Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury

The vague language use scale: Clinical utility and psychometrics from adults with traumatic brain injury

BACKGROUND

Pragmatic communication difficulties encompass many distinct behaviours, including the use of vague and/or insufficient language, a common characteristic following traumatic brain injury (TBI) that negatively impacts psychosocial outcomes. Existing assessments evaluate pragmatic communication broadly, often with only one or two items capturing each behaviour, thus limiting sensitivity and precision to variations within each behaviour. Given that greater nuance is needed to detect subtle pragmatic communication differences and investigate underlying cognitive mechanisms, a more refined measure is critical to improve psychosocial outcomes. The Vague scale was developed to address those needs.

AIM

To provide preliminary evidence supporting the novel Vague language use (Vague) scale's reliability, validity and clinical utility.

METHODS AND PROCEDURES

The Vague scale rates each discourse sample utterance for vague language use on a 3-point scale; the measure's Vague score represents the mean of utterance-level ratings. Using the Vague scale, two raters naïve to diagnosis evaluated Cinderella narratives of 46 adults with severe TBI and 46 controls with no brain injury, providing reliability, construct validity and classification accuracy evidence. Vague scores were also compared to other clinical measures to gather criterion-related validity evidence.

OUTCOMES AND RESULTS

Interrater agreement across all transcripts was moderate. Construct validity was supported by expected group differences and criterion validation, including significant relationships with increased violations of Grice's maxim of quantity and measures of lexical variation; significant relationships with psychosocial outcomes, supporting clinical utility; and nonsignificant relationships with measures of syntax and overall pragmatic communication. Classification accuracy expectedly did not support using Vague scores in isolation for diagnosis, due to unacceptable sensitivity (0.696).

CONCLUSIONS AND IMPLICATIONS

Evidence supported the Vague scores' psychometric properties. Thus, the Vague scale shows promise as a measure of one distinct pragmatic communication behaviour: vague language use. Future research should apply the Vague scale to determine its sensitivity in individuals with subtle social communication challenges (e.g., mild TBI), explore its utility with more naturalistic discourse samples as part of a pragmatic communication battery, longitudinally examine changes in Vague scores, and investigate cognitive mechanisms underlying this specific pragmatic communication behaviour.

WHAT THIS PAPER ADDS

What is already known on this subject Use of vague language is common following traumatic brain injury (TBI) and may contribute to negative psychosocial outcomes related to employment and relationships. However, existing measures of vague language lack sensitivity and precision, limiting their utility for identifying subtle performance variations or determining the cognitive mechanisms underlying this specific pragmatic communication behaviour. What this study adds to existing knowledge The current study gathered promising reliability, validity and clinical utility evidence to support using the novel Vague language use (Vague) scale, which was developed to address these limitations. Based on complex (Cinderella) stories of adults with and without TBI, Vague scores demonstrated moderate interrater agreement and promising construct validity based on expected group differences and criterion validation, including moderate associations with related constructs and weak associations with unrelated constructs. Because pragmatic communication profiles post-TBI can vary, classification accuracy expectedly indicated that Vague scores should not be used alone to identify communication differences post-TBI. What are the clinical implications of this work? Vague scores show promise for documenting clients' use of vague language and planning intervention to address associated discourse-level challenges. Future research should investigate applying the Vague scale to naturalistic discourse samples (1) as part of a battery that sensitively and precisely identifies pragmatic communication differences and (2) as a tool for investigating cognitive mechanisms underlying vague language use, with the goal of improving interventions that support pragmatic communication and enhance psychosocial outcomes.

Relationship between language comprehension and chronic neurobehavioral symptoms in adults with mild traumatic brain injury

PRIMARY OBJECTIVES

Annually, millions of Americans sustain mild traumatic brain injuries (mTBI), and some may experience neurobehavioral symptoms (NBS), like slow processing speed that persist chronically or longer than 6 months post injury. In turn, cognitive processes like language comprehension may be compromised. This study investigates the relationship between NBS and language comprehension in individuals with mTBI history and low or high NBS.

METHODS & PROCEDURES

Thirty-one adults with mTBI and high (n = 13; female = 11) and low (n = 18; female = 10) NBS completed a language comprehension task in speeded and unspeeded conditions. Reduced language comprehension, as measured by slower response times (RTs) and reduced accuracy, was expected to be high compared to low NBS group, regardless of condition. Language comprehension correlates (e.g. cognition and general processing speed) were also measured.

MAIN OUTCOMES & RESULTS

Adults with high NBS showed reduced comprehension, measured by slower RTs in the unspeeded condition compared to low NBS. No difference in accuracy or errors produced was observed. Cognitive skills and processing speed are negatively correlated and predicted language comprehension task performance.

CONCLUSIONS

NBS and predictive factors specific to the individual are important to monitor post-mTBI, as they may affect language functioning.

Practical Strategies to Optimize Cognitive-Communication Intervention in Complex Real-World Conditions: A Life Integration Approach

PURPOSE

Cognitive-communication intervention (CCI) service gaps compromise quality of life for individuals with acquired brain injuries. Speech-language pathologists (SLPs) must examine barriers to care and develop solutions to address current problems in awareness of cognitive-communication disorders, understanding of SLP services, access and referral mechanisms, and care pathways. They must also adapt CCI to the complexities and constraints of daily life. In this article, we explore actions that clinical SLPs can take to overcome service barriers and advocate for fair, timely, and evidence-based CCI.

METHOD

This clinical focus article examines barriers to CCI and provides a set of tools and strategies SLPs can employ to address them. These strategies are organized into a framework called the Life Integration Approach (LIA), which has 10 elements to guide clinical service planning: (a) evidence application, (b) communication education and assertiveness, (c) access and referral, (d) assessment, (e) therapeutic engagement, (f) cognitive-communication goal setting, (g) instructional practices, (h) life integration, (i) communication partner collaboration, and (j) resource allocation. Resources are provided to demonstrate how the LIA can integrate advocacy with clinical service while adapting to complex conditions of life, competing priorities, and service constraints.

RESULTS AND CONCLUSION

Although barriers to provision of quality SLP CCI may seem formidable, there are practical actions SLPs can take to advocate for and adapt CCI services to life demands for individuals living with the devastating effects of brain injury.

Naming Ability in the Chronic Phase of Moderate-Severe Traumatic Brain Injury

INTRODUCTION

Naming difficulties are commonly reported in the acute and subacute stages of recovery of traumatic brain injury (TBI) and across severity levels. Previous studies, however, have used samples of mixed chronicity (acute and chronic) and severity (mild and severe) and then aggregated data across individuals from these distinct groups. Thus, we have little knowledge about the persistence of naming difficulties into the chronic stage of recovery in individuals with moderate-severe TBI.

PURPOSE

To increase the rigor and reproducibility of naming research in TBI, the present study sought to determine the presence and profile of naming disruptions into the chronic stage of moderate-severe TBI using a confrontation naming assessment.

METHOD

Thirty-three individuals aged 24-55 years in the chronic epoch of moderate-severe TBI and 33 demographically matched noninjured comparison (NC) participants completed the Philadelphia Naming Test (PNT). A mixed-effects logistic regression model predicting the probability of a correct response as a function of group was fit to the data.

RESULTS

Participants with TBI performed well on the PNT (all participants with TBI had over 90% accuracy). However, participants with TBI were statistically less likely to correctly name an item relative to demographically matched NC participants.

CONCLUSIONS

This study provides empirical evidence that naming difficulties persist into the chronic epoch of moderate-severe TBI. Despite high accuracy on the PNT, nearly 60% of these individuals with TBI reported continued difficulty with word finding in their daily lives. This discrepancy leaves open the possibility that, at this stage of injury, word-finding issues may be more reliably evoked and studied when the assessment is embedded within cognitively demanding and ecologically valid contexts (i.e., discourse, conversation). Further investigation of naming deficits in chronic moderate-severe TBI using a more naturalistic assessment is warranted.

Factors Influencing Speech-Language Pathology Referral and Utilization in Mild Traumatic Brain Injury: An Exploratory Analysis

PURPOSE

Speech-language pathologists provide important services to people recovering from mild traumatic brain injury (mTBI), also called concussion, although they may be underutilized in outpatient care. Because health care providers face challenges in selecting assessments to efficiently describe patient needs, the purpose of this study was to describe factors related to patients receiving speech-language pathology services after mTBI, as well as how assessments predict amount of services received.

METHOD

In this retrospective chart review study, demographic factors, injury characteristics, and assessment scores were extracted from medical records of patients aged 14-65 years receiving services for recent (within 6 months) mTBI at an outpatient specialty clinic. The Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment, Standardized Assessment of Concussion, and a newly developed self-report measure of cognitive-communication function-the Cognitive-Communication Referral Indicator for Concussion (CCoRI-C)-were used as dependent variables to predict speech-language pathology service referral. For those referred, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Behavior Rating Inventory of Executive Function (BRIEF) scores were added as dependent variables predicting speech-language pathology dosage.

RESULTS

A total of 132 patient charts met inclusion and exclusion criteria. In addition to CCoRI-C and PCSS symptoms, receiving imaging, being injured in a motor vehicle crash, experiencing loss of consciousness, and being of female sex were related to speech-language pathology referrals. Of the 77 patients referred for speech-language pathology care, higher CCoRI-C, PCSS, BRIEF, RBANS total, and RBANS visuospatial scores were associated with recommended speech-language pathology dosage. Only the CCoRI-C, BRIEF-Adult Version (BRIEF-A) Behavioral Regulation, and BRIEF-A Metacognition were associated with actual number of speech-language pathology sessions attended.

CONCLUSIONS

Cognitive-communication symptoms and executive function may be important to planning speech-language pathology rehabilitative episodes of care for people with mTBI. Future work should continue to evaluate how assessments augment demographic and injury characteristics in decision making for both referral to and use of speech-language pathology services after mTBI.

'Do it afraid': An arts-based reflexive collective case study exploring youth responses to post-concussion communication changes in daily life

BACKGROUND

Concussion and communication researchers have yet to study how post-concussion communication changes affect youths' daily lives. The lack of attention paid to how young people respond to communication changes during concussion recovery constitutes a significant gap in current concussion management research and practices.

AIMS

To explore how youth respond to the effects of post-concussion communication changes in their daily life, including (1) daily routines, (2) relationships with family members, (3) relationships with peers and (4) participation in school/work and community activities.

METHODS & PROCEDURES

Five youths (16-25 years) and three family members participated in this arts-based reflexive collective case study. Ecocultural theory provided the theoretical framework for study design, data collection and analysis. Cases consist of (1) pre-interview demographic information, (2) three 60-90-min virtual interviews, (3) optional family member interviews, (4) multi-media arts-based participant-generated materials representing participants' experiences of communication change and concussion, and (5) researcher observations, discussions and reflexive journal entries. Reflexive thematic analysis was used to analyse the data.

OUTCOMES & RESULTS

Analysis yielded four themes that illustrate the ways youth navigated and adapted to post-concussion communication changes: (1) navigating changes in communication tasks, daily roles, and identity; (2) re-negotiating relationships and emotional reactions; (3) seeking control and learning to let go during recovery; and (4) helping youth adapt to post-concussion communication changes.

CONCLUSIONS & IMPLICATIONS

The study findings deepen our understanding of the impact of post-concussion communication changes on youths' daily lives and underscore considerations critical to the development of communication-focused concussion education programs and interventions tailored specifically for youth.

WHAT THIS PAPER ADDS

What is already known on the subject Youth is a critical period of social and emotional development. Communication is integral to identity, relationships, participation in daily activities and well-being. Concussions can affect speech clarity, fluency, understanding and use of language, and social interactions. Re-engaging in routine activities and pre-injury roles can be challenging for youth experiencing communication changes as part of complex concussion recoveries. What this paper adds to the existing knowledge Findings from this research illuminate how youth navigate and adapt to communication changes post-concussion and support the development of youth-focused communication education programs, assessments and interventions. Youth participants actively managed their recoveries by developing innovative strategies to support their communication during daily activities, learning about communication, practicing communication tasks sequentially, and facing fears. Youth also reframed and challenged narrow views of 'normal communication'. What are the potential or actual clinical implications of this work? Findings highlight the need for more youth- and communication-focused education materials and programs within youth concussion management protocols. Information about the specific ecological and sociocultural factors youth encounter during concussion recovery is needed to develop targeted communication-focused education and intervention programs for youth and their families to mitigate risks of isolation, loneliness, and mental health concerns and increase youths' participation in family, community and cultural life. By learning from youth about how communication changes affected their participation in daily activities, identity and relationships, clinicians can provide information and interventions to reduce adverse listener reactions and help young people feel supported and understood.

Reduced on-line speech gesture integration during multimodal language processing in adults with moderate-severe traumatic brain injury: Evidence from eye-tracking

BACKGROUND

Language is multimodal and situated in rich visual contexts. Language is also incremental, unfolding moment-to-moment in real time, yet few studies have examined how spoken language interacts with gesture and visual context during multimodal language processing. Gesture is a rich communication cue that is integrally related to speech and often depicts concrete referents from the visual world. Using eye-tracking in an adapted visual world paradigm, we examined how participants with and without moderate-severe traumatic brain injury (TBI) use gesture to resolve temporary referential ambiguity.

METHODS

Participants viewed a screen with four objects and one video. The speaker in the video produced sentences (e.g., "The girl will eat the very good sandwich"), paired with either a meaningful gesture (e.g., sandwich-holding gesture) or a meaningless grooming movement (e.g., arm scratch) at the verb "will eat." We measured participants' gaze to the target object (e.g., sandwich), a semantic competitor (e.g., apple), and two unrelated distractors (e.g., piano, guitar) during the critical window between movement onset in the gesture modality and onset of the spoken referent in speech.

RESULTS

Both participants with and without TBI were more likely to fixate the target when the speaker produced a gesture compared to a grooming movement; however, relative to non-injured participants, the effect was significantly attenuated in the TBI group.

DISCUSSION

We demonstrated evidence of reduced speech-gesture integration in participants with TBI relative to non-injured peers. This study advances our understanding of the communicative abilities of adults with TBI and could lead to a more mechanistic account of the communication difficulties adults with TBI experience in rich communication contexts that require the processing and integration of multiple co-occurring cues. This work has the potential to increase the ecological validity of language assessment and provide insights into the cognitive and neural mechanisms that support multimodal language processing.

A novel end-to-end dual-camera system for eye gaze synchrony assessment in face-to-face interaction

Quantification of face-to-face interaction can provide highly relevant information in cognitive and psychological science research. Current commercial glint-dependent solutions suffer from several disadvantages and limitations when applied in face-to-face interaction, including data loss, parallax errors, the inconvenience and distracting effect of wearables, and/or the need for several cameras to capture each person. Here we present a novel eye-tracking solution, consisting of a dual-camera system used in conjunction with an individually optimized deep learning approach that aims to overcome some of these limitations. Our data show that this system can accurately classify gaze location within different areas of the face of two interlocutors, and capture subtle differences in interpersonal gaze synchrony between two individuals during a (semi-)naturalistic face-to-face interaction.

Temporary ambiguity and memory for the context of spoken language in adults with moderate-severe traumatic brain injury

Language is processed incrementally, with addressees considering multiple candidate interpretations as speech unfolds, supporting the retention of these candidate interpretations in memory. For example, after interpreting the utterance, "Click on the striped bag", listeners exhibit better memory for non-mentioned items in the context that were temporarily consistent with what was said (e.g., dotted bag), vs. not consistent (e.g., dotted tie), reflecting the encoding of linguistic context in memory. Here, we examine the impact of moderate-severe traumatic brain injury (TBI) on memory for the contexts of language use. Participants with moderate-severe TBI (N=71) and non-injured comparison participants (NC, N=85) interpreted temporarily ambiguous utterances in rich contexts. A subsequent memory test demonstrated that participants with TBI exhibited impaired memory for context items and an attenuated memory advantage for mentioned items compared to NC participants. Nonetheless, participants with TBI showed similar, although attenuated, patterns in memory for temporarily-activated items as NC participants.

Experiences of Acquired Brain Injury as Expressed Through Mask-Making: A Qualitative Analysis

PURPOSE

Acquired brain injury (ABI) extends beyond the immediate aftermath, and understanding individual experience of ABI is paramount to providing effective support mechanisms. This study examined how people with ABI used mask-making to engage in self-expression.

METHOD

Publicly available data from the Unmasking Brain Injury Project website, an advocacy group for people with ABI, were analyzed. A qualitative approach with hybrid inductive/deductive analysis was used to explore how people with ABI use art to express their emotional experiences of ABI.

RESULTS

In total, 1,049 masks had narratives describing the visual components and meaning in the associated masks. Three major themes emerged: the multiplicity of experiences after ABI, including positive, negative, and mixed outcomes; the expression of emotional pain and living with loss through art; and the importance of positivity, purpose, and faith in the experience with ABI. Multiplicity was the central expression represented in the masks. The most commonly represented emotional experiences were: emotional pain and living with loss and positivity, purpose, and faith. The masks incorporated literal depictions of the ABI, visual metaphors, and intentional use of colors and shapes for self-expression.

CONCLUSIONS

These results support previous findings that emotional experiences after ABI are complex and often interlaced with several emotions. The most prominent feelings include emotional pain and living with loss, and positivity, purpose, and faith. Mask-making may be a particularly appropriate method for people with ABI to process or express emotional experiences, as well as to provide clinicians with visual records of sense of self, coping, or progress.

Insights From Important Event Recounts Told by People With Traumatic Brain Injury

PURPOSE

Communication can be chronically impacted by severe traumatic brain injury (TBI), yet there is a critical lack of research investigating communication recovery beyond 12 months postinjury with discourse measures. This longitudinal study aimed to investigate quantitative and qualitative changes in important event recounts produced by a group of people with severe TBI up to 2 years postinjury.

METHOD

A prospective observational design with an inception cohort was adopted. Thirty-four participants with severe TBI were asked to produce an important event recount at 6, 12, and 24 months postinjury. A mixed-methods approach comprised a quantitative analysis of microlinguistic and macrostructural measures, using the automated discourse command EVAL in Computerized Language Analysis (CLAN) and the CLAN Collaborative Commentary tool, respectively. Statistical analysis included a repeated-measures analysis of variance and the Friedman test. An independent qualitative content analysis was also conducted.

RESULTS

The measures revealed significant differences between 6 and 24 months, indicating a protracted recovery trajectory. The microlinguistic analysis showed increased use of revision and repetition over time. The macrostructural analysis indicated changes with orientation to recount characters, evaluative comments, and the number of events or complexity of the recount. The content analysis revealed categories of (a) childhood events, (b) family and relationships, (c) career and education, and (d) grief and loss. Topics at 6 months focused on childhood events and holidays, whereas career and education predominated at 24 months.

CONCLUSIONS

This is the first study to explore important event recounts told by people with severe TBI as they recovered. Participants showed discourse recovery beyond 12 months, highlighting the need for equivalent timing of service provision. The important event recount shows good potential as an ecologically valid assessment tool to evaluate communication recovery that can also be integrated with advances in computerized analysis. Analyses additionally provided insights into potential therapy targets and content categories for chronic discourse impairments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26499271.

Communication between rehabilitation staff and people with traumatic brain injury: A systematic review

This systematic review aimed to synthesize barriers and facilitators in communicative interactions between staff and people with traumatic brain injury (TBI) in the rehabilitation context. Searches captured published evidence up to November 2022 in MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, AMED, and PsycINFO. Eligible studies reported on the communicative interaction between rehabilitation staff and adults with TBI. In total, 31 studies were included in the review; including quantitative, qualitative, and mixed-methods designs. Quality assessment was carried out using standard checklists. Quantitative studies and quantitative components of mixed-method studies were synthesized descriptively according to reported communication barriers and facilitators. Qualitative studies and qualitative components of mixed-method studies were analysed through an inductive thematic meta-synthesis; generating six main themes with four subthemes. Themes were categorized as barriers or facilitators to communicative interaction. Findings demonstrated that cognitive-communication disorders of people with TBI challenge the communicative interaction between rehabilitation staff and people with TBI. However, the extent to which these disorders create a communicative barrier is closely related to staff's communicative approach. While staff holding a collaborative and acknowledging approach and using supportive strategies may facilitate successful communicative interactions, staff using the opposite approach may exacerbate communication barriers.

Comprehension of Miranda warnings in adults with chronic, moderate-severe traumatic brain injury

INTRODUCTION

To compare comprehension of Miranda rights in adults with traumatic brain injury (TBI) versus adults without TBI as measured by response accuracy on the Miranda Right Comprehension Instruments.

METHODS

Data were collected virtually via teleconferencing from July 2022 to February 2023. Participants included 25 adults with moderate-severe TBI (12 females, 13 males) and 25 adults without TBI (12 females, 13 males), ages 20-55 years. In this observational study, both groups (with and without TBI) completed the Miranda Right Comprehension Instruments (MRCI), which includes four instruments including Comprehension of Miranda Rights, Comprehension of Miranda Rights-Recognition, Function of Rights in Interrogation, Comprehension of Miranda Vocabulary instruments. Response accuracy on the MRCI was compared across groups.

RESULTS

The TBI group was significantly less accurate when responding to questions on the MRCI compared to the NC group.

CONCLUSION

Individuals with chronic moderate-severe TBI underperform their non-injured peers on the Miranda Rights Comprehension Instruments, a tool used in legal settings when there is doubt about an individual's understanding of their Miranda rights. TBI is a risk factor for disruptions in comprehension of language in legal contexts that may, in part, contribute to the increased interaction with the criminal justice system and incarceration for individuals with TBI. Implications for policy, advocating, and intervention are discussed.

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study

BACKGROUND

Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability.

AIMS

The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population.

METHODS AND PROCEDURES

A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached.

OUTCOMES AND RESULTS

The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors.

CONCLUSIONS AND IMPLICATIONS

The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation.

WHAT THIS PAPER ADDS

What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

Neuropsychological functioning of adults with PTEN hamartoma tumor syndrome

PTEN hamartoma tumor syndrome (PHTS) might be associated with a distinct cognitive and psychological profile. However, previous studies are limited, predominantly based on small and pediatric cohorts, likely affected by selection bias, and show a broad range of findings. We aimed to characterize the neuropsychological functioning of adults with PHTS. A total of 40 participants, with intellectual disability as exclusion criterium, completed an extensive clinical neuropsychological assessment including cognitive tasks, questionnaires, and a clinical diagnostic interview. The cognitive tasks and questionnaire data were categorized as below and above average based on 1.5 SD. About 80% of participants showed an average level of intelligence. In addition, 30% and 24% of participants scored below average on immediate memory recall and speed of information processing, respectively. Furthermore, about 25% reported above average scores on the majority of the questionnaires, indicating psychological distress, signs of alexithymia, and cognitive complaints. Personality of participants was characterized by inflexibility, social withdrawal, and difficulties in recognizing and describing their own emotions. Adults with PHTS demonstrate a heterogeneous yet distinct neuropsychological profile that is characterized by slower information processing, psychological problems, and specific personality traits. These findings provide directions on how to optimize the care and daily lives of adults with PHTS.

Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments

BACKGROUND

There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI).

OBJECTIVES

To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs.

METHODS

A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs.

RESULTS

We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation.

CONCLUSIONS

Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research.

TRIAL REGISTRATION

PROSPERO database (registration number: CRD42020196861). No funding.

"Stay tuned": an exploratory content and thematic analysis of brain injury videos on YouTube

PURPOSE

This exploratory study aimed to examine brain injury videos on YouTube to determine who posted about brain injury, content categories of videos, and how brain injury was represented.

METHODS

A mixed methods approach was used. Brain injury videos on YouTube were collected in November 2022 and analysed quantitatively and qualitatively using descriptive statistics and content analysis. Visual data analysis was used to generate visual descriptions of a representative sample of the videos, and these were thematically analysed alongside the video transcripts.

RESULTS

The sample of 100 YouTube videos consisted of educational, lived experience, and promotional videos. Medical organisations and hospitals were the predominant source of videos. An overarching theme of "Video tells a story" was generated from eighteen visual descriptions and transcripts which contained three major themes: (a) we choose how the story is told, (b) recovery is a process, and (c) it changed my life.

CONCLUSION

YouTube may have a storytelling role for both people with a brain injury wishing to share their story and for health professionals wishing to communicate information about brain injury. This research may have clinical implications for the integration of YouTube in brain injury rehabilitation and the use of YouTube for health communication.

Memory for Conversation in Traumatic Brain Injury: A Feasibility Study and Preliminary Findings

PURPOSE

Despite common clinical complaints about memory for conversation after traumatic brain injury (TBI), the nature and severity of this deficit are unknown. In this research note, we report feasibility and preliminary data from a new conversation memory study protocol.

METHOD

Participants in this feasibility study were 10 pairs, each including an adult with chronic, moderate-to-severe TBI and their chosen familiar conversation partner. The experiment began with a naturalistic conversation between participants with TBI and their conversation partners. After a filled delay, participants next completed verbal recall for the conversation, which we transcribed and coded for their accuracy relative to the original conversation. Participants also read chosen statements from their original conversation and predicted what each partner would remember in a week. One week later, participants completed a posttest about who said each of the chosen statements, allowing direct comparison to their predictions.

RESULTS

We successfully collected conversation memory data from all 10 pairs, suggesting that this protocol is feasible for future study. In this preliminary sample, people with TBI and their conversation partners did not differ in the accuracy of their recall for the conversation about 20 min after it occurred. When asked to predict their partner's delayed memory, conversation partners were less accurate than participants with TBI because they underestimated how much their partners with TBI would remember.

CONCLUSION

Measuring memory for conversation in TBI is feasible and may advance the characterization of cognitive-communication impairment in TBI, and its heterogeneity, in everyday contexts.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25927513.

Developing a screening instrument for underlying core domains of communicative competence in children with communication support needs

A socio-neurocognitive approach to augmentative and alternative communication (AAC) shows several underlying domains of communicative competence: Attention, perception, cognition, memory, orientation, socio-emotional development, motor skills, and language. To determine developmental markers of these underlying core domains of communicative competence in children with communication support needs, we developed a new screening instrument. The present article consists of three consecutive studies. In study 1, we constructed the first version of the screening instrument based on a sample of both children without disabilities and children with Down syndrome. In study 2, we confirmed the reliability (i.e., internal consistency) of the screening instrument in a new group of young children with typical development and established concurrent validity with the Early Language Scale. In study 3, we established concurrent validity with the Communication Matrix in a clinical sample of children with communication support needs. The screening instrument can be used in clinical practice as part of AAC assessment to provide comprehensive insights into strengths and weaknesses in the underlying core domains of communicative competence of children with communication support needs.

Montreal Cognitive Assessment Scores Do Not Associate With Communication Challenges Reported by Adults With Alzheimer's Disease or Parkinson's Disease

PURPOSES

Screening for cognitive-communication challenges in people with Alzheimer's disease (AD) or Parkinson's disease (PD) may benefit from multiple kinds of information about the client (e.g., patient-reported, performance-based). The purposes of this report are (a) to describe, using recently published score range descriptors (e.g., "mild," "moderate"), the patient-reported communication challenges of people with AD or PD using the Communicative Participation Item Bank (CPIB) and the Aphasia Communication Outcome Measure (ACOM); and (b) to examine the relationships between the performance-based Montreal Cognitive Assessment (MoCA), a cognitive screener, and patient-reported CPIB and ACOM scores.

METHOD

Participants were a convenience sample of 49 community-dwelling adults with AD or PD. Participants completed the measures in person as part of a larger assessment battery.

RESULTS

MoCA total scores ranged from 7 to 28. CPIB T-scores fell in the following ranges: 31% were "within normal limits," 57% reflected "mildly" restricted participation, and 12% reflected "moderately" restricted participation. ACOM T-scores fell in the following ranges: 50% were either "within normal limits" or reflected "mild" impairment, 29% reflected "mild-moderately" impaired functional communication, and 21% reflected "moderately" impaired functional communication. There were only weak and nonsignificant correlations between T-scores on the ACOM or CPIB and scores on the MoCA, and there were no group differences on the ACOM or CPIB between individuals who screened positive versus negative on the MoCA.

CONCLUSION

When screening individuals with AD or PD, patient-reported communication challenges seem to be complementary to information provided by the MoCA and perhaps most useful in screening for mild communication challenges.

Using Conversation Analysis to explore assessments of decision-making capacity in a hospital setting

BACKGROUND

Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision-making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best-practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision-making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties.

AIMS

This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real-life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)-related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment.

METHODS & PROCEDURES

Four naturally occurring capacity assessments were video-recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision-making capacity. The analysis was informed by our knowledge of the MCA best practice guidance.

OUTCOMES & RESULTS

An overall structure of capacity assessment that enacted some of the best-practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option-listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub-components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented.

CONCLUSIONS & IMPLICATIONS

CA is a feasible empirical method for exploring the structure and conduct of capacity assessments. CA identifies and provides ways of describing interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies including a wider range of health and social care professionals and patients have the potential to inform evidence based training for HCPs who conduct assessments of decision-making capacity.

WHAT THIS PAPER ADDS

What is already known on this subject The Mental Capacity Act (MCA) is poorly implemented in practice. Healthcare professionals (HCPs) find it challenging to assess the decision-making capacity of individuals with communication difficulties, and people with communication difficulties are often excluded from or insufficiently supported during capacity assessment. Research is limited to self-report methods. Observational studies of capacity assessment are required. What this study adds This is the first study to use Conversation Analysis (CA) to explore how capacity assessments are conducted in a hospital setting by HCPs with people with communication difficulties as a result of acquired brain injury. One video-recorded capacity assessment was structured in six phases that aligned with best practice MCA guidance. However, other capacity assessments deviated from this structure. One phase, option listing, varied in practice and options were not always presented. What are the clinical implications of this work? CA revealed interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies are warranted to inform training for health and social care professionals who conduct capacity assessments.

Wishes, beliefs, and jealousy: use of mental state terms in Cinderella retells after traumatic brain injury

Introduction

Traumatic brain injury (TBI) negatively impacts social communication in part due to social cognitive difficulties, which may include reduced mental state term (MST) use in some discourse genres. As social cognitive difficulties can negatively impact relationships, employment, and meaningful everyday activities, assessing and treating these difficulties post-TBI is crucial. To address knowledge gaps, the present study examined MST use in the narrative retells of adults with and without severe TBI to compare between-group performance, evaluate changes over the first two years post-TBI, and investigate the impact of participant and injury-related variables.

Methods

The total number of MSTs, ratio of MSTs to total utterances, and diversity of MSTs were identified in the Cinderella narratives of 57 participants with no brain injury and 57 with TBI at 3, 6, 9, 12, and 24-months post-TBI.

Results

Reduced MST use in participants with TBI was found at 3, 6, 9, and 12-months post-TBI, but these reductions disappeared when story length (total utterances) was accounted for. Further, MST diversity did not differ between groups. Similarly, although the total number of MSTs increased over time post-TBI, no changes were observed in the ratio of MSTs to total utterances or MST diversity over time. Injury severity (post-traumatic amnesia duration), years of education, and verbal reasoning abilities were all related to MST use.

Discussion

Overall, although individuals used fewer MSTs in complex story retells across the first year following severe TBI, this reduction reflected impoverished story content, rather than the use of a lower ratio of MSTs. Further, key prognostic factors related to MST use included injury severity, educational attainment, and verbal reasoning ability. These findings have important implications for social communication assessment and treatment targeting social cognition post-TBI.

Family members' and friends' reports after standard and intensive group treatment for social communication difficulties following acquired brain injury - a mixed method approach

OBJECTIVE

To examine family members/friends' perception of change following standard and intensive group interactive structured treatment (GIST) for persons with social communication difficulties (SCDs).

METHODS

A parallel mixed methods design combining data from questionnaires, the Goal Attainment Scale, and interviews.

PARTICIPANTS

Forty-nine adult (>18 years) family members/friends (69.4% female) of persons with SCDs and acquired brain injury (ABI) (cohabitating partner, 53.1%; other relatives, 30.6%; friends, 16.3%).

INTERVENTION

Standard GIST consisted of 12 weekly outpatient sessions (2.5 h). Intensive GIST consisted of 4 weeks of inpatient rehabilitation (2 × 3 days/week, 2 × 4 days/week). Both treatments included 3- and 6-month follow-ups.

MAIN OUTCOME MEASURES

Quantitative measures (n = 49) included the following informant reports: Latrobe Communication Questionnaire (LCQ), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Behavior Rating Inventory for Executive Functions-Adult version (BRIEF-A), and Goal Attainment Scale. The qualitative measure (n=9) was an interview performed at 6-month follow-up.

RESULTS

Converging results were found, suggesting a perceived positive change over time for both standard and intensive GIST, with no substantial differences reported between the treatments.

CONCLUSIONS

Family members/friends reported improved social communication skills of the persons with SCDs following standard and intensive GIST. However, the integration of data showed the complexity of assessing SCDs and the need for further investigation.

How do speech-language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice

BACKGROUND

Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI.

AIMS

To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations.

METHODS & PROCEDURES

This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision-making. Participants were recruited through national and international SLP professional bodies, TBI-specific or SLP special-interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses.

OUTCOMES & RESULTS

There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self-monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings.

CONCLUSIONS & IMPLICATIONS

Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal-based approach. Factors affecting the use of discourse in practice included client-specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision-making for SLPs working in TBI.

WHAT THIS PAPER ADDS

What is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal-based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI-specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice.

A qualitative exploration of speech-language pathologists' approaches in treating spoken discourse post-traumatic brain injury

BACKGROUND

Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice.

AIMS

To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base.

METHODS & PROCEDURES

Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach.

OUTCOMES & RESULTS

Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment.

CONCLUSIONS & IMPLICATIONS

This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice.

WHAT THIS PAPER ADDS

What is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post-TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision-making for discourse interventions post-TBI are limited. What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post-TBI. It details the factors that influence clinical decision-making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context-sensitive discourse intervention post-TBI. It indicates the need for an in-depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience.

Does Facebook Use Provide Social Benefits to Adults with Traumatic Brain Injury?

Drawing on the social compensation hypothesis, this study investigates whether Facebook use facilitates social connectedness for individuals with traumatic brain injury (TBI), a common and debilitating medical condition that often results in social isolation. In a survey (N = 104 participants; n = 53 with TBI, n = 51 without TBI), individuals with TBI reported greater preference for self-disclosure on Facebook (vs. face-to-face) compared to noninjured individuals. For noninjured participants, a preference for Facebook self-disclosure was associated with the enactment of relational maintenance behaviors on Facebook, which was then associated with greater closeness with Facebook friends. However, no such benefits emerged for individuals with TBI, whose preference for Facebook self-disclosure was not associated with relationship maintenance behaviors on Facebook, and did not lead to greater closeness with Facebook friends. These findings show that the social compensation hypothesis has partial utility in the novel context of TBI, and suggest the need for developing technological supports to assist this vulnerable population on social media platforms.

Stakeholder views on cognitive communication assessment and intervention for a person living independently in the community with severe traumatic brain injury

BACKGROUND

Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions. Inadequate treatment provision and an under- or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention.

AIMS

To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap.

METHODS AND PROCEDURES

A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives.

OUTCOMES

Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personal relevance. Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services.

CONCLUSIONS

CCDs are under-recognised and this can have a devastating effect on people with CCD and on those around them. Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI. They also provide additional evidence of persisting barriers to accessing treatment. Future research to explore ways to close this evidence-to-practice gap is required.

WHAT THIS PAPER ADDS

What is already known on this subject Cognitive communication difficulties are a well-documented consequence of TBI. There is evidence for the effectiveness of person-centred interventions for CCD across the recovery continuum. International evidence-based practice recommendations are in place for CCD assessment and management. Barriers to accessing SLT expertise for CCD have previously been reported. What this paper adds to existing knowledge This investigation explores the views of a diverse group of stakeholders involved in a single case of a community-dwelling individual with severe TBI. Stakeholders report positive real-world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team. Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI. What are the potential or actual clinical implications of this work? CCDs are under-recognised, with devastating effect for people with CCD and those around them. These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI.

Rehabilitation access for individuals with cognitive-communication challenges after traumatic brain injury: A co-design study with persons with lived experience

BACKGROUND

Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long-term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access.

AIMS

This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs).

METHODS

We used a co-design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada.

RESULTS

Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech-language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive-communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access.

CONCLUSION & IMPLICATIONS

The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech-language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general.

WHAT THIS PAPER ADDS

What is already known on this subject There is extensive documentation of the long-term rehabilitation needs of individuals with traumatic brain injury (TBI) and their challenges in accessing rehabilitation services over the long term. It is also well known that many individuals with TBI have cognitive and communication deficits that affect their interactions in the community, including with healthcare providers, and that SLTs can train communication partners to provide communication supports to individuals with TBI in these communication contexts. What this study adds This study adds important information about barriers to accessing rehabilitation, including barriers to accessing SLT services in the community. We asked individuals with TBI about challenges to accessing auto insurance funding for private community services, and their responses illustrate the broader challenges individuals with TBI face in communicating their deficits, conveying service needs, educating and convincing service administrators and self-advocating. The results also highlight the critical role that communication plays in healthcare access interactions, from completing forms to reviewing reports and funding decisions, to managing telephone calls, writing emails and explaining to assessors. What are the clinical implications of this work? This study shows the lived experience of individuals with TBI in overcoming barriers to accessing community rehabilitation. The results show that best practices in intervention should include evaluating rehabilitation access, which is a critical step in patient-centred care. Evaluation of rehabilitation access includes evaluating referral and navigation, resource allocation and healthcare communications, and ensuring accountability at each step, regardless of model of service delivery or funding source. Finally, these findings show the critical role of speech-language therapists in educating, advocating and supporting communications with funding sources, administrators and other healthcare providers.

Virtual INSIGHT: Improving natural social interaction: Group reHabilitation after traumatic brain injury

BACKGROUND

There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face-to-face group intervention.

AIM

This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained.

METHODS & PROCEDURES

Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8-week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test-Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale.

OUTCOMES & RESULTS

A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures.

CONCLUSIONS & IMPLICATIONS

There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods.

WHAT THIS PAPER ADDS

What is already known on the subject Recent literature has focused on the benefits of group intervention for cognitive communication diffuclties after traumatic brain injury (TBI). However, research to date examines only face-to-face group rehabilitation. As there has been a demand for a shift in the way we communicate worldwide, we must make adaptations to current intervention procedures to continue to serve individuals with diverse communication needs. What this paper adds to existing knowledge This study contributes new information about the feasibility of a virtual communication skills group for individuals with TBI. This virtual INSIGHT (Improving Natural Social Interaction: Group ehabilitation after Traumatic brain injury) group intervention facilitates progress towards collaboratively set communication goals and the online setting has the potential to increase the accessibility of these services. What are the potential or actual clinical implications of this work? Progress towards cognitive and social communication goals can be facilitated by an online group intervention. However, this progress was not correlated with scores on standard assessments of cognitive communication, social communication and quality of life. This has implications for the evaluation of the assessments typically used and their ecological validity and applicability to the communication context.

'It gives you encouragement because you're not alone': A pilot study of a multi-component social media skills intervention for people with acquired brain injury

BACKGROUND

People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI.

AIMS

To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation.

METHODS & PROCEDURES

The study used a mixed-methods, pre-post-intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self-guided course about social media skills (social-ABI-lity course), and then participated in a private, moderated Facebook group over a 12-week period (social-ABI-lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre-intervention, post-intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post-intervention interview.

OUTCOMES & RESULTS

At post-intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention.

CONCLUSIONS & IMPLICATIONS

This pilot study provided preliminary evidence that an intervention comprising a short, self-guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention.

WHAT THIS PAPER ADDS

What is already known on the subject Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge This pilot study reports the outcomes of people with ABI completing a short, self-guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work? With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive-communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection.

Optimizing our evidence map for cognitive-communication interventions: How it can guide us to better outcomes for adults living with acquired brain injury

BACKGROUND

Speech and language therapists (SLTs) share a collective goal of ensuring that adults with cognitive-communication disorders (CCD) due to acquired brain injuries (ABI) attain their highest possible level of participation and satisfaction in family, community, social, work and academic communications through evidence-based interventions. While there is a considerable evidence base to support SLT cognitive-communication interventions, there are also numerous barriers to its implementation.

AIMS

The first aim is to describe the development of a comprehensive knowledge translation tool that synthesizes evidence-based practice recommendations for SLT cognitive-communication interventions across the care continuum. The second aim is to critically analyse the barriers to implementation of these interventions and to explore how this knowledge translation tool might assist in overcoming these challenges.

METHODS & PROCEDURES

We developed a map of 148 clinical practice recommendations extracted from 129 reviews and guidelines called the Cognitive-Communication Evidence Application for SLTs (CCEAS-Map). The process of developing the CCEAS-Map included: (1) examination of implementation science frameworks to inform knowledge tool creation; (2) search and synthesis of the evidence provided in reviews and guidelines that met specific criteria; (3) development of a framework to critically analyse and categorize the barriers and facilitators affecting the implementation of these clinical recommendations; (4) consultation with potential end users of the CCEAS-Map, including 16 expert SLTs and eight persons with lived experience (PWLE), regarding the tool's construction, barriers and facilitators to implementation, and the potential of the CCEAS-Map to address evidence-practice gaps; and (5) refining the CCEAS-Map based on expert input.

MAIN CONTRIBUTION

To our knowledge this is the first synthesis of all available clinical recommendations for SLT cognitive-communication interventions for ABI, across all severities of injury, stages along the continuum of care, and areas of CCD practice. The paper presents a novel approach to analysing knowledge-practice gaps: drawing on implementation science tools, analysing barriers and facilitators, and collaborating with end users in designing a knowledge translation tool.

CONCLUSIONS & IMPLICATIONS

The CCEAS-Map provides a comprehensive synthesis of the available evidence in a format that can facilitate clinical application of the evidence, provide education for all stakeholders, serve as a basis for CCD pathway development, support researcher-clinician collaboration and encourage advocacy at the system level. As a knowledge translation tool, the CCEAS-Map can promote the availability of SLT services and has the potential to ultimately improve the lives of those with CCD.

WHAT THIS PAPER ADDS

What is already known on this subject A great deal is known about cognitive-communication deficits incurred after ABI, including their impact on daily functioning, optimal methods for sensitive and ecologically valid assessment, and the efficacy of various speech-language therapy interventions along the care continuum. However, considerable constraints remain that interfere with the application of this evidence to daily SLT practice. A need was identified to develop a knowledge translation tool to help close these evidence-practice gaps. What this paper adds to existing knowledge This study describes the development of the CCEAS-Map, a critical synthesis of 129 reviews and guidelines, leading to 148 evidence-based clinical recommendations, which can be used to guide SLT cognitive-communication practice and education, as well as clinical pathway development, and advocacy for systemic changes and other healthcare policy improvements. What are the potential or actual clinical implications of this work? The CCEAS-Map is a clinical knowledge translation tool designed to guide cognitive-communication interventions by linking practice recommendations directly to the current evidence. This paper also offers insights into barriers to SLT intervention across the care continuum and strategies for improving implementation of cognitive-communication best practices, to improve the lives of those living with ABI related disabilities.

Cognitive-communication difficulties due to traumatic brain injury sustained in adults 55 years and older: A survey of speech-language pathology professional practice in Australia

PURPOSE

Limited research informs management of cognitive-communication difficulties following traumatic brain injury (TBI) in older adulthood. The purpose of this study was to understand the characteristics and practice of speech-language pathologists (SLPs) working with people who sustained TBI at ≥55 years and more specifically their management of cognitive-communication difficulties with this population. This included assessment and treatment practices, resource needs, barriers to practice, and impact to service delivery from COVID-19 restrictions.

METHOD

A cross-sectional survey-based design with non-probability sampling of SLPs working in Australia with adults with TBI was utilised. Descriptive statistics and content analysis were used for analysis of survey data.

RESULT

Fifty responses were eligible for inclusion. Participants predominantly worked in inpatient rehabilitation (48%), acute (40%), and community settings (36%). Service delivery to adults who sustained TBI at ≥55 years commonly included cognitive-communication management. Assessment and treatment trends are described. Most SLPs (74%) perceived barriers to cognitive-communication management, often relating to time and funding, that existed prior to the COVID-19 pandemic. Pandemic restrictions presented additional challenges.

CONCLUSION

Research relating to cognitive-communication difficulties following TBI in older adulthood is required to support evidence-based practice and inform services for older adults who sustain TBI.

Development of the Dardashna Checklist for Identifying Triggers of Behavioral Change in Individuals With Dementia: A Qualitative Study

The purpose of the current qualitative study was to describe the development of the Dardashna Checklist to clinically identify behavior change triggers in individuals with dementia. Semi-structured, in-depth, face-to-face interviews were conducted with four physicians and four experienced caregivers involved in the care of individuals with dementia. From analysis of participants' interviews, themes extracted included Triggers of Behavioral Change in Individuals With Dementia and Types of Behavioral Changes, using the checklist structure as a guide. The information gathered by this checklist conveys important messages to experienced physicians or caregivers who want to help less experienced caregivers or individuals with dementia. In this case, physicians' prescriptions and the responses of other experienced caregivers will be more targeted and useful. This checklist will help facilitate clinical care decisions, improve quality of life, reduce expenses and side effects of medications, and improve communication among persons with dementia, their caregivers, and health care providers. [Journal of Gerontological Nursing, 50(1), 37-46.].

Communicating effectively with inclusion health populations: 2022 ICCH symposium

OBJECTIVE

To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice.

METHODS

Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought.

SYMPOSIUM DISCUSSION

We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice.

CONCLUSIONS

People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.

The treatment journey of attention-related communication difficulties following traumatic brain injury: Perspectives of international health professionals

Traumatic brain injuries (TBI) can result in long-lasting changes in cognition, communication, behavior, and physical abilities that require specialized rehabilitation by health professionals. Communication difficulties following TBI are driven by difficulties in all aspects of cognition and linguistic skills. This study focuses specifically on attention-related communication difficulties and how international health professionals are treating this frequently occurring difficulty following TBI. One hundred and sixty-four international health professionals (e.g., speech language therapists, occupational therapists, neuropsychologists, clinical psychologists, and medical doctors) from seven countries completed an online survey. A small portion from New Zealand then participated in a focus group reviewing the topic of attention-related communication difficulties following TBI. This mixed-methods study used reflexive thematic analysis to analyse the qualitative data from both survey and focus groups alongside quantitative survey results. Fourmain themes were identified that relate to how attention-related communication difficulties should be treated and a roadmap for this important area following TBI was outlined. The four themes include: (1) signposts for attention and communication recovery; (2) change agents of attention and communication; (3) core therapy components; and (4) collaborative teams allow for better and more efficient treatment related to the client's goals. Clinical implications are discussed.

The pervasive and unyielding impacts of cognitive-communication changes following traumatic brain injury

BACKGROUND

Cognitive-communication disorders (CCDs) are common in the traumatic brain injury (TBI) population. Despite this, there has been limited research that explores the long-term impacts of reduced cognitive-communication functioning on daily life for this population.

AIMS

To identify the long-term impacts of cognitive-communication impairment as reported by adults with TBI and their significant others.

METHODS & PROCEDURES

A qualitative descriptive approach grounded in phenomenology was used. Semi-structured, one-on-one interviews were conducted with adults with CCDs following TBI (n = 16) and their significant others (n = 12) to explore their lived experiences.

OUTCOMES & RESULTS

Reflexive thematic analysis revealed an overarching theme of 'The pervasive and unyielding impacts of cognitive-communication changes on daily life following TBI'. Within this overarching theme, three subthemes were identified: (1) self-awareness of communication changes; (2) fatigue; and (3) self-identity and life roles.

CONCLUSION & IMPLICATIONS

The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on daily life. Health professionals supporting this population should consider ways to reduce the significant impact CCDs have on the lives of adults following TBI and their significant others. In addition, the findings highlight the importance of long-term rehabilitation services following TBI, with further research needed that explores how these services can be optimised.

WHAT THIS PAPER ADDS

What is already known on this subject Cognitive-communication disorders (CCDs) affect the majority of adults who experience moderate to severe traumatic brain injury (TBI) and encompass any component of communication that is affected by cognition. The hallmark characteristic of CCDs are breakdowns that affect social communication skills as well as cognitive-linguistic deficits. Combined, these can have dramatic implications for a person's quality of life, their level of independence, employment opportunities and social participation. There has been limited research to date that explores the long-term impacts of CCDs on the lives of adults following TBI. Further research that explores these impacts is needed to improve the support services and rehabilitation models of care available for this population. What this study adds The overarching theme was 'The pervasive and unyielding impacts of communication changes on daily life following TBI' with subthemes including changed communication, self-awareness of communication changes, fatigue and self-identity and life roles. The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on everyday functioning and quality of life as well as the importance of long-term rehabilitation services following TBI. What are the clinical implications of this work? Speech-language therapists and other health professionals working with this clinical population should consider how to address the significant and long-lasting impacts of CCDs. Due to the complex nature of the barriers experienced by this clinical population, an interdisciplinary targeted approach is advised wherever possible when providing rehabilitation services.

Communication and Psychosocial Outcomes 2-Years After Severe Traumatic Brain Injury: Development of a Prognostic Model

OBJECTIVE

To examine predictive factors underlying communication and psychosocial outcomes at 2 years post-injury. Prognosis of communication and psychosocial outcomes after severe traumatic brain injury (TBI) is largely unknown yet is relevant for clinical service provision, resource allocation, and managing patient and family expectations for recovery.

DESIGN

A prospective longitudinal inception design was employed with assessments at 3 months, 6 months, and 2 years.

PARTICIPANTS

The cohort included 57 participants with severe TBI (N=57).

SETTING

Subacute and post-acute rehabilitation.

MAIN OUTCOME MEASURES

Preinjury/injury measures included age, sex, education years, Glasgow Coma Scale, and PTA. The 3-month and 6-month data points included speech, language, and communication measures across the ICF domains and measures of cognition. The 2-year outcome measures included conversation, perceived communication skills, and psychosocial functioning. Predictors were examined using multiple regression.

INTERVENTIONS

Not applicable.

RESULTS

The cognitive and communication measures at 6 months significantly predicted conversation measures at 2 years and psychosocial functioning as reported by others at 2 years. At 6 months, 69% of participants presented with a cognitive-communication disorder (Functional Assessment of Verbal Reasoning and Executive Strategies [FAVRES]). The unique variance accounted for by the FAVRES measure was 7% for conversation measures and 9% for psychosocial functioning. Psychosocial functioning at 2 years was also predicted by pre-injury/injury factors and 3-month communication measures. Pre-injury education level was a unique predictor, accounting for 17% of the variance, and processing speed/memory at 3 months uniquely accounted for 14% of the variance.

CONCLUSION

Cognitive-communication skills at 6 months are a potent predictor of persisting communication challenges and poor psychosocial outcomes up to 2 years after a severe TBI. Findings emphasize the importance of addressing modifiable cognitive and communication outcomes variables during the first 2 years after severe TBI to maximize functional patient outcomes.

Intact speech-gesture integration in narrative recall by adults with moderate-severe traumatic brain injury

PURPOSE

Real-world communication is situated in rich multimodal contexts, containing speech and gesture. Speakers often convey unique information in gesture that is not present in the speech signal (e.g., saying "He searched for a new recipe" while making a typing gesture). We examine the narrative retellings of participants with and without moderate-severe traumatic brain injury across three timepoints over two online Zoom sessions to investigate whether people with TBI can integrate information from co-occurring speech and gesture and if information from gesture persists across delays.

METHODS

60 participants with TBI and 60 non-injured peers watched videos of a narrator telling four short stories. On key details, the narrator produced complementary gestures that conveyed unique information. Participants retold the stories at three timepoints: immediately after, 20-min later, and one-week later. We examined the words participants used when retelling these key details, coding them as a Speech Match (e.g., "He searched for a new recipe"), a Gesture Match (e.g., "He searched for a new recipe online), or Other ("He looked for a new recipe"). We also examined whether participants produced representative gestures themselves when retelling these details.

RESULTS

Despite recalling fewer story details, participants with TBI were as likely as non-injured peers to report information from gesture in their narrative retellings. All participants were more likely to report information from gesture and produce representative gestures themselves one-week later compared to immediately after hearing the story.

CONCLUSION

We demonstrated that speech-gesture integration is intact after TBI in narrative retellings. This finding has exciting implications for the utility of gesture to support comprehension and memory after TBI and expands our understanding of naturalistic multimodal language processing in this population.

Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis

BACKGROUND

Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI.

OBJECTIVE

This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation.

METHODS

A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis.

RESULTS

Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies.

CONCLUSIONS

People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/35080.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience

BACKGROUND

Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection.

METHOD

A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on.

RESULTS

Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use.

CONCLUSION

This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study

BACKGROUND

People with acquired brain injury (ABI) experience communication breakdown in everyday interactions many years after injury, negatively impacting social and vocational relationships. Communication partner training (CPT) is a recommended intervention approach in communication rehabilitation after ABI. Access to long-term services is essential, both in rural and remote locations. Digital health has potential to overcome the challenges of travel and improve cost efficiencies, processes, and clinical outcomes.

OBJECTIVE

We aimed to collaboratively develop a novel, multimodal web-based CPT intervention (convers-ABI-lity) with key stakeholders and evaluate its feasibility for improving conversation skills after brain injury.

METHODS

This mixed methods study consisted of 3 key stages guided by the Integrate, Design, Assess, and Share (IDEAS) framework for developing effective digital health interventions. Stage 1 included the integration of current end-user needs and perspectives with key treatment and theoretical components of existing evidence-based interventions, TBI Express and TBIconneCT. Stage 2 included the iterative design of convers-ABI-lity with feedback from end-user interviews (n=22) analyzed using content analysis. Participants were individuals with ABI, family members, health professionals, and paid support workers. Stage 3 included the evaluation of the feasibility through a proof-of-concept study (n=3). A total of 3 dyads (a person with ABI and their communication partner [CP]) completed 7 weeks of convers-ABI-lity, guided by a clinician. The outcome measures included blinded ratings of conversation samples and self-report measures. We analyzed postintervention participant interviews using content analysis to inform further intervention refinement and development.

RESULTS

Collaborative and iterative design and development during stages 1 and 2 resulted in the development of convers-ABI-lity. Results in stage 3 indicated positive changes in the blinded ratings of conversation samples for the participants with traumatic brain injury and their CPs. Statistically reliable positive changes were also observed in the self-report measures of social communication skills and quality of life. Intervention participants endorsed aspects of convers-ABI-lity, such as its complementary nature, self-guided web-based modules, clinician sessions, engaging content, and novel features. They reported the intervention to be relevant to their personal experience with cognitive-communication disorders.

CONCLUSIONS

This study presents the outcome of using the IDEAS framework to guide the development of a web-based multimodal CPT intervention with input from key stakeholders. The results indicate promising outcomes for improving the conversation skills of people with ABI and their CPs. Further evaluation of intervention effectiveness and efficacy using a larger sample size is required.

An international survey of assessment and treatment practice for discourse in paediatric Acquired Brain Injury

PURPOSE

Guidelines recommend routine discourse assessment and treatment in paediatric acquired brain injury (ABI) but provide little guidance for clinical practice. The degree to which this has influenced the nature of discourse assessment and treatment in clinical practice has not been examined in detail.

METHOD

Speech-language pathologists working in paediatric ABI (clients aged <18 years) in Australia, New Zealand, the UK, the USA, Canada, and the Asia Pacific region were invited to complete a survey of discourse assessment and intervention practices (n = 77).

RESULT

Clinicians from Australia and New Zealand comprised over half of a responses (53%). The largest proportion had over 10 years' experience (60%), worked in the metropolitan area (58%), and with secondary school-age children (64%). Routine discourse assessment was undertaken by 80% of respondents, focussing on a limited range of genres. No preferred intervention approach was identified. One-quarter of clinicians routinely considered holistic factors during clinical decision-making. Limited normative data and treatment evidence, insufficient time and training were identified as clinical barriers.

CONCLUSION

Assessment practices were consistent with guidelines, yet interventions were highly variable, reflecting limited evidence, client heterogeneity, time constraints, and limited training. A biopsychosocial approach to practice was evident, yet a focus on impairment level factors was prominent. Findings support the need for standardised discourse assessment and discourse intervention methods. Translation into practice guidelines would promote consistency and confidence in clinical practice.

Contribution of Working Memory and Inferencing to Narrative Discourse Comprehension and Production in Traumatic Brain Injury

PURPOSE

The goal of this study was to identify some potential key cognitive and communicative processes underlying narrative discourse ability following traumatic brain injury (TBI). Specifically, this study (a) investigated the contribution of working memory (WM) and inferencing to narrative discourse comprehension and production; (b) tested key assumptions posited by the Structure Building Framework (SBF), a discourse model; and (c) evaluated the potential for inferencing to contribute to discourse ability beyond a shared variance with WM.

METHOD

Twenty-one individuals with TBI completed six tasks yielding seven measures: verbal and nonverbal WM updating (WMU-V and WMU-NV, respectively), predictive inferencing, the Discourse Comprehension Test (DCT), a picture story comprehension (PSC) task, and story retelling (story grammar and story completeness). Regression analyses were performed using WM and inferencing as predictors for narrative performance.

RESULTS

WM measures were significant predictors of DCT performance and approached significance as predictors of PSC. Inferencing approached significance as a unique predictor for the DCT and story completeness. WMU-V and WMU-NV were highly collinear, and neither WM measure predicted discourse outcomes over and above the other's contribution.

CONCLUSIONS

WM was more strongly associated with comprehension processes, whereas inferencing may be associated with both comprehension and production outcomes. Findings were interpreted as supporting SBF assumptions of domain generality of cognitive processes and mechanisms involved in discourse while also challenging assumptions that the same cognitive substrates are marshaled for comprehension and production processes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23148647.

A simple smartphone-aided program to support meaningful occupation in people with severe neuro-motor and speech disabilities

We assessed a simple smartphone-aided program to help three participants with severe neuro-motor and speech disabilities access preferred songs, call or send messages to distant partners, and call the caregiver. The program relied on the use of a smartphone, five cards with identification tags, and a mini speaker. The participants could select one of the cards (engagement options) by touching it with the smartphone. Using the program, all participants managed to access songs, reach partners, and call the caregiver independently and engaged in the related forms of leisure and communication/interaction throughout the 10-min sessions available. The results suggest that the program might be a valuable aid for people with severe neuro-motor and speech disabilities.

Assessment of communication competence in acquired communication disorders: A systematic scoping review

PURPOSE

Individuals with acquired communication disorders (ACDs) experience reduced ability to participate independently in activities of daily life, and maintain interpersonal relationships and psychosocial wellbeing. Communication interventions are designed to optimise communication competence in personally relevant everyday activities. However, the assessment tools speech-language pathologists (SLPs) typically utilise to evaluate communication competence in everyday life are not ideal. To explore the range and availability of assessments used in research to examine functional communication in adults with ACDs.

METHOD

Five databases (Medline, CINAHL, EMBASE, SCOPUS and PsycINFO) were searched to identify assessment or intervention studies evaluating functional communication in adults with ACDs. Functional communication tools utilised in each study were identified. Extracted tools were categorised according to type, target population, consideration of multimodal communication, person-specificity, consideration of context, availability, administration/analysis time and availability of normative/psychometric data.

RESULT

Forty functional communication assessment tools were included. Just over half the tools were performance-based (n = 25), examined different modes of communication (n = 26) and/or considered context (n = 23). Only 14 tools were person-specific. Many of the most comprehensive tools were out of print or considered excessively time consuming to administer and analyse.

CONCLUSION

A paucity of accessible, time-efficient yet comprehensive tools to assess functional communication in ACDs may limit clinical practice and client outcomes. More versatile functional communication assessments incorporating individualised contexts, and the use of modern communication technologies are recommended.

Assessment and rehabilitation of acquired communication disorders in Aboriginal and Torres Strait Islander adults with stroke or traumatic brain injury: a retrospective chart review

PURPOSE

Speech-language pathologists' (SLP) management practices for Aboriginal and Torres Strait Islander adults with acquired communication disorder (ACD), following stroke or traumatic brain injury (TBI), are not well understood. This study explores SLPs' management approaches for ACDs for Aboriginal and Torres Strait Islander adults post-stroke or TBI.

MATERIALS AND METHODS

SLPs' documented notes were analysed from a two-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years), admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI.

RESULTS

SLPs frequently used informal approaches to assess ACDs. English-language formal assessment tools were also used in conjunction with the informal approaches. ACD diagnosis was more common in stroke than TBI patients. One-third of patients with ACD received inpatient rehabilitation at the study site. SLPs infrequently documented cultural or linguistic adaptions to assessment or interventions.

CONCLUSIONS

Informal approaches to assess ACDs were commonly employed which may be because they are perceived to be more culturally appropriate. Clinical guidelines for stroke and TBI should accommodate the diversity of cultures and languages. Better consideration of Aboriginal and Torres Strait Islander communication styles and incorporation of these into SLP ACD management approaches may facilitate accurate diagnosis and culturally safe rehabilitation services.Implications for RehabilitationInformal approaches for assessment and intervention of ACDs, that incorporate yarning and salient tasks, are likely to be more culturally appropriate and safe for Aboriginal and Torres Strait Islander peoples.More flexibility and guidance in the use of culturally and linguistically appropriate alternative assessment approaches are required in the National stroke guidelines for Aboriginal and Torres Strait Islander peoples.The adoption of enhanced models of culturally secure ACD service provision, that incorporate frequent SLP engagement with an Aboriginal or Torres Strait Islander support person during assessment and rehabilitation, are needed.There is an imperative for health professionals to actively account for culture and language difference in rehabilitation practices to ensure Indigenous peoples worldwide receive equitable and culturally-responsive services.

Speech-Language Pathologists' Views of Using Virtual Reality for Managing Cognitive-Communication Disorders Following Traumatic Brain Injury

PURPOSE

Using virtual reality (VR) to support rehabilitation is an emerging area of research that may offer people with communication disorders a stable and safe communication environment to practice their communication skills. There are currently no VR applications that have been designed to assess or treat cognitive-communication disorders (CCDs) following traumatic brain injury (TBI). Therefore, this study aimed to explore the views of speech-language pathologists (SLPs) who work with people who have a TBI to generate ideas and considerations for using VR in rehabilitation for CCDs. VR researchers were included to provide expert advice about VR technology.

METHOD

A total of 14 SLPs and three VR specialists participated in an online interview or focus group. Semistructured discussions explored participants' perspectives related to potential ideas for VR use and any perceived barriers and facilitators to VR implementation for managing CCDs following TBI. Data were video- and audio-recorded, transcribed, and analyzed qualitatively using thematic analysis.

RESULTS

Three main themes were generated from thematic analysis: VR is a tool that could enhance clinical practice, the need to consider and navigate potential red flags, and solutions to pave the way forward. Suggestions to overcome perceived barriers to VR use were also provided.

DISCUSSION

Participants expressed interest in using VR for rehabilitation of CCDs following TBI. However, potential barriers and risks to use should be considered prior to implementation. The findings offer guidance to support future research and development of VR in this field.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21669647.

Exploring the Cognitive-Communication Challenges of Adults With Histories of Traumatic Brain Injury and Criminal Justice System Involvement: A Pilot Study

INTRODUCTION

The prevalence of traumatic brain injury (TBI) in the criminal justice system (CJS) is well known. Furthermore, the impact of TBI on communication has been well documented; however, no study has explored the communication challenges of those with TBI in the CJS or considered their implications within CJS contexts. Moreover, no study has examined the possible differences in communication between those with TBI and CJS history and those with TBI but no CJS history.

PURPOSE

This cross-sectional pilot study provides a preliminary exploration of the cognitive-communication challenges in a sample of adults with histories of TBI and CJS involvement compared with a sample of adults with histories of TBI but no CJS involvement.

METHOD

Eight individuals with histories of TBI and CJS involvement were recruited through community agencies. The La Trobe Communication Questionnaire (LCQ) was administered to collect self-reported data on perceived cognitive-communication abilities, including social communication behaviors. Findings were examined and then compared with a previously studied sample of 160 individuals with TBI. Logistic regressions were calculated to determine whether response scores on the LCQ would be predictive of group membership (i.e., TBI + CJS or TBI only).

RESULTS

A range of cognitive-communication challenges were reported by both groups. A logistic regression analysis demonstrated a reasonable inference that LCQ responses may predict group membership and support the potential for statistically significant and meaningful results to justify future studies.

CONCLUSIONS

These challenges have the potential to negatively impact the success of communication interactions within the CJS and illustrate a need for speech-language pathology services for individuals with TBI in the CJS. The nature and magnitude of between-group differences merits further investigation with larger samples to explore whether any specific cognitive-communication challenge is unique to, or predictive of, CJS involvement for purposes of targeted assessment and intervention.