Rehabilitation of communication in people with traumatic brain injury: a systematic review of types of intervention and therapeutic ingredients (Rehabilitación de la comunicación en personas con traumatismo encefalocraneal: una revisión sistemática de tipos de intervención e ingredientes terapéuticos)

A Single-Case Design Study of Collaborative Interpersonal Strategy Building With Audio Reflection for Improving Social Communication Following Acquired Brain Injury

PURPOSE

This article reports the results of a single-case experimental multiple-baseline study across participants aiming to evaluate treatment effects of a metacognitive, joint reflection intervention package for social communication after acquired brain injury (ABI).

METHOD

Four adults with a history of ABI and their everyday communication partners (ECPs) participated in a novel intervention, the Collaborative Interpersonal Strategy Building with Audio Reflection (CISBAR), incorporating collaborative goal setting, metacognitive strategy instruction, and joint audio reflection. Primary participants and ECPs engaged in 6- to 7-min conversations on opinion topics during the baseline, intervention, and follow-up phases. Raters scored turn-taking behavior (interruption, length of speaking turn) in each videorecorded conversation sample in random order without knowing study phase. Pre-/post-intervention questionnaires captured client and partner perspectives of communication changes.

RESULTS

All four participants achieved personal communication goals. Visual analysis of specific communication targets supported a treatment effect in the two participants targeting interruption, but not in the two participants targeting verbosity. Design-comparable effect size analysis showed a medium effect size for decreasing interruption. Communication skills of all participants improved following CISBAR according to self- and partner-report questionnaires. Improvements in communication target behaviors maintained at 1-month follow-up.

CONCLUSIONS

Results suggest that CISBAR shows promise as a treatment package for improving social communication post-ABI. The discussion considers the complexities of measuring changes in social communication, the treatment ingredients and candidacy considerations for CISBAR, and the emphasis on shared decision making in the therapy process.

Feasibility and Reliability of the Adapted Kagan Scales for Rating Conversations for People With Acquired Brain Injury: A Multiphase Iterative Mixed-Methods Design

PURPOSE

Rating the quality of conversations can assess communication skills in both people with acquired brain injury and their communication partners. This study explored the clinical feasibility and reliability of two conversation rating scales: the Adapted Measure of Participation in Conversation (MPC) and the Adapted Measure of Support in Conversation (MSC).

METHOD

Raters were final-year speech and language therapy students (n = 14) and qualified clinicians (n = 2). Raters attended training on the Adapted MPC and MSC, watched 5 or 10 min of videotaped conversations (n = 23), and then scored them on the MPC and MSC scales. Data were collected over four phases, which varied according to the length of the training, sample length, number of samples rated, and level of clinical expertise. Feasibility data (time taken to score conversations and ease of use) were collected. Interrater reliability was assessed using intraclass correlations (ICCs: absolute agreement, single measures).

RESULTS

Raters took 30-45 min to score a 10-min sample, and they took 20-30 min to score a 5-min sample. Ease of use was rated highly across all phases. Overall reliability for rating 5 min of conversation (ICC = .52-.73) was better than for 10 min of conversation (ICC = .33-.68). Reliability for the MPC was moderate for both students (ICC = .69) and clinicians (ICC = .55), and for the MSC, it was moderate for both students (ICC = .73) and clinicians (ICC = .58). Reliability was better for students compared with clinicians.

CONCLUSIONS

Rating a 5-min conversation in under 30 min was feasible, with more reliable results for 5-min compared with 10-min conversations. Implications for assessing conversation in the future are discussed.