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Purpose: Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation., Materials and Methods: Nine professionals from different health and technology disciplines participated in an online focus group or individual online interview to evaluate the application and use of the VR prototype. Data sources were analysed using a content thematic analysis., Results: Four main themes relating to VR design and implementation in rehabilitation were identified: (i) designing rehabilitation-focused virtual worlds; (ii) understanding and using VR hardware; (iii) making room for VR in rehabilitation and training; and (iv) implementing VR will not replace the health professional's role., Discussion: Health professionals and technology specialists engaged in co-design while evaluating the VR prototype. They identified software features requiring careful consideration to ensure improved usability, client safety, and success in communication rehabilitation outcomes. Continuing inclusive co-design, engaging health professionals, clients with communication disability, and their families will be essential to creating useable VR applications and integrating these successfully into rehabilitation. Implications for rehabilitationHealth and technology professionals, along with clients, are integral to the co-design of new VR technology applications.Design of VR applications needs to consider the client's communication, physical, cognitive, sensory, psychosocial, and emotional needs for greater usability of these programs.Realism and authenticity of interactions, characters, and environments are considered important factors to allow users to be fully immersed in virtual simulations to enhance rehabilitation.

Objective: This study aims to explore health professionals' perceived benefits of implementing Communication Partner Training (CPT) using Supported Conversation for Adults with Aphasia (SCA™) in a subacute rehabilitation setting with patients in post-traumatic confusional state (PTCS) after TBI., Method: The study was conducted in a clinical setting using a pre-post questionnaire design to explore change. One hundred and four interdisciplinary clinicians attended CPT in the SCA™ method and subsequent implementation support. Participants completed a questionnaire with both quantitative and qualitative questions before and after the training and implementation period. Data were analyzed using descriptive and inferential statistics and qualitative content analysis., Results: Participants' perceived confidence and self-assessed ability to communicate with patients in PTCS significantly increased after CPT (p = 0.006). While participants still experienced communication challenges, they reported using CPT-related tools and strategies in their interactions. Participants found they could apply strategies to improve patients' comprehension of information and to confirm their understanding of patients' communication. However, using strategies to enhance patients' expressive abilities was perceived as more challenging., Conclusions: Training health professionals in CPT increase their confidence in managing communication with patients in PTCS. Further research is needed to evaluate the efficacy of CPT within a more rigorous research design.

Objective: To investigate current speech pathology practice regarding working with friends., Method: An online survey was conducted with 68 speech pathologists who worked with TBI across metropolitan and rural settings in Australia. The survey investigated the reasons speech pathologists work with friends, barriers to working with friends and perceptions of successful friendships post TBI. Descriptive statistics and content analysis of open ended responses were used to analyze the data., Results: There were more speech pathologists (40%) who did not include friends compared to those who did. Friends were most commonly included in the rehabilitation process, through the provision of education programs. The primary rationale for working with friends was to prevent negative psychosocial outcomes for the person with TBI. There were numerous barriers to working with friends, most commonly the inability to access friends., Conclusions: Making and keeping friends are a significant part of most people's lives. Therefore, it is important to consider their role in contributing to improved outcomes for people with TBI. With communication partner training being an integral component to recovery and maintenance of relationships post TBI, the development of targeted education and training materials is warranted, to enable the inclusion of friends in the rehabilitation process.

Primary Objective: To explore the clinical practice of communication partner training by Speech and Language Therapists for people with traumatic brain injury in the UK., Study Design: Online 97-item survey which addressed the practice of training both familiar and unfamiliar communication partners, and barriers and facilitators to implementation informed by the Theoretical Domains Framework., Participants: 169 Speech and Language Therapists from private and public settings in the UK., Results: While 96% reported training familiar communication partners, only 58% reported training unfamiliar communication partners. Therapists reported providing communication partner training consistent with best practice 43% of the time. Evidence-based published programmes were used by 13.8% and 19.9% of participants for training familiar and unfamiliar partners, respectively. Therapists reported using outcomes for familiar and unfamiliar communication partners 83% and 78% of the time. The most frequently reported barrier was lack of behavioral regulation (e.g., planning). Most frequent perceived facilitators were clinicians wanting to deliver communication partner training and that training was part of therapists' professional role (social professional role and identity)., Conclusions: Therapists were motivated to deliver communication partner training but reduced capability affected implementation. Further support to clinicians on outcome measurement with materials to develop workplace systems to monitor implementation is needed.

Objective : People in Post-Traumatic Confusional State (PTCS) present with communication difficulties that are well described in literature. However, limited study has been conducted on the experiences of their communication partners. The current study aimed to understand the experience of rehabilitation staff of their communication with patients in PTCS prior to communication partner training (CPT). Methods : Staff on a subacute inpatient TBI rehabilitation unit were invited to complete a 10-item questionnaire. The questionnaire contained quantitative and open-ended text response formats, analyzed with descriptive statistics and content analysis, respectively. Results : 78 interdisciplinary staff members completed the questionnaire. The majority of staff found communication to be difficult and time-consuming with half not feeling comfortable communicating with patients in PTCS. Confidence in communication was not associated with length of clinical experience. The majority of staff reported utilizing strategies to support communication, largely focused on augmenting activities with supportive objects and ensuring patient's comprehension through modification of verbal language. Conclusions : Staff are aware of the need for creating a structured environment for patients in PTCS and less aware of communication-specific strategies aiming at helping patients' expression, which underlines the need to emphasize these strategies as part of CPT in this type of setting.

Primary Objective : To investigate the nature and patterns of narrative discourse impairment in people with severe Traumatic Brain Injury (TBI) during early recovery. Methods and Procedures : A single image picture description task was administered to 42 participants with severe TBI at 3 and 6-months post-injury. The same task was administered to 37 control participants. Discourse samples were analyzed with measures of productivity, informativeness and story organization. The performance of people with TBI was compared with the control group at both 3 and 6 months, and the performance of the participants with TBI was also compared across the two time points. Individual patterns of performance were also examined. Results : Inferential analyses revealed significant differences between the control group and the group with TBI on informativeness at both time points and  number of complete episodes at 3 months, but no significant differences for productivity measures. There was no significant change for the group with TBI between 3 and 6 months. However, individual improvement over time was observed. Conclusions : People with TBI have discourse difficulties early post TBI that are also present at 6-months post-injury. In order to understand longer-term discourse recovery, it is necessary to examine participant patterns over further time points on this narrative task.

Purpose: To explore the views of people with motor neurone disease (MND) on the barriers, facilitators and potential benefits of using home-based e-Health service delivery (telehealth) to access MND multidisciplinary clinic care. Methods: Twelve patients from three MND multidisciplinary clinics and an MND support association group completed a survey of information technology (IT) use and participated in interviews, to gather participants' experiences and perceptions of home-based telehealth for MND clinic care. Survey data were analyzed descriptively, with interview data analyzed using a stepwise inductive approach. Results: Surveys revealed that participants used IT to communicate with family and friends, but were less likely to use the phone, email or videoconferencing with health professionals. Two themes of participants' use of IT in MND care reflected their experiences of MND care; and personal preferences for modes of healthcare delivery. Participants were willing to use telehealth for MND care, with family members acting as patients' main support for telehealth participation. Nevertheless, participants preferred face-to-face contact with the MND clinic team in the initial and early stages of the disease. Conclusions: People living with MND may wish to participate in individual care planning to facilitate their access to a variety of e-Health service modalities. Additionally, individual care planning may allow healthcare professionals to deliver e-Health-based care, such as telehealth, to increase the scope of care provided. Research to ascertain the views of health professionals and family members as co-participants in service delivery via telehealth is needed to fully assess the potential contribution of e-Health. Implications for Rehabilitation People living with MND face a range of barriers to attending specialized multidisciplinary care, including fatigue, caregiver availability and logistical challenges to travel. Patients have indicated willingness to use e-Health applications to improve their access to care. Use of telehealth could expand service delivery to people with MND living long distances from multidisciplinary clinics, and increase the patient-centred focus of care by tailoring care planning. By offering telehealth services routinely, MND multidisciplinary clinics could also improve the quality and timelines of services offered.

Primary Objective: To investigate whether the degree of participation by people with severe Traumatic Brain Injury (TBI), and the degree of support by their communication partners (CPs) changes in conversation during subacute recovery., Methods and Procedures: Seventeen pairs of participants with TBI and their CPs were video-recorded during a 10 min casual conversation at 3 and 6 months post-injury. Communication behaviors were rated using the adapted Measure of Participation in Conversation (MPC) and the adapted Measure of Support in Conversation (MSC) at both time points and compared., Results: Inferential analyses showed that there was no significant change in the degree of participation in conversation by participants with TBI and the degree of conversation support by their CPs from 3 to 6 months post. Comparison of qualitative field notes revealed that specific conversational behaviors changed over time, including better turn-taking and topic maintenance., Conclusion: Documenting early communication recovery is a complex and challenging endeavor. The lack of change in conversational effectiveness during the sub-acute period using global rating scales highlights the need for social communication tools that are sensitive to communication recovery following severe TBI.

Objectives: Although much is known about discourse impairment, little is known about discourse recovery after severe traumatic brain injury (TBI). This paper explores discourse recovery across the critical first year, controlling for pre-injury, injury and post-injury variables., Design and Methods: An inception cohort comprising 57 participants with severe TBI was examined at 3, 6, 9 and 12 months post-injury and compared to a cross-section of matched healthy control participants. A narrative discourse task was analyzed with main concept analysis (MCA). A mixed linear model approach was used to track recovery controlling for pre-injury, injury and post-injury variables., Results: An upward trajectory of recovery was observed, with peak periods of improvement between 3-6 and 9-12 months and all time points were significantly below controls. Years of education and PTA duration were significant covariates in the recovery model. Presence of aphasia also influenced the recovery model., Conclusions: Individuals with TBI typically improve over the first year, however many will continue to have discourse deficits at 12 months. Years of education, PTA duration and aphasia should be considered when planning services. The 3-6- and 9-12-month periods may offer optimal periods for discourse recovery and increased supports may be beneficial between 6-9 months.

Primary objective: To investigate use of telehealth to deliver social communication skills training (TBIconneCT) to people with severe traumatic brain injury (TBI) and their communication partners (CPs). Research design: Feasibility study involving single case experimental design with two participants. Methods and procedures: TBI Express is an established program for improving social interactions between people with TBI and their CPs. To improve access to the program, we developed a modified version called TBIconneCT that can be delivered via videoconferencing. Two participants with TBI and their CPs completed TBIconneCT training. Outcome measures included exchange structure analysis of conversation samples, blinded ratings of conversation samples and self-report measures. Main outcomes and results: The study indicated positive change on blinded ratings of conversation and self-reported measures for both participants. Exchange structure analysis conducted on session-by-session data did not demonstrate treatment effects due to variability during baseline. Conclusion: This study indicated potential for using telehealth to provide social communication skills training to people with TBI and their families. The study findings provide a foundation for a phase one clinical trial which will compare in-person with videoconferencing delivery of TBIconneCT.

Objective: Cognitive-communication deficits after severe Traumatic Brain Injury (TBI) may contribute to poor psychosocial functioning, however, the possible nature of this relationship remains unclear and warrants investigation. The current study explored the variance and correlations of a measure of cognitive-communication with a measure of psychosocial outcome in adults 12 months following TBI., Method: 36 adults with severe TBI evaluated at 12 months post-injury. Cognitive-communication skills were evaluated with the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES), Sydney Psychosocial Reintegration Scale-2 (SPRS-2) Form A - Informant version assessed psychosocial functioning. Multiple regression analyses were used to investigate association between cognitive-communication and psychosocial outcomes., Results: Two measures of cognitive-communication assessment (Accuracy and Rationale of the FAVRES) contributed significantly to total psychosocial outcome (SPRS-2). Multiple regression analyses revealed these variables accounted for 29.1% of the variance. Cognitive-communication variables accounted for 24.0% and 28.6% of the Work/Leisure and Relationship domains of the SPRS-2., Conclusion: Cognitive-communication ability was significantly related to psychosocial functioning at 12 months post-TBI. Findings suggested continued speech pathology involvement in the post-acute stages of recovery may improve social, vocational and overall psychosocial functioning. The FAVRES is a promising cognitive-communication assessment for identification of treatable factors impacting psychosocial outcomes.

Background: There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults., Methods and Procedures: In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed., Main Outcomes and Results: No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery., Conclusions: Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase.

Objective(s): This study aims to determine the association between cognitive impairment and functional verbal reasoning in adults with severe traumatic brain injury (TBI), at six months post-injury., Method(s): 38 participants with severe TBI were assessed using the four tasks on the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) [1] and a battery of neuropsychological tests at 6 months post injury in a cross-sectional observational study., Results: Overall performance on the FAVRES [1] was strongly associated with overall performance on the neuropsychological battery (rho = 0.60). FAVRES Task 2 and FAVRES Task 4 had the most significant positive associations with the cognitive indices of Attention and speed of processing, Memory and Executive functions. There was one weak significant association between the Task 1 Accuracy score and the Total Cognitive index (rho = 0.46)., Conclusions: Performance on the FAVRES [1] is positively associated with cognitive processes. Participants with stronger verbal reasoning skills which may be required for activities in work, home and social contexts also had higher scores on tests of cognitive functioning. These findings may inform clinical practices for speech pathologists and other health professionals, in the assessment and treatment of cognitive communication disorders during early stages of recovery in people with severe TBI.

Primary Objective: To investigate the nature and patterns of conversational topics discussed by individuals with severe TBI and familiar communication partners at 3 and 6 months post-injury, and to examine changes occurring in conversational topics during sub-acute recovery., Research Design: Qualitative content analysis was used to explore the nature of topics and generate conversational themes. Topic analysis provided an understanding of conversational topic management by identifying patterns of topic initiation and maintenance., Methods: Twenty-two people with severe TBI and a familiar communication partner engaged in a 10-minute casual conversation on self-selected topics at 3 and 6 months post-injury., Main Outcomes and Results: Three main conversational themes were identified: connecting; re-engaging; and impacts of injury. The nature of topics related to these themes changed over time to reflect participants' sub-acute rehabilitation experiences. Most conversational dyads maintained similar conversational and topic patterns during sub-acute recovery., Conclusions: Qualitative analysis provides a new insight into the conversational topics of individuals with severe TBI. Many participants engaged in appropriate conversations and discussed mutually important topics with familiar communication partners. Findings may inform speech-language pathology intervention in sub-acute recovery to improve conversational discourse abilities of individuals with severe TBI and support their communication partners.

Purpose: To determine the impact of a communication training programme by exploring the experiences of paid carers who attended the programme in a residential rehabilitation centre for people with traumatic brain injury (TBI)., Method: Five paid carers attended a communication training programme which comprised 17 hours (across 8 weeks). Semi-structured interviews were conducted pre- and post-training. Analysis used a generic procedure with constant comparative analysis to identify categories across and within interview transcripts., Results: Paid carers described improved knowledge and use of strategies, improved communication, positive emotional experiences and barriers and facilitators to consider for future communication training programmes., Conclusion: Training communication skills of paid carers in a residential rehabilitation centre had a positive impact on their conversations with people with TBI. These positive changes support quantitative findings for the effectiveness of communication training.

Purpose: To determine test-re-test reliability of the 'Computer User Profile' (CUP) in people with and without TBI., Method: The CUP was administered on two occasions to people with and without TBI. The CUP investigated the nature and frequency of participants' computer and Internet use. Intra-class correlation coefficients and kappa coefficients were conducted to measure reliability of individual CUP items. Descriptive statistics were used to summarize content of responses., Results: Sixteen adults with TBI and 40 adults without TBI were included in the study. All participants were reliable in reporting demographic information, frequency of social communication and leisure activities and computer/Internet habits and usage. Adults with TBI were reliable in 77% of their responses to survey items. Adults without TBI were reliable in 88% of their responses to survey items., Conclusions: The CUP was practical and valuable in capturing information about social, leisure, communication and computer/Internet habits of people with and without TBI. Adults without TBI scored more items with satisfactory reliability overall in their surveys. Future studies may include larger samples and could also include an exploration of how people with/without TBI use other digital communication technologies. This may provide further information on determining technology readiness for people with TBI in therapy programmes.

Primary Objective: To describe conversational discourse change after joint communication training for individuals with TBI and their everyday communication partners (ECPs), as compared to untrained controls., Hypothesis: Joint training would lead to significantly greater changes in the discourse behaviour of trained participants., Methods and Procedures: In this multi-centre non-randomized controlled trial, 29 participants with severe TBI and their ECPs were allocated to either the JOINT training or CONTROL group. Social communication training aimed to train ECPs to better support their partner with TBI to produce more effective conversations. Pre- and post-training casual conversations were compared using exchange structure analysis (ESA) and productivity analysis., Results: ESA and productivity analysis revealed significant change in the use of testing moves by trained ECPs and significant change in productivity by trained participants with TBI. ESA facilitated development of discourse profiles (excessive or impoverished) for participants with TBI, which distinguished the groups at baseline., Conclusions: This study extends one's understanding of individual discourse styles in people with TBI. The impact of different discourse styles on group outcome studies has been highlighted. These discourse findings may facilitate goal-setting in social skills intervention after TBI, with focus on training ECPs to support people with TBI in conversations.

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.

Primary Objective: To investigate casual conversations with friends following severe traumatic brain injury (TBI)., Methods: Nine participants with severe TBI were matched by age, gender and education to nine control participants. Each participant also invited a friend to partake in the study. Participants were recorded engaging in a brief casual conversation with a friend. The resulting discourse was analysed using Exchange Structure Analysis (ESA). Rates of information giving, information requesting and communication repair and negotiation were collated. Non-parametric statistical analyses were performed., Results: Participants with and without TBI obtained similar rates of information giving and information requesting. The friends of the participants with TBI produced significantly lower rates of information giving measures when compared to the controls, but achieved comparable rates of information requesting and communication repair and negotiation measures. Participants with TBI were observed to produce tangential language and to have difficulties identifying communication breakdown, asking questions and engaging in conversational joking., Conclusions: People with TBI are able to engage in casual conversations with friends in a similar way to matched controls. Friends of people with TBI are often restricted in contributing information in conversations. Further research is needed to specify the facilitative and restrictive communication behaviours so that they may be translated to clinical practise.

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.

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.

Purpose: To systematically review literature and electronic resources that address the topic of chatroom use of teenagers with and without traumatic brain injury (TBI)., Method: Electronic databases and websites on the Internet were searched up to and including 25 June 2009, using terms relating to chatroom use of teenagers without and with TBI. A separate search was conducted on speechBITETM (www.speechbite.com ), using fields specific to target area, intervention and population. Literature and websites were included if they contained target search terms and were relevant to the topic of chatroom use of teenagers., Results: A total of 46 sources from database searches and 66 websites from Internet searches were included in this systematic review. Most database sources were level IV evidence studies and mainly addressed chatroom and Internet use of typically-developing teenagers. Websites contained many brain injury information pages and links to chatrooms, as well as references to journal articles and books concerning chatroom use., Conclusions: Due to the lack of literature in the area of chatroom use of teenagers with TBI, there is potential to expand on existing literature and Internet resources to enable teenagers with TBI to access, participate and use this forum for social interaction and meaningful communication with peers.