Role of contextual factors in the rehabilitation of adolescent survivors of traumatic brain injury: emerging concepts identified through modified narrative review.

BACKGROUND: Recently research in traumatic brain injury (TBI) intervention has identified the benefits of contextualized, embedded, functionally based approaches to maximize treatment outcomes. An essential component of contextualized intervention is the direct and purposeful consideration of the broader context, in which the person with TBI functions. However, systematic consideration of contextual factors remains limited both in research and clinical practice. AIMS: The purposes of this modified narrative review were (1) to provide a succinct review of the available literature regarding the contextual factors that are specific to adolescent survivors of TBI, one of highest incidence groups for brain injury; (2) to connect these contextual factors to the direct long-term management of TBI and to identify their potential impact on outcome; and (3) to highlight areas that are open to research and clinical advances that could enhance positive outcomes for adolescent survivors of TBI. The framework of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; 2007) was used as a foundation for this review. METHODS & PROCEDURES: A systematic literature search was conducted using databases and hand searches. A total of 102 articles were originally identified. Twenty-five original research articles, eight review papers and four expert opinion papers met inclusion and exclusion criteria and were included in the final review. MAIN CONTRIBUTION: The body of research specifically focused on contextual factors is an emerging area. Early findings indicate that a focus on the direct modification of contextual factors is promising for the facilitation of positive outcomes long into the chronic phase of management for adolescences who have survived a TBI. The contextual factors included in this review were the overall ability of the school to support a student post-TBI, family psychosocial risk (sibling/sibling relationships/stress/burden/support), coping style (TBI survivor and their caregivers), and socioeconomic status of the family. Given the promise of these findings, research and clinical application efforts should be focused on identifying well-prescribed rehabilitation paradigms that capitalize on the modification of contextual factors throughout the recovery process. CONCLUSIONS & IMPLICATIONS: The results of this modified narrative review provide an initial summary of the available evidence for addressing contextual factors in the rehabilitation process for adolescents with TBI. This is an area that is wide open for both systematic research and clinical application and holds potential to improve long-term outcome for survivors of adolescent TBI.

Speech-language pathologists and adult palliative care in Australia.

PURPOSE: This research explored the role of Australian Speech-Language Pathologists (SLPs) to identify SLP experiences and practices regarding adult palliative care (PC) management. METHOD: Utilising mixed methods, phase one comprised a literature scoping review of SLP practices in PC. Phase two involved a survey compiling demographic data of Australian SLPs working in adult PC. Phase three involved in-depth interviews exploring SLP experiences in PC. RESULT: It was found that minimal resources or published literature existed regarding SLPs in PC, however the available literature indicated SLPs can be valuable and influential members of a PC team. Interviewed SLPs acknowledged their proficiency in end-of-life communication and swallowing, nevertheless initially they felt ill-prepared given insufficient knowledge or skills to manage palliative cases based upon their tertiary education and were poorly supported once in the field given a lack of clinical practice guidelines (CPGs). Participants also noted a lack of knowledge among medical, nursing and allied health clinicians about a SLP's contribution to PC, causing barriers for SLPs being professionally accepted within palliative environments. CONCLUSION: Recommendations included the development of improved resources specifically about SLP practice in end-of-life care, the need for greater exposure at the tertiary level of SLP palliative care practices, and CPGs for SLPs working in adult palliative care.

The ICF framework and third party disability: application to the spouses of persons with aphasia.

The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) provides a framework for understanding functioning and disability of persons with a health condition. WHO refers to "third party disability" as the study of the life functioning of family members when faced with a health condition of their significant others. The spouses of persons with aphasia (PWAs) have been referred to as the "hidden victims" of aphasia. Traditionally, rehabilitation and societal efforts have been directed solely at the person who has the overt disability. Although it has been long acknowledged that the spouses of PWAs can also have significant difficulties, the focus and resources of therapy are usually not provided to address spouses' problems directly. In addition, PWAs depend on their communicative environments to maintain and develop the skills learned in therapy. The long-term outcomes of aphasia therapy are greatly influenced by being in a facilitative environment. Thus, understanding and providing appropriate intervention and support services for spouses may help not only the spouses but also the PWAs to have positive long-term outcomes. This article examines whether the ICF framework can be used to study third party disability of the spouses of PWAs and how the ICF could be used to develop clinically applicable research in this crucial area.

The complexity of social/cultural dimension in communication disorders.

There has been growing recognition in the field of communication disorders concerning the importance of multicultural and diversity issues. This discussion needs to move beyond the theoretical and descriptive stage to the clinical use of this knowledge to improve the communicative functioning of diverse populations. This paper argues that the tenets of evidence-based practice and the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be used to advance the scholarship and service concerning diversity issues. Both evidence-based practice and the ICF are client-based approaches that can facilitate the achievement of culturally relevant rehabilitation outcomes. This article discusses the use of evidence-based practice and the ICF for providing assessment and intervention that address the social and cultural complexities of the persons we serve. In addition, the author states that work on diversity issues can also be used to discover crucial underlying knowledge regarding communication and communication disorders.

Towards an international framework for communication disorders: use of the ICF.

UNLABELLED: There has been an interest in the World Health Organization's framework of functioning and disability by those in communication disorders since the original 1980 International Classification of Impairments, Disabilities, and Handicaps (ICIDH). In 2001, WHO published the substantially revised International Classification of Functioning, Disability, and Health (ICF). This framework is gaining in acceptance as a system that would be beneficial for the field and for our clients. This article describes the basics of the ICF and how it differs from the ICIDH; the possible applications of the ICF to communication disorders; some of the work done with the ICF in communication disorders internationally; and the benefits to the field from increased interdisciplinary and international collaboration using the ICF as a common framework. LEARNING OUTCOMES: As a result of this activity the reader will be able to: (1) describe the basics of the ICF, (2) describe the applications of the ICF to communication disorders, and (3) describe the possible impact upon the field internationally.

Outcome assessment in aphasia: a survey.

UNLABELLED: There has been a marked increase in attention to the measurement of "outcomes" after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment tools are available to measure outcomes after aphasia therapy, there is little information regarding the use of these tools in everyday practice by SLPs. Therefore, the current investigation was undertaken to identify and describe the practices of SLPs relative to outcome assessment in aphasia. An online survey of outcome assessment practices was distributed. Results revealed that 85% of the 94 respondents reportedly perform outcome assessment. A majority of respondents reported barriers to assessment such as time and funding limitations. Considerable variability existed in the types of assessments and the actual tools reported. The impact of the results on clinical practice is discussed. LEARNING OUTCOMES: As a result of this activity the reader will be able to (1) define outcome assessment in aphasia, (2) describe patterns of outcome assessment in aphasia as reported by survey respondents, and (3) describe a conceptual framework for situating outcome assessment in aphasia.

Influences on perceived function of a nursing home resident.

UNLABELLED: This article describes a typical, yet fictionalized woman with Alzheimer's disease during her first week at a nursing home. Readers are challenged to ask themselves in what areas of difficulty a speech-language pathologist may or may not be able to contribute to the success of this resident. The authors use the World Health Organization's International Classification of Functioning, Disability, and Health [International Classification of Functioning, Disability, and Health, 2001, Geneva, Switzerland] as the framework for assessments and the resident-centered interventions for this case study. LEARNING OUTCOMES: 1. The reader will be able to identify the four main constructs of the ICF classification system. 2. The reader will be able to identify three environmental factors that may influence the functioning of a person with Alzheimer's disease. 3. The reader will be able to discuss at least four interventions that can be implemented by a speech-language pathologist to improve a nursing home resident's participation in daily activities.

The ICF and speech-language pathology: aspiring to a fuller realization of ethical and moral issues.

The World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) is a tool that was developed to improve the functional health of the world's people. The ICF is meant to be more than simply a better way to classify functional limitations. WHO seeks to change the way people view disability. This article discusses the ethical guidelines listed in the ICF and how they can be used by speech-language pathologists to aspire to a fuller realization of the ethical and moral aspects of their vocation. This realization includes an argument that the disability rights struggle is part of an overall quest for the basic human rights of all people.

Use of the ICF in dysphagia management.

The evaluation and intervention of persons with dysphagia represents a significant percentage of speech-language pathologists' caseloads in medical settings. Because of its overtly medical nature, there has been considerable focus dealing with the direct physical health aspects of dysphagia management. This article argues that the use of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) by clinicians can expand and greatly enhance the outcomes for persons with dysphagia. The different components of the ICF are discussed in relation to dysphagia assessment and management. The article concludes by noting that speech-language pathologists can use the ICF framework beneficially to justify and strengthen their role in the management of dysphagia.

Multiinfarct dementia and communication.

Traditionally, speech-language pathologists have treated patients who have suffered from strokes that resulted in aphasia, but have not always worked with patients labelled as having multiinfarct dementia (MID). Patients with MID also have difficulties with communication in which the speech-language pathologist's input would be beneficial. This article examines the clinical characteristics and neurology of MiD along with the assessment and clinical issues that need to be examined if speech-language pathologists are to evaluate and treat these patients more effectively.