Guest-edited blog from Corinne van Rheede, 2020 graduate from City, University of London
Phase 4 of the LUNA project explored the feasibility of training clinicians to accurately and efficiently analyse aphasic narratives. Clinicians attended a training day at City, University of London in July 2019, and were trained in six analyses – two at word level, two at phrase level, and two at discourse level.
My research project (completed May 2020) focused on the discourse level, specifically, story grammar analyses. I looked at what errors clinicians made on analysing the test narrative (transcribed spoken personal narrative). Looking at their responses, I tried to find patterns and to think of possible reasons why clinicians made particular choices. I explored completion time and errors made as well as the effect that demographic variables such as NHS Band, clinical experience, frequency of use of discourse analysis in the field, and reported self-confidence in performing discourse analysis played on errors made.
I made a classic newbie error and overwhelmed myself in reading many unrelated papers in an attempt to discover exactly what personal narrative and story grammar are. In a nutshell: story grammar is the organisational, structural features of narrative discourse. Nine elements form a vital framework on which information is ‘hung’. Much of our daily communication takes the form of personal narrative and involves story grammar – think ‘telling your friend what you did over the weekend’. Now in aphasic narratives, many of these elements may be missing resulting in shorter, less cohesive narratives that have errors of syntax, semantics, and morphology, and are syntactically simple. Basically, this results in your friend having difficulty in understanding your story because pieces are missing. Story grammar is considered a “robust” measure (Pritchard et al., 2018), which means clinicians can be confident in knowing that analysing and treating this will give reliable, measurable outcomes to their clients. Another benefit is that story grammar analysis takes a few minutes and needs no fancy assessment protocol.
It would have been great if there was a clear-cut reason for why participants made errors, but with nothing glaringly obvious, I wondered what could be changed. This caused another bout of research reading, this time on andragogy – the art and science of adult learning. Training consisted of a teach-practice-discuss-test format, which appears to have been quite successful. Participants may have achieved better results if they had more training time and more opportunities to practice on different aphasic narratives, consolidating their learning. When telling a story the words we use can affect how the listener hears the story (Boyle, 2014), and it may be that participants focused on divergent phrases and tangential speech, missing the salient point of the story. In the future, training, examples and explanations of certain elements would need to be more precise to reduce ambiguity and achieve better overall results.
My takeaways from this research project were many, so I’ve picked two which struck me most:
- Training matters! – Clinicians benefit from training in order to successfully apply aphasia-specific skills and multilevel interventions.
- Standardising outcome measures – researchers need to use the same outcome measures as clinicians, service users and even other researchers.
Quick, simple to understand and to use, practical – that’s what going to make a difference in the lives of our clinicians and ultimately our service users.
REFERENCES:
Boyle, M. (2014). Test–Retest Stability of Word Retrieval in Aphasic Discourse. Journal of Speech, Language, and Hearing Research, 57(3), 966-978.
Pritchard, M., Hilari, K., Cocks, N. and Dipper, L. (2018). Psychometric properties of discourse measures in aphasia: acceptability, reliability, and validity. International Journal of Language & Communication Disorders, 53(6), pp. 1078-1093. doi: 10.1111/1460-6984.12420
Please note – because these findings are in the process of being written up for peer-reviewed publication, we can’t release any more specific story grammar analysis findings at this moment!