Search

Background: Right hemisphere communication disorders are neither consistently labelled nor adequately defined. Labels associated with right hemisphere brain damage (RHD) are broad and fail to capture the essence of communication challenges needed for stroke-related service provisions. Determination of rehabilitation needs and best-practice guidelines for the education, management and functional improvement of communication disorders after RHD are all predicated on an apt diagnostic label and disorder characteristics. Aims: In this paper "apragmatism" is proposed as a potential communication-specific diagnostic label for the impairments in communication that occur after RHD. In particular, the researchers aimed: (1) to establish an operational definition of apragmatism; and (2) to describe the linguistic, paralinguistic and extralinguistic communication deficits under the umbrella term "apragmatism." Methods & Procedures: An international collaborative of researchers with expertise in RHD followed a multilevel approach to consider the utility of apragmatism as a diagnostic label. Adopting the relational approach to concept mapping, the researchers engaged in a series of group meetings to complete four levels of mapping: (1) identify and review, (2) define, (3) expert discussion and (4) label determination. Main Contribution: Apragmatism was established as a suitable diagnostic label for the impairments in communication associated with RHD. The paper offers an operational definition and description of the linguistic, paralinguistic and extralinguistic features of apragmatism through evidence summaries and examples from people with RHD retrieved from the RHDBank. Conclusions & Implications: The adoption of the term apragmatism offers an opportunity to capture the hallmark of RHD communication deficits. The use of the term is recommended when referencing the pragmatic language impairments in this population. Apragmatism, which may co-occur with or be exacerbated by cognitive impairments, can interfere with the ability to interpret and convey intended meaning and impact the lives of right hemisphere stroke survivors and their families.

Background: Cognitive-communication disorders (CCDs) are common in the traumatic brain injury (TBI) population. Despite this, there has been limited research that explores the long-term impacts of reduced cognitive-communication functioning on daily life for this population. Aims: To identify the long-term impacts of cognitive-communication impairment as reported by adults with TBI and their significant others. Methods & Procedures: A qualitative descriptive approach grounded in phenomenology was used. Semi-structured, one-on-one interviews were conducted with adults with CCDs following TBI (n = 16) and their significant others (n = 12) to explore their lived experiences. Outcomes & Results: Reflexive thematic analysis revealed an overarching theme of 'The pervasive and unyielding impacts of cognitive-communication changes on daily life following TBI'. Within this overarching theme, three subthemes were identified: (1) self-awareness of communication changes; (2) fatigue; and (3) self-identity and life roles. Conclusion & Implications: The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on daily life. Health professionals supporting this population should consider ways to reduce the significant impact CCDs have on the lives of adults following TBI and their significant others. In addition, the findings highlight the importance of long-term rehabilitation services following TBI, with further research needed that explores how these services can be optimised.

Background: To meet rising clinical placement demand caused by increasing health student numbers, the use of paired (two students) rather than single (one student) placement models has been proposed. There is, however, limited research available to inform placement providers about the relative effects of both models on healthcare services, including patient- and non-patient-related activities and patient occasions of service. Aims: To investigate a key clinical question: Does clinical educator (supervisor) and student time use differ during paired placements compared with single placements? Also to examine the satisfaction levels of clinical educators (CEs) and students with paired and single clinical placement models. Methods & Procedures: Queensland Health speech and language therapists (N = 44) and speech and language therapy students (N = 32) involved in paired or single clinical placements were recruited for this study. CEs and students completed time-use surveys for 3 days after the midpoint of placements; CEs also completed surveys for 3 matched days during a non-placement period 3 weeks or more following placements for comparative purposes. CEs and students additionally completed a satisfaction survey at the end of placements. Paired and single CE and student groups were compared for differences in their time-use and satisfaction levels using non-parametric statistics. Outcomes & Results: The placement model did not impact on occasions of service provided by CEs (p = 0.931) or students (p = 0.776). It also had no effect on the percentage of time CEs or students engaged in patient-related activities (p = 0.577; 0.291) and non-patient-related activities (p = 0.559; 0.177). On clinical placement days, CEs spent a median 10 minutes longer at work regardless of whether or not it was a paired or single placement, compared with non-placement days (p = 0.107). CEs and students who had been involved in a paired placement reported the same high levels of placement satisfaction (various measures) as those who had been involved in a single placement. Conclusions & Implications: The paired-placement model has the potential to increase student placement offers without negatively impacting on clinical service provision including occasions of service, patient or non-patient-related activities, or overall CE time spent at work.

Background: Cognitive‐communication disorders (CCDs) are common in the traumatic brain injury (TBI) population. Despite this, there has been limited research that explores the long‐term impacts of reduced cognitive‐communication functioning on daily life for this population. Aims: To identify the long‐term impacts of cognitive‐communication impairment as reported by adults with TBI and their significant others. Methods & Procedures: A qualitative descriptive approach grounded in phenomenology was used. Semi‐structured, one‐on‐one interviews were conducted with adults with CCDs following TBI (n = 16) and their significant others (n = 12) to explore their lived experiences. Outcomes & Results: Reflexive thematic analysis revealed an overarching theme of 'The pervasive and unyielding impacts of cognitive‐communication changes on daily life following TBI'. Within this overarching theme, three subthemes were identified: (1) self‐awareness of communication changes; (2) fatigue; and (3) self‐identity and life roles. Conclusion & Implications: The findings from this study highlight the long‐term negative impacts of reduced cognitive‐communication functioning on daily life. Health professionals supporting this population should consider ways to reduce the significant impact CCDs have on the lives of adults following TBI and their significant others. In addition, the findings highlight the importance of long‐term rehabilitation services following TBI, with further research needed that explores how these services can be optimised. What this paper adds: What is already known on this subject: Cognitive‐communication disorders (CCDs) affect the majority of adults who experience moderate to severe traumatic brain injury (TBI) and encompass any component of communication that is affected by cognition. The hallmark characteristic of CCDs are breakdowns that affect social communication skills as well as cognitive‐linguistic deficits. Combined, these can have dramatic implications for a person's quality of life, their level of independence, employment opportunities and social participation. There has been limited research to date that explores the long‐term impacts of CCDs on the lives of adults following TBI. Further research that explores these impacts is needed to improve the support services and rehabilitation models of care available for this population. What this study adds: The overarching theme was 'The pervasive and unyielding impacts of communication changes on daily life following TBI' with subthemes including changed communication, self‐awareness of communication changes, fatigue and self‐identity and life roles. The findings from this study highlight the long‐term negative impacts of reduced cognitive‐communication functioning on everyday functioning and quality of life as well as the importance of long‐term rehabilitation services following TBI. What are the clinical implications of this work?: Speech‐language therapists and other health professionals working with this clinical population should consider how to address the significant and long‐lasting impacts of CCDs. Due to the complex nature of the barriers experienced by this clinical population, an interdisciplinary targeted approach is advised wherever possible when providing rehabilitation services. [ABSTRACT FROM AUTHOR]

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI. Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data. Result: The overarching theme identified was that a "Client-centred and inclusive approach to community-based rehabilitation services" is required. The three subthemes to emerge from the data included the importance of utilising a (1) "flexible service delivery approach", with (2) "meaningful therapy focus", and (3) "collaboration" with multidisciplinary team members and significant others when managing this client group. Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus. [ABSTRACT FROM AUTHOR]

Background: Right hemisphere communication disorders are neither consistently labelled nor adequately defined. Labels associated with right hemisphere brain damage (RHD) are broad and fail to capture the essence of communication challenges needed for stroke‐related service provisions. Determination of rehabilitation needs and best‐practice guidelines for the education, management and functional improvement of communication disorders after RHD are all predicated on an apt diagnostic label and disorder characteristics. Aims: In this paper apragmatism is proposed as a potential communication‐specific diagnostic label for the impairments in communication that occur after RHD. In particular, the researchers aimed: (1) to establish an operational definition of apragmatism; and (2) to describe the linguistic, paralinguistic and extralinguistic communication deficits under the umbrella term apragmatism. Methods & Procedures: An international collaborative of researchers with expertise in RHD followed a multilevel approach to consider the utility of apragmatism as a diagnostic label. Adopting the relational approach to concept mapping, the researchers engaged in a series of group meetings to complete four levels of mapping: (1) identify and review, (2) define, (3) expert discussion and (4) label determination. Main Contribution: Apragmatism was established as a suitable diagnostic label for the impairments in communication associated with RHD. The paper offers an operational definition and description of the linguistic, paralinguistic and extralinguistic features of apragmatism through evidence summaries and examples from people with RHD retrieved from the RHDBank. Conclusions & Implications: The adoption of the term apragmatism offers an opportunity to capture the hallmark of RHD communication deficits. The use of the term is recommended when referencing the pragmatic language impairments in this population. Apragmatism, which may co‐occur with or be exacerbated by cognitive impairments, can interfere with the ability to interpret and convey intended meaning and impact the lives of right hemisphere stroke survivors and their families. What this paper adds: What is already known on the subject: RHD results in a heterogeneous group of deficits that range in cognitive–communicative complexity. Many of the deficits are subsumed under pragmatics. For example, adults with RHD may demonstrate tangential or verbose communication, insensitivity to others' needs and feelings, prosodic changes, minimal gesture use and facial expression, and more. While descriptions of pragmatic impairments pervade the literature, there is no consistently used diagnostic label. The clinical consequences of this absence include difficulty with inter‐ and intra‐disciplinary communication about these patients, difficulty consolidating findings across research studies, and challenges in communicating about these pragmatic changes with patients, families and other stakeholders. What this paper adds to existing knowledge: The term apragmatism is proposed as a diagnostic label to consistently describe pragmatic communication changes after RHD. Apragmatism is characterized using three components of pragmatics: linguistic, paralinguistic and extralinguistic. Descriptions and examples of these three components are provided with supplemental transcripts retrieved from the RHDBank. What are the potential or actual clinical implications of this work?: Adoption of the term apragmatism by speech and language therapists and other medical and rehabilitation professionals has the potential to provide consistency in describing the abilities and challenges experienced by people following a right hemisphere stroke. Such improvements may help drive the development of evidence‐based assessments and treatments for this population. [ABSTRACT FROM AUTHOR]

To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI). An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI. Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others. These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group. [ABSTRACT FROM AUTHOR]

Early recognition of stroke signs and symptoms is critical to ensure people receive the right treatment at the right time. Communication impairment associated with left-hemisphere stroke is easily identifiable due to the recognisable signs of aphasia, whereas signs of cognitive-communication disorder (CCD) after right hemisphere (RH) stroke are often subtler. In contrast to aphasia, no sensitive screening tools exist to allow for early identification of CCD after RH stroke. To prioritise test items required for a screening tool to identify CCD after RH stroke from the perspective of expert speech-language pathologists. The nominal group technique (NGT) was used with expert speech-language pathologists to determine the most important test items required for a screening tool to identify RH CCD. Results were analysed using a quantitative measure of item ranking and inductive content analysis. Five expert speech pathologists located across Australia and the USA, representing a mix of clinicians and researchers participated in the nominal group. The highest ranked test items across the four cognitive-communication domains (lexical semantics, discourse, pragmatics and prosody) were interpretation of sarcasm or humour, rating conversational discourse, a conversational skills checklist, and expressive prosody. Content analysis revealed three themes: Assessment Domains, Considerations in Item Design and Knowledge Gap. The NGT revealed that multiple considerations exist in developing a screening tool for CCD after RH stroke. [ABSTRACT FROM AUTHOR]

Purpose: This article investigated relationship and social network change in the presence of a social cognition impairment post right hemisphere (RH) stroke. Impaired emotion perception and inferential reasoning are sources of interpersonal difficulty in people with social cognition impairment after traumatic brain injury. People with an RH stroke have also been identified as vulnerable to interpersonal relationship change. However, the influence of impairments in particular domains of communication or cognition on relationship and social network maintenance is yet to be explored. Method: A multiple-case study methodology allowed for testing of theoretically developed propositions by exploring social networks and relationships within and between seven participant-proxy dyads. Purposeful recruitment was based on first-onset RH stroke and impaired social cognition, as determined by The Awareness of Social Inference Test. Results: Social network size reduction (71.4%, n = 5) and interpersonal relationship change (85.7%, n = 6) were attributed to altered communication style, impairments in social cognition, and reduced insight and/or motivation. The spouse emerged as a facilitator of social engagement. Conclusion: This study contributes to our understanding of the challenges experienced by people with impaired social cognition post RH stroke in maintaining relationships and their social networks. [ABSTRACT FROM AUTHOR]

Abstract: Background: To meet rising clinical placement demand caused by increasing health student numbers, the use of paired (two students) rather than single (one student) placement models has been proposed. There is, however, limited research available to inform placement providers about the relative effects of both models on healthcare services, including patient‐ and non‐patient‐related activities and patient occasions of service. Aims: To investigate a key clinical question: Does clinical educator (supervisor) and student time use differ during paired placements compared with single placements? Also to examine the satisfaction levels of clinical educators (CEs) and students with paired and single clinical placement models. Methods & Procedures: Queensland Health speech and language therapists (N = 44) and speech and language therapy students (N = 32) involved in paired or single clinical placements were recruited for this study. CEs and students completed time‐use surveys for 3 days after the midpoint of placements; CEs also completed surveys for 3 matched days during a non‐placement period 3 weeks or more following placements for comparative purposes. CEs and students additionally completed a satisfaction survey at the end of placements. Paired and single CE and student groups were compared for differences in their time‐use and satisfaction levels using non‐parametric statistics. Outcomes & Results: The placement model did not impact on occasions of service provided by CEs (p = 0.931) or students (p = 0.776). It also had no effect on the percentage of time CEs or students engaged in patient‐related activities (p = 0.577; 0.291) and non‐patient‐related activities (p = 0.559; 0.177). On clinical placement days, CEs spent a median 10 minutes longer at work regardless of whether or not it was a paired or single placement, compared with non‐placement days (p = 0.107). CEs and students who had been involved in a paired placement reported the same high levels of placement satisfaction (various measures) as those who had been involved in a single placement. Conclusions & Implications: The paired‐placement model has the potential to increase student placement offers without negatively impacting on clinical service provision including occasions of service, patient or non‐patient‐related activities, or overall CE time spent at work. [ABSTRACT FROM AUTHOR]

Background: The ability to return to social activities and roles is an important focus of rehabilitation for people affected by stroke. Rehabilitation professionals currently have limited evidence on the impact of a cognitive-communication disorder (CCD) following right hemispheric (RH) stroke on social participation, and how to support return to social activities and roles. Aims: This study describes (1) social participation change as reported by people with RH stroke; (2) compares social participation change across two groups based on the presence or absence of CCD following RH stroke; and (3) compares self and proxy reports of changes in participation. Methods & Procedures: A telephone survey was conducted with randomly selected people with first onset, unilateral RH stroke, and with matched significant others (proxies). The Sydney Psychosocial Reintegration Scale (SPRS-2) was utilised to explore change associated with stroke across Occupational Activities (OA), Interpersonal Relationships (IR) and Independent Living Skills (LS). Survey responses were compared utilising independent t-tests across two groups based on the presence or absence of CCD. Participant-proxy agreement was established using inter-rater correlation coefficient. Outcomes & Results: Change in social participation was reported for thirty-six participants with an average age of 65.95 years (SD = 13.09), of whom 58.3% were male and 38.9% employed at the time of the stroke. Time post-stroke to completion of the SPRS-2 ranged from six to 33 months. Most participants (94.4%, n = 34) reported change in at least one of the SPRS-2 domains. The presence of CCD had an impact on social participation as measured on the SPRS-2, which was significantly different to what was reported by participants without a communication impairment post-RH stroke (p = 0.02.) Inter-rater agreement statistic (Kappa) indicated a fair participant-proxy dyad agreement in the group with CCD, and a moderate agreement in the group without CCD across the SPRS-2 domains. Conclusions: Changes in social participation following RH stroke occur across Occupational Activities, Interpersonal Relationships and Independent Living Skills for the majority of people and occur with greater frequency and degree where a CCD is present. This exploratory study highlights the importance of rehabilitation goals that address social participation to reduce potential social isolation in people with CCD post-RH stroke. Further identification of risk factors for social participation restriction in this population is required to better inform rehabilitation timing and focus. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined. Objectives:To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment. Methods:A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge. Results:The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge. Conclusions: People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment. [ABSTRACT FROM AUTHOR]