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

Abstract

BackgroundSpoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse‐level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech–language pathologists (SLPs) assess and treat discourse after TBI.AimsTo investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations.Methods & ProceduresThis online survey consisted of 30 questions on SLPs’ practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision‐making. Participants were recruited through national and international SLP professional bodies, TBI‐specific or SLP special‐interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses.Outcomes & ResultsThere were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self‐monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings.Conclusions & ImplicationsOverall, survey respondents’ management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal‐based approach. Factors affecting the use of discourse in practice included client‐specific factors and needs, availability of time for transcription and analysis, and SLPs’ knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision‐making for SLPs working in TBI.WHAT THIS PAPER ADDSWhat is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically.What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents’ practice was generally aligned with recommendations, featuring individualized, goal‐based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors.What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI‐specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice.

Assessment of spoken discourse in patients with a TBI in acute settings

“…Discourse protocols are arguably the most cost-and time-efficient way for SLTs who lack confidence and knowledge to learn how to administer and analyse discourse assessment. Steel et al (2022) found SLTs working in acute setting with patients with TBI reported assessing and treating spoken discourse less often than their colleagues working in inpatient and community settings. Several SLTs explained why they choose not to assess spoken discourse.…”

“…Finally, Steel et al (2022) found that a low number of SLTs reported using discourse protocols such as the Curtin University Discourse Protocol, Mediated Discourse Elicitation Protocol, and TBIBank protocol to assess patients (p. 14). They suggested this may be due to limited knowledge about available protocols, a lack of available training, and the additional time needed to learn and administer the assessment could be a deterrent for SLTs.…”

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

“…This special issue also highlights the importance of translating evidence-based assessment and intervention approaches from research contexts to application in clinical practice. 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.…”

“…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.…”

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

“…However, they also identified a gap in knowledge in relation to how this dynamic relationship presents within current clinical practice. A recent SLP survey of clinical practice explored discourse assessment and treatment approaches (Steel et al., 2022). With regard to treatment, this study reported that clinical practice primarily targeted client self‐monitoring, social skills or conversational interactions, and that practice varied according to client and clinician‐specific factors (Steel et al., 2022).…”