Stakeholder views on cognitive communication assessment and intervention for a person living independently in the community with severe traumatic brain injury

Abstract

Background: Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions. Inadequate treatment provision and an under-or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention. Aims: To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap. Methods and Procedures: A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives. Outcomes: Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personalThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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

“…This special issue also provides examples of innovative approaches to intervention and service delivery that meet the needs for flexible and person-centred care. Howell et al (2023) share a case-based example to illustrate the detrimental effects of under-recognition of CCD for people with TBI. 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.…”