Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI).

BACKGROUND: eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals' experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. METHODS: A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. RESULTS: Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. CONCLUSIONS: Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.

A randomised controlled trial evaluating a brief intervention for deficits in recognising emotional prosody following severe ABI.

Many adults with acquired brain injuries, including traumatic brain injuries (TBI) have impaired emotion perception. Impaired perception of emotion in voice can occur independently to facial expression and represents a specific target for remediation. No research to date has addressed this. The current study used a randomised controlled trial to examine the efficacy of a short treatment (three x two-hour sessions) for improving the ability to recognise emotional prosody for people with acquired brain injury, mostly TBI. Ten participants were allocated to treatment and 10 to waitlist. All participants remained involved for the duration of the study in the groups to which they were allocated. There were no significant treatment effects for group, but analyses of individual performances indicated that six of the treated participants made demonstrable improvements on objective measures of prosody recognition. The reasons why some participants showed improvements while others did not, was not obvious. Improvements on objective lab-based measures did not generalise to relative reports of improvements in everyday communicative ability. Nor was there clear evidence of long-term effects. In conclusion, treatment of emotional prosody was effective in the short-term for half of the participants. Further research is required to determine what conditions are required to optimise generalisability and longer-term gains.

Discourse sampling in the 21st century.

This paper examines the importance of evaluating discourse in individuals with a neurogenic language disorder. Discourse analysis is acknowledged as an important tool for speech-language pathologists, although it is often not the assessment tool of choice due to its apparent time-consuming nature and the overwhelming number of options available. The wide range of analyses available to clinicians such as the number of T-units and total words produced or Pragmatic Protocol checklists make it difficult to choose assessment measures. Even more difficult is the decision of where to direct treatment efforts. This paper aims to show that there are a number of levels of discourse analysis available to clinicians and that it is possible to sample a number of different genres in a clinical setting. The significance of the communication partner's contribution is discussed, particularly with regard to the limitations of the therapeutic interaction and the need to assess clients with a range of communication partners. The discourse opportunities we make available to people with communication problems will influence what is possible for them. To achieve this, the benefits of a theory of linguistic analysis, namely, Systemic Functional Linguistics (SFL) [Halliday, M. A. K. (1994). An introduction to functional grammar (2nd ed.). London: Edward Amold.] will be explored.

Analysing discourse in the traumatic brain injury population: telephone interactions with different communication partners.

A range of discourse analyses are effective in identifying features which are aberrant following traumatic brain injury (TBI). We examined the exchanges of five traumatically brain-injured subjects and five matched controls across four speaking situations which included speaking to a therapist, to the bus timetable information service, to the police, and to their mothers on the telephone. Transcripts were analysed using the exchange structure analysis of systemic functional grammar. This analysis provided an indication of information giving (K1 moves per minute); information requesting and receiving (K2 moves per minute) and the amount of negotiation that was needed for the messages to be conveyed (dynamic moves per minute). Results indicated that the TBI subjects performed differently across the four conditions, and were differentiated from the matched controls on a number of measures. The role of different communication partners is also addressed. Communication partners were noted to interact differently with TBI subjects when compared with controls. This included increased information-giving to control subjects; more requests for information by police from TBI subjects and a greater use of dynamic moves by therapists with controls. The potential of exchange structure analysis is discussed as a useful way of examining the discourse of TBI subjects and their communication partners. Exchange structure analysis highlighted the dynamic nature of information exchange and the subtle ways speakers responded to familiarity and power imbalance in social interaction. This study has implications for family and community education regarding communication with people with TBI.

A new perspective on the relationship between communication impairment and disempowerment following head injury in information exchanges.

Communication disorders following closed head injury (CHI) have been described in terms of the impairments that affect the individual's ability to produce words, sentences and discourse. Rather than focusing on impairments, this paper examines the disability experienced by one CHI subject. Comparison is made between M. R., who has sustained a severe CHI, and his brother, S. R. during four telephone calls to their mother, a therapist, the police and the bus timetable information service, using exchange structure analysis. Results indicated that social distance between communication partners, and the nature of the interaction, affected the language choices made by both subjects. The communication partner was found to have a profound impact on the way each subject was able to negotiate each interaction. Results are discussed in terms of the ways in which therapists and society in general view disability and how this shapes social encounters, which in turn affects the outcomes which are made possible for people with CHI.

Evaluating social skills following traumatic brain injury: the BRISS as a clinical tool.

Deficits in social behaviour are a major obstacle to the reintegration into the community of traumatically brain-injured (TBI) individuals. Recognition of the importance of social skill remediation has highlighted the need for a suitable assessment tool. The TBI population presents particular requirements with respect to the special nature of deficits which commonly occur as a result of frontal lobe impairment. The Behaviorally Referenced Rating System of Intermediate Social Skills (the BRISS) has been shown to have good psychometric properties with a TBI population. It also provides a measure of particular social skills associated with frontal lobe functioning. This study examines the ability of the verbal scales of the BRISS to identify social skill deficits at the individual client level and to detect significant changes in skills following an intervention programme involving five chronic TBI males. In the case of one client, who demonstrated significant clinical improvement in social behaviour, the BRISS was found to identify specific areas of apparent change. The difficulty of using the BRISS as a sole measure of social skills is discussed in the light of relatively large pre-intervention within-subject variability which was found with respect to some behaviours.