Participants' perspectives of feasibility of a novel group treatment for people with cognitive communication difficulties following acquired brain injury

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

OBJECTIVE

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

METHODS

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

PARTICIPANTS

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

INTERVENTION

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIM

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

METHODS & PROCEDURES

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

OUTCOMES & RESULTS

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

CONCLUSIONS & IMPLICATIONS

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

WHAT THIS PAPER ADDS

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

Core components of project-based intervention after acquired brain injury: Delivering meaningful groups online

BACKGROUND

Rehabilitation for cognitive-communication impairments following brain injury can be complex given the heterogenous nature of impairments post injury. Project-based intervention has the potential to improve communication skills and create a meaningful real-life context where individuals collaborate to develop a concrete product, which benefits others. While evidence for this intervention is emerging, the COVID-19 pandemic prompted increased use of telehealth interventions to serve people with brain injury. This paper aims to describe a framework for the delivery of project-based intervention via telehealth within community rehabilitation settings; and present several case studies of telehealth groups completed in the United Kingdom and the United States during the COVID-19 pandemic.

METHODS

A working group was formed to map the components of project-based intervention onto the rehabilitation treatment specification system (RTSS). This system is a conceptual framework that helps to explain the link between treatment theory and ingredients, allowing a clinician to clearly understand how and why a treatment works. First, a literature search was completed to identify eligible studies on project-based intervention after brain injury. Second, those studies were thematically mapped onto the RTSS to identify important intervention components. Third, the presence of these components was assessed for community brain injury groups delivered via telehealth in the United Kingdom and United States. These groups were further described using a taxonomy of social activities that help to describe the degree of meaningful social engagement.

RESULTS

The literature was described with a thematic RTSS summary. Treatment aims focus on skills training and self-efficacy, advocacy and self-empowerment, emotional well-being and quality of life, and collaboration and community belonging. Treatment ingredients involve a range of cognitive and behavioural supports to deliver meaningful activities and contexts to complete a project. Mechanisms of action involve learning by doing and cognitive and affective information processing. All four telehealth groups conducted in the United Kingdom and United States involved at least three treatment aims, >7 targets, and >8 treatment ingredients. All groups reported positive experiences from activities that involve working collaboratively to help others and contribute to society.

CONCLUSIONS

Project-based intervention delivered via telehealth has the potential for supporting people with acquired brain injury to improve their communication skills and engage in meaningful, collaborative activity. Application of the RTSS helps clinicians to understand the aims and therapeutic ingredients (or clinician activities) through which a person with brain injury may achieve specific treatment targets during the rehabilitation process.

WHAT THIS PAPER ADDS

What is already known on the subject Project-based interventions have the potential to improve cognitive, self-regulatory, behavioural and social communication skills, renegotiate identity and reaffirm sense of self, providing a positive impact on quality of life for persons with acquired brain injuries. Projects serve as a context for meaningful engagement for individuals in the chronic phase of traumatic brain injury recovery, without fulfilling work, family or social responsibilities. However, most published research has involved in-person projects and few projects have been delivered via telehealth. What this paper adds to existing knowledge While past published works have shared core principles of intervention, a variety of projects, durations, dosages and methods have been employed. The current paper provides a framework to support more consistent implementation. By mapping previous project-based interventions to the RTSS, clinicians will have a better understanding of the aims, targets, ingredients and theoretical underpinnings of project-based interventions. In the wake of the COVID-19 pandemic, the shift to telehealth moved interventions to a virtual context. The four case projects in this paper demonstrate that it is possible to conduct project-based interventions via telehealth and provides a clear description to guide clinicians in their delivery. What are the potential or actual clinical implications of this work? This work begins to build the foundation for more rigorous, empirical examination of project-based interventions. By mapping project-based interventions to the RTSS, core aims, targets and ingredients are established that can be objectively examined. This investigation also provides a road map for clinicians who wish to implement this complex intervention.

The diagnostic intersection of cognitive-communication disorders and aphasia secondary to TBI

BACKGROUND & AIMS

The present retrospective study examines veterans and military personnel who have sustained a cognitive-communication deficit/disorder (CCD) and/or aphasia secondary to traumatic brain injury (TBI). The prevalence of each disorder secondary to TBI is identified and demographic factors are analysed to determine whether specific characteristics (age, gender, race and/or ethnicity) differentially influenced diagnosis (CCD or aphasia).

METHODS & PROCEDURES

A retrospective analysis examining the prevalence of CCD and aphasia among US service personnel with a complicated mild-to-severe TBI treated over a 4-year period (1 January 2016-31 December 2019) was conducted. Medical diagnoses and demographic factors were obtained from administrative data repositories and a logistic regression was performed to identify the relationship between demographic factors and diagnoses.

OUTCOMES & RESULTS

Analyses revealed that 8.8% of individuals studied had a secondary diagnosis of CCD (6.9%), aphasia (1.5%) or both (0.4%). This signifies 6863 cases of CCD, 1516 cases of aphasia and 396 cases of CCD and aphasia (dual diagnosis) per 100,000 individuals who have sustained a complicated mild-to-severe TBI. The proportion of cases observed with these diagnoses was consistent with the racial, gender and ethnic demographics of those diagnosed with TBI. Statistical modelling revealed that increased age is predictive of a diagnosis of aphasia relative to CCD.

CONCLUSIONS & IMPLICATIONS

Service personnel sustaining TBIs are at increased risk of communication impairments with deficits observed across all gender, racial and ethnic demographics. CCD is more commonly observed than aphasia, though clinicians should be cognisant of both when performing assessments. Age is a factor that can influence diagnosis.

WHAT THIS PAPER ADDS

What is already known on the subject Military personnel are at increased risk of communication disorders (CCDs) with TBI associated with multiple types of communication impairments including CCD, aphasia, dysarthria and apraxia of speech. What this paper adds to existing knowledge This paper examines CCD and aphasia occurring following TBI. The proportion of observed cases of CCD and aphasia secondary to TBI are calculated over a 4-year period and the prevalence of these disorders is provided. Additionally, statistical modelling is used to identify differences in the diagnosis of CCD relative to aphasia using the demographic factors of age, racial identity and ethnicity. What are the potential or actual clinical implications of this work? CCD is a frequently occurring issue following TBI, and the findings of this study demonstrate that it is a concern observed across gender, racial and ethnic lines. Advanced age is linked with the diagnosis of aphasia relative to CCD following TBI and should be a consideration during evaluation of patients who have sustained significant head trauma.

Community-based rehabilitation for adults with cognitive-communication disorders following traumatic brain injury: A mixed methods investigation

OBJECTIVE

To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI).

METHODS

An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI.

RESULTS

Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others.

CONCLUSIONS

These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group.

"I never thought I would be an international speaker … but I am": an interpretive qualitative analysis of experiences of a project-based advocacy intervention

Acquired brain injuries (ABI) result in changes to physical, cognitive, psychosocial, and economic domains, which alter an individual's sense of self and identity. Interactions with healthcare providers may further contribute to conceptualization of self after ABI. Cognitive rehabilitation is intended to address cognitive-communication impairments, as well as psychological changes to the sense of self and identity that follow ABI. The present investigation examined a project-based intervention, focused on advocacy. Participants developed a presentation for healthcare providers regarding consequences of ABI, strategies and supports necessary to successfully overcome daily challenges, and insights into the lived experience. Ten individuals with chronic ABI participated in one of three roles (presenter, video contributor, or content developer). Written interviews allowed participants to generate and refine their responses. Interpretive Description qualitative analyses was used to examine interviews. Iterative analysis identified five themes across all participant roles: renewed sense of self, positive impact on providers to care of future individuals with brain injuries, rewarding and humbling, being heard, and alternate personal narratives and identities. The remaining theme applied only to presenters, improved clarity and conciseness. Group, project-based interventions have the potential to positively influence sense of self in combination with narrative therapy techniques in the chronic phase of recovery.