Redesigning therapy for agrammatism: Initial findings from the ongoing evaluation of a conversation-based intervention study

Therapy for agrammatism, once only targeted at surface grammar, has begun to demonstrate the benefits of rigorous theoretically motivated therapy aimed at underlying syntax. Whilst there is evidence that grammatical ability in the clinical setting can be improved by such therapies, it has proved hard to detect carryover to everyday conversation in the home. Recent research using a qualitative methodology called Conversation Analysis (CA) has shown that utterances produced by agrammatic speakers in peer conversation differ significantly from those elicited during assessment and therapy tasks. This is because tasks target decontextualized language, isolated from an interactional context of real-life talk about needs, opinions, and experiences. This paper explores the idea that, given this finding, it may be more appropriate, and effective, to provide therapy for agrammatism by targeting the grammar of conversation directly. It outlines a new therapeutic approach based on CA concepts, describes the early development of a valid quantitative measure of change in conversation and presents some qualitative data from one of the first dyads involved in an ongoing therapy study.