Healthcare perceptions of persons with traumatic brain injuries across providers: shortcomings in the chronic phase of care.

OBJECTIVE: This investigation sought to examine the perceptions of individuals with mild, moderate, and severe traumatic brain injury (TBIs) toward healthcare providers across rehabilitation contexts (acute, rehabilitation, and chronic). METHODS: The mCARE-TBI survey was distributed via Qualtrics throughout the US and Canada. Sixty-four survey responses met criteria for analysis. Participants were ≥18 years old, one-year post onset, reported no unrelated neurological deficits prior to the single TBI, and reported no prior diagnosed psychiatric disorders. The mCARE was the primary outcome measure. Comparisons were made between provider ratings on each question. RESULTS: Significant differences were found between chronic-phase care, compared to acute care and rehabilitation. Group differences were found in transitioning home after discharge and in between each therapy discipline and both nurses and doctors, as well as for really listening and pairwise differences between therapy disciplines and both nurses and doctors. Group effects were found for showing compassion and care and being positive. CONCLUSIONS: All disciplines need to improve communication, and transition care/discharge planning. Dismissal of ongoing impairments continues to be an area of perceived concern with doctors in particular. Communication training is needed, particularly for nurses and doctors.

Clinically Applicable Sociolinguistic Assessment for Cognitive-Communication Disorders.

PURPOSE: The third International Cognitive-Communication Disorders Conference was held in early 2022, providing an opportunity for researchers and clinicians to discuss management of cognitive-communication disorders (CCDs). Presentations that addressed social discourse initiated broader conversations about implementing sociolinguistic methods in research and clinical contexts. Given the heterogeneity of CCDs and sociocultural contexts, a person-centered approach is needed. Sociolinguistic methods are inherently relevant and salient to the individual's communication context and partners. Sociolinguistic analyses provide information about language skills, cognitive-communication skills, and social cognition. The purpose of this article is to share a model of social communication and provide descriptions of current methods that can be used by researchers and clinicians to capture the complexity of social communication, thereby advancing our knowledge and practice. CONCLUSION: Although there is a growing literature base that supports the inclusion of sociolinguistic methods, there remains a disconnect between the literature and clinical application that current researchers and practitioners have an opportunity to address. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21614268.

"I Avoid Interactions With Medical Professionals as Much as Possible Now": Health Care Experiences of Individuals With Traumatic Brain Injuries.

PURPOSE: This study examined the perceptions of health care experiences by individuals with traumatic brain injuries (TBIs) across the recovery continuum, regarding care received by a variety of health care providers following their TBI. It sought to identify whether perceptions differed across mild, moderate, and severe participants, as well as acute, subacute, and chronic recovery. METHOD: Eighteen individuals with TBI were interviewed, using the Sydney Psychosocial Reintegration Scale-Second Edition (SPRS-2) and a semistructured interview about health care perceptions. A qualitative investigation employing two methods, interpretive phenomenological analysis (IPA) and Systemic Functional Linguistics (SFL; modality and appraisal analysis), provided a micro and macrolevel discourse analysis. RESULTS: IPA analyses of SPRS-2 interviews differed across severity levels but included changes to relationships, identity, and changes to social engagement and activity. IPA results revealed three core themes related to the health care experiences across severity that encompassed (a) frustrations with providers and (b) lack of support in the chronic phase, and (c) that finding support is crucial. SFL results provided insight into how individuals appraised such experiences in light of their identity and personal perspectives. Key differences between individuals with mild, moderate, and severe TBI diagnoses were found, with those who experienced a mild TBI expressing the most discontent with services received. Participants were most satisfied with acute care and least satisfied with chronic phase support. CONCLUSIONS: The results of this study have significant implications for health care professionals interacting with individuals who have experienced a TBI. Facilitating improved communication, referrals, increased access to mental health counseling, and resources such as groups to support identity expression could improve the health care experience.

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.

"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.

Joint Video Self-Modeling for Persons With Traumatic Brain Injury and Their Partners: A Case Series.

Purpose Individuals with traumatic brain injury (TBI) experience impairments to self-regulation and social communication that strain relationships. Video self-modeling (VSM) provides visible and audible, tangible evidence of what they do well and what could improve. Conducting such training in the context of authentic exchanges with their everyday partners may support positive change in social communication. The present investigation sought to evaluate indices of improved social communication. Method A mixed-methods design was employed for this case series investigation. Quantitative measures include pre- and postoutcomes on goal attainment scales (GASs) and measures of conversational effectiveness. Qualitative measures include responsiveness to video-supported prompts, conversational behaviors, and metacognitive statements. Results Participants perceived gains on GAS of 3-4 SDs, as well as perceived improvements on the La Trobe Communication Questionnaire. Those gains were validated by gains on the adapted Measure of Participation in Conversation and Measure of Skill in Supported Conversation. Individuals with TBI and their partners reached consensus on most goals and postintervention La Trobe Communication Questionnaire ratings. Participants made accurate judgments about their behaviors at a high rate, given video review. Conversational behaviors and use of metacognitive statements varied across participants and conversational contexts. Field notes and session transcripts provide evidence that both dyads increased internalization of VSM goals and purpose. Conclusions Joint VSM shows promise as a method for eliciting accurate self-assessments among individuals with TBI and their close partners. Both dyads perceived positive gains in interactions within and outside their dyads. Furthermore, joint VSM and GAS appear to improve self-awareness and internalization of VSM goals and purpose.

Immersion learning at an aphasia camp: Analysing student video reflections.

PURPOSE: Aphasia camps provide a learning context where students can gain knowledge and skills for clinical practise and regarding the lived experience of individuals affected by aphasia. The aim was to examine student learning experiences at a rustic, residential aphasia camp and explore the potential utility of video reflections. METHOD: Twenty-two student participants, who served as volunteer staff at an aphasia camp, reflected daily on their learning experiences. Manual, qualitative coding was used to characterise individual, verbal reflections conducted through video modality. RESULT: Three overarching themes were identified: applied learning, service, and clinical experience. Categories within applied learning included increased application of content knowledge, an evolving perspective of living with aphasia, and collaborative learning. Within service, students identified a commitment to making a meaningful impact, interpersonal relationships, and meeting the challenge. The clinical experience theme included increased confidence/self-efficacy and inspirational/rewarding categories. CONCLUSION: Aphasia camp is a unique learning environment where hands-on experiences influence students' knowledge, sense of civic responsibility, and developing clinical skills. Being immersed in a remote environment alongside individuals affected by aphasia fosters insights into the lived experience of aphasia and may enhance empathy. Video reflections appear to be a viable means of capturing authentic, organic, and emotional reflections.

Using Formative Video Competencies and Summative In-Person Competencies to Examine Preparedness for Entry-Level Professional Practice.

A key element of competency-based education is assessment. Effective assessment requires access to a core set of expectations that match a learner's level of preparation. Miller's triangle provides a framework for establishing appropriate expectations that move learners from novice to entry-level clinicians. Formative assessment and feedback are a crucial part of facilitating learning in this context. A pilot investigation was conducted to examine the effects of a formative, video competency on performance in a summative, live competency. Rubrics were used to score performance on two competencies, an oral mechanism exam (OME) and a clinical bedside swallowing examination (CBSE). Performance on the OME was significantly improved in the summative competency, compared with the formative, video competency. Performance on the CBSE did not change from formative to summative competency. Assessment in competency-based education is important as a measure of readiness for entry-level practice. Formative assessment and feedback can improve preparedness and performance on summative competencies. Detailed, criterion-referenced assessment tools are crucial to identifying performance. While the OME rubric used in this investigation appears to meet that standard, it is likely that the CBSE rubric was not specific enough to detect changes.

A Survey of Counseling Curricula Among Accredited Communication Sciences and Disorders Graduate Student Programs.

Purpose The purpose of this article is to examine the current state of counseling curriculum within the discipline. The last systematic survey of counseling curriculum within the disciplines of communication sciences and disorders was completed with data from 1983 (McCarthy et al., 1986). The Council on Academic Accreditation in Audiology and Speech-Language Pathology (2017) states that counseling should be included in accredited programs but does not specify to what extent. Currently, there are no standards to specify number of credits, need for a stand-alone course, or guidance regarding content delivered. Method The present investigation collected data on the status of counseling curricula in accredited communication sciences and disorders graduate programs. A Qualtrics survey was distributed to identify counseling curriculum practices across accredited programs. Quantitative data such as percentages and frequency counts were compiled to summarize program offerings. Qualitative analyses were used to characterize written responses. Survey responses were also cross-validated with a review of offerings listed on program websites. Results Of programs currently accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, 42.4% responded to the current survey. Fifty-nine percent of programs offer a stand-alone course. Review of curricula from program websites indicated that only 40% of accredited programs offer a stand-alone counseling course. Quantitative details about requirements, number of credits, and embedding counseling within other courses were compared to data from the 1983 survey. Qualitative analyses identified common learner outcomes and the nature of course or curricular content. Conclusions Investigators found a lack of consistency in incorporating counseling across programs and discussed implications of this in speech-language pathology practice. A decrease in the number of programs that offer a stand-alone counseling course was identified as compared to offerings in 1983, as well as a disparity regarding how programs provide training in counseling. Furthermore, survey responses differed from curriculum listings on program websites. Information derived from this study may serve as a starting point for the development of flexible standards that provide direction for achieving consistent preparation of counseling skills. Supplemental Material https://doi.org/10.23641/asha.12149703.

Video-based administration of the La Trobe Communication Questionnaire for adults with traumatic brain injury and their communication partners.

PRIMARY OBJECTIVE: To explore the use of direct video-based review for administration of the LaTrobe Communication Questionnaire (LCQ), and explore use of the LCQ as a tool for identifying and prioritizing targets for partner-based intervention. RESEARCH DESIGN: Between-groups design comparing self- vs partner ratings of social communication behaviours in conversation and qualitative analysis of response patterns and participant feedback. METHODS AND PROCEDURES: Eight adults with moderate-to-severe TBI and their partners engaged in 20-minute videotaped conversations, elicited using a topic-starter task. Each participant with TBI and his or her partner then completed the LCQ while viewing the dyad's videotaped conversation. Self- and partner ratings of the person with TBI were compared to each other and to published LCQ data. MAIN OUTCOMES AND RESULTS: Based on direct review of their videotaped conversations, six of eight individuals with TBI rated themselves as having more frequent problem behaviours than did their partners. Overall agreement between individuals with TBI and their partners was 0.70. CONCLUSIONS: The present study suggests that direct review of videotaped conversations might avoid some of the limitations associated with recall of previous events, which can be biased toward negative events and confounded by memory impairments in individuals with TBI. Participants stated that the video segment reflected their typical interactions and, thus, behaviours observed in this context could serve as a starting point for intervention planning.