Assessment practices of speech-language pathologists for cognitive communication disorders following traumatic brain injury in adults: an international survey

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.

Public awareness and knowledge about speech-language pathology and communication impairments in Aotearoa New Zealand

PURPOSE

This survey-based study explored public awareness of the speech-language pathology profession in Aotearoa New Zealand. The study also aimed to understand participants' knowledge and experiences of individuals with speech, language, and communication impairments.

METHOD

An online survey was designed and distributed via the Qualtrics survey platform. The survey included three sections, which focused on participant demographics, awareness about speech-language pathology, and knowledge and experiences of communication impairments.

RESULT

The responses from 800 fully completed surveys were analysed. A majority of participants indicated that they had never heard or read anything about speech-language pathology and had never met a speech-language pathologist. The participants' responses reflected low or moderate levels of understanding about the roles of speech-language pathologists and their scope of practice.

CONCLUSION

Findings indicated low levels of awareness among the general public about speech-language pathology and individuals with communication impairments. These findings were consistent with similar international research conducted over the past 4 decades. Further research is needed to support the development of initiatives designed to increase awareness of the speech-language pathology profession and the needs of individuals with communication impairments.

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.

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.

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls

BACKGROUND

Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID-19 restrictions have reduced in-person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in-person.

AIMS

To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls.

METHODS & PROCEDURES

A total of 20 individuals with TBI and 20 healthy controls, aged 18-55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post-injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non-parametric analyses were used to analyse the performance of the two groups.

OUTCOMES & RESULTS

Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures.

CONCLUSIONS & IMPLICATIONS

Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed.

WHAT THIS PAPER ADDS

What is already known on this subject Although little research has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra-structural and macro-linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive-communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work? Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech-language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time-consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups.

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.

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.

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.

Interaction of discourse processing impairments, communicative participation, and verbal executive functions in people with chronic traumatic brain injury

Introduction

Especially in the chronic phase, individuals with traumatic brain injury (TBI) (IwTBI) may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a recently developed screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information (e.g., propositional content) in discourse.

Aim

The aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis.

Methods

Data from 23 IwTBI (moderate to severe) and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire (LCQ).

Results

IwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation (LCQ). We also found that the subject's performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms (in terms of verbal fluency and verbal task switching) and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation.

How Do Clinicians Judge Fluency in Aphasia?

PURPOSE

Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency.

METHOD

In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic.

RESULTS

Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments.

CONCLUSIONS

This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19326419.

A Scoping Review of Cognitive Assessment in Adults With Acute Traumatic Brain Injury

PURPOSE

The purpose of this study was to describe and synthesize the current research regarding the prevailing cognitive domains impacted by acute traumatic brain injury (TBI) in adults. Standardized and nonstandardized assessments of cognitive function and comorbidities influencing cognitive function during the initial stages of recovery are presented to help guide clinical assessment.

METHOD

A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, was used to explore four electronic databases. Searches identified peer-reviewed empirical literature addressing aspects of cognitive domains impacted after TBI, cognitive assessment, and comorbidities impacting assessment in adults after acute TBI.

RESULTS

A total of 1,072 records were identified and reduced to 75 studies based on inclusion criteria. The cognitive domains most impacted in acute TBI were memory and executive function. The Glasgow Coma Scale (GCS) was the most frequently used tool to assess cognitive abilities, despite it being a measurement of consciousness, not of cognition. Psychological changes were the most commonly noted comorbidity impacting cognitive assessment.

CONCLUSIONS

Assessment of cognition after acute TBI requires a multifaceted approach that considers the typical profile of cognitive impairment, as well as patient-specific factors influencing cognitive abilities following initial brain injury. The present results support the generally held view that memory and executive function deficits are common cognitive difficulties associated with acute TBI in adults. The GCS remains the most widely used tool to assess function, though numerous tools are available that specifically address cognitive domains. Acute medical comorbidities common within this stage of injury are highlighted, as well as gaps of clinical knowledge that remain.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18372086.

Cognitive-Linguistic outcome in moderate to severe diffuse axonal injury and association with fatigue

PURPOSE

Individuals with traumatic brain injury (TBI) often have persistent cognitive-linguistic deficits that negatively influence their life. Our objective was to examine the cognitive-linguistic outcome in individuals with moderate to severe diffuse axonal injury (DAI) with a novel test battery. As fatigue is a common symptom affecting the lives of individuals with DAI, we also wanted to assess whether the self-reported fatigue was associated with cognitive-linguistic abilities.

METHODS

Selected cognitive-linguistic subtests of the Finnish KAT test and The Mental Fatigue Scale (MFS) were applied to 48 adults with moderate to severe DAI and 27 healthy controls. The majority of the participants with DAI were in the chronic stage. The groups were compared using ANCOVA. Linear regressions were used to analyze the association between MFS and cognitive-linguistic outcomes.

RESULTS

The participants with DAI had significantly poorer scores than the controls in most cognitive-linguistic variables and reported significantly more fatigue. Two of the four cognitive-linguistic composite variables were associated with the degree of self-reported fatigue.

CONCLUSIONS

Cognitive-linguistic deficits are common in individuals with moderate to severe DAI, and The Finnish KAT test is a valuable tool to detect those. Fatigue was associated with linguistic working memory and language production.

Die Erhebung von kommunikativ-pragmatischen Fähigkeiten und Lebensqualität nach Schädel-Hirn-Trauma

Zusammenfassung. Hintergrund: Kommunikationsstörungen nach Schädel-Hirn-Trauma (SHT) können die Betroffenen langfristig in der sozialen Teilhabe und damit in der Lebensqualität (LQ) beeinträchtigen. Der Erfassung dieser Störungen liegt aktuell kein einheitliches Vorgehen zugrunde. Ziele: Ziel des vorliegenden Scoping Reviews war die Erfassung von Diagnostikverfahren, welche die kommunikativ-pragmatischen Kompetenzen und die Auswirkung möglicher kommunikativer Defizite auf soziale Teilhabe und LQ bei Menschen mit SHT überprüfen. Ergebnisse: Eine systematische Datenbankrecherche für den Veröffentlichungszeitraum 2010 bis 2020 identifizierte 14 relevante Testverfahren (6 auf Deutsch verfügbar). Eine inhaltliche und methodische Analyse stellte Verfahren zur Überprüfung der Kommunikationsfähigkeit (z. B. La Trobe Communication Questionnaire [LCQ]) und Verfahren zur Erfassung von Partizipation und LQ (z. B. Quality of Life after Brain Injury [QOLIBRI]) heraus. Zusammenfassung: Trotz der hohen Auftretenshäufigkeit und Persistenz kommunikativer Störungen nach SHT stehen im deutschsprachigen Raum bislang wenige geeignete Diagnostikverfahren zur Ermittlung von Kommunikationsfähigkeiten und LQ zur Verfügung. Eine weiterführende Entwicklung erscheint unerlässlich.

Cognitive Assessments for Patients With Neurological Conditions: A Preliminary Survey of Speech-Language Pathology Practice Patterns

Purpose Speech-language pathologists (SLPs) are often responsible for assessing cognitive disorders that affect communication for individuals with diagnosed or suspected acute or degenerative neurological conditions. However, consensus on appropriate assessment tools for various neurological disorders remains elusive. This preliminary survey was conducted to study current practices in the use of published and unpublished tools by SLPs when assessing cognitive-communication impairments across common neurologic conditions. Method An 18-item web-based survey was sent to SLPs through ASHA Communities and social media, asking them to select which cognitive assessment tools they use to evaluate the cognitive-communication status of individuals with Parkinson's disease, multiple sclerosis, dementia, stroke (i.e., cerebrovascular accident), and traumatic brain injury. The 100 SLPs who completed the online survey represent a spectrum of professionals seeing neurologic patients across the United States. Results Among the 100 responding SLPs, no unique pattern of assessment tool use was noted across neurologic disorders as indicated by a chi-square analysis. A common set of nonstandardized and observational assessment practices was reported most commonly, regardless of the neurologic condition. Conclusions This study shows consistent cognitive assessment practices by SLPs across various neurological conditions rather than unique protocols relevant to the patterns typical across disorders. However, the amount of clinical evaluations supported by informal observation and/or the completion of select subtests of standardized assessment tools is considerable. This preliminary information conflicts with principles of rigorous assessment and increases the risk of erroneous findings when identifying cognitive impairments. Further research into the decision-making process of clinician assessment selection is warranted to encourage consistent, evidence-based practice for persons with cognitive impairments. Better recognition of the limitations imposed by providing clinical services that impact the reliability and validity of cognitive assessments can drive future clinical practice policy and practice recommendations.

The Cognitive-Communication Checklist for Acquired Brain Injury: A Means of Identifying, Recording, and Tracking Communication Impairments

Purpose The communication service needs of individuals with acquired brain injuries (ABIs) are frequently overlooked, leading to delays, denials, or premature discharge from communication interventions. This is particularly true for those with subtle cognitive-communication deficits, which may not be apparent until sufficiently challenged at work, in school, or in the community. The purpose of this study was to evaluate a referral tool that could promote understanding of the broad range of communication impairments that occur following ABI and lead to improved identification and referral. Method This study evaluated the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI) through a survey. The CCCABI is a referral tool that summarizes 45 communication difficulties in 10 areas of cognitive-communication functioning. One hundred sixteen speech-language pathologists, 34 multidisciplinary referral sources, and 41 individuals with lived experience of brain injury were surveyed to evaluate the utility of this referral tool. Results The need for such a referral tool was endorsed by 96% of speech-language pathology respondents, 91% of multidisciplinary respondents, and 100% of respondents with lived experience of brain injury. Responses supported the CCCABI as a clear, comprehensive, and accessible tool for education and identification of the communication impairments that can occur after ABI. Conclusion The CCCABI is a means of increasing understanding of communication service needs following ABI in a manner that is accessible to individuals, families, program designers, funding sources, administrators, and multidisciplinary referral sources.

Computer-based workplace communication training in persons with traumatic brain injury: The work-related communication program

OBJECTIVE

This proof-of-concept study presents a computer-based social communication training for spoken workplace interactions called Work-Related Communication (WoRC) training. This program implements didactic training, role-play, and immediate feedback using a simulation approach to improve spoken language performance. The unique target of this training is a category of linguistic markers called politeness markers which are essential for cooperative workplace exchanges.

METHODS

We recruited eight adults with chronic traumatic brain injury. All participants demonstrated reduced politeness marker use in language sampling before treatment. This study had a quasi-experimental treatment design. We measured the rate of politeness marker use (politeness markers per minute) using the Voicemail Elicitation Task and novel role-play tasks, and the La Trobe Communication Questionnaire as outcome (dependent) variables.

RESULTS

After training, participants demonstrated an increase in trained and untrained politeness marker use that was significant for the novel role-play tasks. The La Trobe Communication Questionnaire found that familiar conversation partners reported a significant increase in social communication skills.

CONCLUSION

The WoRC program has implications for introducing a sociolinguistic foundation for social communication training in general and specifically for vocational placement.

Communication Abilities of Children with DoC after Severe Brain Injury in ICF Frames

INTRODUCTION

The ability to communicate is one of the fundamental factors underlying human relationships. Severe brain damage and disorders of consciousness may indispose a person to participate in everyday social and family life. In spite of this fact, however, the issue of holistic approach to communication in the context of severe traumatic brain injury is still not well explained and described. The goal of this article is to introduce a profile of nonverbal behavior of children with disorders of consciousness.

MATERIALS AND METHODS

The study included 30 children with minimal conscious state after severe brain trauma, aged between 7 and 16 years old. Research was conducted using the Coma Recovery Scale-Revised and the Bykova-Lukyanov Scale of Communication Activity.

RESULTS

Significant differences in communication level between investigated groups were demonstrated, both in Body Function (F = 9.184; p < 0.001) and Activity and Participation (F = 13.100; p < 0.001).

CONCLUSIONS

It is possible to map and classify communication ability of children with minimal conscious state by using International Classification of Functioning, Disability and Health (ICF) protocol and the Bykova-Lukyanov Scale of Communication Activity, with specific consideration of Activities and Participation factors. This approach reveals differences in communication and disability level between children with minimal conscious state plus (MSC+) and minimal conscious state minus (MSC-).

Discourse Analysis of Humor After Traumatic Brain Injury

Purpose Individuals with cognitive communication difficulties after traumatic brain injury (TBI) often experience difficulties with social communication. Humor is a sociolinguistic skill that requires social, cognitive, emotional, and behavioral skills and, when used effectively, may serve to enhance one's social relationships. There is a paucity of research related to the use of humor in individuals with TBI. This study categorizes humor use in individuals with cognitive communication difficulties after TBI and examines the linguistic construction of these humorous exchanges. Method The humorous exchanges of nine individuals who had cognitive communication difficulties after a moderate-to-severe TBI were examined. Conversations were collected from a community-based communication skills group, categorized using thematic analysis methods, and examined linguistically using the discourse analysis tools of systemic functional linguistics. Results All participants demonstrated the ability to use a variety of categories of humor, and discourse analysis methods revealed humor use as a strength for engaging with others. Examples of such engagement include use of humor to elicit attention, assert authority, share information, acknowledge shared difficulties, and demonstrate affiliation toward their communication partners. Conclusions Discourse analysis of humor can provide speech-language pathologists with important information about the linguistic strengths of individuals with cognitive communication difficulties. This has important implications for clinical service provision.

Expression of propositional attitudes in conversation by adults with traumatic brain injury: A relevance theoretic approach

BACKGROUND

Impairments in social communication are ubiquitous after moderate to severe traumatic brain injury (TBI). Most attempts to quantify these impairments have been descriptive rather than theoretically motivated. We propose that Relevance Theory provides a framework for characterizing social communication limitations after TBI and linking these problems to underlying cognitive impairments.

AIMS

This study asked how adult speakers with and without TBI used specific linguistic forms in social communication. We selected three linguistic markers that convey thoughts and feelings of the speaker and which are intended to influence the same in the listener: propositional attitude verbs, the discourse marker like and the quotative like.

METHODS & PROCEDURES

Ten adults with moderate to severe TBI and 12 healthy adults completed 5-min casual conversations with student researcher partners as part of a larger research study. Conversations were transcribed and analysed for the frequency of the three linguistic markers, corrected for total words in the transcript.

OUTCOMES & RESULTS

Participants in the TBI group used discourse marker like significantly less than participants in the healthy comparison group (0.75% and 2.06% of total words, respectively; p = 0.05, d = -0.43) and showed less variety in functions of like. The use of propositional attitude verbs and quotative like was not affected by TBI.

CONCLUSIONS & IMPLICATIONS

Expression of propositional attitude seems largely preserved after TBI. Relevance Theory may provide a helpful framework (1) to interpret subtle quantitative and qualitative differences that contribute to social conversation problems of adults with TBI; and (2) to elucidate relations among the social communication signs and symptoms and underlying cognitive impairments. What this paper adds What are the potential or actual clinical implications of this work? More awareness and understanding of how social cognition may look in everyday conversations, may help SLPs who treat patients with such difficulties as a result of TBI.

Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism

BACKGROUND

Although previous research studies have defined several prognostic factors that affect cognitive-communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive-communication impairment in complicated mild TBI (mTBI) specifically.

AIMS

To determine which demographic and trauma-related factors are associated with cognitive-communication performance in the early recovery phase of acute care following a complicated mTBI.

METHODS & PROCEDURES

Demographic and accident-related data as well as the scores on cognitive-communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism.

OUTCOMES & RESULTS

Females performed better than males on letter-category naming, while those more advanced in age performed worse on most cognitive-communication measures. Patients with higher education achieved better confrontation and letter-category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming.

CONCLUSIONS & IMPLICATIONS

Cognitive-communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury-related factors affect cognitive-communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper adds What is already known on the subject In early acute recovery studies including all severity of TBI, cognitive-communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury-related variables predict cognitive-communication performance after a complicated mTBI specifically. What this paper adds to existing knowledge We confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive-communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive-communication skills in this group of patients. What are the potential or actual clinical implications of this work? The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive-communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care.

UK speech and language therapists' views and reported practices of discourse analysis in aphasia rehabilitation

BACKGROUND

Discourse assessment and treatment in aphasia rehabilitation is a priority focus for a range of stakeholder groups. However, a significant majority of speech and language therapists (SLTs) infrequently conduct discourse analysis, and do not feel competent in doing so. Known barriers identified in other countries, specifically a lack of time, training, expertise and resources, affect use of discourse analysis in clinical practice.

AIMS

To investigate UK SLTs' reported practices and views of discourse analysis, barriers and facilitators, and clinical feasibility in aphasia rehabilitation.

METHODS & PROCEDURES

An online survey of 52 questions adapted from existing research and incorporating behaviour change literature was created for the study and piloted. UK SLTs working in aphasia rehabilitation for at least 6 months were invited to participate. Potential participants were contacted through national and local clinical excellence networks, a National Health Service (NHS) bespoke e-mail list, and national magazine advertisement, and the study was also advertised on social media (Twitter). Therapists read an online participant information sheet and submitted individual electronic consent online; then progressed to the Qualtrics survey. Descriptive, correlational and inferential statistical analyses were conducted, and content analysis was carried out on the questions requiring text.

OUTCOMES & RESULTS

A total of 211 valid responses were received from primarily female SLTs, aged 20-40 years, working full-time in the NHS in England, in community, inpatient and acute/subacute multidisciplinary settings. A total of 30% SLTs collected discourse analysis often, were mostly very experienced, and working part-time in community settings. Years of experience was predictive of use. Discourse was most often collected using standardized picture descriptions and recounts during initial assessment. Samples were infrequently recorded, and typically transcribed in real-time. Most SLTs (53-95%) reported making clinical judgements or manually counted words, sentences, communication of ideas and errors, and were confident in doing so. Barriers included time constraints; lack of expertise, confidence, training, resources and equipment; and patient severity. Discourse 'super-users' were distinguished by significantly higher professional motivation for discourse and workplace opportunity than other SLTs, and 'non-users' were distinguished by significantly less knowledge and skills in discourse analysis than other SLTs. SLTs reported a desire and need for training, new/assistive tools and time to do more discourse analysis in practice.

CONCLUSIONS & IMPLICATIONS

Clinicians were highly engaged and relatively active in at least some aspects of discourse analysis practice. Interventions that target individual clinicians as well as organizations and systems are needed to improve the uptake of discourse analysis in practice. What this paper adds What is already known on the subject? Discourse in aphasia rehabilitation is a priority in clinical practice and research. However, the majority of clinicians infrequently collect and analyse discourse. Research in Australia and the United States indicated that lack of time, assessment resources and relevant knowledge and skills are the main barriers to use. What this paper adds to existing knowledge Compared with existing research, UK SLTs were more likely to see discourse analysis as part of their role and experienced fewer barriers, and more SLTs did it at least sometimes in clinic. However, practices were limited by lack of training, giving rise to challenges in selecting and interpreting findings for clients. More use was predicted by more experience and commitment to discourse analysis, particularly where workplaces supported this approach. Less use was associated with less knowledge and skills in discourse analysis. Practice and decision-making were influenced by client factors and constrained to a lesser degree by logistical challenges. What are the potential or actual clinical implications of this study? Education and training in discourse analyses and in specific procedures are needed to improve individual clinicians' knowledge, skills and confidence in using discourse analysis for clients' rehabilitation. Equally, organizational and systems changes are needed to promote, support and reinforce discourse analysis in the workplace.

Transcultural translation and adaptation of the Assessment Battery for Communication (ABaCo) for the Portuguese population

ABSTRACT Purpose: to perform the transcultural adaptation and translation of the ABaCo battery for the Portuguese population and check its psychometric properties. Methods: initially, the translation and retroversion of ABaCo was done. A total of 40 participants without pathology were recruited. Two equivalent Forms (Form A and Form B) were used, consisting of linguistic, extralinguistic, paralinguistic and context scales. The instrument was also applied to 12 people who were in the chronic phase after severe or moderate traumatic brain injury (TBI). For statistical analysis the following tests were used: Mann-Whitney U test, Student t test for independent samples, Pearson's correlation (the value is considered significant when p ≤ 0.05) and Cronbach's alpha (the value is considered minimally acceptable when superior to 0.65). Results: TBIs’ participants showed lower results as compared to those without neurological pathology. The evidence was discriminatory for the population with TBI, although, on some scales, it was not, due to the ceiling effect. Differences were not found between the two Forms. The results also showed the existence of correlation of schooling and age with some of the components of ABaCo, as verified in the original version. No differences in gender-conditioned responses were found. The battery showed good metrical qualities with a Cronbach's alpha of 0.90 (Form A) and 0.71 (Form B), for the total sample. Conclusion: ABaCo has proved to be an appropriate instrument for assessing communication in the Portuguese adult population. Despite the limitations, this instrument is expected to be useful in the evaluation of the communication, following TBI.

Communication service provision and access for people with Parkinson's disease in Australia: A national survey of speech-language pathologists

Purpose: To determine the clinical practices of Australian speech-language pathologists in the management of communication disorders in people with Parkinson's disease (PwPD) and their perspectives on service provision.Method: A cross-sectional, mix-methods online survey was conducted. Nonprobability, purposive sampling was utilised to recruit speech-language pathologists who currently work with PwPD. Descriptive statistics and thematic analysis were employed.Result: Ninety-nine clinicians responded. Most offered services for both motor speech and cognitive-communication disorders, but a greater focus on the motor speech disorder was evident. A range of impairment and functional assessments and interventions were reported. Therapy was most commonly delivered one session a week over 4 or 6 weeks. Service, client and evidence barriers in the management of both communication disorders were identified. Most clinicians felt PwPD accessed communication services at stages later than optimal, they recognised a need to improve their services in varying degrees (92.3%), and believed not enough services exist for PwPD in Australia (78%). Cognitive-communication management was the highest requested area for further research evidence.Conclusion: This study captured the current practices of Australian speech-language pathologists in the management of communication disorders in PwPD. Findings may inform future service planning, research on service effectiveness and new management targets.

Psychosocial Outcomes of Severe Traumatic Brain Injury in Relation to Discourse Recovery: A Longitudinal Study up to 1 Year Post-Injury

Purpose The interrelationship between psychosocial outcomes and discourse after severe traumatic brain injury remains largely unknown. This study examines outcomes relating to work, relationships, and independence within the context of discourse recovery across the 1st year post-injury. Method An inception cohort comprising 57 participants with severe traumatic brain injury was assessed at 3, 6, 9, and 12 months post-injury. Outcomes were measured with the Sydney Psychosocial Reintegration Scale-2 (Tate et al., 2012; Tate, Simpson, Loo, & Lane-Brown, 2011), and discourse was evaluated with Main Concept Analysis of a narrative retell. Correlation and linear regression analyses were utilized. Results Significant correlations were found between psychosocial outcomes reported by relatives and discourse performance across the 1st year. The 6-month discourse scores significantly predicted the 12-month psychosocial outcomes reported by relatives. Initial discourse severity and recovery pattern also informed outcomes. Conclusions Discourse disorders have a strong relationship with everyday outcomes relating to work, relationships, and independence as reported by relatives. Six months post-injury is a beneficial time for assessment, education, and service planning. Age, years of education, and aphasia may mediate recovery and outcomes. A clinical decision tree is offered to support goal setting. Supplemental Material https://doi.org/10.23641/asha.9755444.

The Voicemail Elicitation Task: Functional Workplace Language Assessment for Persons With Traumatic Brain Injury

Purpose Politeness markers (PMs) are words that enhance cooperativity in dialogue and are an essential component of professional/work communication. Persons with moderate/severe traumatic brain injury (TBI) underuse PMs in connected speech and have employment stability issues. The voicemail elicitation task (VET) is a standardized computerized language sampling procedure measuring PM rate in role-play tasks. Our purpose is to provide preliminary data establishing the potential of a screening assessment tool for professional/work communication. Method We measured VET performance using spoken PMs per minute (PMpM). We present data from 63 persons. Forty-three participants with TBI (22-65 years old, ≥ 1-year postinjury) worked in midlevel jobs before their injury and attempted work return after injury at the same job level. Twenty participants with TBI did not maintain work > 1 year (unstably employed), and 23 did maintain work for ≥ 1 year (stably employed). Twenty controls without history of neurological impairment working at the same job level also completed the VET protocol. We analyzed the data using between-group comparison with 1-way analysis of variance and post hoc analysis. We used receiver operating characteristic curve analysis to calculate sensitivity and specificity, as well as an optimal cutoff value for a screening measure. Results Group differences, F(2, 60) = 19.59, p = .0001, η2 = .376, were identified between unstably employed persons with TBI performing with lower PMpM scores than the stably employed TBI group and the control group. Receiver operating characteristic curve analysis indicated a cutoff score of 11.55 PMpM. There was acceptable specificity (0.700, 95% CI [0.499, 0.901]) and sensitivity (0.696, 95% CI [0.508, 0.883]) for a screening tool indicating further assessment of social communication. Conclusion The VET holds promise as a clinical screening tool to identify persons at risk for social communication-related job instability after TBI and the need for a more comprehensive social communication assessment.

The relationship between trained ratings and untrained listeners' judgments of global coherence in extended monologues

BACKGROUND

Global coherence rating scales have been used by a number of researchers to examine spoken discourse in populations with and without acquired neurogenic communication disorders. The 4-point global coherence (GC) scale in the current study has demonstrated reliability and convergent validity. However, we have not yet established how a global coherence rating corresponds to functional communication.

AIMS

The current study explores the clinical meaningfulness of the 4-point GC rating scale. Survey questions and ratings were developed to examine discourse quality and functional coherence as perceived by untrained listeners. Ratings by untrained listeners were compared to trained discourse ratings using the established 4-point GC scale.

METHODS

Twelve discourse samples, scored by a trained rater, were selected for the current study from a previously collected set of discourse transcripts. Transcripts were extended monologues in response to one of four possible open-ended questions that were re-recorded by the trained rater to remove any distracting features of the original recordings, such as articulatory errors. Twenty-four untrained listeners rated the discourse samples using a short questionnaire that included questions for each sample about: topic maintenance, inclusion of unnecessary information, and the listener level of interest and attention. Questions for untrained listeners were based on operational definitions of global coherence and discourse quality respectively. These untrained ratings were compared to trained ratings of global coherence. Outcome measures were compared using non-parametric tests and a Spearman Rank Order test was also used to examine relationships among variables.

OUTCOMES AND RESULTS

Untrained listeners' ratings for topic maintenance and inclusion of unnecessary information were significantly different between trained low, medium, and high global coherence ratings. Topic maintenance and inclusion of unnecessary information were also both significantly correlated with global coherence. Untrained listeners' ratings of their level of interest and attention for a sample were significantly different between trained medium-high and low-high global coherence ratings. Interest and attention ratings were also significantly correlated with ratings of global coherence.

CONCLUSIONS

Untrained raters did differentiate between levels of global coherence using ratings of topic maintenance, inclusion of unnecessary information, and their level of attention and interest. Global coherence was also significantly correlated with the untrained ratings. These findings provide preliminary external validity for the global coherence scale and support its clinical utility.

Measuring conversations after acquired brain injury in 30 minutes or less: a comparison of two pragmatic rating scales

Primary objective: This study compared the reliability, validity and feasibility of the Pragmatics Rating Scale (PRS) to the Profile of Pragmatic Impairment in Communication (PPIC). It was hypothesized that the PRS would have equivalent reliability and validity and superior feasibility. Research design: A correlational pilot study design was implemented. Methods and procedures: Participants were 15 adults with a history of ABI, who provided two conversation samples each, and 15 adults with no history of ABI, who provided one conversation sample each. Two clinicians used the PRS and PPIC to rate each conversation sample. Main outcomes and results: The results of the PRS showed good discriminative validity between the ABI and non-ABI group, adequate construct validity with the PPIC and the La Trobe Communication Questionnaire, superior interrater reliability to the PPIC, and good test-retest reliability. Also, the PRS demonstrated higher clinical feasibility than the PPIC as measured by mean completion time per sample and ratings on a clinical feasibility survey. Conclusions: These results supported our hypotheses that the PRS is sensitive to aspects of social communication often impaired by ABI, without the feasibility drawbacks of a more complex rating scale.

Feasibility and initial efficacy of project-based treatment for people with ABI

BACKGROUND

Communication impairments are common and pervasive for people a long time following acquired brain injury (ABI). These impairments have a significant impact on a person's quality of life (QOL) post-injury. Project-based treatment is a treatment approach that could have an impact on communication skills and QOL for people with ABI a long-term post-injury. This treatment is embedded in a context of meaningful activities chosen by people with ABI, whereby, as a group, they work collaboratively to achieve a tangible end product.

AIMS

To evaluate the feasibility and initial efficacy of project-based treatment on improving the communication skills and QOL for people with ABI.

METHODS & PROCEDURES

An exploratory controlled trial with alternate allocation of groups, and follow-up at 6-8 weeks, was completed. Twenty-one people with chronic ABI were recruited in groups of two to three from community settings, allocated to either a TREATMENT (n = 11) or WAITLIST group (n = 10). Participants attended a 20-h group-based treatment over 6 weeks where they worked towards achieving a project that helped others. To determine feasibility, four criteria were used: demand, implementation, practicality and acceptability. A range of communication and QOL outcomes was used to determine a fifth feasibility criterion, initial efficacy. Some of these criteria were additionally used to evaluate the feasibility of the outcomes.

OUTCOMES & RESULTS

All participants received the treatment as allocated with high attendance and no dropouts. The treatment was feasible to deliver as intended and was highly acceptable to participants. Medium and large effect sizes were found from pre- to post-treatment, and from pre-treatment to follow-up for measures of conversation, perceived communicative ability and QOL.

CONCLUSIONS & IMPLICATIONS

Project-based treatment is feasible with indications of initial efficacy for both communication skills and QOL. The treatment provides a promising new approach for improving communication skills and QOL in people with chronic acquired brain injuries in the community setting.

Social communication following traumatic brain injury part I: State-of-the-art review of assessment tools

PURPOSE

The primary aim of this paper was to identify and describe current social communication assessment tools for adults with traumatic brain injury.

METHOD

We conducted a state-of-the-art review to identify and categorise the range of social communication assessment tools found in the assessment and treatment literature that revealed 42 measures that were coded according to characteristics related to assessment types, psychometrics, and implementation.

RESULT

Of the 42 assessments, 64% evaluated social cognition and the remaining 36% evaluated communication. Coding of implementation categories revealed that only 18/42 (43%) measures were ecologically grounded and 23/42 (55%) were available to clinicians by purchase or in the public domain. Only three measures incorporated questions or an assessment of the examinee's priorities or concerns.

CONCLUSION

A number of factors limit current social communication assessment. The lack of tools that objectively and reliably evaluate communication or social cognition in ecologically valid ways remains problematic. Of particular concern is the lack of prioritisation of the individual's communication values and needs. Recommendations include a call to focus research on the development of more contextual, standardised assessments, consider availability and feasibility when tools are being developed, and evaluate assessment processes as well as discrete tools.

Social communication assessment after TBI: a narrative review of innovations in pragmatic and discourse assessment methods

BACKGROUND

Social communication assessment after traumatic brain injury (TBI) remains a challenging area within speech-language pathology (SLP) clinical practice. Difficulties include the lack of TBI-specific standardized assessment instruments and limited knowledge and uptake of discourse assessment methods clinically. The aim of this paper was to review recent research literature reporting on innovative social communication and discourse assessment measures and methods, to guide evidence-based SLP practice and inform future research.

MAIN CONTRIBUTION

This review describes novel standardized and non-standardized assessment tools for SLP use reported in TBI research literature from the past 15 years. Measures include published assessment batteries and pragmatic rating scales designed for use with adults with TBI, and novel discourse tasks and protocols.

CONCLUSION

This paper delineates social communication assessment measures and discourse analyses described in research literature that may be practical for SLPs to use with adults with TBI. The clinical implications and utility of these measures are discussed. This should assist SLPs in decision-making on social communication assessment for adults with TBI. Further research is needed to investigate translation of research knowledge on discourse assessment methods to SLP practice.

An International Survey of Assessment Practices for Short-Term and Working Memory Deficits in Aphasia

PURPOSE

Recent research has highlighted the clinical relevance of understanding the nature of short-term memory (STM) and working memory (WM) deficits in persons with aphasia and the way these deficits affect linguistic processing and functional communication in activities of daily living. The psychometric properties of tests commonly used to identify STM/WM problems in individuals with aphasia, however, have been questioned. No previous study has sought to investigate assessment practices and attitudes by speech-language pathologists involved in aphasia management. Accordingly, the aims of this study were (a) to investigate both attitudes toward STM/WM assessment in individuals with aphasia, as well as the types and frequency of STM/WM tests used with individuals with aphasia, and (b) to explore factors (e.g., educational background) that may influence STM/WM assessment practices.

METHOD

Respondents recruited via professional and aphasia support organizations completed an online survey. The survey elicited information about the respondents' demographic and clinical backgrounds and STM/WM assessment clinical practices and views, including frequency and preferred use of specific STM/WM tests.

RESULTS

The majority of respondents reported regular use of STM/WM tests as part of aphasia management. Positive attitudes toward STM/WM assessments were also reported. The most popular rankings of tests were the Cognitive Linguistic Quick Test (Helm-Estabrooks, 2001), the Comprehensive Aphasia Test (Swinburn, Porter, & Howard, 2005), and the Token Test (McNeil & Prescott, 1978). Results suggested limited knowledge about measures that assess self-perceptions of functional memory abilities. Regression analyses showed that the frequency of reported STM/WM test use was similar between clinicians and dual-role researchers/clinicians, but their attitudes toward the value of STM/WM differed. U.S. and UK respondents reported similar assessment practices.

CONCLUSIONS

It is reassuring that STM/WM is taken into consideration by clinicians when providing aphasia management. Two of the most popular tests, however, have poor psychometric properties, and caution should be exercised in clinical decision making. The different value placed on STM/WM testing by clinicians and researchers/clinicians has implications for continuing professional development.

Knowledge, Confidence, and Practice Patterns of Speech-Language Pathologists Working With Adults With Traumatic Brain Injury

PURPOSE

Although speech-language pathologists (SLPs) are important members of the health care team serving adults with traumatic brain injury (TBI) with cognitive-communication disorders, little is known about services SLPs deliver and how they rate their own knowledge and skills. The aims of this study were to identify practice patterns, knowledge, and confidence levels of SLPs working with adults with TBI with cognitive-communication disorders.

METHOD

We surveyed 100 SLPs from rural and urban hospitals, skilled nursing facilities, and outpatient clinics in Wisconsin and analyzed data descriptively.

RESULTS

SLPs in this sample had a combination of accurate and inaccurate knowledge related to TBI. Although all participants reported working with individuals with TBI, many participants rated themselves as lacking confidence or knowledge in this practice area. SLPs reported variable use of evidence-based procedures and training related to TBI.

CONCLUSION

Results confirmed the high prevalence of TBI-related practice among SLPs in medical settings, but there was variable knowledge, confidence, and use of current evidence in practice. SLP graduate training programs, individual providers, health care administrators, and the American Speech-Language-Hearing Association can use results from this study to advance and improve SLP clinical services for adults with TBI.

Normative Study of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) Test in the French-Canadian Population

PURPOSE

The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES; MacDonald, 2005) test was designed for use by speech-language pathologists to assess verbal reasoning, complex comprehension, discourse, and executive skills during performance on a set of challenging and ecologically valid functional tasks. A recent French version of this test was translated from English; however, it had not undergone standardization. The development of normative data that are linguistically and culturally sensitive to the target population is of importance. The present study aimed to establish normative data for the French version of the FAVRES, a commonly used test with native French-speaking patients with traumatic brain injury in Québec, Canada.

METHOD

The normative sample consisted of 181 healthy French-speaking adults from various regions across the province of Québec. Age and years of education were factored into the normative model.

RESULTS

Results indicate that age was significantly associated with performance on time, accuracy, reasoning subskills, and rationale criteria, whereas the level of education was significantly associated with accuracy and rationale.

CONCLUSION

Overall, mean scores on each criterion were relatively lower than in the original English version, which reinforces the importance of using the present normative data when interpreting performance of French speakers who have sustained a traumatic brain injury.

Assessment and Rehabilitation of Social Cognition Impairment after Brain Injury: Surveying Practices of Clinicians

Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury.

Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia.

Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation.

Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation.