As a clinician working with people with dementia I was often required to assess people’s speech, language and communication using formal language tests. The scores an individual achieved on these tests provided a baseline for future comparison. The scores also provided information on areas of relative strength and difficulty, providing a communication profile to inform diagnosis. But it was actually the qualitative information that I found most useful both diagnostically and therapeutically.
Individuals often performed differently on assessment when compared to a real life conversation. Often able to hold a conversation about the weather, their journey in to the clinic or tell an anecdote about their lives. Observing people in conversation with me, with the receptionist, or with their loved ones was more informative than counting up how many objects they could name. Rarely is one asked to name objects on a daily basis, yet conversation happens all the time. And relationships, opinions and the self are formed and conveyed through conversation. In short conversation is pretty important for everyone.
Conversation Analysis is a research method that allows us to really examine what is happening during these types of interactions to identify how turns work, what each turn means and how conversational troubles occur, and are repaired. Sacks, Schegloff and Jefferson were the founding fathers of this approach in the 60s and 70s over in the US. Sacks famously made audio recordings of telephone calls to suicide hotlines and examined the organisation of the conversations that occurred. These researchers noticed that conversation followed certain rules and order. Atypical conversations- those between individuals who may have communication disorders for example don’t always follow the same rules and order, and can often consequently result in a conversational breakdown.
Nowadays video recording has become increasing acceptable, and accessible. This allows us to record both the verbal and visual components of conversation, the latter often being the key components that enable someone with limited language to engage in an interaction. Actions such as gesture, eye contact, vocalisation and tone can be as effective in moving conversation forward as a fully articulated sentence. And observing how someone with dementia is or isn’t able to converse in a group or with just one other person can tell us a lot about how they are coping. Observing how others are engaging with them also provides a significant amount of information about how others may be able to adapt, or not to support a person’s conversational needs.
Conversation Analysis studies have shown that people with Primary Progressive Aphasia may be able to use gestural enactment effectively to keep conversation flowing (Kindle et al, 2013). CA studies have also shown that people with primary progressive Aphasia and their conversation partners use many strategies not dissimilar to people with post stroke aphasia, and less similar to other people with dementia and their communication partners (Taylor et al, 2014). This information is particularly useful when planning and developing potential interventions for people with dementia and their families.
Examining the impact of health care professionals as communication partners can often be rather challenging, but Conversation Analysis has been used to examine video recorded interactions between people with dementia and staff on an acute hospital ward for people with dementia (Allwood et al, 2017). This work has shown that when staff attempted to close conversations they often conveyed mixed messages that confused people with dementia. Typical questions such as “Is there anything else I can do for you?” that seem logical final closing questions in ordinary health care interactions may be difficult for some people with dementia to recognise as a closure. This can be useful guidance when developing training programs for health care staff working and communicating with people with dementia.
Conversation Analysis also has the potential to provide diagnostic information. For example at a recent conference I was attending one of the presenters provided examples of conversations between a person with frontotemporal dementia and her friends. The analysis highlighted that the person with frontotemporal dementia was unable to effectively respond when required to provide an evaluation, for example when presented with an attractive object that her friend was hoping to purchase. This could be attributed to a loss of empathy, or poor social skills but essential this resulted in a breakdown in conversation, and consequently impacted on her relationships with these people. A change in empathy may be subtle and difficult to measure by many other methods.
Despite being a novice researcher, I find Conversation Analysis a logical and intuitive methodology. I am less confident in quantitative research and am drawn to qualitative research, but I have realised that equally many other researchers are drawn to quantitative research and are less sure of qualitative methods. I plan to immerse myself further in Conversation Analysis methods, I have lots of interesting video recordings I have collected (during my current research project) from people with primary progressive aphasia and their families. So watch this space.
- Allwood, R., Pilnick, A., O’Brien, R., Goldberg, S., Harwood, R. H., & Beeke, S. (2017). Should I stay or should I go? How healthcare professionals close encounters with people with dementia in the acute hospital setting. Social science & medicine, 191, 212-225.
- Kindell, J., Sage, K., Keady, J., & Wilkinson, R. (2013). Adapting to conversation with semantic dementia: Using enactment as a compensatory strategy in everyday social interaction. International journal of language & communication disorders, 48(5), 497-507.
- Taylor, C., Croot, K., Power, E., Savage, S. A., Hodges, J. R., & Togher, L. (2014). Trouble and repair during conversations of people with primary progressive aphasia. Aphasiology, 28(8-9), 1069-1091.
Anna Volkmer is a Speech and Language Therapist and NIHR Doctoral Research Fellow working in Language and Cognition, Department of Psychology and Language Sciences, University College London. Anna is researching Speech and language therapy interventions in language led dementia.