ACQ Vol 12 No 2 2010

Working with families

Clinical insights TBI express: A communication training program for everyday communication partners of people with TBI Leanne Togher, Emma Power, Skye McDonald, Robyn Tate, and Rachael Rietdijk

Traumatic brain injury (TBI) can result in social communication breakdown that affects the person with TBI and their communication partners, especially their families. While we have shown that we can train people with TBI to have better social interactions, training programs to provide conversation-based communication strategies for communication partners of people with TBI have been non- existent. In this article, we introduce a partner- centered approach to communication training and describe our 10 week program. We outline our current treatment study and provide general communication strategies that can be the basis for more enjoyable and effective conversations. Why involve communication partners? The communication difficulties experienced by people with traumatic brain injury (TBI) have been a research focus for some members of our team for many years (Flanagan, McDonald, & Togher, 1995; Togher, Hand, & Code, 1997). People with TBI can have seeming disinterest in conversations, and an inability to generate and maintain topics. Alternatively, they may interrupt frequently, make disinhibited, inappropriate responses, or swear and get stuck on the same topics (Coelho, 2007). These frustrating and disturbing communicative behaviours are difficult to manage, particularly when in a community setting such as a shopping centre or at a social function. However, the person with communication difficulties represents only one side of the interaction. The behaviour of their conversational partner is also important. Indeed, it has been found that individuals with TBI are often disadvantaged in interactions because of the way their communication partners interact with them (Togher et al., 1997). In one study of telephone conversations, participants with TBI were asked to find out information from a range of communication partners, including therapists, their mothers, police officers and call centre service providers. For example, they asked the therapists about their current treatment goals, and they asked their mothers about their weekly program of activities. The matched control participants were brothers of the people with TBI. The results suggested that the individuals with TBI were asked for and were given less information than matched control participants (Togher et al., 1997). Therapists

and mothers never asked people with TBI questions to which they did not already know the answer. Participants with TBI were more frequently questioned regarding the accuracy of their contributions and their contributions were followed up less often than the adults without TBI. The results from this research also revealed that communication partners sometimes used patronising comments, flat voice tone and slowed speech production and therefore compromised an adult interactional style. The difficulty for communication partners is that they do not know how to deal with challenging communication behaviours and have not received training in this area. Changes in their communication style and interaction may be largely unconscious and may have developed over an extended period of time since the actual injury. However, research has demonstrated that when communication partners are provided with training (e.g., police officer trained on telephone service requests), partners can implement communication strategies that appear to enable the person with TBI to engage in more appropriate and successful interactions. If communication partners’ behaviours can positively and negatively affect how a person with brain injury communicates, and training the communication partner may benefit the person with TBI’s conversations, then it seems essential that training programs be developed to assist everyday communication partners, such as family and friends, in supporting people with TBIs. However, to date, no studies have investigated training everyday communication partners of people with TBI. The communication partner training program The innovative aspect of this training is that it focuses upon on the communication partner, providing education and training to improve their ability to successfully interact with the person with TBI. We have previously identified common communication problems in the interaction between staff, families and others in the community and people with TBI that can be targeted for training. Specifically, training uses a combination of approaches arising from programs we have previously developed (e.g., Togher & Grant, 1998) and also from the work of Dr Mark Ylvisaker from Albany, NY, USA. Ylvisaker advocates that specific scaffolding conversational strategies such as helping the person with TBI to elaborate and collaborate in the interaction can facilitate communication, cognitive and social recovery in people with TBI (Ylvisaker, Feeney, & Urbanczyk, 1993; Ylvisaker, Sellars, & Edelman, 1998). The communication partner training program is divided into 10 modules run over 10 weeks (Togher, McDonald, Tate,

Keywords cognitive- communication deficits communication partner training families rehabilitation program traumatic brain injury (TBI)

Leanne Togher (top) and Emma Power

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ACQ Volume 12, Number 2 2010

ACQ uiring knowledge in speech, language and hearing