Comprendre la situation d’interaction entre des personnes vivant avec de l’aphasie et les interlocuteurs non-familiers de leur communauté

Background  Aphasia is a difficulty in speaking, understanding, reading or writing as a result of neurological damage. The quality of life of people living with aphasia (PLWA) is not related to the severity of aphasia, but to their participation - that is, how well a person functions in society. PLWA perform fewer social activities and are less satisfied with them. They find it difficult to communicate in their daily interactions, including with people unfamiliar within their community such as clerks, waiters, etc. They have difficulty communicating in their daily interactions. If these interactions are felt to be too difficult, PLWA may avoid communicating with people other than their relatives, and remain in a protected but limited communication environment. This does not allow them to engage in society as much as they would like. By isolating themselves this way, their quality of life is threatened. It is therefore important to encourage PLWA’s interactions outside their home, which is still uncommon in speech-language pathology interventions offered in rehabilitation. This requires an understanding of the situations in which PLWA may engage in their daily activities. However, there is little literature that has examined in detail the situations in which PLWA interact with unfamiliar people in their community.   Objective  The objective of this Ph.D. project is to understand the situation of interaction between PLWA and unfamiliar people within their community.   Methodology  Three studies were carried out. The first is an exploratory study whose objective is to describe through conversation analysis the structure of service encounters collected from 6 PLWA (study 1). Based on Study 1 and still using conversation analysis, we conducted a new study to describe how these 6 PLWA made their requests understood during service interactions despite their aphasia (study 2). Finally, in a third study we sought to understand with a case study how a person with severe aphasia experienced this communication situation in everyday life (study 3). Results   In Study 1, we described the Daily Service Encounter (DSE) situations for PLWA, including the four-step communication structure. Interlocutors must agree on: 1) their availability to perform the interaction, 2) the purpose of the purchase, 3) the price, 4) that the business interaction is complete. This study also found that: -Steps 1 and 4, where the PLWA must make the interlocutor understand that they are ready to begin/end the interaction, do not present specific challenges for PLWA. -Steps 2 and 3 however may present communication challenges. Since Step 2 aims to make the clerk understand the purpose of the purchase, the interaction will be facilitated if PLWA can help themselves or point to visual aids. Step 3 will be facilitated if the price is visible when PLWA are ready to pay. This initial study thus made it possible to better identify the sources of communication challenges for PLWA at the checkout.    In the second study, we specifically looked at Step 2 of the service interactions in order to analyze how PLWA make the clerks understand the purpose of their interest. We looked at how the PLWA expressed their request, and how the clerks responded to it. This study highlighted how PLWA – even severe aphasia - could make the subject of their request understood during service encounters by supporting their non-verbal communication in the context and physical environment of the interaction.    In our third study, we found that participation in DSE appeared to be related - in this case study - to the confidence of the participant in his ability to perform the DSE despite his language impairment. This participant demonstrated a range of interpersonal skills and abilities that smoothed interaction where aphasia might have nicked it, enabling him to obtain the good or service he wanted, while still presenting the image of a good customer, despite his aphasia. Conclusion Service encounters provide communication situations in which PLWA could participate effectively. Their structure, context, and physical environment would support the non-verbal communication of PLWA, and the service relationship would direct the interlocutors towards collaborative exchange. It is possible for PLWA - even those with severe aphasia - to be confident in their communication with unfamiliar people in service encounters, and to participate in their community in a more satisfying manner.

Keyphrases: Go-along, Observation, Aphasia, Community participation, Service encounters, Unfamiliar communication partners, Conversation analysis, Interviews