A conversation analysis of therapist repeats in open dialogue network meetings.

Writings on Open Dialogue approaches to working with families experiencing mental distress emphasize the importance of the therapist repeating the family's words back to them verbatim. Repeats are theorized to display the therapist's listening and to encourage elaboration without imposing the therapist's own interpretations or conclusions on the family. These recommendations have not been subjected to rigorous interactional investigation. In this study, we used conversation analysis to analyze 160 examples of therapists repeating the prior talk of the family from 14 h of video-recorded Open Dialogue sessions. We found that these repeats had similar functions to those previously described in conversation analysis research such as initiating repair, marking receipt, and requesting elaboration as well as examples of therapist repeats occurring in overlap with the talk of the client. Open Dialogue writings thus present an oversimplified account of how repeats are utilized in clinical Open Dialogue sessions. Consistent with dialogical writings, repeats can elicit elaboration with limited input from the therapist, however repeats reflect selectivity and function to direct and guide the conversation to some extent. So, while therapist authority can be mitigated by repeating clients' words, when a therapist chooses to employ a repeat actively shapes the direction of the interaction.

How is right hemisphere communication disorder disabling? Evidence from response mobilizing actions in conversation.

AIM: Assessment and intervention strategies for communication disorders caused by right hemisphere stroke are at an early stage of development. There is also little evidence on how right hemisphere communication disorder is disabling for everyday life. This study explores how a woman with conversational problems following right hemisphere stroke participated in everyday conversation with family members. METHOD: One hour of triadic conversation was recorded and analyzed using the descriptive qualitative methodology of conversation analysis. It focused on attempts by the woman with right hemisphere stroke to direct conversation with "response mobilizing" communicative acts, i.e., communicative acts that set out clear expectations about who should speak, and how they should respond. RESULTS: Seventy-eight communicative acts produced by the woman with right hemisphere communication disorder were divided into five groupings based on how her conversation partners addressed them. Around half of her response mobilizing communicative acts received unsupportive responses from her conversation partners, including minimal acknowledgements, explicit rejections, and ignoring responses. CONCLUSION: The findings of this study provide novel insight into the ways that right hemisphere communication disorder affects routine communication, and the nature of the disability it causes. This information will support the future development of evidence-based speech pathology assessment and intervention for right hemisphere stroke.IMPLICATIONS FOR REHABILITATIONRight hemisphere stroke can have complex implications for communication, but little is known about how they manifest in daily life.Familiar communication partners may deal with troublesome communicative acts in conversation by preventing them from developing, which may be useful information for speech pathology assessment.Speech pathologists should consider sampling everyday conversation because it can provide insight into the ways that communication disorders caused by right hemisphere stroke restrict participation in daily life.

Genetic mapping and transcriptomic characterization of a new fuzzless-tufted cottonseed mutant.

Fiber mutants are unique and valuable resources for understanding the genetic and molecular mechanisms controlling initiation and development of cotton fibers that are extremely elongated single epidermal cells protruding from the seed coat of cottonseeds. In this study, we reported a new fuzzless-tufted cotton mutant (Gossypium hirsutum) and showed that fuzzless-tufted near-isogenic lines (NILs) had similar agronomic traits and a higher ginning efficiency compared to their recurrent parents with normal fuzzy seeds. Genetic analysis revealed that the mutant phenotype is determined by a single incomplete dominant locus, designated N5. The mutation was fine mapped to an approximately 250-kb interval containing 33 annotated genes using a combination of bulked segregant sequencing, SNP chip genotyping, and fine mapping. Comparative transcriptomic analysis using 0-6 days post-anthesis (dpa) ovules from NILs segregating for the phenotypes of fuzzless-tufted (mutant) and normal fuzzy cottonseeds (wild-type) uncovered candidate genes responsible for the mutant phenotype. It also revealed that the flanking region of the N5 locus is enriched with differentially expressed genes (DEGs) between the mutant and wild-type. Several of those DEGs are members of the gene families with demonstrated roles in cell initiation and elongation, such as calcium-dependent protein kinase and expansin. The transcriptome landscape of the mutant was significantly reprogrammed in the 6 dpa ovules and, to a less extent, in the 0 dpa ovules, but not in the 2 and 4 dpa ovules. At both 0 and 6 dpa, the reprogrammed mutant transcriptome was mainly associated with cell wall modifications and transmembrane transportation, while transcription factor activity was significantly altered in the 6 dpa mutant ovules. These results imply a similar molecular basis for initiation of lint and fuzz fibers despite certain differences.

Downgrading Deontic Authority in Open Dialogue Reflection Proposals: A Conversation Analysis.

The Open Dialogue approach promotes collaboration with clients and families in decisions about the direction of therapy. This creates potential problems for Open Dialogue therapists who seek collaboration but also have responsibility for managing the session. Using conversation analysis, we examined 14 hours of video recordings of Open Dialogue sessions, and specifically how therapists proposed the transition to a reflecting conversation. We found that, when making proposals to reflect, therapists routinely downgrade their deontic authority (i.e., adopt a less powerful, more collaborative position). They did this through framing proposals as interrogatives, providing accounts, and by prefacing their proposals with "I'm wondering". More heavily downgraded proposals made acceptance less salient, potentially risking transition to the reflection. These findings provide more detail on how theoretical concepts such as "collaboration" and "power" are actually displayed and negotiated in practice and can contribute to a more nuanced understanding of what constitutes Open Dialogue.

El método de diálogo abierto promueve la colaboración con los pacientes y las familias en las decisiones acerca del rumbo de la terapia. Esto genera posibles problemas para los terapeutas que implementan el diálogo abierto y que buscan colaboración, pero que también tienen la responsabilidad de manejar la sesión. Utilizando el análisis de la conversación, analizamos 14 horas de videograbaciones de sesiones de diálogo abierto y, específicamente, cómo los terapeutas propusieron la transición a una conversación reflexiva. Descubrimos que, cuando los terapeutas hacen una propuesta de reflexionar, habitualmente rebajan su autoridad deóntica (p. ej.: adoptan una postura menos poderosa y más colaborativa). Para esto, los terapeutas plantearon las propuestas como interrogaciones, ofrecieron explicaciones e introdujeron sus propuestas con la frase: "Me pregunto". Las propuestas más rebajadas hicieron que la aceptación se destacara menos, arriesgando potencialmente la transición a la reflexión. Estos hallazgos ofrecen mas detalles sobre cómo los conceptos teóricos, como la "colaboración" y el "poder", en realidad se muestran y se negocian en la práctica, y pueden contribuir a una comprensión más matizada de lo que constituye el diálogo abierto.

Eliciting Stance and Mitigating Therapist Authority in Open Dialogue Meetings.

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing "I'm wondering." These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well-crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances.

Communication disorders, enchrony, and other-participation in repair.

Communication disorders pose various challenges for valid and reliable measurement. Previously, we sketched how the prevailing concepts and measurement practices employed in research and speech pathology practice for communication disorders have framed the real-time accomplishment of co-present communication, and contrasted them with its observable properties. We also proposed that distinctive aspects of communication disorders could be divided into three conceptual/causal frames: microgenetic, synchronic, and enchronic. The enchronic frame aligns with the real-time accomplishment of communication, capturing the ways that cognitive processing and language systems are actually put to use for communication. In this special issue, the contributors explore a core aspect of communication - repair organization - in interactions involving people with communication disorders. Each contribution provides detailed insight into population-specific ways that other-participation in repair (and associated activities) shapes communication in daily life.

A pilot randomized controlled trial comparing online versus face-to-face delivery of an aphasia communication partner training program for student healthcare professionals.

BACKGROUND: Training conversation partners of people with aphasia who use facilitative communication strategies is one method that can improve access to healthcare for people with aphasia. However, the efficacy of communication partner training (CPT) has been investigated almost exclusively in the context of face-to-face (F2F) delivery. Online training may offer more cost-effective and accessible options to a wider range of conversation partners, including student healthcare professionals. AIMS: To conduct a pilot randomized controlled trial with student healthcare professionals comparing (1) an online aphasia CPT program, (2) a F2F CPT program and (3) no program (control group) on outcomes relating to attitudes and knowledge of aphasia. METHODS & PROCEDURES: A 45-min introductory aphasia CPT program was developed using the theories and techniques of Supported Conversations for Adults with Aphasia (SCA)™. A total of 30 first-year undergraduates studying occupational therapy at The University of Sydney were randomly allocated to one of three conditions: online CPT delivery, F2F delivery or delayed training control (no program). Outcomes measures included pre-post-testing with the Aphasia Attitudes, Strategies and Knowledge (AASK) survey. OUTCOMES & RESULTS: A significant difference existed for the AASK survey pre-post-change scores between the online, F2F and control groups (χ2 (2) = 20.038, p = 0.000). Post-hoc analysis revealed that, compared with the control (Ctrl) group, participants in both the online and F2F groups had significantly higher knowledge of aphasia (Online versus Ctrl: p = 0.000; F2F versus control: p = 0.002), knowledge of facilitative strategies (Online versus Ctrl: p = 0.000; F2F versus Ctrl: p = 0.002), and positive attitudes towards aphasia (Online versus Ctrl: p = 0.031; F2F versus Ctrl: p = 0.032). No significant difference was observed between the online and F2F groups for the Total or any subtotals (p = 1.000). CONCLUSIONS AND IMPLICATIONS: The results from this pilot randomized controlled trial indicate that online delivery of the 45-min introductory CPT is equally as efficacious as F2F delivery, and thus may be a viable mode of delivery for future aphasia CPT programs. These pilot results pave the way for a larger study that will comprehensively evaluate the efficacy of an online aphasia CPT program for improving attitudes, knowledge and skills in a broad range of student healthcare professionals. What this paper adds What is already known on this subject The efficacy of F2F CPT for aphasia is well established. Online delivery of CPT programs may offer more cost-effective and accessible services when compared with F2F approaches; however, there is a need to explore the efficacy of online programs. What this paper adds to existing knowledge The 45-min online aphasia CPT program was found to be efficacious for improving student healthcare professionals' knowledge and attitudes towards aphasia and communication, and produced equally successful outcomes when compared with F2F delivery. This is the first study to report the efficacy of an online CPT program that is aligned with SCA for use with student healthcare professionals that also uses a self-report outcome measure with validated psychometric properties. What are the potential or actual clinical implications of this work? Online CPT programs may be useful in both clinical and education contexts to support improved efficiency of services and to enhance communication environments for people with aphasia in healthcare contexts.

Dysarthria and other-initiated repair in everyday conversation.

Dysarthria is commonly understood as a motor speech disorder characterized by symptoms that are framed as physiologically or acoustically measurable. The effects of dysarthria on social interaction through conversation have been reported but, in comparison with physical measures, remain relatively unexplored. Other-initiated repair sequences are particularly common in dysarthria-in-interaction, drawing attention to the actions of both participants in managing (un)intelligibility, rather than the behavior(s) of the person with dysarthric speech in isolation. These sequences merit detailed and ongoing investigation as they enable us to understand how dysarthria impacts on conversation and, critically, how participants attempt to manage difficulties when they arise. This study explores the organization of other-initiated repair sequences in a dyad where one participant has severe dysarthria arising from amyotrophic lateral sclerosis (ALS) also known as MND. Two hours of recordings were collected on four dates over a 12-month period with the data presented here from recording two. The evidence shows that the participants were able to resolve their troubles, but it required extensive work to both identify the trouble sources and to unravel the problems to reach a satisfactory understanding. The interactions presented in this paper reveal an important limitation of other initiation of repair. Physical restrictions were seen to play an important part in the dysarthric speaker's ability to position his talk in sequential context and successfully accomplish self-repair; particularly, third-turn repair. The present study has offered a depiction of layered conversational problems that other-initiation of repair may not completely resolve or, in some cases, multiply.

Conversation Analysis and Family Therapy: A Critical Review of Methodology.

This article critiques the use of conversation analysis (CA) as applied to the study of family therapy. Searches of relevant databases and journals as well as citation searches were conducted in April 2018 for relevant articles. Inclusion criteria included the explicit use of CA either solely or in combination with discourse analysis and discursive psychology. This resulted in the inclusion of 25 articles that were reviewed against a guideline for the evaluation of qualitative research to which five items specific to CA were added to ensure a specific and balanced evaluation of the studies. Articles generally had a good application of quality criteria although there was a variation in detail of transcription, application of sequence analysis, and a limited use of validity testing. CA has the potential to complement existing research on family therapy but requires a rigorous application of process and quality criteria. The article provides recommendations for future CA research into family therapy.

Este artículo analiza el uso del análisis de la conversación (CA) según se aplica al estudio de la terapia familiar. En abril de 2018 se realizaron búsquedas en bases de datos y revistas relevantes así como búsquedas de citas para artículos relevantes. Los criterios de inclusión incluyeron el uso explícito del análisis de la conversación, ya sea exclusivamente o combinado con el análisis del discurso y la psicología discursiva. Esto resultó en la inclusión de 25 artículos que se revisaron según una guía para la evaluación de la investigación cualitativa a la cual se agregaron cinco puntos específicos del análisis de la conversación para garantizar una evaluación específica y equilibrada de los estudios. Los artículos generalmente tuvieron una buena aplicación de los criterios de calidad, aunque hubo una variación en el detalle de la transcripción, la aplicación del análisis de secuencias y un uso limitado de la evaluación de la validez. El análisis de la conversación tiene el potencial de complementar las investigaciones existentes sobre terapia familiar, pero exige una aplicación rigurosa de los criterios de procesamiento y calidad. El artículo ofrece recomendaciones para futuras investigaciones sobre el análisis de la conversación en la terapia familiar.

Right hemisphere damage and other-initiated repair in everyday conversation.

Right hemisphere damage causes communication problems in conversation, but its precise effects have been challenging to study. As such, there are few clinical assessments focused on right hemisphere damage and conversation, and essentially no evidence-based interventions. Other-initiated repair sequences (i.e. moments when a problem of hearing or understanding are indicated and addressed) are a well-described aspect of interaction, with a large body of empirical research evidencing their organisation. Because of the communicative activities they implicate, these sequences may also be a site in which the symptoms of right hemisphere communication disorder become salient. This study explores the organisation of other-initiated repair sequences in interactions involving people with right hemisphere communication disorder using conversation analysis. Two people with right hemisphere communication disorder caused by stroke and four of their familiar conversation partners were recorded in triadic interactions; 104 minutes of recordings were collected, and 28 other-initiated repair sequences were subjected to analysis. This included other-initiations of repair produced by participants with right hemisphere communication disorder, and other-initiations of repair addressed to them. Participants with right hemisphere communication disorder were found to implement efficacious other-initiations of repair, to recognise core aspects of the trouble sources indicated in their own turns, and to design suitable repair solutions. That is, their inferences about communication problems were successful. However, one participant with right hemisphere communication disorder displayed difficulty managing aspects of the repair sequences, with her conversation partners also orienting towards her difficulties. It is argued that her difficulties were driven by problems dealing with multifaceted and ambiguous conversational moments. These observed difficulties suggest that other-initiated repair sequences may be valuable for detecting right hemisphere communication disorder, and highlight the possible role of conversational sampling in clinical assessment.

Why is measuring communication difficult? A critical review of current speech pathology concepts and measures.

Human society is organised through communicative interactions between co-present people. Speech pathology (SP) assessment and intervention strategies aim to access these sites of communication in order to facilitate participation in life situations for people with communication disorders. Surprisingly, however, there is no explicit theory of communication underpinning SP practice and research. As a result, the conceptual and practical basis for rigorous, empirical measurement of communication remains limited, which is a significant challenge for professional practice and research. This critical review discusses the prevailing ways that co-present communication has been conceptualised and measured in SP. In particular, we examine how models of health have informed current ideas and measurement practices. We argue that although patently valuable for SP, they are largely incommensurate with the realities of co-present communication. Drawing on current empirical research in Sociology and Linguistics, we specify the properties of real-time co-present communication and discuss their relationship to current SP concepts and measurement practices. We conclude by suggesting directions for conceptual development and empirical research that will draw SP assessment and intervention strategies closer to real-time co-present communication.

Interaction-focussed therapy for aphasia: Effects on communication and quality of life.

PURPOSE: This study examined the effects of an interaction-focussed therapy for aphasia, which involved both people with aphasia and their familiar conversation partners. It was hypothesised the interaction-focussed therapy would lead to positive changes in targeted conversation behaviours, and improved quality of life for participants with aphasia. METHOD: Three people with chronic aphasia and three of their familiar conversation partners completed an 8-week interaction-focussed therapy programme. A series of single case multiple-baseline ABA experiments were conducted. Outcome measures focussed on changes in targeted behaviours between pre- and post-therapy conversation samples, and changes in quality of life. RESULT: All participant dyads improved their conversations. Familiar conversation partners demonstrated significant changes in targeted behaviours, while only one participant with aphasia achieved significant improvements. There was little evidence of a positive impact on quality of life for participants with aphasia. CONCLUSION: Interaction-focussed therapy enhances everyday communication for people with aphasia and their conversation partners. However, the complex nature of learning in this intervention means that further, likely interdisciplinary work is required to better understand what mediates skill acquisition and therapeutic change and its psychosocial impact. This information is particularly important for optimising interaction-focussed therapy for people with aphasia.

Refractive Surgery: Malpractice Litigation Outcomes.

PURPOSE: To review data on malpractice claims related to refractive surgery to identify common allegations and injuries and financial outcomes. METHODS: The WestlawNext database was reviewed for all malpractice lawsuits/settlements related to refractive eye surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. RESULTS: A total of 167 cases met the inclusion criteria, of which 108 cases (64.7%) were found to be favorable and 59 cases (35.3%) unfavorable to the defendant. A total of 141 cases were tried by a jury with 108 cases (76.4%) favorable and 33 cases (23.6%) unfavorable to the defendant. Laser in situ keratomileusis was performed in 127 cases (76%). The most common allegations were negligence in treatment or surgery in 127 cases (76%) and lack of informed consent in 83 cases (49.7%). For all cases, the need for future surgery (P = 0.0001) and surgery resulting in keratoconus (P = 0.05) were more likely to favor the plaintiff. In jury verdict decisions, cases in which failure to diagnose a preoperative condition was alleged favored the defendant (P = 0.03), whereas machine malfunction (P = 0.05) favored the plaintiff. After adjustment for inflation, the overall mean award was $1,287,872. Jury verdicts and settlements led to mean awards of $1,604,801 and $826,883, respectively. CONCLUSIONS: Malpractice litigation in refractive surgery tends to favor the defendant. However, large awards and settlements were given in cases that were favorable to the plaintiff. The need for future surgery and surgery leading to keratoconus increased the chance of an unfavorable outcome.

Repeat Head CT? Not Necessary for Patients with a Negative Initial Head CT on Anticoagulation or Antiplatelet Therapy Suffering Low-Altitude Falls.

Anticoagulation and antiplatelet (ACAP) medications are increasingly prescribed to patients at high risk for falls. Many trauma centers have developed protocols for obtaining repeat head CT (HCT) for patients with low-altitude falls on ACAP therapy. We assess the need for routine scheduled repeat HCT in this population. Prospective, observational analysis of all low-altitude fall (<6 feet) patients on ACAP therapy evaluated at a Level II trauma center. All low-altitude fall patients with visible or suspected head trauma received an initial HCT. Patients were admitted and repeat HCT was obtained 12 hours later or earlier if acute neurologic decline developed. Chi-squared, Fischer exact, t, and Wilcoxon rank-sum tests were used. Statistical significance was defined as P < 0.05. Total of 1501 patients enrolled suffering low-altitude falls with initial HCT. Among them 1379(91.2%) were negative and 122(8.1%) were initially positive for intracranial hemorrhage. Mean age was 79.9 ± 11.4 years, 61 per cent were female and 85 per cent had visible head trauma at presentation. One hundred ninety-nine were excluded secondary to not receiving repeat HCT. Of the 1180 patients with normal initial HCT who underwent repeat HCT, only 7 (0.51%) had delayed intracranial hemorrhage. None of these patients required surgery, major changes in medical management or suffered head trauma-related mortality; 69 per cent were taking aspirin (acetylsalicylic acid, ASA), 19 per cent warfarin, 17 per cent clopidogrel, 6 per cent other anticoagulants, and 11 per cent were on combination therapy. Repeat HCT for patients on any ACAP therapy after low-altitude fall with a negative initial HCT is not necessary. Thorough neurologic examination and close monitoring is as effective as obtaining a repeat HCT.

Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study.

OBJECTIVE: To investigate the awareness and the use of Spanish version of National Institutes of Health Stroke Scale (NIHSS) throughout the United States (US) by regions using a web-based survey. METHODS: A survey targeting physicians from two specialties that regularly manage acute stroke patients was conducted from February to August of 2015. Academic centers from the Accreditation Council for Graduate Medical Education online directory belonging to emergency medicine (EM) and neurology residency programs were identified. The questionnaire was composed of ten questions separated into three different groups. The responses received from the programs were separated by specialty and grouped into different regions in the US for comparison. RESULTS: Out of 230 residency-invited programs, we received a total of 73 responses, 35 from EM and 26 responses from neurology residency programs. In addition, 12 respondents were categorized as unknown recipients. The South region had the highest response rate with 30.3%. There was no significant difference in the responses by region if Puerto Rico was not analyzed. Interviewees reported a substantial percentage of Spanish-speaking patients reported across the regions and more than 75% of the programs report lack of knowledge of the Spanish version of the NIHSS and/or the use of it. CONCLUSION: There may be a need to increase awareness and to promote the use of the Spanish version of the NIHSS. Spanish-speaking population in the US may be inaccurately assessed for acute stroke and could impact the outcomes. Larger population studies should be conducted to confirm our findings. AUTHOR CONTRIBUTIONS: Dr. Villalobos and Dr. Barnes are involved in formulating the study concept and design; Dr. Rodriguez and Dr. Maud are involved in manuscript writing; Dr. Qureshi is involved in statistical analysis of the data; Dr. Cruz-Flores is involved in critical revision of the manuscript. DISCLOSURES: Dr. Villalobos reports no disclosure; Dr. Barnes reports no disclosure; Dr. Qureshi reports no disclosure; Dr. Cruz-Flores reports no disclosure; Dr. Maud reports no disclosure; Dr. Rodriguez reports no disclosure.

Expanded butterfly plots: A new method to analyze simultaneous pressure and shear on the plantar skin surface during gait.

The current method of visualizing pressure and shear data under a subject's foot during gait is the Pedotti, or "butterfly" diagram. This method of force platform data visualization was introduced in the 1970s to display the projection of the ground reaction force vector in the sagittal plane. The purpose of the current study was to examine individual sub-components of the vectors displayed in Pedotti diagrams, in order to better understand the relationship between one foot region and another. For this, new instrumentation was used that allows multiple Pedotti diagrams to be constructed at any instant during the gait cycle. The custom built shear-and-pressure-evaluating camera system (SPECS) allows for simultaneous recordings of pressure and both components of the horizontal force vector (medio-lateral and antero-posterior) at distinctive regions under one's foot during gait. Data analysis of such recordings affirms three conclusions: (i) pressure and shear values on individual sites on the plantar surface of the foot are not associated in a linear manner, (ii) force vectors in the heel and forefoot regions exhibit horizontal force components that oppose one another, and similarly, (iii) force vectors in the frontal plane transecting the forefoot region also exhibit medial-lateral shear components that counteract one another. This approach sheds light on individual vectors that collectively sum to each vector displayed in a Pedotti diagram. The results indicate that shearing between the foot and the ground is not simply a passive event. The structures of the arches and/or muscular activities are major contributors to the observed interfacial stresses.

Aphasia and topic initiation in conversation: a case study.

BACKGROUND: Aphasiologists often research, assess and treat linguistic impairment and its consequences for daily life separately. Studies that link the language used by people with aphasia to routine communicative activities may expand the linguistic forms treated as relevant for successful communication by people with aphasia. Previous research has suggested that initiating topics in conversation can be problematic for people with aphasia, but it has not been widely investigated. AIMS: This paper uses Conversation Analysis to examine how a person with aphasia initiated topics in everyday conversation. It describes the utility of and-prefacing for topic initiation. METHODS & PROCEDURES: A person with chronic aphasia ('Valerie') was recruited to participate and was video-recorded speaking with four conversation partners. Approximately 3.5 h of recordings were collected, and transcribed according to conversation analytic conventions. Topic initiations in this data set were identified and analysed using conversation analytic procedures. OUTCOMES & RESULTS: It was found that topic initiations often led to trouble, and that Valerie recurrently used and-prefaced turns when initiating topics (e.g. and how was your turkey?). This paper argues that and-prefacing was an advantageous method for initiating topics because it smoothed the conversational discontinuities that this action creates. CONCLUSIONS & IMPLICATIONS: These findings are consistent with previous observations about the hazardousness of topic initiation for people with aphasia. Valerie's use of and-prefacing suggests that conjunctions and other turn prefaces may be useful for promoting successful communication by people with aphasia during everyday conversation. Future investigation should identify if and how other people with aphasia use turn prefacing when initiating topics, and whether this changes over time.