Aphasia and speech therapy. A multimodal analysis of patients’ initiatives

This paper deals with a specific type of medical interaction, speech therapy sessions designed for the linguistic recovery of aphasic speakers.
During the last decades, an extensive body of conversation analytical research has focussed on aphasia, showing the importance of a contextual and sequential analysis of aphasic speaker’s limited productions (Damico et al. 1995; Laakso 1997; Ferguson 1998; Wilkinson 1999; Oelschlaeger & Damico 2003; Helasvuo et al. 2004; Wilkinson et al. 2010; Barnes et al. 2013). This has generated a better understanding of aphasia as a pathology that is also situated in human interaction (Goodwin 1995, 2003) and, as such, worth to be studied in natural occurring communicative contexts. Looking at the way the aphasic speaker, despite his/her linguistic impairments, interacts in both speech therapy and ordinary conversations with family members, has brought into focus, among other things, the interactional resources (s)he uses to co-construct meaningful actions. These resources mainly concern the sequential organization of talk and the possibility to exploit the interlocutor’s previous turn and/or action; as well as the multimodal dimension of communication (gestures, gaze, prosody).
In an applied perspective, important attempts have been made to incorporate these theoretical findings in speech language therapists’ professional practice (Booth & Perkins 1999; Ferguson & Armstrong 2004) and to develop interventionists program for changing interactional behaviours of aphasic patients’ significant others (Whitworth et al. 1997; Lock et al. 2001; Wilkinson et al. 2011).
My paper pursues these theoretical and applied lines of research, by approaching speech therapy as a specific type of institutional and medical encounter that can be characterized as: a) a goal-oriented activity (aiming at the patient’s linguistic recovery, see Simmons-Mackie & Damico 1999); b) structured by the speech therapist’s agenda; c) ruled by an asymmetric distribution of discursive roles (the patient usually aligning with a responsive position solicited by the speech therapist’s initiatives), d) further implemented by the corrections and instructions of the speech therapist.
A detailed multimodal analysis of my data shows that this global organization of the speech therapy can be oriented to and modified by the patient, who exploits specific sequential moments within the session (e.g. transitions between activities and between different phases of the performed tasks) as well as the material environment (the objects used to perform the tasks, e.g. cards) to initiate different kinds of actions (questions, topic initiations, proposals). These initiatives allow the patient to open up “alternative” participation opportunities within the session and can be the objet of smooth negotiations with the speech therapist. They not only show at work the audible and visible resources the aphasic speaker employs to self-select and do actions other than the ones implied in the therapeutic activities, but they also call into question issues of identity and institutional asymmetry.
The research is based on a corpus of speech therapy sessions in French with both fluent and non fluent aphasic patients, video-recorded in private speech therapy surgeries (approx. 25 hours) as well as in a neurological section of a hospital where patients are hospitalized after a stroke (approx. 10 hours).