Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework

BACKGROUND

Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context.

METHODS

Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately.

RESULTS

We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve.

CONCLUSIONS

The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.

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

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

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design

Background

Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools.

Methods

A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison.

Results

Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services.

Conclusions

Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.

Facial affect recognition in context in adults with and without TBI

Introduction

Several studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab.

Methods

Participants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person's real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels.

Results

Over 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups.

Discussion

Results revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI.

Comparator Groups in ICU-Based Studies of Physical Rehabilitation: A Scoping Review of 125 Studies

To characterize comparator groups (CGs) in ICU-based studies of physical rehabilitation (PR), including the type, content, and reporting.

DATA SOURCES

We followed a five-stage scoping review methodology, searching five databases from inception to June 30, 2022. Study selection and data extraction were completed independently, in duplicate.

STUDY SELECTION

We screened studies by title and abstract, then full-text. We included prospective studies with greater than or equal to two arms enrolling mechanically ventilated adults (≥ 18 yr), with any planned PR intervention initiated in the ICU.

DATA EXTRACTION

We conducted a quantitative content analysis of authors' description of CG type and content. We categorized similar CG types (e.g., usual care), classified content into unique activities (e.g., positioning), and summarized these data using counts (proportions). We assessed reporting using Consensus on Exercise Reporting Template (CERT; proportion of reported items/total applicable).

DATA SYNTHESIS

One hundred twenty-five studies were included, representing 127 CGs. PR was planned in 112 CGs (88.2%; 110 studies), representing four types: usual care (n = 81, 63.8%), alternative treatment than usual care (e.g., different from intervention; n = 18, 14.2%), alternative treatment plus usual care (n = 7, 5.5%), and sham (n = 6, 4.7%). Of 112 CGs with planned PR, 90 CGs (88 studies) reported 60 unique activities, most commonly passive range of motion (n = 47, 52.2%). The remaining 22 CGs (19.6%; 22 studies) reported vague descriptions. PR was not planned in 12 CGs (9.5%; 12 studies), and three CGs (2.4%; three studies) reported no details. Studies reported a median (Q1-Q3) of 46.6% (25.0-73.3%) CERT items. Overall, 20.0% of studies reported no detail to understand planned CG activities.

CONCLUSIONS

The most common type of CG was usual care. We identified heterogeneity in planned activities and CERT reporting deficiencies. Our results could help guide the selection, design, and reporting of CGs in future ICU-based PR studies.

Reporting of Classroom-Based Morphological Awareness Instruction and Intervention for Kindergarten to Grade 3 Students in the Literature: A Scoping Review

PURPOSE

The purpose of this scoping review was to document how the literature reports morphological awareness instruction and interventions delivered by speech-language pathologists (SLPs) and/or educators in classroom settings for kindergarten to Grade 3 students.

METHOD

We followed the Joanna Briggs Institute's methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Six relevant databases were searched systematically with article screening and selection completed by two reviewers calibrated for reliability. For data charting, one reviewer extracted content and a second reviewer verified it was pertinent to the review question. Charting for the reported elements of morphological awareness instruction and interventions was guided by the Rehabilitation Treatment Specification System.

RESULTS

The database search yielded 4,492 records. After removal of duplicates and screening, 47 articles were selected for inclusion. Interrater reliability for source selection exceeded the pre-established criterion of k = .61. Our analysis generated a comprehensive description of the elements of morphological awareness instruction as reported in the included articles.

CONCLUSIONS

Our findings provide school-based SLPs and educators a systematic means of reviewing the literature to identify key elements of morphological awareness instruction in published articles for application of evidence-based practices with fidelity, thus helping to close the research-to-practice gap. Our manifest content analysis revealed reporting of the elements for classroom-based morphological awareness instruction was varied, and in some cases, underspecified in the articles included in our study. Implications for clinical practice and future research to advance knowledge and promote implementation of evidence-based practices by SLPs and educators in today's classrooms are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22105142.

Designing evidence-based support aids for social media access for individuals with moderate-severe traumatic brain injury: A preliminary acceptability study

Background

Adults with traumatic brain injury (TBI) report significant barriers to using current social media platforms, including cognitive overload and challenges in interpreting social cues. Rehabilitation providers may be tasked with helping to address these barriers.

Objectives

To develop technological supports to increase social media accessibility for people with TBI-related cognitive impairments and to obtain preliminary data on the perceived acceptability, ease of use, and utility of proposed technology aids.

Methods

We identified four major barriers to social media use among individuals with TBI: sensory overload, memory impairments, misreading of social cues, and a lack of confidence to actively engage on social media platforms. We describe the process of developing prototypes of support aids aimed at reducing these specific social media barriers. We created mock-ups of these prototypes and asked 46 community-dwelling adults with TBI (24 females) to rate the proposed aids in terms of their acceptability, ease of use, and utility.

Results

Across all aids, nearly one-third of respondents agreed they would use the proposed aids frequently, and the majority of respondents rated the proposed aids as easy to use. Respondents indicated that they would be more likely to use the memory and post-writing aids than the attention and social cue interpretation aids.

Conclusions

Findings provide initial support for social-media-specific technology aids to support social media access and social participation for adults with TBI. Results from this study have design implications for future development of evidence-based social media support aids. Future work should develop and deploy such aids and investigate user experience.

Working Memory for Emotions in Adolescents and Young Adults with Traumatic Brain Injury

This preliminary study investigated the interaction between working memory and social cognition in adolescents and young adults with traumatic brain injury (TBI). It was hypothesized that participants with or without TBI would better recognize social information when working memory or social cognitive load was low, and that adolescents and young adults with TBI would be more affected by increased cognitive demand than their uninjured peers. Eight adolescents and young adults with complicated mild-severe TBI (aged 14-22 years) and eight age- and sex-matched typically developing (TD) adolescents completed computer-based n-back tasks requiring recognition of either face identity or facial affect, with 0-back, 1-, and 2-back conditions. The TBI group had lower scores overall than the TD group, and scores for both groups were lower for affect recognition than identity recognition. Scores for both groups were lower in conditions with a higher working memory load. There was a significant group-by-working memory interaction, with larger group differences in high-working memory conditions. Study results and their potential implications for social outcomes are discussed.

A mapping review of adolescent identity after TBI: what clinicians need to know

ABSTRACTAdolescence is a critical period for developing a sense of identity, an iterative process that relies on the development of skills such as self-reflection and self-appraisal. Outcomes of identity development include personal ethics, knowledge of one's strengths and challenges, and, ultimately, independence. Traumatic brain injury (TBI) affects these outcomes in adults, when identity has been established and may need to be redefined; but what happens when an injury occurs while identity is being formed? To answer this question, we used mapping review methodology to explore TBI effects on adolescent identity formation, mapping the evidence onto a biopsychosocial framework for rehabilitation. We reviewed studies on identity in adolescents with mild to severe TBI ages 13-18 years, published from inception to 2021, with a focus on outpatient rehabilitation settings. Key findings of the mapping review noted adolescents post-TBI are likely to: (1) question their identity considering dissonance between the current self and their pre-injury self; and (2) seek to establish new, adaptive meanings and identities. All studies drew conclusions regarding identity and participation of adolescents post-TBI. Results provided insight into the importance of considering individualized rehabilitation interventions for adolescents, given their unique developmental path towards identity formation.

Discourse Performance in Adults With Mild Traumatic Brain Injury, Orthopedic Injuries, and Moderate to Severe Traumatic Brain Injury, and Healthy Controls

INTRODUCTION

Adults with mild traumatic brain injury (mTBI) are at risk for communication disorders, yet studies exploring cognitive-communication performance are currently lacking.

AIMS

This aim of this study was to characterize discourse-level performance by adults with mTBI on a standardized elicitation task and compare it to (a) healthy adults, (b) adults with orthopedic injuries (OIs), and (c) adults with moderate to severe TBI.

METHOD

This study used a cross-sectional design. The participants included mTBI and OI groups recruited prospectively from an emergency medicine department. Moderate to severe TBI and healthy data were acquired from TalkBank. One-way analyses of variance were used to compare mean linguistic scores.

RESULTS

Seventy participants across all groups were recruited. Groups did not differ on demographic variables. The study found significant differences in both content and productivity measures among the groups. Variables did not appear sensitive to differentiate between mTBI and OI groups.

DISCUSSION

Cognitive and language performance of adults with mTBI is a pressing clinical issue. Studies exploring language with carefully selected control groups can influence the development of sensitive measures to identify individuals with cognitive-communication deficits.

Building a theoretical foundation for cognitive rehabilitation

This scientific commentary refers to ‘A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury’ by Mahncke et al. (doi:10.1093/brain/awab202).

Current Practices Among Speech-Language Pathologists for Mild Traumatic Brain Injury: A Mixed-Methods Modified Delphi Approach

Purpose The study purpose was to capture the clinical practice patterns of speech-language pathologists (SLPs) treating mild traumatic brain injury (mTBI; concussion). Study aims were to (a) characterize expert SLP practice patterns for the management of mTBI and (b) use qualitative content analysis to explore areas of quantitative variability within participants' responses. Method Using a modified Delphi approach, SLPs completed an online survey, with Round 1 responses shaping questions for Round 2. Round 2 results were analyzed using a concurrent partially mixed-methods approach with quantitative and qualitative items. Quantitative consensus agreement levels were set prestudy at 75% agreement or higher. Topic-level items that did not reach consensus were analyzed using qualitative content analysis. Participants SLPs engaging in a specialty mTBI-SLP networking group were invited to participate. Round 1 had nine participants (United States: 4, Canada: 5). Round 2 had 18 participants (United States: 12, Canada: 6), with a mean of 15.7 years of experience in mTBI (range: 3-33) and a mean of 7.6 clients with mTBI seen weekly (range: 1-25). Results Nearly all topic-level practice items met quantitative consensus (42/45). Consensus areas included using conceptual frameworks, interprofessional teaming, assessment and intervention practices, goal setting, and outcomes. Functional, collaborative, and client-centered care anchored clinical practice. Areas lacking consensus included SLP roles in mTBI mental and somatic health symptoms, specific measurement tools, and intervention dosages. Qualitative themes that emerged included limited interprofessional awareness for the role of SLPs in mTBI and challenges in measurement selection. Conclusions Study aims were met with clear consensus on clinical patterns implemented by SLPs specializing in mTBI. Results will inform both current clinical practices and future practice guidelines. High-level guidance and advocacy are needed to clarify SLP practice concerns and advance interprofessional education. Future work should address identified gaps, including targeted assessment tools and consensus on intervention methods.

Confidence and Training of Speech-Language Pathologists in Cognitive-Communication Disorders: Time to Rethink Graduate Education Models?

Purpose The purpose of this article is to highlight the need for increased focus on cognitive communication in North American speech-language pathology graduate education models. Method We describe key findings from a recent survey of acute care speech-language pathologists (SLPs) in the United States and expand upon the ensuing discussion at the 2020 International Cognitive-Communication Disorders Conference to consider some of the specific challenges of training for cognitive communication and make suggestions for rethinking how to prepare future clinicians to manage cognitive-communication disorders. Results Results from the survey of acute care SLPs indicated inconsistent confidence and training in managing cognitive-communication disorders. We discuss the pros and cons of several avenues for improving the consistency of cognitive-communication training, including a standalone cognitive-communication course, integrating cognitive communication in all courses across the speech-language pathology undergraduate and graduate curriculum, and using problem-based learning frameworks to better prepare students as independent thinkers in the area of cognitive communication and beyond. Conclusions Cognitive-communication disorders cut across clinical diagnoses and settings and are one of the largest and fastest growing parts of the SLP's scope of practice. Yet, surveys, including the one discussed here, have repeatedly indicated that SLPs do not feel prepared or confident to work with individuals with cognitive-communication disorders. We propose several avenues for increasing educational emphasis on cognitive communication. We hope these ideas will generate discussion and guide decision making to empower SLPs to think critically and step confidently into their roles as leaders in managing the heterogeneous and ever-growing populations of individuals with cognitive-communication disorders.

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.

Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

INTRODUCTION

Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results.

METHODS

In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.

RESULTS

Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.

DISCUSSION

We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.

Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions

In this report, we identify existing issues and challenges related to research on traumatic brain injury (TBI) in females and provide future directions for research. In 2017, the National Institutes of Health, in partnership with the Center for Neuroscience and Regenerative Medicine and the Defense and Veterans Brain Injury Center, hosted a workshop that focused on the unique challenges facing researchers, clinicians, patients, and other stakeholders regarding TBI in women. The goal of this "Understanding TBI in Women" workshop was to bring together researchers and clinicians to identify knowledge gaps, best practices, and target populations in research on females and/or sex differences within the field of TBI. The workshop, and the current literature, clearly highlighted that females have been underrepresented in TBI studies and clinical trials and have often been excluded (or ovariectomized) in preclinical studies. Such an absence in research on females has led to an incomplete, and perhaps inaccurate, understanding of TBI in females. The presentations and discussions centered on the existing knowledge regarding sex differences in TBI research and how these differences could be incorporated in preclinical and clinical efforts going forward. Now, a little over 2 years later, we summarize the issues and state of the science that emerged from the "Understanding TBI in Women" workshop while incorporating updates where they exist. Overall, despite some progress, there remains an abundance of research focused on males and relatively little explicitly on females.

Sex-based differences in expectations for social communication after TBI

Sex-based differences have been reported in several TBI outcome studies, including studies of social functioning. In some studies, social outcomes have been evaluated via perceptual judgments on questionnaires, which may be influenced by stereotypes about acceptable behaviour for men and women. To explore potential sex-based rater bias in social judgments, we asked 68 typical undergraduates (34 women) to identify problematic behaviour for men vs. women on a widely used questionnaire for TBI social outcome, the LaTrobe Communication Questionnaire. Results revealed more consensus among raters of both sexes about acceptable behaviours for men than behaviours for women, and women were more critical than men when judging persons of either sex. These findings support the importance of considering sex in TBI social outcome research, past and future, not only sex of the participant but also sex of the person judging social outcome. Sex-based differences here also have implications for social evaluations in clinic, where female clinicians are often judging male patients. Future research should consider gender (the social construct), as well as sex (the biological construct), as both may contribute to perceived social outcome after TBI.

Development, Reliability, and Validity of the Perceptions of Brain Injury Survey

BACKGROUND AND PURPOSE

The purpose of this study was to assess psychometric properties of the Perceptions of Brain Injury Survey (PBIS), an instrument designed to assess nurses' perceptions and preparation to care for patients with traumatic brain injury (TBI).

METHODS

We adapted two instruments to create the PBIS, and 724 nurses completed the PBIS at three hospitals.

RESULTS

Final instrument has 66 items and is composed of four subscales, which can be used independently. Results showed Cronbach's alpha for the overall scale was excellent (.93) and alphas for each composite subscale were acceptable to excellent (.73-.93). Findings also suggest good discriminant validity and evidence of external validity.

CONCLUSIONS

The PBIS is a reliable and valid measure for assessing nurses' perceptions of caring for patients with TBI in practice or research.

Sex and Gender Differences in Emotion Recognition and Theory of Mind After TBI: A Narrative Review and Directions for Future Research

A growing body of literature has examined sex differences in a variety of outcomes from moderate-severe traumatic brain injury (TBI), including outcomes for social functioning. Social functioning is an area in which adults with TBI have significant long-term challenges (1-4), and a better understanding of sex and gender differences in this domain may have a significant clinical impact. This paper presents a brief narrative review of current evidence regarding sex differences in one aspect of social functioning in adults with TBI: social cognition, specifically affect recognition and Theory of Mind (ToM). Data from typical adults and adults with TBI are considered in the broader context of common stereotypes about social skills and behaviors in men vs. women. We then discuss considerations for future research on sex- and gender-based differences in social cognition in TBI, and in adults more generally.

Language Comprehension After Mild Traumatic Brain Injury: The Role of Speed

Purpose The aim of this study was to characterize language comprehension in mild traumatic brain injury (mTBI) by testing a speed-based hypothesis. We hypothesized that adults with mTBI would perform worse than a group of adults with orthopedic injuries (OIs) on an experimental language comprehension task. Method The study employed a prospective experimental design. Participants were 19 adults with mTBI and 19 adults with OI ages 18-55 years. Participants completed the Whatdunit task, a sentence agent selection task in speeded and unspeeded conditions. Results In the unspeeded condition, the mTBI group performed with a marginally significant higher accuracy than the OI group. In the speeded condition, the mTBI group performed with lower accuracy than the OI group; however, this difference did not reach statistical significance. There was a marginally significant interaction of Sentence Type × Group for reaction time in the speeded condition. Conclusions While our task might have been sensitive to cognitive processing abilities in both groups (as evidenced by the main effects of condition and sentence type), the task was not specific enough to capture mTBI-related deficits. The similarities in performance between both groups have clinical implications for the treatment of not just brain-related trauma but also trauma in general.

Facial-affect recognition deficit as a predictor of different aspects of social-communication impairment in traumatic brain injury

OBJECTIVE

To examine the relationship between facial-affect recognition and different aspects of self- and proxy-reported social-communication impairment following moderate-severe traumatic brain injury (TBI).

METHOD

Forty-six adults with chronic TBI (>6 months postinjury) and 42 healthy comparison (HC) adults were administered the La Trobe Communication Questionnaire (LCQ) Self and Other forms to assess different aspects of communication competence and the Emotion Recognition Test (ERT) to measure their ability to recognize facial affects.

RESULTS

Individuals with TBI underperformed HC adults in the ERT and self-reported, as well as were reported by close others, as having more communication problems than did HC adults. TBI group ERT scores were significantly and negatively correlated with LCQ-Other (but not LCQ-Self) scores (i.e., participants with lower emotion-recognition scores were rated by close others as having more communication problems). Multivariate regression analysis revealed that adults with higher ERT scores self-reported more problems with disinhibition-impulsivity and partner sensitivity and had fewer other-reported problems with disinhibition-impulsivity and conversational effectiveness.

CONCLUSIONS

Our findings support growing evidence that emotion-recognition deficits play a role in specific aspects of social-communication outcomes after TBI and should be considered in treatment planning. (PsycINFO Database Record

Reaction time and cognitive-linguistic performance in adults with mild traumatic brain injury

Objective: The purpose of this study was to characterize cognitive-linguistic performance in adults with mild traumatic brain injury (mTBI) to advance assessment and treatment practices. We hypothesized that individuals with mTBI would demonstrate longer reaction times (RTs) and greater error rates when compared to an orthopedic injury (OI) group on a category-naming task. Method: Participants were age and education-matched adults with mTBI (n = 20; 12 females) and adults with OI (n = 21; 5 females) who were discharged to home after an Emergency Department visit. Our primary task was a category-naming task shown to be sensitive to language deficits after mTBI. The task was adapted and administered under speeded and unspeeded conditions. Results: There was a significant main effect of condition on RT (speeded faster than unspeeded) and accuracy (more errors in the speeded condition). There was a marginally significant effect of group on errors, with more errors in the mTBI group than the OI group. Naming RT and accuracy in both conditions were moderately correlated with injury variables and symptom burden. Conclusions: Our data showed a marginal effect of group on accuracy of performance. Correlations found between naming and neurobehavioural symptoms, including sleep quality, suggest that the latter should be considered in future research.

Comprehension of social-legal exchanges in adults with and without traumatic brain injury

OBJECTIVE

To characterize comprehension of conditional social-legal rules and broader social reasoning in adults with and without traumatic brain injury (TBI).

PARTICIPANTS

Participants were 20 adults with moderate-to-severe TBI (11 women) and 21 adults without TBI (13 women), ages 24 to 64 years.

METHOD

Participants completed the Wason task, a test of logical reasoning of conditional rules comprising precautionary rules, social-exchange rules, and legal social-exchange rules. Dependent variables were response accuracy and response time.

RESULTS

Across rule categories, TBI group participants were significantly less accurate, F(1, 39) = 9.03, p < .01, semipartial R2 = 0.18, and slower, F(1, 39) = 7.32, p < .01, semipartial R2 = 0.16, than comparison peers. Rule category had no effect on accuracy, but for both groups legal social-exchange rules were associated with longer response times, F(1, 78) = 9.82, p < .01, semipartial R2 = 0.11. Processing speed test scores correlated with accuracy, F(1, 37) = 4.62, p < .05, semipartial R2 = 0.11, and response times, F(1, 78) = 4.45, p < .05, semipartial R2 = 0.14, in both groups.

CONCLUSIONS

Adults with TBI underperformed their uninjured peers in both accuracy and speed of comprehending on precautionary rules, social-exchange rules, and legal social-exchange rules. These differences were attributable in part to differences in processing speed both within and between groups. Results highlight the potential costs of TBI-related cognitive problems in social-legal contexts, suggest the need to better accommodate individuals with TBI who are already involved in legal systems, and identify cognitive mechanisms for future study of social-legal rule comprehension in TBI and other populations with cognitive impairments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Characterizing computer-mediated communication, friendship, and social participation in adults with traumatic brain injury

BACKGROUND

Adults with traumatic brain injury (TBI) report loss of friendship and reduced social participation after injury, but there is limited information regarding quantity of friends and methods of communication. Our objective was to characterize friendship networks, social participation, and methods of communication, including computer-mediated communication (CMC), used by adults with TBI compared to uninjured adults.

METHODS

Participants were 25 adults with TBI and 26 uninjured healthy comparisons (HC) adults, who completed the Participation Assessment with Recombined Tools-Objective (PART-O) and the Social Network Questionnaire (SNQ).

RESULTS

Adults with TBI had significantly fewer total friends and significantly lower levels of productivity and overall social participation. Face-to-face interaction was the preferred method of contact for both groups. Adults with TBI were significantly less likely to use texting as a primary method of communication than their uninjured peers, but used other methods of communication at similar rates.

CONCLUSION

Our study supports prior findings of reduced friendships and reduced social participation after TBI and adds new information about similarities and differences in communication methods between adults with and without TBI.

The Latent Structure and Test-Retest Stability of Connected Language Measures in the Wisconsin Registry for Alzheimer's Prevention (WRAP)

INTRODUCTION

While it is well known that discourse-related language functions are impaired in the dementia phase of Alzheimer's Disease (AD), the presymptomatic temporal course of discourse dysfunction are not known earlier in the course of AD. To conduct discourse-related studies in this phase of AD, validated psychometric instruments are needed. This study investigates the latent structure, validity, and test-retest stability of discourse measures in a late-middle-aged normative group who are relatively free from sporadic AD risk factors.

METHODS

Using a normative sample of 399 participants (mean age = 61), exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted on 18 measures of connected language derived from picture descriptions. Factor invariance across sex and family history and longitudinal test-retest stability measures were calculated.

RESULTS

The EFA revealed a four-factor solution, consisting of semantic, syntax, fluency, and lexical constructs. The CFA model substantiated the structure, and factors were invariant across sex and parental history of AD status. Test-retest stability measures were within acceptable ranges.

CONCLUSIONS

Results confirm a factor structure that is invariant across sex and parental AD history. The factor structure could be useful in similar cohorts designed to detect early language decline in investigations of preclinical or clinical AD or as outcome measures in clinical prevention trials.

Friendship Quality, Friendship Quantity, and Social Participation in Adults with Traumatic Brain Injury

Adults with traumatic brain injury (TBI) often report reduced social participation and loss of friends, but little is known about quality of friendship after TBI. Our objective was to characterize social participation, friendship quantity, and friendship quality of adults with TBI and a comparison group of uninjured adults. Participants included 18 adults with moderate to severe TBI and 16 of their informant friends; and 18 uninjured adults and 11 of their informant friends. The main measures used were the Participation Assessment with Recombined Tools-Objective, the Social Network Questionnaire, and the McGill Friendship Questionnaire. Participants with TBI reported significantly less social participation and had fewer total friends, although this difference was not statistically significant. Adults with TBI differed from their friends on one measure of friendship quality, but reports for friendship quality were high in both groups. Adults with TBI reported overall high levels of friendship quality despite having lower levels of social participation compared with uninjured adults. Future research should investigate how the balance of quantity and quality of friendships relates to satisfaction with social participation and overall quality of life.

Connected speech and language in mild cognitive impairment and Alzheimer's disease: A review of picture description tasks

INTRODUCTION

The neuropsychological profile of people with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia includes a history of decline in memory and other cognitive domains, including language. While language impairments have been well described in AD dementia, language features of MCI are less well understood. Connected speech and language analysis is the study of an individual's spoken discourse, usually elicited by a target stimulus, the results of which can facilitate understanding of how language deficits typical of MCI and AD dementia manifest in everyday communication. Among discourse genres, picture description is a constrained task that relies less on episodic memory and more on semantic knowledge and retrieval, within the cognitive demands of a communication context. Understanding the breadth of evidence across the continuum of cognitive decline will help to elucidate the areas of strength and need in terms of using this method as an evaluative tool for both cognitive changes and everyday functional communication.

METHOD

We performed an extensive literature search of peer-reviewed journal articles that focused on the use of picture description tasks for evaluating language in persons with MCI or AD dementia. We selected articles based on inclusion and exclusion criteria and described the measures assessed, the psychometric properties that were reported, the findings, and the limitations of the included studies.

RESULTS

36 studies were selected and reviewed. Across all 36 studies, there were 1, 127 patients with AD dementia and 274 with MCI or early cognitive decline. Multiple measures were examined, including those describing semantic content, syntactic complexity, speech fluency, vocal parameters, and pragmatic language. Discriminant validity widely reported and distinct differences in language were observable between adults with dementia and controls; fewer studies were able to distinguish language differences between typically aging adults and those with MCI.

DISCUSSION

Our review shows that picture description tasks are useful tools for detecting differences in a wide variety of language and communicative measures. Future research should expand knowledge about subtle changes to language in preclinical AD and Mild Cognitive Impairment (MCI) which may improve the utility of this method as a clinically meaningful screening tool.

Response to text-based social cues in the formation of causal attributions in adults with traumatic brain injury

BACKGROUND

Adults with traumatic brain injury (TBI) may have deficits recognizing spoken social cues, with major negative social consequences. We do not know if these deficits extend to written social cues. Written cues, such as letterhead, provide information we use to make critical inferences about an author's perspective, and interpret subsequent text considering that perspective, and thus are critical for social communication. This study examined response to written social cues in adults with and without TBI.

METHODS AND PROCEDURES

We asked adults with TBI (n = 38) and uninjured adults (n = 20) to read an article describing actions of a mass murderer and give reasons for the those actions. Materials were presented on letterhead from either a social or a personality institute, to bias responses to either situational or dispositional factors. We hypothesized persons with TBI would be less likely to show bias consistent with the letterhead.

MAIN OUTCOMES AND RESULTS

Significantly more comparison-group responses (72%) than TBI-group responses (52%) were biased (p = 0.01) to match the institute in the letterhead.

CONCLUSIONS

Results indicated reduced sensitivity to written social cues in adults with TBI. Our findings add to evidence of impaired social cue response after TBI, and extend this to written text.

Social Participation and Navigation (SPAN): Description and usability of app-based coaching intervention for adolescents with TBI

BACKGROUND

Adolescents with brain injury (BI) often experience impairment in participation, which is an important predictor of outcomes.

OBJECTIVE

Describe the Social Participation and Navigation (SPAN) program, and report participant feedback and preliminary outcomes.

METHOD

Four adolescents and four coaches participated. SPAN included a mobile app, online didactic information, and peer coaching. Adolescents met weekly with coaches via video-conference, developed participation goals, and plans to achieve goals. Social and behavioral functioning before and after was assessed, and feedback about SPAN was collected.

RESULTS

SPAN was well received. Participants used the app to define and achieve goals. Medium to large effect sizes were found on adolescent self-reported measures, with negligible effects on parent-report measures. Positive and critical feedback is described.

CONCLUSIONS

Findings support the usability of SPAN, which has the potential to improve social participation of adolescents with a history of TBI through an innovative use of technology and peer coaching.

A Theory-Driven System for the Specification of Rehabilitation Treatments

The field of rehabilitation remains captive to the black-box problem: our inability to characterize treatments in a systematic fashion across diagnoses, settings, and disciplines, so as to identify and disseminate the active ingredients of those treatments. In this article, we describe the Rehabilitation Treatment Specification System (RTSS), by which any treatment employed in rehabilitation may be characterized, and ultimately classified according to shared properties, via the 3 elements of treatment theory: targets, ingredients, and (hypothesized) mechanisms of action. We discuss important concepts in the RTSS such as the distinction between treatments and treatment components, which consist of 1 target and its associated ingredients; and the distinction between targets, which are the direct effects of treatment, and aims, which are downstream or distal effects. The RTSS includes 3 groups of mutually exclusive treatment components: Organ Functions, Skills and Habits, and Representations. The last of these comprises not only thoughts and feelings, but also internal representations underlying volitional action; the RTSS addresses the concept of volition (effort) as a critical element for many rehabilitation treatments. We have developed an algorithm for treatment specification which is illustrated and described in brief. The RTSS stands to benefit the field in numerous ways by supplying a coherent, theory-based framework encompassing all rehabilitation treatments. Using a common framework, researchers will be able to test systematically the effects of specific ingredients on specific targets; and their work will be more readily replicated and translated into clinical practice.

Advancing Rehabilitation Practice Through Improved Specification of Interventions

Rehabilitation clinicians strive to provide cost-effective, patient-centered care that optimizes outcomes. A barrier to this ideal is the lack of a universal system for describing, or specifying, rehabilitation interventions. Current methods of description vary across disciplines and settings, creating barriers to collaboration, and tend to focus mostly on functional deficits and anticipated outcomes, obscuring connections between clinician behaviors and changes in functioning. The Rehabilitation Treatment Specification System (RTSS) is the result of more than a decade of effort by a multidisciplinary group of rehabilitation clinicians and researchers to develop a theory-based framework to specify rehabilitation interventions. The RTSS describes interventions for treatment components, which consist of a target (functional change brought about as a direct result of treatment), ingredients (actions taken by clinicians to change the target), and a hypothesized mechanism of action, as stated in a treatment theory. The RTSS makes explicit the connections between functional change and clinician behavior, and recognizes the role of patient effort in treatment implementation. In so doing, the RTSS supports clinicians' efforts to work with their patients to set achievable goals, select appropriate treatments, adjust treatment plans as needed, encourage patient participation in the treatment process, communicate with team members, and translate research findings to clinical care. The RTSS may help both expert and novice clinicians articulate their clinical reasoning processes in ways that benefit treatment planning and clinical education, and may improve the design of clinical documentation systems, leading to more effective justification and reimbursement for services. Interested clinicians are invited to apply the RTSS in their local settings.

Social Participation and Navigation (SPAN) program for adolescents with acquired brain injury: Pilot findings

PURPOSE/OBJECTIVE

Our goal was to examine the feasibility and preliminary efficacy of an app-based coaching intervention (Social Participation and Navigation; SPAN) to help survivors of acquired brain injury attain social participation goals. Research Method/Design: This is a nonrandomized pilot trial of SPAN, including 15 adolescents (9 with traumatic brain injury, 6 with brain tumor) between the ages of 14-22. The SPAN intervention consisted of a mobile app to support the development and implementation of social participation goals, weekly video-conference coaching sessions to identify goals and step-by-step action plans, and online didactic materials. Assessments were completed pre- and postintervention. Satisfaction with the intervention, confidence in the adolescents' ability to participate in and plan social activities and manage their emotions and behaviors, and frequency and satisfaction with social participation were assessed via self- and parent-report questionnaires developed for this project. Behavior problems, social competence, and social problems were measured by using the Child Behavior Checklist and the Youth Self-Report.

RESULTS

High levels of participant and parent satisfaction were reported. Increases in parent-reported frequency of social participation and teen-reported confidence in their ability to participate and develop social participation goals and plans were observed. A decline in parent-reported total problems, internalizing problems, externalizing problems, and social problems was noted.

CONCLUSION/IMPLICATIONS

Results support the feasibility of the program, because participants were able to successfully meet with their coaches and use the app to develop and accomplish social participation goals. Further research will be needed to refine the app and program, particularly when reaching out to populations beyond traumatic brain injury. (PsycINFO Database Record

White matter correlates of different aspects of facial affect recognition impairment following traumatic brain injury

Although facial affect recognition deficits are well documented in individuals with moderate-to-severe traumatic brain injury (TBI), little research has examined the neural mechanisms underlying these impairments. Here, we use diffusion tensor imaging (DTI), specifically the scalars fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD), to examine relationships between regional white-matter integrity and two facial affect sub-skills: perceptual affect recognition abilities (measured by an affect matching task) and verbal categorization of facial affect (measured by an affect labeling task). Our results showed that, within the TBI group, higher levels of white-matter integrity in tracts involved in affect recognition (inferior fronto-occipital, inferior longitudinal, and uncinate fasciculi) were associated with better performance on both tasks. Verbal categorization skills were specifically and positively correlated with integrity of the left uncinate fasciculus. Moreover, we observed a striking lateralization effect, with perceptual abilities having an almost exclusive relationship with integrity of right hemisphere tracts, while verbal abilities were associated with both left and right hemisphere integrity. The findings advance our understanding of the neurobiological mechanisms that underlie subcomponents of facial affect recognition and lead to different patterns of facial affect recognition impairment in adults with TBI.

Nurses' concerns about caring for patients with acute and chronic traumatic brain injury

AIMS AND OBJECTIVES

As a first step in developing traumatic brain injury-specific nursing education, the purpose of this study was to investigate nurses' concerns about caring for patients with moderate-to-severe traumatic brain injury.

BACKGROUND

Patients with moderate-to-severe traumatic brain injury typically have significant immediate and chronic cognitive impairments. These cognitive impairments can negatively affect their inpatient stay after an acute traumatic brain injury and affect their health care later in life when seeking care for other acute health conditions during the chronic phase of traumatic brain injury. Nurses must be knowledgeable about modifying care to accommodate the cognitive impairments of these patients throughout the continuum of care. Yet, current guidelines focus exclusively on acute care and do not address nurses' central role in dealing with residual cognitive impairments of these patients. Thus, educational and training interventions are needed to ensure nurses have adequate knowledge to care for these patients.

DESIGN

We conducted a cross-sectional, exploratory survey of 692 nurses across hospital departments at three hospitals between October 2014-August 2015. Nurses answered the following qualitative open-ended question: "What are your primary concerns about providing care to patients with moderate-to-severe traumatic brain injury?"

METHODS

Conventional qualitative content analysis was used to analyse nurses' responses.

RESULTS

Findings showed nurses reported multiple concerns about caring for patients in the acute phase after traumatic brain injury, but few concerns about caring for patients in the chronic phase. Some of the concerns nurses reported included: (i) preventing physical injury; (ii) missing changes in condition; (iii) providing adequate education; (iv) providing support; and (v) promoting recovery. Barriers to providing adequate care were as follows: (i) lack of knowledge; (ii) limited staffing; and (iii) inadequate resources.

CONCLUSIONS

Findings have implications for education of nurses and development of nursing guidelines for management of patients with traumatic brain injury, including providing direction for nurses on development of care plans for patients in the chronic phase after a moderate-to-severe traumatic brain injury.

Different aspects of facial affect recognition impairment following traumatic brain injury: The role of perceptual and interpretative abilities

It is well established that many individuals with traumatic brain injury (TBI) are impaired at facial affect recognition, yet little is known about the mechanisms underlying such deficits. In particular, little work has examined whether the breakdown of facial affect recognition abilities occurs at the perceptual level (e.g., recognizing a smile) or at the verbal categorization stage (e.g., assigning the label "happy" to a smiling face). The aim of the current study was to investigate the integrity of these two distinct facial affect recognition subskills in a sample of 38 individuals with moderate-to-severe TBI and 24 demographically matched healthy individuals. Participants were administered an affect matching (perceptual skills) and an affect labeling (verbal categorization skills) task. Statistical analyses revealed that, while individuals with TBI showed significantly higher levels of impairment in the verbal categorization task than in the perceptual task, they performed less well than healthy comparison participants on both tasks. These findings indicate that facial affect recognition impairment can occur at different cognitive stages following TBI, suggesting the necessity of careful screening to offer targeted treatment. Moreover, they provide further neuropsychological evidence supporting the notion that distinct types of subskills are necessary to achieve successful recognition of facial affects.

Impaired theory of mind in adults with traumatic brain injury: A replication and extension of findings

OBJECTIVE

To replicate a previous study of Theory of Mind (ToM) task performance in adults with traumatic brain injury (TBI) under different working memory (WM) demands, and determine if there are sex-based differences in effects of WM load on ToM task performance.

METHOD

58 adults with moderate-severe TBI (24 females) and 66 uninjured adults (34 females) matched group-wise for age, sex, and education viewed a series of video vignettes from the Video Social Inference Task (VSIT) (Turkstra, 2008) and answered ToM questions. Vignette presentation format required updating and maintenance of information, and WM load was manipulated by varying presence of distracters.

RESULTS

There were main effects of group and WM load, no significant effect of sex, and a marginal interaction of group by WM load, with larger between-group differences in conditions with higher WM load. VSIT scores for the condition with the highest WM load were significantly correlated with scores on the first trial of the California Verbal Learning Test.

CONCLUSIONS

We replicated findings of lower scores in adults with TBI on a video-based ToM task, and provided additional evidence of the effect of WM load on social cognition task performance. There were no significant accuracy differences between men and women, inconsistent with prior evidence - including our own data using the same test. There is strong evidence of a female advantage on other social cognition tasks, and the parameters of this advantage remain to be discovered.

Connected Language in Late Middle-Aged Adults at Risk for Alzheimer's Disease

Connected language is often impaired among people with Alzheimer's disease (AD), yet little is known about when language difficulties first emerge on the path to a clinical diagnosis. The objective of this study was to determine whether individuals with psychometric (preclinical) evidence of amnestic mild cognitive impairment (pMCI) showed deficits in connected language measures. Participants were 39 pMCI and 39 cognitively healthy (CH) adults drawn from the Wisconsin Registry for Alzheimer's Prevention, who were matched for age, literacy, and sex. Participants completed a connected language task in which they described the Cookie Theft picture from the Boston Diagnostic Aphasia Examination. Language samples were analyzed across three language domains: content, syntactic complexity, and speech fluency. Paired t-tests were used to compare CH and pMCI groups on all variables, and Cohen's d effect sizes were calculated for each comparison. The CH and pMCI groups differed significantly on measures of content (e.g., CH group produced more semantic units, more unique words and had larger idea density, on average, than the pMCI group). The picture description findings are consistent with previous retrospective studies showing semantic language differences in adults with autopsy-confirmed AD. Given that these comparisons are between cognitively healthy and pMCI individuals (before a clinical MCI diagnosis), these findings may represent subtle language difficulty in spontaneous speech, and may be predictive of larger language changes over time.

Declines in Connected Language Are Associated with Very Early Mild Cognitive Impairment: Results from the Wisconsin Registry for Alzheimer's Prevention

Changes to everyday spoken language ("connected language") are evident in persons with AD dementia, yet little is known about when these changes are first detectable on the continuum of cognitive decline. The aim of this study was to determine if participants with very early, subclinical memory declines were also showing declines in connected language. We analyzed connected language samples obtained from a simple picture description task at two time points in 264 participants from the Wisconsin Registry for Alzheimer's Prevention (WRAP). In parallel, participants were classified as either "Cognitively Healthy" or "Early Mild Cognitive Impairment" based on longitudinal neuropsychological test performance. Linear mixed effects models were used to analyze language parameters that were extracted from the connected language samples using automated feature extraction. Participants with eMCI status declined faster in features of speech fluency and semantic content than those who were cognitively stable. Measures of lexical diversity and grammatical complexity were not associated with eMCI status in this group. These findings provide novel insights about the relationship between cognitive decline and everyday language, using a quick, inexpensive, and performance-based method.

Implicit causality bias in adults with traumatic brain injury

INTRODUCTION

Individuals with moderate or severe traumatic brain injury often experience impairments in pragmatic language functions. Pragmatic language has been studied primarily in connected language genres such as narratives. It may be, however, that individuals with traumatic brain injury also miss microscopic cues, such as social cues embedded in single word meanings or sentence structure. The current study examined one type of sentence-level pragmatic language cue: implicit causality bias. Implicit causality bias is the attribution of an interpersonal transitive verb action to either the subject noun phrase or object noun phrase of a sentence, and is an inherent property of English-language verbs.

METHOD

In this study, 19 adults with traumatic brain injury and 18 typical adults were asked to provide sensible and spontaneous completions to 96 sentence fragments. Each fragment contained one interpersonal transitive verb and two noun phrases to which the cause of the verb could be attributed.

RESULTS

Adults with traumatic brain injury showed significantly less implicit causality bias than typical adults, and also made more errors in assigning the causality of a clause.

CONCLUSIONS

These results challenge assumptions regarding intact implicit processing in adults with traumatic brain injury, and reveal mechanisms by which communication could fail in everyday social interactions.

Informing design of an app-based coaching intervention to promote social participation of teenagers with traumatic brain injury

OBJECTIVE

To examine perspectives of multiple stakeholders to inform the design of an app-based coaching intervention to promote social participation in teenagers with traumatic brain injury (TBI).

METHODS

Teenagers and college students with and without TBI and parents of teenagers with TBI were recruited from two children's hospitals and two universities in the USA (n = 39). Data were collected via interviews, focus groups, and surveys and examined using descriptive statistics and content analyses.

RESULTS

Teenagers with TBI reported more social participation barriers and fewer strategies for addressing these barriers than teenagers without TBI. There was consensus across groups about the value of college student coaches and use of smartphones and apps. Participants expressed mixed views on the use of chat rooms and degree of parent involvement.

CONCLUSION

Results provided insights about the possible benefits of the intervention, and informed its initial design (e.g., desired coach qualities, and type of coach training and supervision).

Pragmatic skills after childhood traumatic brain injury: Parents' perspectives

The purpose of this study was to characterize pragmatic deficits after childhood traumatic brain injury (TBI) within the home environment social contexts where they occur. We used a descriptive qualitative approach to describe parents' experiences in communicating with their child with TBI. Participants were ten mothers of children ages 6-12 years who had sustained a moderate to severe TBI more than one year prior to the study. Mothers' experiences were collected through semi-structured interviews and questionnaires. Interviews were analyzed using a deductive framework to develop social contexts and pragmatic deficit themes for communication in the home. Overall, mothers primarily described their children with TBI as exhibiting average or near average pragmatic skills at home, but nine observed some pragmatic deficits and/or social behavior problems. There were four in-home social contexts in which pragmatic deficits were observed. Emergent themes also included outside-of-the home social contexts and social behavior problems. There was some overlap of pragmatic deficit and social behavior problem themes among contexts, but many deficits were context specific. This study's pragmatic deficit themes expanded on prior childhood TBI pragmatic investigations by identifying contexts in and outside of the home in which pragmatic deficits may occur after TBI. Learning Outcomes Readers will be able to describe the day-to-day social contexts that may be impacted by pragmatic deficits after childhood TBI. Readers will be able to compare the pragmatic deficit themes identified as occurring in the home to those occurring outside of the home.

Caring for Patients with traumatic brain injury: a survey of nurses' perceptions

AIMS AND OBJECTIVES

The purpose of this study was to determine nurses' perceptions about caring for patients with traumatic brain injury.

BACKGROUND

Annually, it is estimated that over 10 million people sustain a traumatic brain injury around the world. Patients with traumatic brain injury and their families are often concerned with expectations about recovery and seek information from nurses. Nurses' perceptions of care might influence information provided to patients and families, particularly if inaccurate knowledge and perceptions are held. Thus, nurses must be knowledgeable about care of these patients.

METHODS

A cross-sectional survey, the Perceptions of Brain Injury Survey (PBIS), was completed electronically by 513 nurses between October and December 2014. Data were analysed with structural equation modelling, factor analysis, and pairwise comparisons.

RESULTS

Using latent class analysis, authors were able to divide nurses into three homogeneous sub-groups based on perceived knowledge: low, moderate and high. Findings showed that nurses who care for patients with traumatic brain injury the most have the highest perceived confidence but the lowest perceived knowledge. Nurses also had significant variations in training.

CONCLUSIONS

As there is limited literature on nurses' perceptions of caring for patients with traumatic brain injury, these findings have implications for training and educating nurses, including direction for development of nursing educational interventions.

RELEVANCE TO CLINICAL PRACTICE

As the incidence of traumatic brain injury is growing, it is imperative that nurses be knowledgeable about care of patients with these injuries. The traumatic brain injury PBIS can be used to determine inaccurate perceptions about caring for patients with traumatic brain injury before educating and training nurses.

Nurses' Beliefs About Caring for Patients With Traumatic Brain Injury

Patients with traumatic brain injury (TBI) and their families rely on health care providers, particularly nurses, to provide accurate information, yet inaccurate beliefs about TBI have been found among nurses. Although prior studies have assessed nurses' beliefs about TBI recovery and rehabilitation, none have assessed specific beliefs about the nursing role to care for these patients. The purpose of this study was to investigate nurses' beliefs and learning preferences about caring for patients with moderate-to-severe TBI. A cross-sectional survey was administered to 513 nurses at a Midwestern hospital between October and December 2014 (20.3% response rate). Latent class analysis was used. Findings showed that nurses had inaccurate beliefs about TBI relating to recovery and the nursing role, and had significant differences in learning preferences. These findings have implications for development of educational and training interventions specific to nurses to ensure that they have factual information about TBI and to clarify the nursing role.

Rehabilitation for Adults with Traumatic Brain Injury: Where Will We Be Clinically in 2026?

In 10 years, there might be fewer adults who need rehabilitation after traumatic brain injury because of advances in injury prevention and very early treatment. For adults who do need rehabilitation, assessment might include biosensor recordings in their everyday communication contexts, and home practice might be delivered by a robot that can be programmed to mimic target characteristics of human behavior. These advances in science and technology will enhance rehabilitation, but it will always be our responsibility as speech-language pathologists to advocate for our patients and clients and support them in achieving the best possible quality of communication life.

Knowing What We're Doing: Why Specification of Treatment Methods Is Critical for Evidence-Based Practice in Speech-Language Pathology

PURPOSE

The purpose of this clinical focus article is to describe the conceptual framework of the multidisciplinary rehabilitation treatment taxonomy (RTT) and illustrate its potential use in speech-language pathology (SLP) clinical practice and research.

METHOD

The method used was a critical discussion.

RESULTS

Current methods of defining and classifying SLP and other rehabilitation interventions maintain the "black box" of rehabilitation by referring to hours or days of therapy or using problem-oriented labels (e.g., naming treatment) to describe treatments, none of which reveal what is actually done to effect desired changes in patient functioning. The RTT framework uses treatment targets, ingredients, and mechanisms of action defined by treatment theory to specify SLP and other rehabilitation interventions with greater precision than current methods of treatment labeling and classification. It also makes a distinction between the target of treatment at which ingredients are directed and broader aims of treatment, which may be downstream effects explained instead by enablement/disablement theory.

CONCLUSION

Future application of the RTT conceptual scheme to SLP intervention may enhance clinical practice, research, and knowledge translation as well as training and program evaluation efforts.