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Working with families
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ACQ
Volume 12, Number 2 2010
ACQ
uiring knowledge in speech, language and hearing
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,
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
Leanne Togher
(top) and
Emma Power
Keywords
cognitive-
communication
deficits
communication
partner
training
families
rehabilitation
program
traumatic brain
injury (TBI)
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