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Leanne Togher 1 , Skye Mcdonald 2 , Robyn Tate 3,4 , Emma Power 1 & Rachel Rietdijk 1,5

Communication partner training facilitates everyday outcomes for people with acquired communication disability. Leanne Togher 1 , Skye Mcdonald 2 , Robyn Tate 3,4 , Emma Power 1 & Rachel Rietdijk 1,5 1 Speech Pathology, Faculty of Health Sciences, the University of Sydney, Sydney

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Leanne Togher 1 , Skye Mcdonald 2 , Robyn Tate 3,4 , Emma Power 1 & Rachel Rietdijk 1,5

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  1. 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

  2. Acknowledgements • NH&MRC project Grant 402687 • We are grateful to study participantsas 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

  3. 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

  4. NH&MRC 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)

  5. TBI Participants • 44 participants with TBI • recruited from Liverpool, Royal Ryde and Westmead Brain Injury Units, Sydney Australia • Mean age = 36 years (SD=14, range=18-68) • Mean education = 12 years (SD=3, range=7-20 ) • Mean time post injury = 8 years (SD=7.2, range=1-25) • Mean PTA = 83.15 days (SD=61, range=6-182) • 38 males: 6 females

  6. 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

  7. Study Participants • Allocated to • TBI JOINT - Communication partner treatment • n=14 ( 1 dropout = 13) • TBI SOLO - Person with TBI alone treatment • n=15 ( 1 dropout = 14) • CTRL - Delayed treatment control • n=15 ( 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

  8. 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

  9. 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

  10. Control condition • Waitlist group • deferred treatment

  11. 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

  12. 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, O’Flaherty & Snow, 2000) • Self report • Other report

  13. 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 interactionsrated by 2 blind assessors • 9-point Likert scales, presented as a range of 0 to 4 with 0.5 levels for ease of scoring

  14. 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)

  15. 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

  16. 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

  17. 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

  18. Casual conversation: Interaction scale CC = Casual conversation 20

  19. Purposeful conversation: Interaction scale PC = Purposeful conversation 21

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

  21. Casual conversation: Transaction scale CC = Casual conversation 23

  22. Purposeful interaction: Transaction scale PC = Purposeful conversation 24

  23. 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

  24. 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 TBI’s contribution • Speaking to the person with TBI as an adult and not a child

  25. Conclusions in the context of the World Disability Report • A person’s 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

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