An interactional perspective on sound prolongation in multilingual encounters in residential care.

Elderspeak refers to adapting one's language to a  perceived language decline of an older interlocutor. Earlier studies have explored different features of elderspeak; some of these studies attribute positive outcomes to using elderspeak that facilitates communication, but other studies consider elderspeak a negative way of communicating that should be avoided. The aim of this study is to investigate a largely unexplored feature of elderspeak, namely sound prolongation in a multilingual context. There are five participants in this study: three carers and two care recipients in a residential care unit. The carers and care recipients have limited access to a shared spoken language. The data consist of video- and audio recordings of interaction between the participants. The recordings have been transcribed and analysed in accordance with Conversation Analytical methodology. The analysis shows that the carers use sound prolongation as part of their interactional repertoire in order to manage situations of distress. We conclude that in some distressful situations carers' use of sound prolongation may help mitigating the care recipient's emotional concerns since the source of agitations has been addressed properly. In other situations, the use of sound prolongation may lead to an escalation in distress, if the source of agitation is not addressed adequately. Our results bring to the fore that an interactional practice, such as the use of sound prolongation in the context of expressed distress must be interpreted in relation to the complexity of each and every situation participants find themselves in, their level of understanding, and the task/activity at hand.

Language brokering in multilingual caregiving settings.

Using the methodology of conversation analysis to examine audio-recorded multi-party conversations between a Swedish-/Farsi-speaking resident and multilingual staff in a Swedish residential home, this article describes a practice for establishing shared understanding by one caregiver enacting the role of language broker. The focus is on caregiving settings where caregivers assist an elderly person with her personal hygiene. We demonstrate how brokering is used to (1) maintain the conversational flow in a small talk sequence and (2) address the contents in the resident's complaints. The article thus advances our understanding of language brokering as an activity that multilingual staff in a linguistically asymmetrical workplace setting take on to assist a colleague in performing client-oriented activities.

Implementing Internet-Based Aural Rehabilitation in a General Clinical Practice.

PURPOSE: The purpose of this paper is to share the lessons that were learned about the process of implementing an Internet-based, randomized controlled trial (RCT) in general clinical practice (GCP) and to address some of the advantages of using the Internet as a tool to implement a RCT in GCP. The RCT implemented focused on investigating Internet-based aural rehabilitation (AR) in addition to hearing aid (HA)-fitting supplemented with telephone support, and it was applied in a clinical setting. The results of this RCT and the questionnaires chosen will be presented in an article elsewhere. PROCEDURE: Here, the procedure of the implemented trial is presented, and the implementation challenges are presented and discussed. Specifically, we describe the trial research question, recruitment strategy, patient eligibility criteria, the questionnaires, clinician participation, funding and time (for the clinicians), and risks and benefits (for the participants). DISCUSSION: The trial implementation showed that AR in addition to HA-fitting can be carried out in GCP using the Internet. Using an Internet-based RCT overcomes some of the challenges of implementing a trial in GCP.

Response practices in multilingual interaction with an older Persian woman in a Swedish residential home.

In the present case study, a care encounter between an older multilingual (Farsi/Swedish/English) Persian woman and staff in an ordinary, Swedish residential home is investigated. The woman is perceived as suffering from dementia symptoms, but has not received any formal diagnosis of the disease. More specifically, the study focuses on how the woman's contributions in her mother tongue, Farsi, are responded to by a carer, who is also multilingual and speaks Swedish as a second language (L2), but has a very limited knowledge of Farsi. The data consists of recorded material from a mundane morning activity in the residential home, as the woman is undressed and prepared to go to the shower. The method employed is conversation analysis, and the study addresses the interactional outcome of this type of multilingual encounters, highlighting the way the establishment of mutual understanding is negatively affected by the fact that the participants do not or only to a limited extent share a common language. Analysis of the data shows that most of the woman's contributions in Farsi are responded to in L2-Swedish by the carer, primarily by means of seven different response practices: soothing talk, instrumental talk, minimal responses, explicit expressions of understanding, mitigating talk, questions, and appraisal. The findings are discussed in light of new demands on Swedish (and Western) care- and health care systems to adapt to the increasing number of multilingual, older people, who will become residents in care facilities and attend day centers within the coming years.

Daily living with hyperacusis due to head injury 1 year after a treatment programme at the hearing clinic.

The aim of this study was to gain a deeper understanding of the quality of daily living of persons with hyperacusis after a traumatic head injury 1 year after these persons had participated in a treatment programme at a Swedish hearing clinic. The study group consisted of 21 patients with a mean age of 36 years. In-depth interviews, conducted 1 year after the treatment programme, were analysed using the grounded theory method. Five emergent categories were labelled moderating vulnerability, awareness of restrictions, conditioned participation, structuring daily life and controlling mood changes. The core category, moderating vulnerability, describes the necessary balancing act between activity and recovery. The informants were aware of their new restrictions and managed daily life by structuring and planning each day in detail to minimize exposure to sensory stimuli. They had learned to prioritize their activities and, thereby, rationed their time. The evaluated programme appears to have positive effects and facilitates patients' adjustment process to hyperacusis with relatively restricted costs for the society.

Struggling for a new self: in-depth interviews with 21 patients with hyperacusis after an acute head trauma.

The aim of the study was to gain a better understanding of what suffering from hyperacusis means. Twenty-one out-patients referred to a hearing clinic due to persisting hypersensitivity to sounds after an acute head trauma were interviewed. Before the head trauma, they had lived an independent, active and externally oriented life. As a consequence of the trauma, the patients became psychosocially vulnerable and suffered from a variety of symptoms: hypersensitivity to sounds, difficulties with concentrating and remembering, increased anxiety and sensitivity to stress. Structuring everyday life and using a variety of coping strategies was necessary for reducing life stress and symptoms in the process of adjusting to the changed life situation.