›Rewarding and important part of our social interactions
›Maintains and develops close relationships
›Solve problems
›Work out personal issues
›Share our history
›Make sense of the present
›Plan for the future
Conversation
› Caused by a blow to the head or by the head being forced to move rapidly forward or backward, usually with some loss of consciousness
› Brain damage arises from being torn, stretched, penetrated, bruised and swelling can make the injury worse
› Alcohol associated with up to
half of all cases of TBI
› Car accidents, falls, assaults
sporting accidents
Traumatic brain injury
Most common in males aged 15-35 years and in people >75 yrs
In 2008, the total cost of TBI in Australia was $8.6 billion (Access Economics 2009)
Incidence and cost
Medical difficulties
Changes in physical and sensory abilities
Changes in the ability to think and learn
Changes in behaviour and personality
Communication difficulties
Conversational skill difficulties
Slurred speech
Word finding difficulties
Consequences of TBI
Family strain, emotional distress, caregiver burden, and social isolation
A study of 273 caregivers across six Traumatic Brain Injury Centers in the USA, found that one-third of caregivers are at risk for depression, anxiety, or other forms of psychological distress
A main source of stress is difficulty communicating with the person with TBI
Impact on family
8
Families can affect communication outcomes
Early work compared people with brain injury and their brothers without TBI interacting with a range of communication partners
Communication partners had significant positive and negative effects for person with TBI
- Negative effects: asking questions repeatedly, testing questions, not knowing what to do, talking to them like a teacher
- Suggestion: change communication partner behaviours and therefore provide an environment for people with TBI to communicate appropriately
› Participants were allocated to one of 3 groups:
1. Communication partner + person with TBI
2. Person with TBI alone
3. Delayed treatment – control group
› 44 participants with TBI (38 males, 6 females)
Average age = 36 years (range=18-68)
Average education = 12 years (range=7-20)
Average time post injury = 8 years (range=1-25)
Average PTA = 83.15 days (range=6-182)
NHMRC funded clinical trial (Togher, McDonald, Tate, Power and Rietdijk)
10
Everyday communication partners
44 communication partners of person with TBI
Mean age = 50 years (range = 17-79)
Mean education = 13 years (range = 9-19)
80% were female
80% knew the person before the TBI
The majority were partners or parents, however siblings and friends also participated in the study
TBI Express Conversational skills training program
Group of 4-5 people with TBI & their communication partners
2.5 hr weekly group sessions (+ morning tea/social break)
1 hour weekly individual sessions for each pair
10 week program, with assessment of conversation before, immediately after and 6 months after treatment finished
TBI Express is available at
www.assbi.com from
ASSBI Resources
Collaborative
›Shares information
›Confirms partner’s contributions
›Shows enthusiasm
›Communicates respect
›Questions in a non demanding, supportive way
X Non collaborative
›Demands information
›Talks like a teacher
›Lack of enthusiasm
›Corrects the person
›Fails to acknowledge difficulties
›Quiz like questions
Being collaborative when planning a barbecue
Person with TBI says: “I want to have my BBQ at home”
Less collaborative
partner:
“No. We can’t have a big barbecue in our unit,
we’ll have it at a community centre”.
More collaborative
partner:
It would be nice to have the BBQ at home.
I was thinking though, we’ve got lots of people
coming and our place is pretty small…(see if
this cues an alternative)…
“Let’s think of bigger places we could have it”.
› I am going to help you organise and extend your thinking
›Elaboration of topics: I want to keep things going
›Elaborative organisation: I’ll help organise the conversation so we can talk in more detail
Elaboration
Elaborative
› Introduce topics of interest
› Add information to help develop topics
› Organises information
› Makes connections when topics change
› Reviews what has been said
X Non elaborative
› Introduces topics which are not interesting to the person
›Changes topic frequently
›Fails to make connections from one day to the next
Question asking
Good questions
›Open ended
›True questions
- About events where you were not present
- Feelings
- Opinions
X Poor questions
›Closed
›Testing, quiz like
- Question asker already knows the answer
- Testing performance, memory
›Yes!!
After treatment there were significant treatment effects found for
those who attended communication partner training
Person with TBI was judged to have better interactional skills
Communication partners improved in their ability to help the
person with TBI communicate effectively
Conversations were rated as being more rewarding, less effortful
and more interesting
Did the treatment work?
›Yes !!
Effect was maintained at 6 month follow up
i.e., The communication partner training group
improved relative to the other two groups
(Togher et al., 2012, 2013)
And was it maintained over time?
Non collaborative behaviours › Giving him too many options without allowing him enough time to think
about the choices
› Asking him to rely on his memory without giving cues
› Testing his memory rather than helping the conversation to be interesting
or enjoyable
› Correcting him in a punishing manner while making his errors obvious
rather than giving a natural conversational response
› Talking to him like a teacher, including praising his ability to remember in a
condescending way
› Lecturing him on correct behaviour rather than showing understanding
› Taking a leadership role in conversation and stating her own plans rather
than allowing him to contribute.
Collaborative behaviours › Asks questions that include information which help him remember rather
than putting pressure on him to remember
› Gives cues in a conversational manner
› Gives correct information conversationally and connects his incorrect information to the correct answer to make his error less obvious
› She contributes her opinions so that they are sharing equally in the conversation
› Invites him to share his opinions without putting pressure on him
› Acknowledges his opinion even though she may not agree
› She communicates respect for his concerns
› She makes a suggestion about going to the shops but leaves it open for him to agree or disagree
› She guides him to organize his thinking and make a plan
28
Summary
Training communication partners was more efficacious than
training the person with TBI alone
Communication training for families led to improved
engagement in social activities, increased independence for
some people with brain injury
Provided the first link in re-establishing the social network of
the person with TBI
Training everyday communication partners is an important
complementary treatment for people with TBI and their families
to facilitate and promote improved communication outcome
Telehealth – Assessment
and treatment using Skype
(Rachael Rietdijk)
Trialing the use of TBI Express
with people in outer urban, rural and remote areas
(Seeding funding from the Institute of Safety Compensation and Recovery Research (VIC)
Where to from here?
We are currently conducting a clinical trial of
communication partner based training: Comparing
Skype with in-person training
Participants need to:
• Be at least 6 months post-TBI
• Have significant social
communication problems
• Have a communication partner
• Have a computer with Internet
connection at home
• CONTACT:
We are excluding participants who:
• Require an interpreter
• Are unable to participate in conversation (severe aphasia)
• Are unintelligible in conversation (severe dysarthria)
• Are unable to provide informed consent (severe amnesia)
• Have current drug or alcohol addiction or active psychosis
›Recovery after TBI can extend beyond 2 years
›Brain plasticity: rewiring of the brain occurs with repetition of specific tasks which are meaningful
›Treatment intensity is needed to create structural brain changes –practice practice practice
›Positive motivation and realistic goal setting are essential to success
Successful conversation is essential to all aspects of daily life and we can all improve our skills
Some take home messages
Top Related