Meeting the confused patient with confidence: perceived benefits of communication partner training in subacute TBI.

OBJECTIVE: This study aims to explore health professionals' perceived benefits of implementing Communication Partner Training (CPT) using Supported Conversation for Adults with Aphasia (SCA™) in a subacute rehabilitation setting with patients in post-traumatic confusional state (PTCS) after TBI. METHOD: The study was conducted in a clinical setting using a pre-post questionnaire design to explore change. One hundred and four interdisciplinary clinicians attended CPT in the SCA™ method and subsequent implementation support. Participants completed a questionnaire with both quantitative and qualitative questions before and after the training and implementation period. Data were analyzed using descriptive and inferential statistics and qualitative content analysis. RESULTS: Participants' perceived confidence and self-assessed ability to communicate with patients in PTCS significantly increased after CPT (p = 0.006). While participants still experienced communication challenges, they reported using CPT-related tools and strategies in their interactions. Participants found they could apply strategies to improve patients' comprehension of information and to confirm their understanding of patients' communication. However, using strategies to enhance patients' expressive abilities was perceived as more challenging. CONCLUSIONS: Training health professionals in CPT increase their confidence in managing communication with patients in PTCS. Further research is needed to evaluate the efficacy of CPT within a more rigorous research design.

Communication with patients in post-traumatic confusional state: perception of rehabilitation staff.

Objective: People in Post-Traumatic Confusional State (PTCS) present with communication difficulties that are well described in literature. However, limited study has been conducted on the experiences of their communication partners. The current study aimed to understand the experience of rehabilitation staff of their communication with patients in PTCS prior to communication partner training (CPT).Methods: Staff on a subacute inpatient TBI rehabilitation unit were invited to complete a 10-item questionnaire. The questionnaire contained quantitative and open-ended text response formats, analyzed with descriptive statistics and content analysis, respectively.Results: 78 interdisciplinary staff members completed the questionnaire. The majority of staff found communication to be difficult and time-consuming with half not feeling comfortable communicating with patients in PTCS. Confidence in communication was not associated with length of clinical experience. The majority of staff reported utilizing strategies to support communication, largely focused on augmenting activities with supportive objects and ensuring patient's comprehension through modification of verbal language.Conclusions: Staff are aware of the need for creating a structured environment for patients in PTCS and less aware of communication-specific strategies aiming at helping patients' expression, which underlines the need to emphasize these strategies as part of CPT in this type of setting.

Disorders of Consciousness: Classification and Taxonomy.

In this article, we discuss the taxonomy associated with the four major disorders of consciousness (DoC): coma, vegetative state or unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state. We briefly review the history of each disorder and then provide operational definitions and diagnostic criteria for each one. We rely heavily on recently released practice guidelines and, where appropriate, identify knowledge gaps and discuss future directions to advance DoC research and practice.

Focal Electroencephalographic Changes Index Post-Traumatic Confusion and Outcome.

While the duration and severity of post-traumatic confusional state (PTCS) after traumatic brain injury have well-established implications for long-term outcomes, little is known about the underlying pathophysiology and their role in functional outcomes. Here, we analyzed the delta-to-alpha frequency band power ratios (DAR) from localized scalp areas derived from standard resting electroencephalographic (EEG) data recorded during eyes closed state in 49 patients diagnosed with PTCS. Higher global, occipital, parietal, and temporal DARs were significantly associated with the severity of PTCS, as assessed by the Confusion Assessment Protocol (CAP) observed on the same day, after controlling for injury severity. Also, occipital DARs were positively associated with both the CAP disorientation score 2, and the CAP symptom fluctuation score 4, after controlling for injury severity (n = 35). Posterior DARs were significantly associated with Functional Independence Measure-cognitive subscale average score at 1 (n = 45), 2 (n = 42), and 5 (n = 34) year(s) post-injury. The associations at 1 (temporal left) and 2 (parietal left) years survive after controlling for an injury severity index. Our finding that posterior DAR is a marker of PTCS and functional recovery post-injury, likely reflects functional de-afferentation of the posterior medial complex (PMC) in PTCS. Altered function of the PMC is proposed as a unifying physiological mechanism underlying both acute and chronic confusional states. We discuss the relationship of these findings to electrophysiological markers associated with disorders of consciousness.