Better Conversations with Aphasia Research

What is the problem?

Aphasia is a communication difficulty most commonly caused by stroke. According to the Stroke Association, in the UK around a third of stroke survivors live with aphasia. It has an impact on relationships, life roles and participation in everyday activities. 

Aphasia has an impact on all aspects of social life because it affects conversations. People with aphasia and their families tell us that a key goal is to regain the ability to have conversations that go beyond conveying basic needs. When we spoke to people with aphasia about their experiences of conversations, they told us “If you have aphasia your conversation is very is like information, information you know, ‘I want food’...very pedestrian, very yuk...proper conversation is...your relate other people.”

We know that speech and language therapy for words and sentences in aphasia doesn’t have as much impact on language use in everyday conversation as we would hope. One solution is to train conversation skills directly. This way we can also help communication partners to use strategies to support their family members with aphasia, so everyone can have more complex and enjoyable conversations. This intervention is called communication partner training.

What do we know already?

A systematic review of communication partner training in aphasia (Simmons Mackie et al, 2010, updated 2016) reveals that this intervention is effective at improving the communication of a range of professional and family communication partners. In addition, it is probably effective in improving participation in conversations for a person with chronic aphasia when they talk to a trained communication partner. The recommendation is that as SLTs, we should routinely be offering communication partner training to our clients with aphasia and their key communication partners. We still need more research to better understand the active ingredients of communication partner training – how it works to change people’s conversation behaviours – and how best to measure outcomes.

Current Project

The Better Conversations with Aphasia (BCA) project was funded by the UK Stroke Association from 2008-2011 to evaluate an approach to communication partner training underpinned by conversation analysis. BCA is designed to train a person with aphasia and their chosen communication partner to identify key barriers and facilitators to their conversations, and as a result to choose strategies to practice to have better conversations together. Video feedback is a key feature of the intervention. The outcome of BCA is evaluated using videos of everyday conversations before and after the intervention to count the number of facilitators and barriers used. We also ask people to complete self-report measures of conversation.

The BCA project aimed to determine the effectiveness of BCA intervention for people with agrammatic aphasia and their regular communication partners. We examined the conversation strategies that change (barriers and facilitators) and explored implications for BCA delivery such as joint goal setting. In addition we explored participants’ views of the intervention and the parts of it that influenced them to change their conversation behaviours.

Out of the eight dyads who received BCA, we found an increase in the use of conversation facilitators for three dyads, and this was statistically significant for two of them (Best et al., 2016). Examples of facilitators include: a person with aphasia using a key word to introduce a topic, or using writing when encountering a word-finding difficulty, and a communication partner pausing to allow more time, or offering a comment (instead of a question, for example). Barriers to conversation significantly decreased for five dyads in our study. Examples included: a person with aphasia stopping conversation to rehearse the correct way of saying a word, and a communication partner using test questions.

Social Media Outputs

Better Conversations podcast 2023 for Giving Voice

UCL CRN talk - the Better Conversations Approach

Key Publications

Beckley F., Best W. & Beeke S. (2016) Delivering communication strategy training for people with aphasia: what is current clinical practice? International Journal of Language and Communication Disorders 52 (2), 197–213. http://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12265/full

Best W., Maxim J., Heilemann C., Beckley F., Johnson F., Edwards S.I., Howard D. & Beeke S. (2016) Conversation Therapy with People with Aphasia and Conversation Partners using Video Feedback: A Group and Case Series Investigation of Changes in Interaction. Frontiers in Human Neuroscience 10:562. doi:10.3389/fnhum.2016.00562 

Johnson F.M., Best W., Beckley F.C., Maxim J. & Beeke S. (2016) Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods. International Journal of Language and Communication Disorders 52(3), 374–387. http://onlinelibrary.wiley.com/wol1/doi/10.1111/1460-6984.12279/full

Beeke S., Beckley F., Johnson F., Heilemann C., Edwards S., Maxim J. & Best W. (2015) Conversation focused aphasia therapy: investigating the adoption of strategies by people with agrammatism. Aphasiology 29 (3), 355-377. http://www.tandfonline.com/doi/abs/10.1080/02687038.2014.881459

Beeke S., Johnson F., Beckley F., Heilemann C., Edwards S., Maxim J., & Best W. (2014) Enabling better conversations between a man with aphasia and his conversation partner: Incorporating writing into turn taking. Research on Language and Social Interaction, 47:3, 292-305. Open access: http://dx.doi.org/10.1080/08351813.2014.925667

Beckley F., Best W., Johnson F., Edwards S., Maxim J., & Beeke S. (2013) Conversation therapy for agrammatism: Exploring the therapeutic process of engagement and learning by a person with aphasia. International Journal of Language and Communication Disorders 48 (2), 220-239. http://onlinelibrary.wiley.com/doi/10.1111/j.1460-6984.2012.00204.x/abstract