A qualitative exploration of speech–language pathologists’ approaches in treating spoken discourse post‐traumatic brain injury

Abstract

BackgroundSpoken discourse impairments post‐traumatic brain injury (TBI) are well‐documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech–language pathologist (SLP) is recommended for adults with discourse impairments post‐TBI, with an emphasis on context‐sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice.AimsTo explore the under‐researched area of clinical practice for spoken discourse interventions with adults post‐TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base.Methods & ProceduresParticipants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi‐structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach.Outcomes & Results:Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight‐building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client‐specific factors and rationales prioritized tailored, context‐sensitive and goal‐directed treatment.Conclusions & ImplicationsThis study provided insight into a previously under‐researched area. It highlighted a wide range of treatment activities and factors informing current SLPs’ treatment of spoken discourse impairment post‐TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post‐TBI, from initial assessment to outcome measurement, may help inform clinical decision‐making and the transfer of research to practice.WHAT THIS PAPER ADDSWhat is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post‐TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision‐making for discourse interventions post‐TBI are limited.What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post‐TBI. It details the factors that influence clinical decision‐making for this caseload and identifies an emphasis on client priorities and the value of clinician experience.What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context‐sensitive discourse intervention post‐TBI. It indicates the need for an in‐depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience.

It's a changing landscape: Complexity and innovation in cognitive‐communication rehabilitation for people with acquired brain injury (ABI)

“…Steel et al (2022) observed some markers of success in translation of evidence-based approaches to management of discourse after TBI, with most of the surveyed clinicians in their study reporting the use of discourse-level tasks in communication assessment, and an individualised goal-based approach to intervention. Hoffman et al (2023) similarly found the interviewed clinicians in their study employed evidence-based principles when targeting discourse after TBI, such as contextsensitive treatment, using group service delivery and communication partner training, and tailoring to individual client needs. The findings of these two studies (Hoffman et al, 2023;Steel et al, 2022) (Togher et al, 2023).…”

“…Hoffman et al (2023) similarly found the interviewed clinicians in their study employed evidence-based principles when targeting discourse after TBI, such as contextsensitive treatment, using group service delivery and communication partner training, and tailoring to individual client needs. The findings of these two studies (Hoffman et al, 2023;Steel et al, 2022) (Togher et al, 2023). There is also an audit tool to assist clinicians and managers to monitor guidance adherence via clinical file audits.…”