An international survey of assessment and treatment practice for discourse in paediatric Acquired Brain Injury

Abstract

Purpose: Guidelines recommend routine discourse assessment and treatment in paediatric acquired brain injury (ABI) but provide little guidance for clinical practice. The degree to which this has influenced the nature of discourse assessment and treatment in clinical practice has not been examined in detail. Method: Speech-language pathologists working in paediatric ABI (clients aged <18 years) in Australia, New Zealand, the UK, the USA, Canada, and the Asia Pacific region were invited to complete a survey of discourse assessment and intervention practices (n=77). Result: Clinicians from Australia and New Zealand comprised over half of a responses (53%). The largest proportion had over 10 years' experience (60%), worked in the metropolitan area (58%), and with secondary school-age children (64%). Routine discourse assessment was undertaken by 80% of respondents, focussing on a limited range of genres. No preferred intervention approach was identified. One-quarter of clinicians routinely considered holistic factors during clinical decision-making. Limited normative data and treatment evidence, insufficient time and training were identified as clinical barriers. Conclusion: Assessment practices were consistent with guidelines, yet interventions were highly variable, reflecting limited evidence, client heterogeneity, time constraints, and limited training. A biopsychosocial approach to practice was evident, yet a focus on impairment level factors was prominent. Findings support the need for standardised discourse assessment and discourse intervention methods. Translation into practice guidelines would promote consistency and confidence in clinical practice.

How do speech–language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice

“…These factors, alongside the small sample size mean the findings may not accurately represent the practices and opinions of SLPs working with a TBI caseload. Our survey sample size is similar to a recent survey of practice with paediatric TBI ( n = 77) (Hill et al., 2022), but smaller than Riedeman and Turkstra's (2018) survey of knowledge, confidence and practice patterns with TBI ( n = 100). Our response rate on practice with TBI discourse was lower than previous studies on discourse practice with post‐stroke aphasia (e.g., Cruice et al., 2020; Stark et al., 2021) ( n = 211 and 189, respectively).…”

“…This survey investigated SLPs’ practice with assessment methods and materials, analysis and treatment of spoken discourse. While previous SLP surveys have reported on discourse as part of investigation into cognitive communication management more broadly after TBI (e.g., Frith et al., 2014; Riedeman & Turkstra, 2018; Steel et al., 2013), or within a paediatric population (Hill et al., 2022), the current research provides the first detailed reporting on spoken discourse management with adults with TBI. Our sample size of 70 participants limits generalization of results, but findings from this survey add to the existing knowledge of post‐TBI discourse practice and provide information that can be used to inform future clinical and research guidelines.…”

Culture, Mindset and Functionality in Regional Organisations – A Study on ASEAN and the European Union

“…One way to assess the performance of ASEAN as an RO, as it seeks to promote developmental improvement through economic growth, social progress, and cultural development among its member states, is to use the concept of pragmatics. While pragmatism is concerned with the ability of an agency to undertake practical tasks, pragmatics enhances the concept by referring to the agency's ability to cope in its behaviour with complexity, uncertainty, and change in its environment [272]. Successful pragmatics can be measured by applying the criteria of development evaluation [273,274], which considers the relationship between agency intervention and the context of that intervention, and can be used to determine the meaning and value of such intervention [272].…”

“…While pragmatism is concerned with the ability of an agency to undertake practical tasks, pragmatics enhances the concept by referring to the agency's ability to cope in its behaviour with complexity, uncertainty, and change in its environment [272]. Successful pragmatics can be measured by applying the criteria of development evaluation [273,274], which considers the relationship between agency intervention and the context of that intervention, and can be used to determine the meaning and value of such intervention [272]. The criteria are: relevance, effectiveness, efficiency, sustainability, and impact.…”

“…Efficacy can be seen as a precondition for effectiveness, efficiency, sustainability, and impact, assuming relevance, as well as a criterion for evaluating the quality and value of the intervention (cf. [272]). This is so since efficacy refers to how well the intervention is attainable and feasible, given the constraints and opportunities of a context.…”