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Title: Managing everyday participation in Parkinson's Disease: a conversation analytic study
Author: Griffiths , Sarah
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2013
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Communication impairments in Parkinson's Disease (PO) have largely been investigated 'on demand' in clinical settings or using self/carer report measures. Those affected report that participation in everyday conversations is restricted. However, research into everyday 'outside the clinic' communication is limited and speech and language therapists (SL Ts) lack resources targeting participation for people with PD. SL Ts look to the International Classification of Functioning, Health and Disability (ICF: WHO, 2001) for guidance on defining and measuring participation, however, there are limitations to this framework, including a neglect to incorporate social interaction. Starting with a broad definition of participation, adapted from the health literature as 'interacting with others, with or without carrying out a specific activity together', the aim of this research was to identify threats to participation and strategies used to manage participation in conversations, that might not be uncovered by commonly used speech and language therapy assessments. A second aim was to generate ideas for the development of clinical interventions targeting participation for this client group. 13 people with PO and their familiar conversation partners (CPs) collected over 10 hours of video data of their own everyday talk, in the home setting. These data were transcribed in detail and analysed using conversation analytic methods. Further clinical assessment data was collected in order to better describe the sample and to look informally at how well this could predict patterns in interaction. Findings were disseminated to key stakeholder groups. CPs were found to use various methods to manage the threat to participation caused by the communication disability and thereby encourage participation, some of which have not been described previously, such as using prompts to modify speech (e.g. 'can you speak a bit louder please?'). PO speakers can show unexpected competencies in securing their own participation by repairing utterances that were not heard or understood, through upgrading phonetic aspects such as pitch and loudness. When 'multiple repair' sequences occur, whereby several attempts are made to resolve a problem, CPs use 'repair initiators' of gradually increasing specificity in terms of their ability to help the PO speaker locate the trouble source (e.g. 'Pardon?' is non-specific and 'You went where?' more specific). Environments that more commonly threaten participation are identified, such as when overlapping talk occurs. Also, CPs sometimes manage participation by constraining the type of turns that PO speakers take e.g. by asking the majority of the questions, or by initiating topics about which both participants already have shared knowledge. It is argued that these constraints can restrict participation by preventing the PO speakers pursuing their own agendas. No obvious links between the clinical data and patterns in interaction were identified. Findings contribute to the on-going debate in health care over the conceptualisation and measurement of participation. A new definition encompassing 'participation-in-interaction' is proposed and the relevance of this for future versions of the ICF considered. The theoretical concepts of competence, 'face', identity and severity are also contemplated in light of the results. The strengths and limitations of the methodology are discussed and the clinical implications, taking into account the dissemination findings, are outlined. This includes a proposed model to support SLTs in providing individualised therapy relating to repair management and improved participation-in-interaction.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available