Dysarthria-in-interaction profiles
The following four profiles describe features of interaction associated with adult
dyads where one person has a degenerative disease and an associated motor speech
impairment (dysarthria). Building on existing scales and checklists the profiles
incorporate the behaviour of both conversation partners in a dyad. For ease of
reference the person with dysarthric speech is referred to below as the PWD. The nondysarthric person is referred to as the NDP.
Work on this profile is ongoing with inter-rater reliability tests to be reported in due
course. Further practical ideas relating to these profiles can be found in Bloch, S. J.
(2012) Conversation and interaction in degenerative diseases. In Yorkston, K. M.,
Miller, R. M., Strand, E. A., Britton, D. (Eds.). Management of Speech and
Swallowing Disorders in Degenerative Diseases (Third edition). Austin, Texas: ProEd.
Blue profile: No observable or reported changes to the interaction of either
conversation partner.
General description: Interaction between the conversation partners within this profile
is unproblematic in everyday life even though speech may be dysarthric as measured
through acoustic/perceptual assessments. Either or both partner(s) may be aware of
the dysarthria but are not concerned about its impact on day-to-day interaction.
Interaction problems experienced: Any speech impairment has no observable or
reported impact on everyday conversation or interaction. There may be some reports
of difficulties in noisy environments but overall both conversation partners are able to
interact and participate at their preferred level.
How interaction problems are managed: Neither partner reports excessive problems
with intelligibility or with the timing of turns. There is no evidence of the NDP
repeating prior turns to show understanding.
What strategies are used: There is no, or minimal, reported or observable evidence of
the PWD adapting how they interact to facilitate intelligibility or of the NDP taking
more responsibility for the interaction. Augmentative and alternative communication
(AAC) strategies are not used.
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Yellow profile: Some observable or reported changes in the interaction of either
conversation partner.
General description: Conversation partners within this profile experience some
problems with interaction. Typically both partners are coping with everyday
conversation but report or display some difficulties familiar settings as well as with
unfamiliar conversation partners. There may be some use of augmentative and
alternative communication (AAC) in specific circumstances, particularly to resolve
problems with intelligibility.
Interaction problems experienced: The PWD is aware of the impact of their dysarthric
speech in a range of circumstances and reports having to repeat him/herself
particularly over background noise and/or when interacting with less familiar people.
Being able to produce a turn quickly may be particularly difficult, for example in
multi-party conversations or as a speedy response to a quip or tease. Additional
cognitive and/or fatigue factors may impact on interaction (e.g. delayed word
finding).
How interaction problems are managed: The NDP will signal that she/he has not
understood all or part of a prior turn. This will prompt the PWD to repair the problem,
commonly by repeating what has not been heard or understood by using slower,
louder or more pronounced articulation. Most of these problems will be resolved
through just one repeat sequence. In some instances the NDP will repeat what has just
been said to check that he/she has understood correctly.
What strategies are used: There may be some attempts to ensure that the PWD has
the NDP’s attention before initiating a turn. The PWD may also simplify some of
their utterances by using fewer words in a turn. This may help reduce the problems of
unintelligibility and/or allow the NDP to show their understanding more regularly. In
multi-party conversations a familiar NDP may create opportunities for the PWD to
contribute to jointly produced stories/news telling.
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Orange profile: Significant interaction adaptations made by both conversation
partners
General description: Interaction here commonly features a combination of natural
and AAC modalities. The PWD may still initiate turns using speech but makes
increasing use of AAC. The conversation partners may identify a number of situations
in which interaction is problematic but they will still be motivated to interact through
whatever modalities are used. Cognitive/linguistic and/or fatigue levels may have an
additional impact but not as a predominant feature of the interaction.
Interaction problems experienced: Specific features of interaction may cause
difficulties such as gaining attention, introducing or changing topic. AAC system use
is likely to present further problems for interaction, particularly in turn-taking and the
understandability of AAC mediated turns. In some instances the NDP may ‘lose the
thread’ of the conversation. Additional physical disabilities may make self-repair
and/or correction by the PWD difficult. Problems are very notable in interaction with
unfamiliar partners and/or where there is pressure to interact quickly.
How interaction problems are managed: Some problems are likely to result in
lengthy repair work involving both conversation partners, i.e. they may take a large
number of turns to resolve. The NDP may need to be very explicit about the nature of
the problem they are experiencing and may adopt novel strategies to resolve problems
such as ‘can you spell it?’ or ‘is it something we’ve been talking about?’ AAC may be
used to repair problems with speech intelligibility but may in itself lead to more
problems.
Strategies: The conversation partners may be using AAC systems and/or have
developed their own strategies for reducing the risks of unintelligibility. Within this
profile AAC use may well be highly effective and strategic, particularly if the
conversation partners are highly familiar with each other. AAC utterances, for
example, may not simply replicate normal speech turns but will be designed for
maximum interactive effectiveness. The NDP will be much more active in, for
example, finishing off utterances started by the PWD. There may also be regular
displays of understanding by NDP. These may take the form of individual utterance
repeats but also longer recaps of prior sequences of conversation.
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Purple profile: Significant interaction challenges encountered by both
conversation partners
General description: The conversation partners will both experience significant
interaction challenges. These may be due to severe physical and/or cognitive
impairments having a direct impact on the ability to communicate. Interactions
featuring a less-familiar conversation partner are likely to be particularly difficult.
AAC systems may be available but are likely to require far more input from the NDP.
Interaction problems experienced: There may be minimal attempts by the PWD to
initiate talk, with turns typically comprising one or two words or yes/no responses.
Introducing new topics will be regularly problematic. Some attempts to interact may
be closed down or abandoned by either partner. Many actions, such as story telling
and non-serious talk may not be attempted by the PWD. Many situations and new
conversations may be avoided due to difficulties with interaction.
Managing troubles: The context of prior talk is very important here and the NDP will
attempt to manage troubles by linking attempts to interact with what has just been
said. Questions by the NDP such as ‘are you talking about….?’ may be more
common. The NDP may need to be far more explicit about trouble resolution by
offering fixed response options such as ‘Did you say help or hope?’. Physical and/or
cognitive/linguistic restrictions may make trouble resolution by the PWD difficult.
Strategies: A familiar conversation partner is likely to take a highly active role in
managing the interaction. He or she will ask a lot of questions and will provide
opportunities for the PWD to express preferences, choices etc. He or she will also
regularly offer understandings of what has just been said. The NDP is also likely to
take a highly active role in interactions with others in multi-party conversations.
For further details of this work please contact Steven Bloch.
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