Communication partner training facilitates everyday outcomes for people with acquired communication disability Leanne Togher 1 , Skye Mcdonald 2 , Robyn Tate 3,4 , Emma Power 1 & Rachel Rietdijk 1,5 1 Speech Pathology, Faculty of Health Sciences, the University of Sydney, Sydney 2 School of Psychology, the University of New South Wales, Sydney 3 Rehabilitation Studies unit, Northern Clinical School, Faculty of Medicine, University of Sydney 4 Royal Rehabilitation Centre, Sydney 5 Brain Injury Rehabilitation Unit, Liverpool Health Service, Sydney
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Communication partner training facilitates everyday outcomes for people with acquired communication disability Leanne Togher 1, Skye Mcdonald 2, Robyn.
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Communication partner training facilitates everyday outcomes for people with acquired communicationdisability
1 Speech Pathology, Faculty of Health Sciences, the University of Sydney, Sydney
2 School of Psychology, the University of New South Wales, Sydney
3 Rehabilitation Studies unit, Northern Clinical School, Faculty of Medicine, University of Sydney
4 Royal Rehabilitation Centre, Sydney
5 Brain Injury Rehabilitation Unit, Liverpool Health Service, Sydney
Westmead Brain Injury Unit
Acknowledgements
› NH&MRC project Grant 402687
› We are grateful to study participants as well as staff from:
› Liverpool Brain Injury Unit, including Dr Grahame Simpson, Dr Adeline Hodgkinson, Manal Nasreddine, Kasey Metcalf
› Westmead Brain Injury Unit and speech pathology department, including Dr Kathy McCarthy, Anna Jones, Dr Alex Walker, Dr Ian Baguley, Dr Joe Gurka, Rod Gilroy
› Royal Rehab Centre Sydney Brain Injury Unit, including Audrey McCarry, Vanessa Aird, Alanna Huck and Dr Clayton King
› Gaye Murrills, private speech pathologist
Approaches to improve communication in TBI
Train the person with TBI (Flanagan, McDonald & Togher, 1995, Medd & Tate, 2000, Tate, 1987,
Cannizzaro & Coelho, 2002; Cramon et al, 1992, Helffenstein & Wechsier, 1982 ; Dahlberg et al., 2007)
Train communication partners (Togher, McDonald, Code & Grant, 2004)
1. Treating communication deficits of person with TBI directly
(TBI SOLO)
2. Training everyday communication partners (ECP) along with the person with TBI (TBI JOINT)
3. A delayed treatment control group (CTRL)
TBI Participants
44 participants with TBI recruited from Liverpool, Royal Ryde and Westmead Brain Injury Units,
Sydney Australia
Mean age = 36 years (SD=14, range=18-68)
Mean education = 12 years (SD=3, range=7-20 )
Mean time post injury = 8 years (SD=7.2, range=1-25)
Mean PTA = 83.15 days (SD=61, range=6-182)
38 males: 6 females
Everyday communication partner (ECP) participants
44 communication partners of person with TBI
Mean age = 50 years (SD = 15.5, range = 17-79)
Mean education = 13 years (SD = 2.7, 9-19)
80% were female
80% knew the person before the TBI
The majority were partners or parents, however siblings and friends also participated in the study
Study Participants
Allocated to TBI JOINT - Communication partner treatment
n=14 ( 1 dropout = 13)
TBI SOLO - Person with TBI alone treatment
n=15 ( 1 dropout = 14)
CTRL - Delayed treatment control
n=15 ( 1 dropout = 14)
93 % retention rate at post assessment and 87.5% retention at 6 mo f/up
ANOVA comparison across groups ‘ns’ for: Age, education
Time post onset, PTA
Cognitive-linguistic impairment (SCATBI)
ECP age
ECP education
Treatment – Communication Partner training
Group and individual training for TBI JOINT group Group of 4-5 people with TBI & their communication partners
2.5 hr weekly group sessions (+ morning tea/social break)
1 hour weekly individual sessions for each pair
10 week program
Manualised approach
• Interpersonal communication skills
• Collaborative and elaborative conversational strategies (Ylvisaker et al 1998)
• Enhancing / supporting communication of person with TBI/ question asking
Treatment – TBI only training
Group and individual training TBI SOLO group
Group of 4-5 people with TBI
No communication partners
2 therapists
2.5 hr weekly group sessions (with morning tea/social break)
1 hour weekly individual sessions
10 week program
Manualised approach – parallels JOINT contents
Control condition
Waitlist groupdeferred treatment
Conversation assessment
Outcome measures were collected at: Initial assessment,
1-3 weeks after group intervention and
6 months after assessment
2 discourse samples were collected:Casual conversation
Purposeful conversation
Primary outcome measures
Adapted Kagan scale
(Kagan et al., 2001,2004; Togher et al, in press)
Measure of Participation in Conversation (MPC)(TBI)
La Trobe Communication Questionnaire (LCQ)
(Douglas, O’Flaherty & Snow, 2000)
Self report
Other report
Primary outcome measure
Adapted Kagan scale (Kagan et al., 2001,2004; Togher et al, in press)
Measure of Participation in Conversation (TBI)
level and quality of conversational participation
Ability to interact and socially connect (Interaction scale)
Ability to respond to and/or initiate content (Transaction scale)
videotaped interactions rated by 2 blind assessors
9-point Likert scales, presented as a range of 0 to 4 with 0.5 levels for ease of scoring
The Adapted Kagan scales for TBI Interactions
Scales ranged from 0 (no participation) through 2 (some) participation to 4 (full participation) in conversation
Inter-rater reliability scores for both the Adapted MPC scales were excellent
(MPC: ICC = 0.84-0.89). Over 90% of ratings scored within 0.5 on a 9 point scale
Intra-rater agreement was also strong
(MPC: ICC = 0.81-0.92). Over 90% of ratings scored within 0.5 on a 9 point scale
(Togher et al., 2010, Aphasiology)
Secondary measures
Adapted Measure of Support in Conversation (MSC)(Kagan et al., 2001,2004; Togher et al, in press)
Global ratings of communication (Bond & Godfrey, 1997) Appropriate Effortful Interesting/engaging Rewarding
on a 9 point scale, 0-4
Social perception ability: The Awareness of Social Inference Test (McDonald, Flanagan & Rollins, 2002)
Social participation: Sydney Psychosocial Reintegration Scale (Tate et al., 1999)
Confidence and self esteem: Rosenberg Self Esteem Scale (Rosenberg, 1965)
Caregiver satisfaction: Modified Care Burden Scale (Machamer et al., 2002) Discourse analysis measures
Initial analysis compared amount of change across the 3 groups with repeated measures ANOVA pre and post treatment in purposeful and casual conversation conditions
Intention to treat analysis used
Analysis
RESULTS
No statistically significant differences between the three groups at baseline on MPC ratings
Significant treatment effect measured on the MPC
Interaction scale in both casual conversation and
purposeful conversation conditions
i.e., the JOINT group improved relative to the other two
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Casual conversation: Interaction scale
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CC = Casual conversation
Purposeful conversation: Interaction scale
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PC = Purposefulconversation
Results
Significant treatment effect was also found on the MPC Transaction Scale in both casual conversation and purposeful conversation conditions
Casual conversation: Transaction scale
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CC = Casualconversation
Purposeful interaction: Transaction scale
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PC = Purposefulconversation
Discussion
Training communication partners was more efficacious than training the person with TBI alone
Success was due to key training principles including: Communication being a collaborative and elaborative process (Ylvisaker
et al., 1998)
Training the ECP to reveal the competence of the disabled speaker (Kagan et al., 2004)
Sensitively targeting behaviours of the ECP (eg test questions, speaking for the person with TBI) led to a significant change in everyday interactions
Discussion
Communication partners were challenged to change THEIR OWN communication behaviours
Eliminating “testing” questions to which they already knew the answer
Reducing questions which checked the accuracy of the person with TBI’s contribution
Speaking to the person with TBI as an adult and not a child
Conclusions in the context of the World Disability Report
A person’s communication environment will significantly impact on their ability to engage in daily living activities
Building capacity within the family unit will promote good psychosocial outcomes for both the person with brain injury and their family members
Training everyday communication partners is an important complementary treatment for people with TBI and their families to facilitate and promote improved communication outcomes