Assessments in Outcome Evaluation in Aphasia Therapy: Substantiating the Claim

AbstractOutcomes of aphasia therapy in Denmark are documented in evaluation sessions in which both the person with aphasia and the speech-language therapist take part. The participants negotiate agreements on the results of therapy. By means of conversation analysis, we study how such agreements on therapy outcome are reached interactionally. The sequential analysis of 34 video recordings focuses on a recurrent method for reaching agreements in these outcome evaluation sessions. In and through a special sequence of conversational assessment it is claimed that the person with aphasia has certain communicative skills. Such claims are systematically substantiated by invoking examples of the person with aphasia performing this skill either outside or inside the therapeutic setting. Substantiation can be seen as a form of validation of the claim and thereby a basis is set for agreement. The findings suggest that in this type of evaluation the requirements of producing a valid account in which the person with aphasia has been heard are being met.KEYWORDS: OUTCOME EVALUATION; AGREEMENT; APHASIA THERAPY; ASSESSMENT; CONVERSATION ANALYSIS; EPISTEMIC RIGHTS(ProQuest: . denotes formulae omitted.)1. IntroductionMeasures or evaluations of outcomes are commonly seen during and after aphasia therapy (Simmons-Mackie et al., 2005; Verna et al., 2009). Outcome measures are generally associated with formal tests or questionnaires. Simmons-Mackie et al. (2005) divide their findings of tools and methods for outcome measures into the categories cognitive/linguistic, functional, subjective/ qualitative and vague/other. The first two are most frequently reported in studies, and make use of formal tests or specified procedures that have varying degrees of reliability and/or validity. Although this holds true for some described tools in the category subjective/qualitative too, this category as well as the category of vague/other mainly include more individualized approaches such as observations, qualitative speech analysis, and assessment of goal attainment. Natural speech and interaction is the basic element in these methods: either it is the object studied through observations or an actual tool for assessment (e.g. in the person with aphasia's (PWA) report of his/her own competencies). The evaluation sessions, which are less constrained by formal requirements, and are carried out by means of interaction, may thus pose a problem with regard to consistency: Are they at all structured, can they be compared, and, thus, can anything at all be said about their quality? The very terms denoting these methods (subjective/qualitative, and vague/other) may suggest that such sessions are unsystematic. Furthermore, an interactional approach to outcome evaluation may pose challenges to the evaluator (most often the SLT) who has to attain a PWA's true feelings about therapy while at the same time directing and guiding the conversation.This study reports on outcome evaluations that are carried out by means of interaction. Although such sessions may vary widely with regard to what is talked about and how it is talked about, all of them contain sequences in which communicative performance by the PWA is assessed by the participants interactively. These assessment sequences have a clear interactional organization, and can be described as exemplars of outcome evaluations which are systematic and orderly.The present study focuses on outcome evaluation as an interactional achievement by addressing the structural organization of assessment sequences. Drawing on conversation analysis (CA) (Hutchby and Woofitt, 2008; Psathas, 1995; Schegloff et al., 2002; Steensig and Asmuss, 2003) the study presents in-depth analyses of how such assessment sequences are accomplished by the participants. As we will show, the interactional organization of assessment sequences in this setting resembles, but is not identical to, the organization of assessment sequences in everyday conversation as has been described by Pomerantz (1984). …