Acquired dysarthria in conversation: methods of resolving understandability problems.

BACKGROUND: People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such problems are likely to impact on both the person with dysarthria and those with whom they interact. If this is the case then we may ask questions not just about the nature of these problems but how it is that such problems are dealt with by participants when they occur. AIMS: To investigate ways through which problems resulting from dysarthria in everyday conversation are resolved by participants. Further, to examine some of the features of repair resolution, particularly where understanding of self-repair attempts themselves prove difficult. METHODS & PROCEDURES: Video data of natural conversation from two dyads were selected for this paper. One dyad features a 58 year-old man with multiple sclerosis and moderate intelligibility problems, the other a 79 year-old woman with motor neurone disease with mild to moderate intelligibility problems. Both elected to be recorded in conversation with their spouses. The dyads were video-recorded at home with no researcher present. Using the methods of Conversation Analysis (CA) a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the participants resolve problems in the understanding of dysarthric speech. OUTCOMES &
RESULTS: It is shown how some problems resulting from dysarthria in conversation can be resolved relatively quickly, particularly where a specific element of a prior turn is highlighted by the recipient as problematic. In other instances, the recipient's understanding problem may be more global. These result in longer repair sequences in which problematic elements are addressed individually. Such a resolution method is ultimately successful but may also be characterised by additional understanding problems. These findings draw attention to an important distinction between intelligibility and understandability. CONCLUSIONS & IMPLICATIONS: It is concluded that problems resulting from dysarthria in conversation can require extensive repair work involving both parties. This has implications for the assessment of dysarthria in everyday conversation and also the promotion of intervention strategies that encompass the activities of both participants when dealing with dysarthria in interaction. These findings may be usefully employed in informing both direct clinical work and through training those who work with this client group and their significant others.