Communication partner training facilitates everyday outcomes for people with acquired communication disability

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Communication partner training facilitates
everyday outcomes for people with acquired
communicationdisability

• Leanne Togher1, Skye Mcdonald2, Robyn Tate3,4,
  Emma Power1 Rachel Rietdijk1,5
• 1 Speech Pathology, Faculty of Health Sciences,
  the University of Sydney, Sydney
• 2 School of Psychology, the University of New
  South Wales, Sydney
• 3 Rehabilitation Studies unit, Northern Clinical
  School, Faculty of Medicine, University of Sydney
• 4 Royal Rehabilitation Centre, Sydney
• 5 Brain Injury Rehabilitation Unit, Liverpool
  Health Service, Sydney

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Acknowledgements

• NHMRC project Grant 402687
• We are grateful to study participants as well as
  staff from
• Liverpool Brain Injury Unit, including Dr Grahame
  Simpson, Dr Adeline Hodgkinson, Manal Nasreddine,
  Kasey Metcalf
• Westmead Brain Injury Unit and speech pathology
  department, including Dr Kathy McCarthy, Anna
  Jones, Dr Alex Walker, Dr Ian Baguley, Dr Joe
  Gurka, Rod Gilroy
• Royal Rehab Centre Sydney Brain Injury Unit,
  including Audrey McCarry, Vanessa Aird, Alanna
  Huck and Dr Clayton King
• Gaye Murrills, private speech pathologist

Westmead Brain Injury Unit
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Approaches to improve communication in TBI

• Train the person with TBI
• (Flanagan, McDonald Togher, 1995, Medd Tate,
  2000, Tate, 1987, Cannizzaro Coelho, 2002
  Cramon et al, 1992, Helffenstein Wechsier, 1982
  Dahlberg et al., 2007)
• Train communication partners
• (Togher, McDonald, Code Grant, 2004)
• Train both

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NHMRC Clinical trial (Togher, McDonald Tate,
2007-2009)

• 3 arm trial which compares
• 1. Treating communication deficits of person with
  TBI directly
• (TBI SOLO)
• 2. Training everyday communication partners (ECP)
  along with the person with TBI (TBI JOINT)
• 3. A delayed treatment control group (CTRL)

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TBI Participants

• 44 participants with TBI
• recruited from Liverpool, Royal Ryde and Westmead
  Brain Injury Units, Sydney Australia
• Mean age 36 years (SD14, range18-68)
• Mean education 12 years (SD3, range7-20 )
• Mean time post injury 8 years (SD7.2,
  range1-25)
• Mean PTA 83.15 days (SD61, range6-182)
• 38 males 6 females

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Everyday communication partner (ECP) participants

• 44 communication partners of person with TBI
• Mean age 50 years (SD 15.5, range 17-79)
• Mean education 13 years (SD 2.7, 9-19)
• 80 were female
• 80 knew the person before the TBI
• The majority were partners or parents, however
  siblings and friends also participated in the
  study

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Study Participants

• Allocated to
• TBI JOINT - Communication partner treatment
• n14 ( 1 dropout 13)
• TBI SOLO - Person with TBI alone treatment
• n15 ( 1 dropout 14)
• CTRL - Delayed treatment control
• n15 ( 1 dropout 14)
• 93 retention rate at post assessment and 87.5
  retention at 6 mo f/up
• ANOVA comparison across groups ns for
• Age, education
• Time post onset, PTA
• Cognitive-linguistic impairment (SCATBI)
• ECP age
• ECP education

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Treatment Communication Partner training

• Group and individual training for TBI JOINT group
• Group of 4-5 people with TBI their
  communication partners
• 2.5 hr weekly group sessions ( morning
  tea/social break)
• 1 hour weekly individual sessions for each pair
• 10 week program
• Manualised approach
• Interpersonal communication skills
• Collaborative and elaborative conversational
  strategies (Ylvisaker et al 1998)
• Enhancing / supporting communication of person
  with TBI/ question asking

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Treatment TBI only training

• Group and individual training TBI SOLO group
• Group of 4-5 people with TBI
• No communication partners
• 2 therapists
• 2.5 hr weekly group sessions (with morning
  tea/social break)
• 1 hour weekly individual sessions
• 10 week program
• Manualised approach parallels JOINT contents

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Control condition

• Waitlist group
• deferred treatment

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Conversation assessment

• Outcome measures were collected at
• Initial assessment,
• 1-3 weeks after group intervention and
• 6 months after assessment
• 2 discourse samples were collected
• Casual conversation
• Purposeful conversation

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Primary outcome measures

• Adapted Kagan scale
• (Kagan et al., 2001,2004 Togher et al, in
  press)
• Measure of Participation in Conversation
  (MPC)(TBI)
• La Trobe Communication Questionnaire (LCQ)
• (Douglas, OFlaherty Snow, 2000)
• Self report
• Other report

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Primary outcome measure

• Adapted Kagan scale (Kagan et al., 2001,2004
  Togher et al, in press)
• Measure of Participation in Conversation (TBI)
• level and quality of conversational participation
  
• Ability to interact and socially connect
  (Interaction scale)
• Ability to respond to and/or initiate content
  (Transaction scale)
• videotaped interactions rated by 2 blind
  assessors
• 9-point Likert scales, presented as a range of 0
  to 4 with 0.5 levels for ease of scoring

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The Adapted Kagan scales for TBI Interactions

• Scales ranged from 0 (no participation) through
  2 (some) participation to 4 (full participation)
  in conversation
• Inter-rater reliability scores for both the
  Adapted MPC scales were excellent
• (MPC ICC 0.84-0.89). Over 90 of ratings
  scored within 0.5 on a 9 point scale
• Intra-rater agreement was also strong
• (MPC ICC 0.81-0.92). Over 90 of ratings
  scored within 0.5 on a 9 point scale
• (Togher et al., 2010, Aphasiology)

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Secondary measures

• Adapted Measure of Support in Conversation
  (MSC)(Kagan et al., 2001,2004 Togher et al, in
  press)
• Global ratings of communication (Bond Godfrey,
  1997)
• Appropriate
• Effortful
• Interesting/engaging
• Rewarding
• on a 9 point scale, 0-4
• Social perception ability The Awareness of
  Social Inference Test (McDonald, Flanagan
  Rollins, 2002)
• Social participation Sydney Psychosocial
  Reintegration Scale (Tate et al., 1999)
• Confidence and self esteem Rosenberg Self Esteem
  Scale (Rosenberg, 1965)
• Caregiver satisfaction Modified Care Burden
  Scale (Machamer et al., 2002)
• Discourse analysis measures

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Analysis

• Initial analysis compared amount of change across
  the 3 groups with repeated measures ANOVA pre and
  post treatment in purposeful and casual
  conversation conditions
• Intention to treat analysis used

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RESULTS

• No statistically significant differences between
  the three groups at baseline on MPC ratings
• Significant treatment effect measured on the MPC
  Interaction scale in both casual conversation and
  purposeful conversation conditions
• i.e., the JOINT group improved relative to the
  other two

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Casual conversation Interaction scale
CC Casual conversation
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Purposeful conversation Interaction scale
PC Purposeful conversation
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Results

• Significant treatment effect was also found on
  the MPC Transaction Scale in both casual
  conversation and purposeful conversation
  conditions

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Casual conversation Transaction scale
CC Casual conversation
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Purposeful interaction Transaction scale
PC Purposeful conversation
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Discussion

• Training communication partners was more
  efficacious than training the person with TBI
  alone
• Success was due to key training principles
  including
• Communication being a collaborative and
  elaborative process (Ylvisaker et al., 1998)
• Training the ECP to reveal the competence of the
  disabled speaker (Kagan et al., 2004)
• Sensitively targeting behaviours of the ECP (eg
  test questions, speaking for the person with TBI)
  led to a significant change in everyday
  interactions

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Discussion

• Communication partners were challenged to change
  THEIR OWN communication behaviours
• Eliminating testing questions to which they
  already knew the answer
• Reducing questions which checked the accuracy of
  the person with TBIs contribution
• Speaking to the person with TBI as an adult and
  not a child

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Conclusions in the context of the World
Disability Report

• A persons communication environment will
  significantly impact on their ability to engage
  in daily living activities
• Building capacity within the family unit will
  promote good psychosocial outcomes for both the
  person with brain injury and their family members
• Training everyday communication partners is an
  important complementary treatment for people with
  TBI and their families to facilitate and promote
  improved communication outcomes