{"schema_version":1,"research_id":"eoa_inverse_innovation_exp03_external48_20260801","source_assessment_id":"eoa_inverse_innovation_exp03_opportunity320_20260801","cell_id":"negative_space_design__speech_language_pathology","selection_stratum":"HIGH_UPSIDE_RESEARCH_OPTION","search_queries":["aphasia conversation partner training wait time allow time to respond systematic review primary study Supported Conversation for Adults with Aphasia","AAC communication partner training wait time expectant delay adult aphasia official guidance","site:asha.org Practice Portal aphasia communication partner allow time respond AAC","aphasia partner completes sentences interruptions response latency conversation analysis study","\"What Happens to Topics and Conversations\" aphasia DOI","site:aphasia.ca communication partner wait time aphasia give time respond","AAC communication partner instruction wait time adult primary study communication partner skills","aphasia conversation analysis partner sentence completion guessing self repair study","Better Conversations with Aphasia conversation therapy wait time partner guessing study randomized controlled trial","SPPARC aphasia partner wait time video conversation therapy study","aphasia partner training individualized strategies video feedback communication success primary trial","supported conversation adults aphasia protocol time respond confirm understanding communication partner","aphasia conversation partner interruption frequency completes sentences observational study","aphasia partner turns ratio dominant conversation quantitative study interruptions","people with aphasia communication partner speaking for them lived experience study time respond","AAC users partners dominate conversation response time quantitative observational adults","communication partner training aphasia implementation barriers clinician time resources study full text","cost communication partner training aphasia implementation"],"sources":[{"source_id":"S1","title":"The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate","publisher":"PLOS ONE","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC5555562/","source_class":"PRIMARY_RESEARCH","publication_date":"2017-08-14","accessed_at":"2026-08-02","claims_supported":["In a video-recorded joint task involving 20 aphasia–partner dyads, communication partners performed most scaffolding, including 40 speaking-for events, 164 reformulations and 165 prompts.","Communication partners dominated several aspects of the task interaction, while people with aphasia both requested and resisted help.","The study used an artificial task and reported only moderate coding reliability, limiting prevalence generalization."]},{"source_id":"S2","title":"“If You Just Stay With Me and Wait…You'll Get an Idea of What I'm Saying”: The Communicative Benefits of Time for Conversational Self-Repair for People With Aphasia","publisher":"American Journal of Speech-Language Pathology","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9567347/","source_class":"PRIMARY_RESEARCH","publication_date":"2022-03-29","accessed_at":"2026-08-02","claims_supported":["Ten people with mild-to-moderate aphasia conversed with partners who maintained an engaged stance and allowed time for self-repair.","The corpus contained 311 edited turns; these turns produced autobiographical and new or topic-extending content.","This was not a randomized comparison of protected waiting against ordinary partner support."]},{"source_id":"S3","title":"What Happens to Topics and Conversations When People with Aphasia Have Time to Repair Their Speaking Turns? A Systematic, Functional Investigation","publisher":"Topics in Language Disorders; ERIC record hosted by the U.S. Institute of Education Sciences","url":"https://eric.ed.gov/?id=EJ1444638","source_class":"PRIMARY_RESEARCH","publication_date":"2024","accessed_at":"2026-08-02","claims_supported":["Videos from 10 people with aphasia were analyzed to examine conversation segments originating in self-repaired turns.","On average, 35% of turns and 38% of words occurred in segments dependent on topics introduced through those turns.","The observational analysis supports possible conversational importance of allowing repair time but does not estimate premature-entry prevalence or causal effects versus a control condition."]},{"source_id":"S4","title":"Supported Conversation for Adults with Aphasia (SCA™)","publisher":"Aphasia Institute","url":"https://aphasia-institute.s3.amazonaws.com/uploads/2022/04/Supported-Conversation-for-Adults-with-Aphasia-SUPPLEMENT-VF.pdf","source_class":"OFFICIAL_GUIDANCE","publication_date":"2022-04","accessed_at":"2026-08-02","claims_supported":["SCA explicitly instructs partners to allow extra response time and become comfortable with silence.","SCA also retains multimodal supports, verifies messages, observes frustration and comprehension cues, and recommends changing or adding support when needed.","The core protected-time mechanism is therefore already part of established aphasia partner guidance."]},{"source_id":"S5","title":"Augmentative and Alternative Communication (AAC) Guidance","publisher":"Royal College of Speech and Language Therapists","url":"https://www.rcslt.org/members/clinical-guidance/augmentative-and-alternative-communication/augmentative-and-alternative-communication-guidance/?download-tabbed-content-as-pdf=1","source_class":"OFFICIAL_GUIDANCE","publication_date":"2026","accessed_at":"2026-08-02","claims_supported":["AAC partner training should include sufficient communication time, attention to the AAC user's signals and views, and flexible, context-specific support.","AAC users differ in whether they need continual co-construction or repeated modeling.","The guidance supports user-centered partner training but does not validate the candidate's exact timing boundary, help-signal protocol or comparative effect."]},{"source_id":"S6","title":"Aphasia: Practice Portal","publisher":"American Speech-Language-Hearing Association","url":"https://www.asha.org/practice-portal/clinical-topics/aphasia/","source_class":"OFFICIAL_GUIDANCE","publication_date":"n.d.","accessed_at":"2026-08-02","claims_supported":["SLPs have central roles in aphasia assessment, treatment, counseling and research.","Established partner approaches include participant-chosen conversational coaching, multimodal SCA and participant-driven SPPARC using recorded conversation assessment and training.","Individualized partner strategies, retained multimodal support and video review are established clinical concepts rather than unique candidate components."]},{"source_id":"S7","title":"Communication Partner Training With Familiar Partners of People With Aphasia: A Systematic Review and Synthesis of Barriers and Facilitators to Implementation","publisher":"International Journal of Language & Communication Disorders","url":"https://opus.lib.uts.edu.au/bitstream/10453/163851/2/Shrubsole_SYST%20RV%20aphasia%20CPT%20B%26F%20familiar%20CPS_IJLCD_2022.pdf","source_class":"PRIMARY_RESEARCH","publication_date":"2022-11-23","accessed_at":"2026-08-02","claims_supported":["The review included 17 empirical studies and identified barriers and facilitators spanning resources, social influences, skills, knowledge, decision-making, perceived capability and reinforcement.","Client and family goals, preferences, readiness and time can affect implementation.","Implementation requires contextual tailoring; the review did not report costs for this candidate."]},{"source_id":"S8","title":"Improving Communication Partner Training of Familiar Partners of People With Aphasia: Results of a Pilot Stepped Wedge Implementation Trial and Embedded Process Evaluation","publisher":"Disability and Rehabilitation","url":"https://pubmed.ncbi.nlm.nih.gov/40719210/","source_class":"PRIMARY_RESEARCH","publication_date":"2025-07-28","accessed_at":"2026-08-02","claims_supported":["A three-service implementation study involved 36 clinicians and audits of 113 patient files.","The implementation package produced short-term increases in offering and providing partner training, but changes were not sustained.","Organizational barriers and mismatches between service capacity and client or family readiness constrain diffusion."]}],"problem_evidence":{"support":"MODERATE","rationale":"The problem mechanism exists: S1 directly documented speaking-for, reformulation, prompting and partner dominance, while S2-S3 showed that self-repaired turns can carry substantial client-authored content when partners wait. S4-S5 independently recognize extra response time as necessary support. However, none estimates how often partner input occurs specifically before an unfinished formulation, agreed help signal or individualized boundary in the proposed clinic. Evidence is concentrated in aphasia, with no comparable verification for the candidate's motor-speech subgroup and only guidance-level AAC support. Material prevalence in the target setting remains unverified.","source_ids":["S1","S2","S3","S4","S5"]},"stakeholder_evidence":{"support":"MODERATE","rationale":"Professional and first-party guidance treats response time, direct engagement, multimodal access and user-specific preferences as important, and the implementation review identifies client and family goals, preferences and readiness as consequential. This establishes credible institutional and affected-party relevance, but no source directly asks clients, partners or clinicians whether they want this exact negotiated-window protocol or would prioritize it over other partner-training needs.","source_ids":["S4","S5","S6","S7","S8"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"Time-supported conversational self-repair","similarity":"S2 is an especially close mechanism match: partners maintained a supportive, engaged stance and withheld progressivity-oriented help long enough for people with aphasia to complete self-repairs; S3 analyzed downstream topics arising from the same corpus.","remaining_difference":"S2-S3 did not compare randomized or alternating protected-window blocks with otherwise matched individualized support, did not start from a negotiated help/stop signal and individualized maximum boundary, and did not jointly evaluate access failures, distress and meaningful task success.","source_ids":["S2","S3"]},{"name":"Supported Conversation for Adults with Aphasia (SCA™)","similarity":"S4 already combines extra response time and tolerance of silence with multimodal supports, message verification, observation of comprehension or frustration and contingent changes in support.","remaining_difference":"The candidate operationalizes these practices as a prompt-episode protocol with an explicit help signal, individualized maximum wait and coded within-client comparison; S4 is guidance rather than a test of that incremental package.","source_ids":["S4"]},{"name":"Individualized conversation-partner approaches including SPPARC and conversational coaching","similarity":"S6 describes participant-chosen strategies, recorded natural conversation, individualized assessment and partner training—overlapping the candidate's negotiation, video mapping and individualized response.","remaining_difference":"The bounded search did not find an SPPARC or coaching study isolating a protected formulation window against a matched active comparator while applying the candidate's explicit safety and access outcomes.","source_ids":["S6"]},{"name":"AAC communication-partner training guidance","similarity":"S5 already recommends sufficient time, attention to user signals and views, individualized support, and adaptation rather than uniform co-construction or modeling.","remaining_difference":"S5 does not define or test a retained-prompt, client-controlled response interval with an agreed help signal and individualized re-entry boundary.","source_ids":["S5"]}],"distinctive_claim_remaining":"Against S2-S6, protected waiting, multimodal context, individualization and partner training are not distinctive. The remaining testable claim is narrower: an explicitly negotiated, individually bounded response-formulation protocol with accessible help/stop signaling will improve client-attributable meaningful communication over otherwise matched individualized SCA/CPT support, without increasing distress, repair burden or access failure.","confidence":"HIGH"},"implementation_evidence":{"support":"MODERATE","rationale":"Existing SCA, SPPARC and AAC partner-training methods make the behavior technically deliverable with ordinary clinical resources. S7 identifies recurring implementation burdens involving time, skills, knowledge, resources, social influence and client/family readiness. S8 demonstrates that a multi-service implementation package can change practice temporarily but that gains may not persist. No source validates fidelity, training dose, compliance workload or cost for the candidate's exact protocol.","source_ids":["S4","S5","S6","S7","S8"]},"scores":{"meaningful_impact":{"score":4,"rationale":"S2-S3 indicate that protected self-repair can yield autobiographical, new and topic-directing content, while S1 shows that partner help can also create asymmetry. A successful protocol could therefore materially improve authorship and participation, but causal improvement over current individualized practice remains unproven.","source_ids":["S1","S2","S3"]},"stakeholder_pull":{"score":3,"rationale":"S4-S6 endorse time, direct participation and individualized communication access, and S7-S8 show organizational interest in partner training. Exact demand for this protocol and target-setting priority are not established.","source_ids":["S4","S5","S6","S7","S8"]},"incremental_advantage":{"score":2,"rationale":"The main mechanism and most support components already appear in SCA, AAC guidance and individualized partner approaches. Only the explicit signal/boundary package and matched comparative evaluation remain incremental, with no outcome advantage yet demonstrated.","source_ids":["S2","S4","S5","S6"]},"distinctiveness_plausibility":{"score":2,"rationale":"No exact single-package match was found, but S2-S6 collectively cover protected time, multimodal context, observation of frustration, verification, user-specific strategy choice and video-based partner training. Distinctiveness is confined to protocolization and comparison design.","source_ids":["S2","S3","S4","S5","S6"]},"technical_implementability":{"score":4,"rationale":"Video-coded interaction studies and individualized partner-training programs already use the required observation, partner behavior change, multimodal supports and conversation analysis. Reliable event coding and individualized cue interpretation remain nontrivial.","source_ids":["S1","S2","S3","S4","S6"]},"adoption_authority_feasibility":{"score":4,"rationale":"ASHA identifies SLP authority for aphasia treatment, while S4-S5 emphasize direct interaction, permission and user-specific wishes. A consenting client and treating SLP can authorize a non-deployment comparison, although severe access or consent limitations require individualized safeguards.","source_ids":["S4","S5","S6"]},"evidence_readiness":{"score":4,"rationale":"S1-S3 demonstrate feasible video-based event and conversation coding, and the candidate supplies a within-client comparator and falsifiers. The active comparator, operational definitions, thresholds and inter-rater reliability target still need prespecification.","source_ids":["S1","S2","S3"]},"safety_net_benefit":{"score":4,"rationale":"The candidate's retained prompt, multimodal access, help/stop signals and immediate re-entry align with S4-S5 recommendations to preserve supports, observe frustration and adapt to individual signals. Direct safety evidence for prolonged or negotiated silence is absent.","source_ids":["S4","S5"]},"scalability":{"score":3,"rationale":"The intervention is low-equipment and fits existing partner-training roles, but S7-S8 document time, skills, resource, readiness and sustainability barriers. Individual timing and signal negotiation also limit simple standardization.","source_ids":["S6","S7","S8"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"Resource-equivalent cost for protocol and ethics preparation, accessible consent and communication materials, recruitment and coordination of 4-6 dyads, two recorded sessions per dyad, clinician and partner time, independent dual video coding, inter-rater calibration, comfort and access monitoring, secure data handling and analysis.","confidence":"LOW","assumptions":["An existing clinic, SLP, AAC supports, room and recording equipment are available.","Approximately 80-120 eligible prompt episodes can be obtained without extensive recruitment infrastructure.","Independent coding and analysis are labor-intensive, as suggested by the video-analysis precedents, but no candidate-specific wage or cost study exists.","No regulated product, diagnosis change or live-care restriction is introduced."],"source_ids":["S1","S2","S3"]},"initial_deployment_startup":{"band_2026_usd":"10K_TO_50K","scope":"One-service preparation after favorable comparative evidence, including protocol refinement, accessible signal and prompt materials, staff and partner training, documentation and consent workflows, privacy/compliance review, initial fidelity sampling and implementation coordination.","confidence":"LOW","assumptions":["Deployment means a limited addition to an existing service, not a new clinic or software product.","Existing AAC equipment and clinical information systems remain in use.","The band includes clinician backfill and coordinator labor because time, knowledge and resource barriers are documented.","Local compliance requirements and training dose are not yet measured."],"source_ids":["S4","S5","S6","S7"]},"operational_launch":{"band_2026_usd":"50K_TO_250K","scope":"Launch across a multi-clinician service or small partner network, including implementation leadership, clinician and caregiver-partner training, accessible materials, workflow integration, privacy and quality governance, fidelity observation, adverse-outcome review and comparative outcome evaluation.","confidence":"LOW","assumptions":["Launch remains a small network rather than regional or national adoption.","Existing clinical rooms, AAC systems and recording equipment are adequate.","Sustained implementation support is included because short-term practice change was not maintained in S8.","Site count, caseload, labor rates and compliance pathway remain undefined."],"source_ids":["S7","S8"]},"annual_recurring":{"band_2026_usd":"10K_TO_50K","scope":"Annual resource requirement for one established service, including onboarding and refresher training, individualized signal and boundary reviews, partner coordination, accessible-material maintenance, periodic fidelity and safety audits, secure data handling and limited outcome monitoring.","confidence":"LOW","assumptions":["The protocol is embedded in existing care rather than separately staffed full time.","Monitoring uses sampled sessions rather than continuous video coding.","No proprietary software or new equipment fleet is required.","High-volume or multisite use would exceed this band."],"source_ids":["S7","S8"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"YES","reason":"S1 verifies speaking-for, prompting and partner dominance in observed aphasia dyads, and S2-S3 show that content can emerge when self-repair time is preserved. This supports the problem's existence, although its material prevalence in the intended setting remains unresolved.","source_ids":["S1","S2","S3"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"ASHA assigns aphasia treatment and counseling roles to SLPs, while official aphasia and AAC guidance centers direct participation, permission and the user's communication preferences. The client–SLP authority structure is therefore credible.","source_ids":["S4","S5","S6"]},"distinct_testable_incremental_claim":{"status":"YES","reason":"After accounting for substantial prior art, the residual claim is a head-to-head effect of explicit negotiated signals and individualized boundaries versus otherwise matched individualized partner support, measured on meaningful communication and adverse/access outcomes.","source_ids":["S2","S4","S5","S6"]},"bounded_next_evidence_step":{"status":"YES","reason":"Video-based interaction coding is feasible in prior primary studies, and a small randomized within-dyad active-comparator study can directly test the residual claim without live deployment.","source_ids":["S1","S2","S3"]},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"A non-deployment test can retain all communication modalities, allow immediate help or stopping, monitor frustration and comprehension, and remain under client and clinician control. These safeguards align with official person-centered guidance; they must be operationalized before enrollment.","source_ids":["S4","S5","S6"]},"credible_cost_scope_and_range":{"status":"UNCERTAIN","reason":"S7-S8 identify labor, skills, resource, coordination, readiness and sustainability burdens but report no candidate-specific costs. The bands are scoped resource-equivalent estimates, not externally validated ranges.","source_ids":["S7","S8"]}},"next_evidence_step":"At one clinic, recruit 4-6 consenting clients with extended response latency and an accessible independent help/stop signal. First video-code at least 20 otherwise eligible, comprehensible prompt episodes per dyad under ordinary individualized support; do not proceed if fewer than 10% contain partner speech or cues before client initiation/help signaling, or if independent coders cannot reach prespecified agreement. If that problem threshold is met, use balanced randomized blocks across two sessions to compare (A) individualized SCA/CPT support with retained prompt and usual clinician-timed re-entry against (B) the same support plus the explicit client-negotiated maximum window and help/stop signal. Blind independent coders to the hypothesis where feasible and compare client-attributable new or meaningful content and task success, with secondary measures of premature entry, help requests, repairs, distress, refusals, fatigue and access failures. Falsify the incremental claim if condition B produces no within-client improvement in meaningful communication or task success, or exceeds the client's prespecified adverse-outcome boundary. This is a research comparison, not live deployment.","blocking_evidence":["Target-setting prevalence of partner entry specifically before unfinished formulation, client initiation or an agreed help signal remains unknown; S1 documents related behavior but not this temporal definition.","No active-comparator study shows that explicit negotiated timing boundaries and help/stop signals outperform established individualized SCA/CPT support.","Evidence for the mechanism is concentrated in mild-to-moderate aphasia; generalization to severe aphasia, motor-speech impairment and diverse AAC access profiles is unverified.","Reliable operational definitions and inter-rater thresholds are still needed for ongoing formulation, comprehensible prompt, premature entry, client-attributable content, meaningful success, distress and access failure.","The safe and acceptable maximum response interval has not been established and must be client-specific rather than inferred from diagnosis or latency.","No direct cost evidence validates labor, training, compliance, coordination or monitoring ranges for this protocol."],"research_disposition":"PRIOR_ART_DIFFERENTIATION_STUDY","world_novelty_boundary":"This bounded web search through 2026-08-02 found substantial collision with time-supported self-repair, SCA, AAC partner guidance and individualized video-based partner training (S2-S6). It did not find a single source testing the entire negotiated-boundary/help-signal package against an otherwise matched active comparator. That residual absence is not a world-novelty, patentability or exhaustive-prior-art claim."}