JCPSLP Vol 21 No 3 2019

communication in clinical practice. So, in short, Barnes and Bloch (2019) argue that we do not currently have good theoretical models or measures for the actual process of communicating in real time. This is important because the process of communicating is what we are ultimately aiming to address for our clients. If we do not have well-grounded ways of thinking about communication, then it is going to hamper efforts to provide valid assessment and intervention. Barnes and Bloch (2019) suggest that a starting point for improving how we approach communication is to describe its fundamental properties; particularly, when the people communicating are co-present, which is the basic site for communication (and using language). Essentially, communication involves a two or more people working together to accomplish some practical activity (e.g., a conversation, an interview, a service encounter), and they do this by finely and continuously making sense of each other’s behaviours. Coming to terms with the properties embedded in this description provides a basis for thinking about communication and moving towards sensitive clinical measurement strategies. But what exactly should be measured? There are several aspects of communication that are pervasively relevant whenever people communicate. The field of conversation analysis (e.g., Schegloff, 2006; Sidnell & Stivers, 2013) has been researching them for around 50 years, and there is evidence that they operate in qualitatively similar ways across languages and cultures (see, e.g., Enfield, 2013; Stivers et al., 2009). First, people pay attention to each other’s behaviour for how it is contributing to the ongoing communication situation. At a more macro level, we can call this participation status . That is, communication situations provide various ways of participating (e.g., current speaker–next speaker, judge–witness, parent–child, storyteller–story recipient, friend–friend), and people calibrate their behaviours to enacting their specific roles. At a more micro level, we can call this action . In every moment of communication, people create behaviours that have transparent reasons, or actions. We conventionally refer to actions with speech act verbs (e.g., questioning, complaining, asking, inviting). Determining the reasons for communication behaviours and responding to them is the driving force of every communication situation. Second, communicative actions set up expectations for how others should respond, and for the direction of the communication situation. These expectations are called sequence organisation . Third, and finally, the dynamic nature of communication means that it requires mechanisms for regulating who should participate and when, and methods of fixing problems when they arise. That is, communication requires turn-taking organisation and repair organisation for it to operate successfully and efficiently. These aspects of communication provide its basic infrastructure. More specifically, they set the parameters for how people generate meaning and coordinate their behaviour with others when communicating. I will now outline how this infrastructure is realised via various meaning-making modalities. What are the “modalities” and how are they “multi”? If we are to develop a technical version of multimodal communication, it will be important to specify the modalities within its scope. Speech pathologists tend to think about

language disorder requires us to carefully analyse different components of a client’s language system. In doing so, it makes sense for us to focus on language as a set of relationships supported by specific cognitive processing. However, this perspective also tends to leak into how speech pathologists think about communication. That is, we tend to focus on how language reflects disorder/ impairment rather than how it supports communication (cf. Ferguson, 2008, p. 26). Speech pathology is not alone with this kind of language “bias”. Linell (2005), for example, argues that the field of linguistics is variously biased towards the features of written language, and away from the features of spoken language. As a result, the relationship between spoken language and communication has been treated as inessential by much of mainstream linguistics, which has focused on language as an abstract, independent system that is fundamentally a property of the mind. One of the reasons that people, professional disciplines, and societies prioritise language is its raw semiotic (i.e., meaning-making) power. We can remove language – especially in its written form – from the precise circumstances of its authorship and still retain important parts of its meaning. For example, we can see and hear sentences like ‘Whiskers is a cat’ and ‘Pass me the butter’ and get a strong sense of what they are referring to, and the circumstances in which they could be relevantly used. This creates the illusion that language can be easily set apart from other resources for meaning creation. In fact, for the duration of our lives, spoken language is embedded in communicative moments, and designed to be understood relative to the meanings of those moments and the range of other behaviours co-occurring in them. For example, when people talk, their hands and arms make shapes, their mouths and lips contort, their eyes meet and part, and their bodies shift and rest around one another and the material environment. This is not to say that language is equipotent to gaze or gesture or facial expression; all speech pathologists have observed and experienced the troubles that replacing language with a less powerful meaning-making resource can cause. Instead, I am arguing that it is important to recognise that language is profoundly interwoven with communicative moments and the multiple modalities intrinsic to them. Systematically integrating this fact into clinical practice has the potential for far-reaching effects on how we go about assessing and intervening with communication disorders – and not just for people with complex communication needs, and/or who use alternative and augmentative communication methods. For this potential to be fully realised, however, we must develop more explicit and consistent ways of thinking about communication and multimodality, both individually and together. What is communication? Barnes and Bloch (2019) highlight that our profession does not have an explicit, widely accepted theoretical framework for communication. Instead, speech pathology has tended to lean on models of health and disability when thinking about communication. The profession has also drawn on expert knowledge of the sensorimotor systems and cognitive processing supporting communication, and, at the other end of the spectrum, the implications of communication disorders for psychosocial well-being and participation in society. This theoretical gap has then had flow-on effects for the ways we go about measuring

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology