Co‐constructed communication therapy for individuals with acquired brain injury: A systematic review

Abstract

BackgroundMeaningful, varied, joyful conversation is an important therapy target for adults with language or cognitive–communication disorders following acquired brain injury (ABI). However, the complexity of daily communication is often reduced to component parts within intervention programmes, with mixed evidence of generalization to everyday conversation. Interventions targeting co‐construction of communication within a dyad offer a structured way in which to retain and treat elements of everyday conversation for individuals and their communication partner (CP). Such interventions exist but they are variably labelled, target different ABI populations and have not been synthesized.AimsTo identify the nature, scope and effects of intervention studies targeting co‐constructed communication in adults with ABI.MethodThis systematic review was completed using PRISMA Guidelines. Six databases (MEDLINE, Embase, CINAHL, Scopus, LLBA, PsychInfo) were searched and 1210 studies were screened. Data were extracted and studies were rated for methodological quality and completeness of reporting. Outcome measures and effects of treatment were collated through descriptive synthesis.Main ContributionThis review highlights an emerging evidence base in relation to an intervention approach that targets everyday communication. Co‐constructed communication interventions have been reported by 13 studies, from a total of 206 participants with post‐stroke aphasia, traumatic brain injury and progressive language impairments. These interventions take a range of formats, including referential communication tasks, retell/recount therapies and communication training programmes. Methodological quality evaluation indicated mostly low‐level study designs. Heterogeneity was identified in primary outcome measures, with 28 unique primary outcome measures reported across studies. Most studies demonstrated change in task‐specific or broad communication outcome measures.ConclusionsCo‐constructed communication interventions may offer clinicians a systematic, protocolized, replicable way to target everyday communication for adults with ABI. More high‐quality, experimental designs with complete reporting and psychometrically sound outcome measures are needed to strengthen the evidence base.What This Paper AddsWhat is already known on this subjectEveryday conversation is an important therapy target for adults with ABI, but there is mixed evidence of therapy gains generalizing to everyday life. Many interventions reduce conversation to component parts such as naming or sentence construction. A different approach is needed to capture the social, dyadic, interactive and multifaceted nature of conversation. We propose the term ‘co‐constructed communication interventions’ as a therapy genre targeting semi‐structured dialogue. These interventions retain elements of everyday conversation (such as multimodal communication and situating tasks within dyads), combined with experimental elements (where stimuli prompt interactions and responses can be scored against normative data).What this paper adds to existing knowledgeThis review proposes and describes a distinct genre of discourse intervention within the current evidence base with a novel operational definition of ‘co‐constructed communication’.What are the potential or actual clinical implications of this work?Co‐constructed communication interventions directly target elements of everyday communication by situating the therapy goals within a dyadic, interactive, multimodal task. A range of intervention tasks have been identified, including collaborative storytelling and problem‐solving. This review will be of interest to clinicians working with adults with ABI; co‐constructed communication interventions may offer a useful, replicable way to target aspects of everyday communication. This synthesis of the current evidence base encourages clinicians’ informed, evidence‐based decisions around these interventions.

Hope as experienced by people with acquired brain injury in a rehabilitation—or recovery process: a qualitative systematic review and thematic synthesis

“…Our review suggests that collaborating with the person on co-constructing a personal narrative holds the potential to support a positive view of identity and to empower persons with aphasia (or other communication difficulties) with new levels of confidence in themselves. This is in line with research within the field of communication disorders, where several studies talk about co-constructed communication as being essential in offering communication partners a way to approach everyday conversation and supporting positive narratives that reaffirm a sense of self ( 91 – 93 ).…”

Towards efficient, ecological assessment of interaction: A scoping review of co‐constructed communication

“…This review represents the first time that co‐constructed communication assessments have been defined and systematically collated within aphasia and cognitive–communication disability literature bases (for a review of co‐constructed communication as a therapy task, see Hall et al., 2023). Unlike traditional assessments, co‐constructed communication assessments are designed to focus on communication as a joint activity (e.g., Barnes & Bloch, 2019; Clark, 1996): meaning is constructed, negotiated and shaped by the active participation of both participants within the dyad.…”

“…Both communication partners play a shared role in the interaction. A separate systematic review has investigated intervention targeting co‐constructed communication (Hall et al., 2023).…”

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

“…They demonstrate that person-centred intervention delivered by an expert interdisciplinary team can maximise participation and capability in real-life contexts, whilst also reducing risks to autonomy and independence resulting from maladaptive communication strategies. Similarly, Hall et al (2022) identify that co-constructing communication interventions with people with ABI and their communication partners may provide opportunities to directly address person-centred priorities for communication, through situating therapy within everyday contexts and addressing goals for meaningful communicative interactions.…”

“…Similarly, Hall et al. (2022) identify that co‐constructing communication interventions with people with ABI and their communication partners may provide opportunities to directly address person‐centred priorities for communication, through situating therapy within everyday contexts and addressing goals for meaningful communicative interactions.…”