How assisted eating becomes a caring practice in institutional settings: Embodied gestures and stages of assisted eating.

Assisted eating is a basic caring practice and the means through which many individuals receive adequate nutrition. Research in this area has noted the challenges of helping others to eat while upholding their independence, though has yet to explicate how this caring practice is achieved in detail and across the lifespan. This paper provides an empirical analysis of assisted eating episodes in two different institutions, detailing the processes through which eating is collaboratively achieved between two persons. Data are video-recorded episodes of infants during preschool lunches and care home meals for adults with dementia, both located in Sweden. Using EMCA's multimodal interaction analysis, three core stages of assisted eating and their underpinning embodied practices were identified: (1) establishing joint attention, (2) offering the food, and (3) transferring food into the mouth. The first stage is particularly crucial in establishing the activity as a collaborative process. The analysis details the interactional practices through which assisted eating becomes a joint accomplishment using a range of multimodal features such as eye gaze, hand gestures, and vocalisations. The paper thus demonstrates how assisted eating becomes a caring practice through the active participation of both caregiver and cared-for person, according to their needs. The analysis has implications not only for professional caring work in institutional settings but also for the detailed analysis of eating as an embodied activity.

Intercorporeal collaboration: Staging, parsing, and embodied directives in dementia care.

This study shows how concerted bodily movements and particularly intercorporeality play a central role in interaction, particularly in joint activities with people with late-stage dementia. Direct involvement of bodies in care situations makes intercorporeal collaboration the basic form for engaging with people with late-stage dementia. By detailed analysis of a videorecording of a joint activity involving a person with late-stage dementia as an example, we show that the process of concerted bodily movements includes not only an interactive bodywork but also a reconfiguration of the routine activities and actions in situ. Reconfigurations often require, and are the outcome of, particular practices for the systematic modification of the embodied conducts of the participants and their use of artifacts in the surrounding environment. These practices, that we highlight in our study, are (1) staging activities through organization and re-organization of body parts, as well as artifacts (rather than using verbal descriptions of activities); (2) decomposing (parsing) activities into smaller parts possible for the person with dementia to perform (rather than using verbal action descriptions); and (3) providing embodied directions and bodily demonstrations of actions (rather than using verbal directives). As a result, we point to these practices for their reflexive roles in the change of the use of modalities in interaction: from mainly using verbal language to the prominence of visual depiction and bodily demonstration as necessary methods to facilitate the participation of people with latestage dementia in joint activities.

Socio-cultural perception of robot backchannels.

Introduction: Backchannels, i.e., short interjections by an interlocutor to indicate attention, understanding or agreement regarding utterances by another conversation participant, are fundamental in human-human interaction. Lack of backchannels or if they have unexpected timing or formulation may influence the conversation negatively, as misinterpretations regarding attention, understanding or agreement may occur. However, several studies over the years have shown that there may be cultural differences in how backchannels are provided and perceived and that these differences may affect intercultural conversations. Culturally aware robots must hence be endowed with the capability to detect and adapt to the way these conversational markers are used across different cultures. Traditionally, culture has been defined in terms of nationality, but this is more and more considered to be a stereotypic simplification. We therefore investigate several socio-cultural factors, such as the participants' gender, age, first language, extroversion and familiarity with robots, that may be relevant for the perception of backchannels. Methods: We first cover existing research on cultural influence on backchannel formulation and perception in human-human interaction and on backchannel implementation in Human-Robot Interaction. We then present an experiment on second language spoken practice, in which we investigate how backchannels from the social robot Furhat influence interaction (investigated through speaking time ratios and ethnomethodology and multimodal conversation analysis) and impression of the robot (measured by post-session ratings). The experiment, made in a triad word game setting, is focused on if activity-adaptive robot backchannels may redistribute the participants' speaking time ratio, and/or if the participants' assessment of the robot is influenced by the backchannel strategy. The goal is to explore how robot backchannels should be adapted to different language learners to encourage their participation while being perceived as socio-culturally appropriate. Results: We find that a strategy that displays more backchannels towards a less active speaker may substantially decrease the difference in speaking time between the two speakers, that different socio-cultural groups respond differently to the robot's backchannel strategy and that they also perceive the robot differently after the session. Discussion: We conclude that the robot may need different backchanneling strategies towards speakers from different socio-cultural groups in order to encourage them to speak and have a positive perception of the robot.

Assisted eating in late-stage dementia: Intercorporeal interaction.

In this article, we argue that investigating and learning about agentive abilities of people living with late-stage dementia requires a theoretical framework that focuses on the use of bodily resources in interpersonal interaction (i.e., intercorporeality) for performing joint activities rather than on solely the use of spoken language. Assisted eating, which involves people living with late-stage dementia and professional carers, is taken as an empirical example. The study is based on observations and video recordings of occasions of assisted eating involving five people with late-stage dementia in a residential elder care home; one of these people is used as an example in this paper. The analysis shows that assisted eating is performed as a joint intercorporeal activity. The participants create joint attentional space and a common space of action for their bodily movements when they give and receive food. The participants engaged in the activity coordinate their bodily moves with each other. The analysis (1) demonstrates that the collaboration between people living with late-stage dementia and nurses is based on practical interdependent and co-operative bodily actions. (2) This makes it possible to better understand agency in terms of intercorporeal interaction displayed by people living with late-stage dementia. (3) The agency demonstrated in intercorporeal interaction is thus considered to be shared and distributed across bodies and requires support to be interactionally achieved. (4) The intercorporeal interaction as grounds for agency not only calls on other participants to note and honor the agency of the person with dementia that is still evident in embodied interaction, but also invites others to support people with dementia to claim and display their agency in social interactions and joint activities.

Spatiotemporal arrangement of objects in activities with people with dementia.

PURPOSE: This study shows how the spatial organization of objects and their use may impact locally produced order of activities and how that can affect the accomplishment of everyday activities by people with dementia. METHODS: The study is based on ethnomethodological conversation analysis of eight and a half hours of video recordings in three different settings. Eighteen sequences of activities identified were multimodally transcribed and analyzed. RESULTS: The availability or non-availability of objects, their arrangements and manipulations play a crucial role in the management of the order of activities and may present both challenges and facilitations for people with dementia. The organizations of objects directly influence the order of the activity, and the objects' potential use may afford actions that deviate from the trajectory and the order of the main activity. CONCLUSIONS: One of the significant uses of objects is how they contribute to the perceptual field where attention is organized for building actions. Participants in activities modify the perceptual field by manipulating objects in the material surrounds in response to the relevancies resulting from the unfolding activities. Therefore, spatial contingency is significant in the accomplishment of activities by people with dementia. As it is not self-evident that verbal instructions may result in the instructed actions accordingly, the rearrangement of objects and making them timely available to people with dementia may increase the possibilities of keeping the order of the activities intact.

Embodiment in tests of cognitive functioning: A study of an interpreter-mediated dementia evaluation.

This study explores how manners of mediation, and the use of embodiment in interpreter-mediated conversation have an impact on tests of cognitive functioning in a dementia evaluation. By a detailed analysis of video recordings, we show how participants-an occupational therapist, an interpreter, and a patient-use embodied practices to make the tasks of a test of cognitive functioning intelligible, and how participants collaboratively put the instructions of the tasks into practice. We demonstrate that both instructions and instructed actions-and the whole procedure of accomplishing the tasks-are shaped co-operatively by embodied practices of all three participants involved in the test situation. Consequently, the accomplishment of the tasks should be viewed as the outcome of a collaborative achievement of instructed actions, rather than an individual product. The result of the study calls attention to issues concerning interpretations of, and the reliability of interpreter-mediated tests and their bearings for diagnostic procedures in dementia evaluations.

Baking together-the coordination of actions in activities involving people with dementia.

This study explores interaction and collaboration between people with dementia and their spouses in relation to the performance of household chores with the focus on instruction as an interactional context to engage the person with dementia in collaboration to accomplish joint activities. Dementia is generally associated with pathological changes in people's cognitive functions such as diminishing memory functions, communicative abilities and also diminishing abilities to take initiative as well as to plan and execute tasks. Using video recordings of everyday naturally occurring activities, we analyze the sequential organization of actions (see Schegloff, 2007) oriented toward the accomplishment of a joint multi-task activity of baking. The analysis shows the specific ways of collaboration through instructional activities in which the person with dementia exhibits his competence and skills in accomplishing the given tasks through negotiating the instructions with his partner and carrying out instructed actions. Although the driving force of the collaboration seems to be a series of directive sequences only initiated by the partner throughout the baking activity, our analyses highlight how the person with dementia can actively use the material environment-including collaborating partners-to compensate for challenges and difficulties encountered in achieving everyday tasks. The sequential organization of instructions and instructed actions are in this sense argued to provide an interactional environment wherein the person with dementia can make contributions to the joint activity in an efficient way. While a collaborator has been described as necessary for a person with dementia to be able to partake in activities, this study shows that people with dementia are not only guided by their collaborators in joint activities but they can also actively use their collaborators in intricate compensatory ways.