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Steel J, Coluccio I, Elbourn E, Spencer E. How do speech-language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice. Int J Lang Commun Disord 2024; 59:591-607. [PMID: 36117377 DOI: 10.1111/1460-6984.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Joanne Steel
- The University of Newcastle, Newcastle, NSW, Australia
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Elbourn E, Brassel S, Steel J, Togher L. Perceptions of communication recovery following traumatic brain injury: A qualitative investigation across 2 years. Int J Lang Commun Disord 2024; 59:463-482. [PMID: 36239151 DOI: 10.1111/1460-6984.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. AIMS The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post-injury. METHODS & PROCEDURES Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. OUTCOMES & RESULTS Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re-establishing a sense of self and the perceived importance of a strong social network post-injury. CONCLUSIONS & IMPLICATIONS The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post-injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team-based service delivery models for individuals with TBI that span from acute to long-term care are warranted. WHAT THIS STUDY ADDS?: What is already known on this subject Communication recovery from traumatic brain injury (TBI) is complex and multifaceted. The perceptions of individuals with TBI toward their communication recovery is largely unknown. To establish rehabilitation services that meet the needs of these individuals, we need to understand how they experience communication recovery. What this paper adds to existing knowledge Social communication interventions were perceived as a priority for intervention by individuals with TBI. Fatigue was identified as perceived barrier to communication recovery. Taking ownership over one's recovery process was revealed as a facilitator of recovery. Illness narratives were found to strengthen post-injury identity over time. What are the potential or actual clinical implications of this work? Speech pathologists should prioritise social communication interventions and fatigue management for communication. Facilitating ownership of the recovery process and offering long-term supports are key aspects of treatment. Supporting positive illness narratives as part of treatment may facilitate post-injury identity construction.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sophie Brassel
- The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Steel
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, New South Wales, Australia
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Hall Z, Elbourn E, Togher L, Carragher M. Co-constructed communication therapy for individuals with acquired brain injury: A systematic review. Int J Lang Commun Disord 2024; 59:496-518. [PMID: 36640114 DOI: 10.1111/1460-6984.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Meaningful, varied, joyful conversation is an important therapy target for adults with language or cognitive-communication disorders following acquired brain injury (ABI). However, the complexity of daily communication is often reduced to component parts within intervention programmes, with mixed evidence of generalization to everyday conversation. Interventions targeting co-construction of communication within a dyad offer a structured way in which to retain and treat elements of everyday conversation for individuals and their communication partner (CP). Such interventions exist but they are variably labelled, target different ABI populations and have not been synthesized. AIMS To identify the nature, scope and effects of intervention studies targeting co-constructed communication in adults with ABI. METHOD This systematic review was completed using PRISMA Guidelines. Six databases (MEDLINE, Embase, CINAHL, Scopus, LLBA, PsychInfo) were searched and 1210 studies were screened. Data were extracted and studies were rated for methodological quality and completeness of reporting. Outcome measures and effects of treatment were collated through descriptive synthesis. MAIN CONTRIBUTION This review highlights an emerging evidence base in relation to an intervention approach that targets everyday communication. Co-constructed communication interventions have been reported by 13 studies, from a total of 206 participants with post-stroke aphasia, traumatic brain injury and progressive language impairments. These interventions take a range of formats, including referential communication tasks, retell/recount therapies and communication training programmes. Methodological quality evaluation indicated mostly low-level study designs. Heterogeneity was identified in primary outcome measures, with 28 unique primary outcome measures reported across studies. Most studies demonstrated change in task-specific or broad communication outcome measures. CONCLUSIONS Co-constructed communication interventions may offer clinicians a systematic, protocolized, replicable way to target everyday communication for adults with ABI. More high-quality, experimental designs with complete reporting and psychometrically sound outcome measures are needed to strengthen the evidence base. WHAT THIS PAPER ADDS What is already known on this subject Everyday conversation is an important therapy target for adults with ABI, but there is mixed evidence of therapy gains generalizing to everyday life. Many interventions reduce conversation to component parts such as naming or sentence construction. A different approach is needed to capture the social, dyadic, interactive and multifaceted nature of conversation. We propose the term 'co-constructed communication interventions' as a therapy genre targeting semi-structured dialogue. These interventions retain elements of everyday conversation (such as multimodal communication and situating tasks within dyads), combined with experimental elements (where stimuli prompt interactions and responses can be scored against normative data). What this paper adds to existing knowledge This review proposes and describes a distinct genre of discourse intervention within the current evidence base with a novel operational definition of 'co-constructed communication'. What are the potential or actual clinical implications of this work? Co-constructed communication interventions directly target elements of everyday communication by situating the therapy goals within a dyadic, interactive, multimodal task. A range of intervention tasks have been identified, including collaborative storytelling and problem-solving. This review will be of interest to clinicians working with adults with ABI; co-constructed communication interventions may offer a useful, replicable way to target aspects of everyday communication. This synthesis of the current evidence base encourages clinicians' informed, evidence-based decisions around these interventions.
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Affiliation(s)
- Zali Hall
- The Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Elise Elbourn
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Leanne Togher
- The Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marcella Carragher
- The Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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Christensen I, Power E, Togher L, Brassel S, Elbourn E, Folder N, Jensen LR. Communication between rehabilitation staff and people with traumatic brain injury: A systematic review. Neuropsychol Rehabil 2023:1-39. [PMID: 37944003 DOI: 10.1080/09602011.2023.2274625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
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.
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Affiliation(s)
- Iben Christensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen South, Denmark
| | - Emma Power
- Department of Speech Pathology, University of Technology Sydney, Ultimo, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sophie Brassel
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Naomi Folder
- Department of Speech Pathology, University of Technology Sydney, Ultimo, Australia
| | - Lise Randrup Jensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen South, Denmark
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Togher L, Elbourn E, Kenny B, Honan C, Power E, Tate R, McDonald S, MacWhinney B. Communication and Psychosocial Outcomes 2-Years After Severe Traumatic Brain Injury: Development of a Prognostic Model. Arch Phys Med Rehabil 2023; 104:1840-1849. [PMID: 37146957 DOI: 10.1016/j.apmr.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/19/2023] [Accepted: 04/09/2023] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- Leanne Togher
- Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia
| | - Elise Elbourn
- Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia.
| | | | - Cynthia Honan
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Emma Power
- The University of Technology, Sydney, Australia
| | - Robyn Tate
- Faculty of Medicine & Health, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA
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Elbourn E, MacWhinney B, Fromm D, Power E, Steel J, Togher L. TBIBank: An International Shared Database to Enhance Research, Teaching and Automated Language Analysis for Traumatic Brain Injury Populations. Arch Phys Med Rehabil 2023; 104:824-829. [PMID: 36639093 DOI: 10.1016/j.apmr.2022.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
Traumatic brain injury (TBI) has been established as a priority research area for public health, affecting an estimated 69 million individuals worldwide each year. Large-scale collaborative datasets may help to better understand this heterogenous and chronic health condition. In this paper, we present TBIBank; an innovative digital health resource that aims to establish a shared database for the study of communication disorders after TBI. We provide an overview of the current database, the standard discourse protocol used for the main TBIBank corpus, and the automated language analyses that can enable diagnostic profiling, comparative evaluation of treatment effects and profiling of recovery patterns. We also highlight the e-learning component of the digital health resource as a research translation tool. We conclude with a discussion of the potential research, clinical, and educational applications of TBIBank and future directions for expanding this digital resource.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Davida Fromm
- Carnegie Mellon University, Pittsburgh, PA 15213, United States
| | - Emma Power
- University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Joanne Steel
- The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, NSW 2006, Australia
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Power E, Falkenberg K, Barnes S, Elbourn E, Attard M, Togher L. A pilot randomized controlled trial comparing online versus face-to-face delivery of an aphasia communication partner training program for student healthcare professionals. Int J Lang Commun Disord 2020; 55:852-866. [PMID: 32654395 DOI: 10.1111/1460-6984.12556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/05/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Training conversation partners of people with aphasia who use facilitative communication strategies is one method that can improve access to healthcare for people with aphasia. However, the efficacy of communication partner training (CPT) has been investigated almost exclusively in the context of face-to-face (F2F) delivery. Online training may offer more cost-effective and accessible options to a wider range of conversation partners, including student healthcare professionals. AIMS To conduct a pilot randomized controlled trial with student healthcare professionals comparing (1) an online aphasia CPT program, (2) a F2F CPT program and (3) no program (control group) on outcomes relating to attitudes and knowledge of aphasia. METHODS & PROCEDURES A 45-min introductory aphasia CPT program was developed using the theories and techniques of Supported Conversations for Adults with Aphasia (SCA)™. A total of 30 first-year undergraduates studying occupational therapy at The University of Sydney were randomly allocated to one of three conditions: online CPT delivery, F2F delivery or delayed training control (no program). Outcomes measures included pre-post-testing with the Aphasia Attitudes, Strategies and Knowledge (AASK) survey. OUTCOMES & RESULTS A significant difference existed for the AASK survey pre-post-change scores between the online, F2F and control groups (χ2 (2) = 20.038, p = 0.000). Post-hoc analysis revealed that, compared with the control (Ctrl) group, participants in both the online and F2F groups had significantly higher knowledge of aphasia (Online versus Ctrl: p = 0.000; F2F versus control: p = 0.002), knowledge of facilitative strategies (Online versus Ctrl: p = 0.000; F2F versus Ctrl: p = 0.002), and positive attitudes towards aphasia (Online versus Ctrl: p = 0.031; F2F versus Ctrl: p = 0.032). No significant difference was observed between the online and F2F groups for the Total or any subtotals (p = 1.000). CONCLUSIONS AND IMPLICATIONS The results from this pilot randomized controlled trial indicate that online delivery of the 45-min introductory CPT is equally as efficacious as F2F delivery, and thus may be a viable mode of delivery for future aphasia CPT programs. These pilot results pave the way for a larger study that will comprehensively evaluate the efficacy of an online aphasia CPT program for improving attitudes, knowledge and skills in a broad range of student healthcare professionals. What this paper adds What is already known on this subject The efficacy of F2F CPT for aphasia is well established. Online delivery of CPT programs may offer more cost-effective and accessible services when compared with F2F approaches; however, there is a need to explore the efficacy of online programs. What this paper adds to existing knowledge The 45-min online aphasia CPT program was found to be efficacious for improving student healthcare professionals' knowledge and attitudes towards aphasia and communication, and produced equally successful outcomes when compared with F2F delivery. This is the first study to report the efficacy of an online CPT program that is aligned with SCA for use with student healthcare professionals that also uses a self-report outcome measure with validated psychometric properties. What are the potential or actual clinical implications of this work? Online CPT programs may be useful in both clinical and education contexts to support improved efficiency of services and to enhance communication environments for people with aphasia in healthcare contexts.
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Affiliation(s)
- Emma Power
- University of Technology Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | | | | | | | - Michelle Attard
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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Elbourn E, Kenny B, Power E, Togher L. Psychosocial Outcomes of Severe Traumatic Brain Injury in Relation to Discourse Recovery: A Longitudinal Study up to 1 Year Post-Injury. Am J Speech Lang Pathol 2019; 28:1463-1478. [PMID: 31487472 DOI: 10.1044/2019_ajslp-18-0204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Elise Elbourn
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
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Chia AA, Power E, Kenny B, Elbourn E, McDonald S, Tate R, MacWhinney B, Turkstra L, Holland A, Togher L. Patterns of early conversational recovery for people with traumatic brain injury and their communication partners. Brain Inj 2019; 33:690-698. [DOI: 10.1080/02699052.2019.1571632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- An An Chia
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Discipline of Speech Pathology, UTS Graduate School of Health, University of Technology, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Tate
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lyn Turkstra
- Department of Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Audrey Holland
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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Elbourn E, Kenny B, Power E, Honan C, McDonald S, Tate R, Holland A, MacWhinney B, Togher L. Discourse recovery after severe traumatic brain injury: exploring the first year. Brain Inj 2018; 33:143-159. [DOI: 10.1080/02699052.2018.1539246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elise Elbourn
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Belinda Kenny
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Cynthia Honan
- School of Medicine, The University of Tasmania, Hobart, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Robyn Tate
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Audrey Holland
- Speech, Language and Hearing Sciences, The University of Arizona, Tucson, USA
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA
| | - Leanne Togher
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
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Elbourn E, Togher L, Kenny B, Power E. Strengthening the quality of longitudinal research into cognitive-communication recovery after traumatic brain injury: A systematic review. Int J Speech Lang Pathol 2017; 19:1-16. [PMID: 27315590 DOI: 10.1080/17549507.2016.1193896] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/23/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE (i) To systematically review longitudinal and prognostic studies relating to the trajectory of cognitive-communication recovery after TBI and (ii) to provide recommendations to strengthen future research. METHOD Thirteen health literature databases were accessed up until July 2014. MAIN MEASURES Articles were screened systematically against pre-determined inclusion and exclusion criteria. Quality reviews were performed on the selected articles using a modified Downs & Black Rating Scale. Two independent reviewers performed the reviews. RESULT Sixteen longitudinal and prognostic articles met the inclusion criteria. There was evidence of either maintenance or improvement of cognitive-communication skills during the first 3 years post-injury. However, the studies did not provide detailed recovery trajectories, by failing to evaluate numerous data points over time. No studies evaluated recovery beyond 3 years post-injury. Injury severity, lesion location, brain volume loss and conversation skills may predict specific cognitive-communication outcomes. There was high variability in study characteristics and measures. CONCLUSION There is currently scarce evidence regarding cognitive-communication recovery and prognosis. People with TBI may recover or maintain pre-morbid cognitive-communication skills during the early rehabilitation stage. Further research detailing the recovery trajectory with a view to evaluating predictive factors is strongly indicated. Guidelines for future research are provided.
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Affiliation(s)
- Elise Elbourn
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Leanne Togher
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Belinda Kenny
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Emma Power
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
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Brassel S, Kenny B, Power E, Elbourn E, McDonald S, Tate R, MacWhinney B, Turkstra L, Holland A, Togher L. Conversational topics discussed by individuals with severe traumatic brain injury and their communication partners during sub-acute recovery. Brain Inj 2016; 30:1329-1342. [DOI: 10.1080/02699052.2016.1187288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sophie Brassel
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Tate
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lyn Turkstra
- Department of Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Audrey Holland
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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