ALD Week 7

What is the microstructural level of discourse?

Across sentence measures. Discourse cohesion, cohesive adequacy (maintainin these topics and linking each sentence appropriately to the sentence before and the sentence after), look at the text to see if the person is using the appropriate words, vocabulary items to link an entire sample together

Measure of Participation in Conversation; Measure of Support of Conversation; Kagan et al. (2001) rating scales:

Analyzes people with aphasia. Train in support of communication. Train other people in their lives that are positive associations.

What is within the category of dialogue discourse?

Conversation - interplay between 2 speakers.

What is the Pragmatic Protocol?

Developed Prutting & Kirchner. Based on Levinson's Theory: pragmatic aspects of behavior fall along a continuum and include both context-dependent verbal as well as nonverbal elements. Communicative acts are broken up into: 1. verbal aspects 2. paralinguistic aspects 3. nonverbal aspects. Rate on a scale of appropriate, not appropriate, or no opportunity to judge. You can provide examples and comments.

Social skills treatment and focus approach:

Focus on improving the quantity of information, the clarity of expression because when we're interacting with another person, we want whatever it is that we're saying to be understood, to be clear. Real emphasis on social piece of communication.

How do we assess formulaic language?

Formulaic language is often a component of aphasia assessment: • Automatic speech/recitation: (count 1-10, etc) • Informal acknowledgment of greetings/salutations • Sentence completions with idioms (e.g., It's raining cats and ____)

What is the expository discourse genre?

Give me your opinion on this topic. Use high-level expository activities with someone who is higher functioning. See what level they are at before you have them explain some complex topic.

Discourse-level treatment focus:

Hierarchical Discourse Therapy: treat impairments that aren't easily identified on traditional aphasia tests because we are looking at larger units. The focus is on promoting text understanding, increasing personally-relevant responses to questions, and improving and increasing overall production on a discourse-level, increasing abstractness in discourse. Examples: • Provide conversational environment with varying levels of support from clinician • Give the client different roles (e.g., guest speaker on experience with TBI) → inc CIUs (correct information utterance) • Positive feedback and positive communication strategies → increase compliance, attention, participation

Pragmatics: Evaluation and assessments include

Informal assessments: Narrative analysis Interviews Behavioral observation Formal assessments: Rating scales Checklists Standardized assessments.

What is the conversation discourse genre?

Interplay between client and clinician. Ex. How are you? Tell me why you are here. What are some of your opinions on your communication function? What do you want to get from therapy?

What is the macrostructural level of discourse?

Measurements of how the individual utterances are relating to preceding utterances (local coherence). How each utterance relates to the greater topic of the discourse sample (global coherence), content units, How information is provided and requested. How speakers are interacting to exchange this information.

Coelho's (2007) levels of discourse analysis for people with TBI include?

Microlingustic Microstructural Macrostructural Superstructural

Discourse can be:

Monologue Dialogue

What is within the category of monologue discourse?

Narrative and Procedural - client is speaking alone

LH stroke

Non-propositional/formulaic language is often preserved even when aphasia is present.

What is the superstructural level of discourse?

Overall organization of the content within the discourse sample, story grammar (identification of characters, settings, a problem within a story, the steps it takes to solve that problem, the resolution of the problem, feelings and emotions are given). Analyze a topic and look at topic maintenance.

What is "formulaic language"?

Overlearned words, phrases, or longer linguistic units that are: • Known to the native speaker • Occur naturally in discourse • Are important for normal social interaction

Dual process model of language:

Prepositional novel speech is controlled by left hemisphere, these left hemisphere language areas. Non-prepositional or formulaic language is controlled by right hemisphere structures and subcortical regions of the brain.

Conversation Analysis Profile for People With Aphasia (Whitworth et al., 1997): based on theory of conversation analysis:

Provides information on how individuals are repairing following communicating breakdown. Looking at turn-taking, topic initiation and maintenance. Utilize caregivers to respond certain ways to their loved ones.

What is the goal of treatment for discourse?

Remediation for conversational skills and narrative production.

What is discourse?

Some unit of message: unit of language that conveys some type of information.

Pragmatics

Structure and semantics are not the only features of language that transmit meaning.

T/F: The idea is that the treatment and training of simpler language structures (RH and subcortical areas) will facilitate the regaining of more complex structures that rely more on LH networks.

TRUE

What is the procedural discourse genre?

Tell me the steps to do some activity. Ex. the steps to make a peanut butter and jelly sandwich.

What is the narrative discourse genre?

Telling a story or recounting a story. Ex. What's your favorite movie? Tell me what happens in your movie. Tell me what it was like growing up...

What is the goal of treatment for pragmatics?

To improve functional communication.

What is the microlinguistic level of discourse?

Within sentence measures. The words that are used, the number of words, the grammatical complexity, syntactic constructions, the number of content units (how much content is being provided within the sample.)

What are some tasks that you could use to elicit a discourse sample from a patient/client during language therapy?

You could ask patients/clients to tell a story, describe the plot of their favorite movie, tell you what their morning routine is from when they wake up to when the arrive in your office for therapy, have them talk about what they do/did for a living, have a conversation with them about a topic of interest, etc.

Ability to make inferences is

an important element of pragmatic competence

Novel language production relies on:

an intact cortical left hemisphere

What is Utterance With New Information?

coherent and relevant utterance that provides new information that's semantically related to a prior utterance within the discourse sample

RH and subcortical stroke:

formulaic language is often impaired and reduced

What do the turn taking aspects of pragmatic protocol include?

initiation, responding, the time of pausing, feedback to speaker, cohesion

What do the paralinguistic aspects of pragmatic protocol include?

intelligibility, prosody, fluency of speech, vocal quality

What do the verbal aspects of pragmatic protocol include?

speech acts, introducing topics, maintaining topics

Form - content - use =

structure - semantics - pragmatics

What are some of the computerized technology used?

• AphasiaScripts: computer based program that provides a virtual therapist as a conversational partner. People with aphasia can use this outside of the clinical setting. • SentenceShaper: computer based program that would help the person to increase personally-relevant texts (composing texts that are important and motivating), to facilitate longer productions (longer sentences, then build narratives).

Psycholinguistic approaches to discourse analysis and treatment

• Based on idea that there is a disruption in linguistic rule system or access to modules within the individual • Aphasic characteristics are often described specifically and tested non-contextually. Highly structured task are used. • Del Toro (2008): new measure—Utterance With New Information— (evolved from Nicholas & Brookshire's [1993] CIUs) • Some evidence of CIU-type measures effective for measuring dialogue, but others find it may be more effective for monologue tasks

What does formulaic language include?

• Conversational/social speech formulae: Hi How are you? I'm good how are you? (Greeting/Quick expression) • Idioms and proverbs: It's raining cats and dogs. • Pause fillers: umm uhh • Discourse elements: well, so, and: when its not joining 2 clauses • Sentence/utterance initials: "I just wanna say.." "Dont take this the wrong way..." • Conventional expressions: (collocations, lexical bundles: groups of words that tend to occur frequently in a text)

What is automatic speech?

• Counting • Reciting days of the week, months of the year • Recited speech: recitation of overlearned larger linguistic units: Pledge of Allegiance, Humpty Dumpty, prayers, etc.

In severe cases of aphasia (receptive and expressive), clinicians may attempt to elicit the simplest language forms first:

• Counting • Reciting days of the week/months of the year • Sentence completions for common phrases • Producing greetings

Sociolinguistic approaches to discourse analysis

• Greater focus on the USE of language as opposed to form. • Language is a semantic unit that is examined in context. >Language should always be evaluated when considering context. >Assessment should ideally utilize videotaped interactions or audio record. • Scales can be used to examine functional communication with more objectivity (e.g.,Therapy Outcome Measure; Enderby & John, 1997) • Conversation Analysis Profile for People With Aphasia (Whitworth et al., 1997): based on theory of conversation analysis. • Measure of Participation in Conversation; Measure of Support of Conversation; Kagan et al. (2001) rating scales.

Pragmatic Treatment: Promoting Aphasic Communicative Effectiveness (PACE)

• Incorporated elements of pragmatics by recognizing that methods used by clinicians in tx are somewhat limiting and restrictive in the responses elicited. • PACE promotes turn-taking, providing information, asking questions, etc. by patients/clients. Naturalistic environments. • This insight into the lack of naturalness in tx has led to further approaches that emphasize the conversational interactions/social context of communication.

What are the discourse genres?

• Narrative • Procedural • Expository • Conversation

Grice's cooperative behaviors 4 maxims:

• Quality: of information • Quantity: give as much info as needed • Relevance: info is relevant to the topic. • Manner: you want to be specific and avoid obscurity or ambiguity in conversation.

3 major approaches to assessment evolving from pragmatic theory:

• Rating scales • Focus on assessing inferential aspects of language • Standardized pragmatic language assessments

Neural bases of formulaic language?

• Right hemisphere • Subcortical structures

What are the function of formulaic language?

• Structural support • Semantic • Social bonding

McDonald et al.

• Subgroup of patients with TBI are less able interpret conversational inferences despite relatively intact linguistic function • Concluded that these individuals have difficulty using contextual information to generate inferences • BUT: this is not well researched or understood

Standardized assessments of pragmatic language competence

• The Communicative Abilities of Daily Living -2 (Holland, 1980) >Clinician observes clients in simulated environment. • The Functional Assessment of Communication Skills for Adults (ASHA-FACS) >Comprehensive assessment that indirectly examines the pragmatics behind functional communication. • The Awareness of Social Inference Test (McDonald et al., 2002) >Looks at social cognition of language interaction and ability to detect sarcasm, deception, inferencing, etc.

Examples of pragmatic behaviors:

• Turn-taking • Topic initiation • Topic maintenance • Eye contact • Responds appropriately in conversation • Asks questions • Gives information • Uses appropriate gesture, body posture, facial expressions, personal space • Sarcasm/humor • Politeness • Self-correction/self-monitoring