Collaborative Discourse and Task Management in Individuals with AmnesiaMelissa C. Duff1, Julie A. Hengst1, Daniel Tranel2, & Neal J. Cohen1

1Beckman Institute, University of Illinois at Urbana-Champaign; 2Dept of Neurology, University of Iowa

Amnesia

Research

LabINTRODUCTION

Collaborative and complex communication relies critically on what Clark(1992) has called “common ground” – the knowledge, beliefs, attitudes and assumptions about the world, and about current and previouscommunication interactions, that are shared by communication partnersand evolve across subsequent interactions. Clark argues that commonground involves the ability of speakers and listeners to track, recall andcontinuously update their record of new events.

Using a barrier task protocol, Clark and Wilkes-Gibbs (1986) explored howthis evolving common ground is displayed in discourse by tracing the wayscommunication pairs developed specific verbal labels for novel geometricshapes (e.g., tangrams). Specifically, these authors found that 1) pairsconverged on a shared perspective for each card; 2) their verbal labels forthe cards became more concise; 3) and their overt collaboration (e.g.,number of words, turns) declined across trials.

Adapting Clark’s protocol for use with individuals with aphasia, Hengst (2003) showed that even for pairs managing aphasia, evolving common ground was displayed in their discourse in the ways identified by Clark.

Current StudyThis study uses a barrier task protocol with individuals with amnesia andtheir routine communication partners in order to more systematicallyexplore the interaction between memory and discourse and the waysindividuals with amnesia organize and manage communicative exchanges.This study asks the following questions:

1) Does the discourse of individuals with amnesia and their familiarcommunication partner display the predicted patterns of learning (i.e.stabilized perspectives and simplified labels for the cards; and reducedovert collaboration) across trials? 2) Does the performance of the pairs with amnesia differ from thecomparison pairs, and if so, how?

Characteristics of the 24 Participants•6 participants with amnesia

• 3 anoxic, 1 CHI – damage restricted to hippocampus

• 2 post-encephalitic (HSE) – extensive MTL damage

• 4 males, 3 females; age ranged from 45 to 54 years

• Education ranged from 9 to 16 years

• Mean WMS-III = 59.16; WAIS-III = 101.5

• 6 comparison participants

• Matched on age, sex, and education; No history of brain injury

•12 familiar communication partners

• Each participant selected a partner to complete all trials

• Relationship and age not controlled; long communication histories

• Materials

• Identical boards for each partner, numbered 1-12

•Identical sets of 12 cards for each partner displaying tangram shapes

METHOD

Coronal section of participant with anoxia

3-D lesion reconstruction of participant with HSE

Tangrams used in Barrier Task

• Procedures• Amnesic and comparison participants served as directors; their familiar communication partners served as matchers

• Director’s board pre-arranged in unique sequence for each trial

• Directors instructed to describe each card to matcher who arranged board to match director’s

• Pairs instructed to communicate freely—facial expressions & gestures as needed

• Pairs not allowed to look over barrier

• Experimenter out of the room during trials; provides feedback only on total number correctly placed

Card 7 Well, the first one looks like…3…your little uh diamond at the bottom of it, and there’s a ledge holding it…and it’s kinda got a oblong figure, kinda looks like… a::: somebody’s standing on their head trying to read a book and their feet are sticking out More clue? Someone’s laying on their back, not laying on their back, standing (er, s:::: ) they’re standing on their shoulders…straight up and down Standing on their shoulders?…Standing on their…well, their head or their shoulders… they (er) upside down…looks like they’re holding a book which would look like a triangle…er I mean uh…er…a diamond…and it’s straight up and down, that what would be the feet, would be… curved back towards the::: left……….10……….if it was (wide) Are the feet together? Yeah… And the legs are bent up? Yeah… I don’t see a triangle on that one…3…I mean not a triangle, a uh, box::: rectangle, triangle…it’s it’s, kind a It, it well, it looks like a person (I, that that’s how) I’m visualizing it as a person but it, if you Is the card up and down? Or is it this way?... Are they all the cards up and The cards are up and down All the cards are up and down. Right. And the person is standing No, the person is:: is um, looks like what would be the top of their head or their shoulder…and: it kinda angles out from their… and then it looks like their… holding the book…er::: what could be a book, and uh part of their hand…..4….and then there’s a straight section of…then there’s a triangular section up to the::...3…to the: uh to the left side, and then at the top At the end? there’s a triangular section…that goes to the right. Okay I gottcha .

Card 8 Okay, number two:::…3….is a: solid figure in, I mean, uh, the same type of figure….except. Okay. that the smallest section of the triangle that would have been put on the first one, is now pointed down…..5…..and: then the body of the:: type of thing is…is: going up straight, and the::::: what would be the:::of the legs are pointed back to the:::: right, and the::::um, there’s a triangular section that kinda joins right at where the feet would be, and then there’s the diamond section right below that…and then there right below A free: triangle, uh, okay:: that narrows it down. And the diamond shape is just barely touching….the figure and the body of the figure is pointing straight up and down…except that the smaller triangle::: on on the first one:: was at the top, on the second one, it’s at the bottom. It looks like the figure on one almost upside down with a triangle added to it. And the triangle’s at the bottom? Right. …….7…….And does it kinda look like…at the top like the arms are stretched out and the head is back. Well, they’re heading not …in the direction of the:: triangle diamond and the first triangle. …….8…….Are they on the right hand side of the body? Yep.

Card 12 Okay, number three looks like the same (or) similar figure layed down…the long part of the body is almost horizontal, the angle part that would be equivalent to what would be the feet, are::: to the::…right side of the figure, there’s a small triangle right above it… and then Right above the feet Right, right above the feet, and then there’s the diamond figure:: right above that body I mean square. XXXXsquare Though, it looks like a diamond when it’s turned sideways. ^^h, Are the square and the triangle…free from the body? Yes. Are they:::…is the triangle on the right hand side of the square? …..5…..Yes. And then there’s a space in between them? Yes. And they::, square’s almost touching the body. Okay, At the point of the X. But the triangle looks like it could almost be a tail. Well, it could almost be a tail, but it’s not attached. So, I don’t consider it a tail.

Card 2 this is a solid figure that in the distance would look like a barn. There’s a triangle to the::: left side of the figure, it’s attached…to A triangle? Right. But it’s a solid figure, To the left side of the figure. it’s got a square bottom, it’s got a triangular sides like a roof, there’s a triangle attached to one side, it’s on the left hand side, it goes up to a point…that is like a::, a straight stack up, and then there’s a triangular section off to the::: left side of the figure at the top of it…right ta- tatched almost at that point where it’s flat, is a::: square diamond shape that’s kind of rotated…and it’s off to the:::right of the figure, and then right below that is a triangle that is just barely touching the square ……………. 15………………..The first things to identify would be the square at the top Square at the top, And is it square?… It’s square, it’s it’s square but XXX a square…that’s in a diamond shape Okay. And and that is sitting on, that is attached or detached? Well its almost touching a little triangle right below it And then there’s a big figure: that looks like kinda Okay, like a Okay, and does it come down and kinda go, like that?… on the left hand side? Right. Correct. And then the right hand side kinda goes like this?…. 4…..kinda out and in and out?

Card 6 its got a diamond at the top of the figure, and its barely touching the bottom part of the figure…3….and its it’s a rectangle I mean it’s a square oh no, it’s a square rotated ninety degrees. And there’s a big figure below it. Does it look like it’s standing up or sitting down? It looks like somebody::: kneeling to pray…3… Okay…so the right hand side goes out like this, and then back, like that…The right hand side… goes like they’re sitting there with their hands out, sitting on their knees And the body is straight up and down and that the head was the trian- or the diamond the diamond.

Card 11 I visualize this as a uh, almost an abstract dog….okay, With a square on it? With a square right on the top part, with a small::: Rectangle? Rectangle right below it. And a diamond tail.

Card 5 This looks like somebody praying again….it’s kinda like a zigzag…he’s kind a like bent down….and his body’s:::::straight up and down, his arms which are in a triangular type shape, are out and his: head is rotated forward and his head would be a square, in this figure…….6……… He looks like he’s kneeling. I didn’t think he was kneeling, I thought he was s::itting. Well, no, he’s not sitting, he’s well he could be, he could be sitting if he had a chair there. Does he kinda have…3….up, down, up, down, like there is a triangle down by where the feet would be?…… 6……..No, there’s no triangle, but the… attached? No, the:::this is solid figure that makes up the body that’s kinda like on a diagonal.…going to the right… 3...like that would be where his knees would point up and go back s:: towards the left with a straight line, ^^h right above the middle where, where the body would be it’s triangle again, pointing out to the right…3…and there’s a kind of a bulky figure attached to where the triangle is that looks like it could be the torso of the body and then the square part would be the head and the head would be::: which would be::; a diamond shape in this case is kinda looking down towards that point…3… Is it attached?No, it’s not attached…..5….. At all…..5…..but, it looks very close to being attached …..5…..but it’s not touching…that’ s a distinction between that and another figure on here….4…. Well, then I think (XX something wrong). The easiest way::: is the only figure… on here….4…. that has an up and down shape… 3… to the body and the diamond, or the uh square diamond head is not attached and and looking down towards the only one I have left that’s standing up and down No, it’s not standing up and down, it’s kneeling up and down…3… it’s kinda l like kneeling. I don’t have any XXXX Well, it looks kinda like semi-kneel, I’ll just put it that way. A semi-kneel. The, the it would be bent at the knees ……6…… and the torso part of it would be going straight up and down. Then So, it doesn’t have a triangle in it?……6……Well, there’s a triangle part to the top where the what would be the head would attach which is the little square that’s shaped that’s kinda pointed up to the side like a diamond ………15…………… So, there’s a triangle attached to the head..2..No, a diamond. ……6…… There’s a triangular section to the body part, right where the head would be attached to the body… like the shoulders, where the shoulders would be.

Card 4 the next one looks almost… the opposite of somebody kind uh slumped down, on the ground, with the same type of sh: head XX Well, sitting with their head down like this? Right.

Card 3 nine is::::: kind of an abstract figure… it’s got a triangular shape to it, but it’s got a dent in it, so it’s not a full triangle it’s kinda comes down as a triangle that has a small section that goes:::: up again it kinda goes like this? Yeah, that’s it and and then down. …3… And then it has a square up here. Right, and it has, well it has And a triangle up here? It has a s::: a square rotated Two triangles? and two triangles.

Card 1 Okay, the next one looks like a:: body with somebody kicking their foot out

Card 10 The next one looks like a:::;barn or: attached with a silo and an arrow…Now wait a minute, which one has the arrow? The one that I am talking about, has the arrow Okay. Alright, I got that Okay and the arrow is on the right side of the barn.

Card 9 Alright then the ten is the opposite figure except it’s got a straight up and down silo on it…

• Data Analysis • Each trial was timed, card placements were scored for accuracy, and each session was video taped and transcripts were generated

• Transcripts were coded for number of words, gestures, and turns used by the pairs and verbal descriptions and labels used to reference target cards were identified and analyzed for changes across sessions

• To begin to differentiate the function of collaborative effort displayed in the discourse, each turn was coded using the following system:

• R- referencing card or place (e.g., This one looks like a horse; Number two is the Viking ship)• M-task management (e.g., My turn; Can I show you the card; You have to describe the cards to me; Okay, I got that one; The next one is the guy reading a book)

Patient SideDirectorPartner Side

Matcher

RESULTS

0:00

2:24

4:48

7:12

9:36

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14:24

16:48

Trial 1 Trial 2-6,Session 1

Session 2 Session 3 Session 4

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HSE

Comparison

• Amnesic and comparison pairs successfully completed all trials, with high card placement accuracy, 93.8% and 97.6% respectively.

• All pairs displayed dramatic reductions in time to complete each trial.

Average Time to Generate Labels per Session

11:15 1:20

16:20 5:06

9:08 0:48

• There was a stark reduction of communicative resources (i.e., words, turns) used to complete the task, and by the final trial the descriptions generated by the amnesic participants had simplified.

Descriptions of Cards by Participant with Anoxia and Partner (Black text is patient; Red text is the partner)

First Session (Session 1, Trial 1)

Card 6 Man with kneeling and diamond head is number one praying praying

Card 8 Oddball figure

Card 4 Siesta man

Card 7 Man reading a book

Card 1 Kicking man

Card 3 Mountain with box sliding down

Card 2 The microphone speaking man

Card 11 Dog with the tail down

Card 12 Dog with the tail up

Card 10 Barn with the arrow

Card 9 Barn without the arrow

Card 5 Knee bend

• Protocol• Pairs completed 6 barrier task trials per session

•4 sessions, across two consecutive days (minimum of 30 min separation between sessions)

•Total of 24 trials

• Analysis of variance revealed a main effect of group for time (F (1, 10) = 8.004, p= <.05) indicating that the amnesic pairs had, on average, higher completion times than comparison pairs.

• The anoxic/CHI pairs had completion times approaching the comparison pairs while the HSE pairs took, on average, 3 minutes longer to complete each trial.

Last Session (Session 4, Trial 6)

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• Although the amnesic pairs demonstrated the same rate of learning as the comparison pairs, they did so with greater effort overall (i.e. time, communicative resources).

•In addition, HSE pairs required significantly more communicative resources than anoxic/CHI pairs and comparison pairs.

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SUMMARY / DISCUSSION• Common ground can be supported by various aspects of memory

including more procedural forms of memory (Duff, Hengst, Tranel, & Cohen, under review).

• Participants with amnesia demonstrated rapid and robust learning in the collaborative learning paradigm with significant reductions in communicative resources to complete task.

• Points to promise of using the collaborative referencing task therapeutically to promote re-learning and new learning for individuals with neurogenic disorders.

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• All pairs displayed a dramatic reduction in the number of turns dedicated to both referencing and management indicating that amnesic participants learned the labels as well as the rules and procedures of the task.

• All pairs distributed task management across resources (i.e., prefabricated artifacts and practices, use of cards as memory aid) .

Session 1, Trial 1• Going out of order, describing the cards he thinks are easier to describe.

Use of Cards as External Memory Aid for Task Management

Session 1, Trial 1• Realizes that he can’t keep track of cards so asks his brother which ones they have done so he can flip the cards over. He then independently flips the cards over that he has described for the next 2 sessions.

Session 3, Trial 1• Instead of flipping the cards over he holds them in his hand after he describes them, still going out of order.

Session 4, Trial 1

• By the beginning of session 4, he is moving the cards off of the board into a pile.

Session 4, Trials 5 and 6• He leaves the cards on the board, goes in order (although reversed order) and touches the cards as he labels each card.

•This is in service of memory for the task, topic, references and evolving discourse.