Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey.

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

The pervasive and unyielding impacts of cognitive-communication changes following traumatic brain injury.

BACKGROUND: Cognitive-communication disorders (CCDs) are common in the traumatic brain injury (TBI) population. Despite this, there has been limited research that explores the long-term impacts of reduced cognitive-communication functioning on daily life for this population. AIMS: To identify the long-term impacts of cognitive-communication impairment as reported by adults with TBI and their significant others. METHODS & PROCEDURES: A qualitative descriptive approach grounded in phenomenology was used. Semi-structured, one-on-one interviews were conducted with adults with CCDs following TBI (n = 16) and their significant others (n = 12) to explore their lived experiences. OUTCOMES & RESULTS: Reflexive thematic analysis revealed an overarching theme of 'The pervasive and unyielding impacts of cognitive-communication changes on daily life following TBI'. Within this overarching theme, three subthemes were identified: (1) self-awareness of communication changes; (2) fatigue; and (3) self-identity and life roles. CONCLUSION & IMPLICATIONS: The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on daily life. Health professionals supporting this population should consider ways to reduce the significant impact CCDs have on the lives of adults following TBI and their significant others. In addition, the findings highlight the importance of long-term rehabilitation services following TBI, with further research needed that explores how these services can be optimised. WHAT THIS PAPER ADDS: What is already known on this subject Cognitive-communication disorders (CCDs) affect the majority of adults who experience moderate to severe traumatic brain injury (TBI) and encompass any component of communication that is affected by cognition. The hallmark characteristic of CCDs are breakdowns that affect social communication skills as well as cognitive-linguistic deficits. Combined, these can have dramatic implications for a person's quality of life, their level of independence, employment opportunities and social participation. There has been limited research to date that explores the long-term impacts of CCDs on the lives of adults following TBI. Further research that explores these impacts is needed to improve the support services and rehabilitation models of care available for this population. What this study adds The overarching theme was 'The pervasive and unyielding impacts of communication changes on daily life following TBI' with subthemes including changed communication, self-awareness of communication changes, fatigue and self-identity and life roles. The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on everyday functioning and quality of life as well as the importance of long-term rehabilitation services following TBI. What are the clinical implications of this work? Speech-language therapists and other health professionals working with this clinical population should consider how to address the significant and long-lasting impacts of CCDs. Due to the complex nature of the barriers experienced by this clinical population, an interdisciplinary targeted approach is advised wherever possible when providing rehabilitation services.

Speech pathologists' perspectives when managing adults following traumatic brain injury in community-based rehabilitation settings: A qualitative investigation.

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI.Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data.Result: The overarching theme identified was that a "Client-centred and inclusive approach to community-based rehabilitation services" is required. The three subthemes to emerge from the data included the importance of utilising a (1) "flexible service delivery approach", with (2) "meaningful therapy focus", and (3) "collaboration" with multidisciplinary team members and significant others when managing this client group.Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus.

Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review.

OBJECTIVE: To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research. METHODS AND PROCEDURES: Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed. OUTCOMES AND RESULTS: Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years. CONCLUSIONS AND IMPLICATIONS: We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.

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.

Strategy-based reading comprehension therapy during early acquired brain injury rehabilitation: preliminary results.

INTRODUCTION: An evidence-based intervention and service delivery model for early acquired brain injury reading comprehension rehabilitation (involving multiple-strategy, hierarchical reading) was investigated with 3 clients <3 m post onset as part of their brain injury rehabilitation program. MATERIALS AND METHODS: A multiple-baseline single case experimental design was used for each participant, with data analysed using Tau-U. Assessments of reading comprehension (impairment and activity level) were performed pre/post intervention, and at follow-up (3-6 months post-treatment). Participants' perceptions of the intervention and service delivery model were captured via semi-structured interviews. RESULTS: All participants demonstrated improved reading comprehension post-intervention on all formal measures. At follow-up, reading comprehension was grossly maintained by 2 participants. The single case experimental design results (Tau-U) showed moderate-large intervention effect sizes for factual and inferential reading comprehension, two participants had significant (p = 0.01) changes. Participants reported overall positive experiences with the intervention. CONCLUSION: The intervention and service delivery model were successfully implemented in clinical practice, and preliminary results show the intervention has clinical promise with an early acquired brain injury population.IMPLICATIONS FOR REHABILITATIONCognitive communication reading comprehension deficits occur following acquired brain injury and impact participation during rehabilitation and in the community.An evidence-based intervention for the early rehabilitation of cognitive communication reading comprehension deficits following acquired brain injury has been developed and trialled in clinical practice with adults <3 months post-acquired brain injury, via a series of single-case experimental designs.Improvements in reading comprehension skill and activity/participation occurred for all participants post-intervention; statistically significant changes occurred for 2 of 3 clients.Early rehabilitation of cognitive communication reading comprehension deficits can be successfully implemented as a component of a multidisciplinary rehabilitation program.

Physical rehabilitation of central facial palsy: A survey of current multidisciplinary practice.

Purpose: The role of allied health practitioners providing physical rehabilitation of central facial palsy (CFP) is minimally reported in the literature. This study explores current practice and the roles, attitudes and perceptions of allied health professionals (AHPs) working with people with CFP.Method: An electronic survey was distributed to speech-language pathologists (SLPs), occupational therapists and physiotherapists. Responses (n = 78) were analysed using qualitative and quantitative methods.Result: SLPs often lead management of CFP; however, their role is not clearly defined nor well recognised. Several barriers were identified which prevent AHPs from providing consistent specialist rehabilitation to people with CFP. These included a lack of training, no clear delegation of role, limited evidence and lack of resources.Conclusion: Survey respondents viewed CFP to be within SLP scope of practice; although, ownership of management varies between countries and professions. Most SLPs recognise the negative impact of CFP and feel a sense of responsibility to provide assessment and treatment of this impairment, but many barriers to doing so have been identified. Suggestions to improve access to rehabilitation for people with CFP included increased access to training for SLPs, more evidence, clinical practice guidelines and more clinical resources. Further research is required to ensure people suffering from CFP can access services that provide skilled management of their impairment.

A Systematic Review of Physical Rehabilitation of Facial Palsy.

Background: Facial palsy is a frequent and debilitating sequela of stroke and brain injury, causing functional and aesthetic deficits as well as significant adverse effects on quality of life and well-being. Current literature reports many cases of acquired facial palsy that do not recover spontaneously, and more information is needed regarding the efficacy of physical therapies used in this population. Methods: A systematic search of eight electronic databases was performed from database inception to December 2018. Gray literature searches were then performed to identify additional articles. Studies were included if they addressed physical rehabilitation interventions for adults with acquired facial palsy. Reasons for exclusion were documented. Independent data extraction, quality assessment, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Following abstract screening, a total of 13 full-text articles were identified for independent screening by two reviewers. This included four randomized control trials, two non-randomized control trials, one cohort study, and six prospective case series studies. Twelve out of the 13 included studies reported on facial palsy as a sequela of stroke. A total of 539 participants received intervention for facial palsy across the 13 included studies. Therapy design, length and frequency of intervention varied across the studies, and a wide range of outcome measures were used. Improvement on various outcome measures was reported across all 13 studies. The quality of the evidence was low overall, and most studies were found to have high risk of bias. Conclusions: All the studies in this review report improvement of facial movement or function following application of various methods of physical rehabilitation for facial palsy. Methodological limitations and heterogeneity of design affect the strength of the evidence and prevent reliable comparison between intervention methods. Strong evidence supporting physical rehabilitation was not found; well-designed rigorous research is required.

A scoping review of interventions for adults with dysarthria following traumatic brain injury.

Primary objective: To review the current literature on interventions for dysarthria following traumatic brain injury (TBI) for their effectiveness and methodological quality, and identify future directions for research in developing guidelines for treating dysarthria in this population.Research design: Scoping review.Methods and procedures: Electronic databases were searched up until July 2018 to find intervention trials for treating dysarthria following TBI. Articles were assessed by three reviewers to meet the following criteria: (1) population (adults with dysarthria following TBI only) and (2) intervention studies. Of the 1481 articles initially identified, 17 were selected based on inclusion criteria. 16 articles were single case designs (SCD) and one was a cohort study. Methodological qualities of eligible articles were examined using the single-case experimental design (SCED) rating scale; the cohort study was qualitatively described.Main outcomes and results: The interventions described fell into six broad categories - behavioral, prosthetic, instrumental, pharmacological, augmentative and alternative communication (AAC), and mixed intervention. Behavioral interventions received the most focus in the literature. The articles rated using the SCED received an average score of 6.8, indicating moderate methodological quality.Conclusions: This field currently lacks high-quality research. Further research is required to determine the best clinical practice.

Aphasia and reperfusion therapies in hyper-acute settings: A scoping review.

Purpose: Reperfusion therapies are medical treatments that restore blood flow either by surgical removal of a blood clot or with medications that dissolve clots. The introduction of reperfusion therapies has the potential to change the presentation of aphasia following acute ischaemic stroke (AIS). This scoping study will explore the relationship between aphasia and reperfusion therapies from a speech-language pathology perspective. Method: A systematic literature search was performed on studies published up until October 2016. Relevant studies that reported on aphasia and reperfusion therapy were assessed for quality and the relationship between the two. Results: Overall, 27 studies were identified, these studies were heterogeneous in nature. Despite speech-language pathologists filling a central role in management of aphasia, only seven of these studies mentioned involvement of speech-language pathologists, with minimal information about the precise nature of the involvement of speech-language pathology services. Conclusion: Based on this scoping review, reperfusion therapy appears to be impacting on the presentation of aphasia. A prospective study into reperfusion therapy and aphasia is required to inform speech-language pathologists on this patient population.

Remediation of social communication impairments following traumatic brain injury using metacognitive strategy intervention: a pilot study.

OBJECTIVE: To perform a pilot study to evaluate whether a novel metacognitive, goal-based intervention improved and maintained the social communication skills of adults with traumatic brain injury (TBI). METHOD: Eight community-dwelling participants with TBI completed three study phases: (1) baseline, (2) eight-week intervention targeting social communication impairments and (3) follow-up. Participants completed the Profile of Pragmatic Impairment in Communication (PPIC), LaTrobe Communication Questionnaire (LCQ) and Goal Attainment Scaling (GAS) at the commencement of baseline phase, pre- and post-intervention and completion of the follow-up phase. During the intervention programme phase, participants attended two 1-hour therapy sessions (one individual; one group) per week focusing on remediating impaired social communication skills using metacognitive strategy intervention and goal-based therapy. RESULTS: Variable changes in PPIC feature-summary scores were observed post-intervention. A non-significant improvement in LCQ scores was also observed. There was a significant increase in GAS goal T-scores following the intervention, with six of the eight participants achieving or exceeding their expected level of performance on all goals. CONCLUSION: A goal-driven, metacognitive approach to intervention may assist individuals with TBI to achieve their personal social communication goals, with benefits reported by participants and observable during conversations. Further research is required.

Discourse level reading comprehension interventions following acquired brain injury: a systematic review.

Purpose Reading comprehension can change following acquired brain injury (ABI), impacting independence and participation. This review aims to identify and evaluate the interventions used for rehabilitation of discourse level reading in adults with ABI. Methods A systematic review was conducted of published journal articles. Methodological quality of studies was reviewed using formal and informal rating scales. Inclusion criteria involved adults with non-progressive ABI who experienced discourse level reading deficits related to aphasia or cognitive-communication disorders. Results A total of 23 studies were identified; these included randomized controlled trials, cohort and case studies. Six different types of reading interventions were found, overall results of these interventions were mixed. Reading deficits were reportedly related to language (aphasia) and/or cognitive deficits, with assessment processes varying. Questions arose regarding comparability of assessment methods and diagnostic issues across the studies. Conclusions Interventions for discourse level reading comprehension can make positive changes to reading function. However, no intervention was identified as a gold standard. A trend toward strategy-based reading was found, with these offering a potential for (comparatively) cost-effective lower-dosage reading treatments with positive-trend results. Cognitive and language features should be considered for assessment and intervention planning for discourse reading in ABI. Implications for Rehabilitation Six different types of discourse reading comprehension interventions for people with ABI were identified, with mixed evidence for each intervention. Clinicians need to consider both the linguistic and cognitive features of reading for assessment and intervention planning for discourse level reading. There is a research trend toward strategy-based reading interventions, which use a lower treatment dosage.

Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management.

There is limited evidence for cognitive-communication reading comprehension (CCRC) interventions for adults following acquired brain injury (ABI), particularly during sub-acute rehabilitation. The purpose of this study was to investigate the clinical practice of speech-language pathologists (SLPs) with CCRC deficits during sub-acute ABI rehabilitation and compare it to the best available evidence. An electronic survey was used to gather information from clinicians across Australia regarding clinical practice in the areas of assessment, intervention, treatment hierarchies and service delivery; survey questions were developed from an extensive review of the literature and expert clinician opinion. Survey findings were then compared with the literature in the form of a systematic review. Surveyed clinicians provided multiple interventions for CCRC rehabilitation, including impairment based (94.7%), activity based (94.7%) and reading strategy interventions (100.0%). Five strategies were used by >94% of SLPs (highlighting, identifying main points/wh- questioning, re-reading, summarising, reducing visual load). When compared with the literature, strong similarities were found for strategy-based interventions and individual service delivery, with broad similarities for functional and impairment-based interventions, and impairment based treatment hierarchies. Strong differences in assessment were identified. Strategy use reported in clinical practice (100.0% SLPs) was higher than in the literature. Further investigation into the effectiveness of specific reading strategies for people with ABI is warranted.

Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

Systematic Review of Behavioral Interventions Targeting Social Communication Difficulties After Traumatic Brain Injury.

OBJECTIVE: To determine whether behavioral interventions are beneficial for adults with social communication difficulties after traumatic brain injury (TBI). DATA SOURCES: Electronic databases were searched through October 2013 to find behavioral intervention trials. Keywords used in our search were intervention, therapy, treatment, and program combined with pragmatic disorder, pragmatic impairment, social communication disorder/impairment, conversation disorder/impairment, social disorder/impairment, cognitive-linguistic and cognitive-communication deficit; adult; and traumatic brain injury, head injury, and brain injury. Hand searches of the reference lists of relevant articles were also conducted. STUDY SELECTION: To be selected for detailed review, articles found in the initial search were assessed by 2 reviewers and had to meet the following criteria: (1) population (adults with TBI); (2) intervention (behavioral intervention); and (3) outcomes (changes in social communication). Articles needed to describe interventions that were delivered directly to adults with TBI with or without other people (such as significant others) involved. Of the 2181 articles initially identified, 15 were selected for detailed review. DATA EXTRACTION: Data were independently extracted by members of the research team, then collated and reviewed by the team. DATA SYNTHESIS: Of the 15 publications that met the study criteria, 7 were single-case design studies, 3 were randomized controlled trials, 1 was a nonrandomized controlled trial, and 4 were cohort studies. The methodological qualities of eligible articles were examined using the Physiotherapy Evidence Database and Single-Case Experimental Design rating scales. The interventions described in the studies fell into 2 broad categories: those addressing a specific impairment in social communication, and context-specific interventions with a holistic focus on social communication skills. Studies using context-sensitive approaches had been published more recently and were generally group studies with higher methodological quality. CONCLUSIONS: Overall, interventions addressing social communication skills for people with TBI were found to be beneficial irrespective of treatment approach used. While the evidence base is small and with varying levels of scientific rigor, there is a body of quality evidence that supports the use of context-sensitive approaches. Further research is still required to determine the role of impairment-specific versus context-specific interventions when treating individuals with social communication difficulties after TBI to inform clinical decision-making.

Does metacognitive strategy instruction improve impaired receptive cognitive-communication skills following acquired brain injury?

AIMS: To investigate if metacognitive strategy instruction (MSI) improves the receptive language skills of adults with cognitive-communication disorders secondary to acquired brain injury (ABI). RESEARCH DESIGN: An ABA intervention programme was implemented with eight adults with ABI, aged 25-70 years. The Measure of Cognitive-Linguistic Abilities (MCLA) was administered at baseline and following treatment. The treatment employed in this study involved three components: individual goal-based therapy, group remediation therapy using self-instruction and home practice. RESULTS: No receptive language sub-tests of the MCLA reached statistical significance. However, participants' raw score improvements in receptive language sub-tests indicated that MSI may be effective at remediating CCDs following ABI. CONCLUSIONS: Preliminary findings indicate that MSI may be effective in improving receptive language skills in adults with CCDs following ABI. Further research involving a more rigorous study, a larger sample size and a more reliable outcome measure is necessary and may provide statistically significant evidence for the effectiveness of MSI for remediating receptive language disorders.

The reliability of a severity rating scale to measure stuttering in an unfamiliar language.

With increasing multiculturalism, speech-language pathologists (SLPs) are likely to work with stuttering clients from linguistic backgrounds that differ from their own. No research to date has estimated SLPs' reliability when measuring severity of stuttering in an unfamiliar language. Therefore, this study was undertaken to estimate the reliability of SLPs' use of a 9-point severity rating (SR) scale, to measure severity of stuttering in a language that was different from their own. Twenty-six Australian SLPs rated 20 speech samples (10 Australian English [AE] and 10 Mandarin) of adults who stutter using a 9-point SR scale on two separate occasions. Judges showed poor agreement when using the scale to measure stuttering in Mandarin samples. Results also indicated that 50% of individual judges were unable to reliably measure the severity of stuttering in AE. The results highlight the need for (a) SLPs to develop intra- and inter-judge agreement when using the 9-point SR scale to measure severity of stuttering in their native language (in this case AE) and in unfamiliar languages; and (b) research into the development and evaluation of practice and/or training packages to assist SLPs to do so.

The current practices of speech-language pathologists in providing information to clients with traumatic brain injury.

The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes.