Emma Power

Speech pathologists' experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study.

BackgroundCommunication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs.MethodsSpeech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.Results320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.ConclusionsThere are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

Furry families : making a human-dog family through home

The last fifty years have seen dogs increasingly drawn into the home as family members. While the health and social implications of these relatings have been the focus of much research, the everyday practices by which more-than-human families are constituted have received little attention. The paper draws on interviews with, and diaries recorded by, new dog owners in 2006–2007. It highlights three ways that dogs became family in and through the home. First, describing dogs as ‘furry children’, participants emphasised the time spent caring for dogs. Second, engaging with dogs as ‘pack animals’, participants discussed an inherent ‘otherness’ that shaped family relations, and reconceptualised the human-family as a pack relation. Third, the individual agency of dogs was recognised as shaping family and home. However, these familial relatings were often tenuous as humans were faced with the particular character and ‘otherness’ of dogs. While the majority experienced a strengthening of family ties following the introduction of a dog, a number of individuals discussed the divisive impact of this experience. The paper extends debates about family and home, broadening family beyond biological relations to include more-than-human relationships forged through cohabitation and interaction.

Human–Nature Relations in Suburban Gardens

Gardens have been considered predominately in terms of a nature–culture binary, with nature positioned as a passive object of human control. Placing the human at the centre of the garden, these perspectives understand this space in terms of human cultures, needs and understandings. This paper critiques these perspectives, questioning whether gardens are ever simply human constructions. Actor–network theory (ANT) provides a framework for this research, which examines human–nature relations through a focus on the material processes of gardening. Drawing on interviews with suburban gardeners in northern Sydney and the analysis of two popular gardening magazines, the research shows that gardening entails an embodied engagement between active human and non-human actors. Involving processes of collaboration, negotiation, challenge and competition, gardening is a dynamic process. Describing human relations with the plants of the garden, this research argues for gardens to be understood as hybrid achievements.

Aphasia rehabilitation in Australia: Current practices, challenges and future directions.

Abstract This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ˜ 33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

Training communication partners of people with severe traumatic brain injury improves everyday conversations: a multicenter single blind clinical trial.

OBJECTIVE To determine effectiveness of communication training for partners of people with severe traumatic brain injury. DESIGN Three arm non-randomized controlled trial comparing communication partner training (JOINT) with individual treatment (TBI SOLO) and a waitlist control group with 6 month follow-up. PARTICIPANTS Forty-four outpatients with severe chronic traumatic brain injuries were recruited. INTERVENTION Ten-week conversational skills treatment program encompassing weekly group and individual sessions for both treatment groups. The JOINT condition focused on both the partner and the person with traumatic brain injury while the TBI SOLO condition focused on the individual with TBI only. MAIN OUTCOME MEASURES Primary outcomes were blind ratings of the person with traumatic brain injurys level of participation during conversation on the Measure of Participation in Communication Adapted Kagan scales. RESULTS Communication partner training improved conversational performance relative to training the person with traumatic brain injury alone and a waitlist control group on the primary outcome measures. Results were maintained at six months post-training. CONCLUSION Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone. The Adapted Kagan scales proved to be a robust and sensitive outcome measure for a conversational skills training program.

Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales

Background: Considerable attention has been given to the nature of communication impairments of individuals with TBI (Coelho, 2007; Ylvisaker, Turkstra, & Coelho, 2005). However, there have been few data focusing on the way communication partners deal with the often distressing sequelae of TBI. Aims: This study reports inter- and intra-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions. Method & Procedures: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. A total of 10 casual and 10 purposeful TBI interactions were independently rated by two raters to establish inter-rater reliability and by one rater on two separate occasions to determine intra-rater reliability. Outcomes & Results: Excellent inter-rater agreement was established on the MSC (ICC = 0.85–0.97) and the MPC (ICC = 0.84–0.89). Intra-rater agreement was also strong (MSC: ICC = 0.80–0.90; MPC: ICC = 0.81–0.92). Over 90% of all ratings scored within 0.5 on a 9-point scale. Conclusions: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programmes.

Evaluating communication training for paid carers of people with traumatic brain injury.

Primary objective: To evaluate the effectiveness of a communication training programme for paid carers to improve their conversational interactions with people with TBI. Research design: Single blinded randomized controlled study. Methods and procedures: Ten paid carers were randomly selected from a post-acute residential rehabilitation programme and allocated to either a training or control group. Training comprised a 17-hour programme (across 8 weeks) with conversational interactions (i.e. structured and casual) between paid carers and people with TBI videotaped pre-training, post-training and at 6-months follow-up. Interactions were rated on the Adapted Measure of Support in Conversation (MSC), Adapted Measure of Participation in Conversation (MPC) and Global Impression Scales of conversation. Main outcomes and results: Trained paid carers were more able to acknowledge and reveal the competence of people with TBI. Conversations were perceived as more appropriate, interesting and rewarding compared to the control group. Improvements were confined to the structured conversation and were maintained for 6 months. Conclusions: Training paid carers has a positive effect on improving conversational interactions with people with TBI in a long-term care facility. These improvements can help to foster increased independence for the person with TBI in the home and community.

An exploratory prospective study of the association between communication skills and employment outcomes after severe traumatic brain injury

Abstract Primary objective: The aim of this pilot study was to explore possible correlations between measures of functional communication skills in the first year post-injury and later employment outcome. Design: A preliminary observational study employing a prospective longitudinal design. Methods: Fourteen adults with traumatic brain injury completed an assessment involving two functional communication measures: an objective test of cognitive communication skills (Functional Assessment of Verbal Reasoning and Executive Strategies, FAVRES) and self-ratings of communication impairment (LaTrobe Communication Questionnaire, LCQ). Follow-up of participants’ employment outcome was conducted 9–18 months after the initial assessment. Results: At follow-up, eight participants had returned to employment (working a similar number of hours to their pre-injury status), five were unemployed and one was lost to follow-up. Employment status at follow-up was strongly correlated with both FAVRES Total Accuracy scores (r = 0.833) and Total Rationale scores (r = 0.837), but there were no correlations with FAVRES Time and Reasoning scores or with the LCQ. Conclusions: The FAVRES shows initial promise as an assessment that may be associated with successful employment outcome following traumatic brain injury. Further research with larger samples is required to provide further information on the prognostic utility of measures such as the FAVRES and the LCQ.

The impact of communication partner and discourse task on a person with traumatic brain injury: the use of multiple perspectives.

Primary objective: This study investigated whether varying the communication partner (i.e. mother vs paid caregiver) and discourse task (i.e. casual conversation vs purposeful conversation vs problem-solving task) affected the nature of information exchange for a person with traumatic brain injury (TBI). Methods: Three discourse tasks were recorded involving a TBI participant with his mother and, on a separate occasion, with his paid caregiver. Texts were analysed using multiple perspectives, comprising exchange structure analysis, ratings by independent observers and self and others’ perceptions of communication. Results: The TBI participant was more likely to give information when interacting with his mother than with the paid caregiver, as shown by exchange structure analysis. The participants also varied the way they exchanged information according to the discourse tasks. Results from exchange structure analysis were corroborated by the ratings by independent observers. Additionally, the mother was found to perceive that the TBI participant ‘usually’ had communication difficulty, while the caregiver perceived that he ‘rarely’ had communication difficulty. Conclusion: The nature of information exchange for a person with TBI varied with the communication partner and discourse task. The multiple perspectives used in this study appeared promising for the examination of discourse ability following TBI.

An exploration of participant experience of a communication training program for people with traumatic brain injury and their communication partners

Purpose: To investigate the experiences of participants who attended communication training programs for people with traumatic brain injury (TBI) and their everyday communication partners (CP) as part of a non-randomised controlled trial. Method: The participants were people with TBI and their CP, who were family members or carers of the people with TBI. Twenty-six participants (13 participants with TBI and 13 CP) completed the JOINT program, which involved participants with TBI and CP attending the program together. Fourteen participants with TBI completed the TBI SOLO training program, which did not involve the participation of a CP. Semi-structured videotaped interviews were completed by all participants at the end of the training. Using a six-step generic analysis procedure, data were categorised into topics and then subtopics to identify conceptually discrete units. Results: Participants described improvements in communication skills, the impact of improved communication skills, valuable components of the programs and components that needed changes. Conclusion: The accounts of participants provided additional evidence for the effectiveness of the training programs, assisted with identifying helpful components of the training and demonstrated the usefulness of a qualitative research methodology as part of evaluating the outcomes of the clinical trial. Implications for Rehabilitation Participants in social communication skills training programs for people with traumatic brain injury report positive outcomes. Including communication partners in training programs is reported to be beneficial, although there are some challenges. Qualitative methodologies are a useful way of understanding the processes and outcomes of complex interventions such as communication skills training programs.