and an additional clinical assessment tool, the Communication Confidence Rating Scale for Aphasia (Babbit & Cherney, 2010), to monitor the potential impact of the intervention on Mr. Lee’s communication confidence outside of treatment conditions.Data collection included four initial assessment sessions, followed by 15 overall treatment sessions comprised of 12 barrier game sessions and three photo album sessions.Treatment sessions were carried out two times per week for a total intervention duration of two months.Each barrier treatment session (treatment sessions 1-4, 6-9, 11-14) included an initial captioning exercise of new photo playing cards, up to six rounds of playing the two-player barrier game, and a final elicited narrative probe.The barrier game consisted of Mr. Lee and a clinician partner working together to match configurations of their identical photo playing card sets (of 12 playing cards each) onto their playing boards, with a partial-barrier in between them.Playing cards used were photographs personalized to Mr. Lee’s life and interests, and were contributed both by Mr. Lee and by the research team.During photo album sessions (treatment sessions 5, 10, 15), a photo album was collaboratively constructed between Mr. and Mrs. Lee and the research team, utilizing photo cards played with during the barrier game.Analyses of the video data from the 12 barrier game treatment sessions were completed, with the goal of identifying the total number of conversational narratives told, characteristics of their tellings, and their evolution across retellings.Coding of each barrier game session involved a four-pass consensus process, transcribing and identifying full and kernel conversational narratives, their initiator, tellership, initiation context, audience involvement, linearity, and general theme.Later analysis of intra-rater agreement revealed high overall agreement, with 94% agreement in identification of conversational narratives, and coding of additional narrative characteristics ranging from 76-93% agreement.Narratives of repeated themes were also identified and tracked across retellings to view their evolution across time.Results were supportive of the conclusion that the intervention used in this study was able to support conversational narratives, with a total of 761 full and kernel conversational narratives identified.However, as fidelity to game-play was not maintained, no claims could be made on the ability of the barrier game specifically to support conversational narrative telling.Analysis additionally showed patterns in the increased ability of personal playing cards (photos taken by Mr. Lee or the clinician) to facilitate and support conversational narrative telling, as compared to non-personal playing cards (photographs individualized to Mr. Lee’s life and interests, however not taken by Mr. Lee or the clinician themselves).In addressing the evolution of narrative tellings across retellings, 32 thematically distinct narratives were found to be told and retold over the course of barrier treatment sessions, with a range of two to 12 retellings per distinct narrative.Patterns were also seen in the streamlining of narratives across retellings, with 74% of retold narratives told as a full conversational narrative and later indexed into a succinct indexical kernel narrative.Additionally, Mr. Lee’s single-teller narratives told in the elicited narrative probes showed a pattern of increasingly closed linearity in later treatment sessions as compared to initial treatment sessions.Lastly, results of the self-report Communication Confidence Rating Scale (Babbit & Cherney, 2010) administered across four, equally-distributed points, revealed a pattern in Mr. Lee’s increasing communication confidence across the course of the intervention.Overall, this study showed the ability of a collaborative, individualized intervention to support conversational narrative telling between an individual with aphasia and a clinician partner, revealed the pair’s ability to successfully streamline conversational narratives across retellings, and displayed the social impact of the intervention on Mr. Lee’s life outside of treatment conditions, seen through the continual increase in his self-reported communication confidence.The use of situated discourse analysis methods, additionally showcased the benefit of acknowledging and highlighting situated and embodied communicative interactions to further understand and characterize patterns of communication.Finally, this research points to the potential benefits of maintaining clinical awareness of and providing support for engagement in telling and retelling of full and kernel conversational narratives in intervention.