ACQ Vol 12 No 2 2010

30 / 52

84 ACQ Volume 12, Number 2 2010 ACQuiring knowledge in speech, language and hearing
Kasey Metcalf, the staff from Westmead Brain Injury Unit,
particularly Dr Kathy McCarthy, Dr Alex Walker and Anna
Jones, Dr Ian Baguley, Dr Joe Gurka and Rod Gilroy, and the
staff at the Royal Rehabilitation Centre Sydney Brain Injury
Unit, especially Audrey McCarry and Dr Clayton King, and
the private speech pathologist, Gaye Murrills.
References
Coelho, C. A. (2007). Management of discourse deficits
following traumatic brain injury: Progress, caveats, and
needs. Seminars in Speech & Language, 28(2), 122–135.
Dahlberg, C. A., Cusick, C. P., Hawley, L. A., Newman,
J. K., Morey, C. E., Harrison-Felix, C. L., et al. (2007).
Treatment efficacy of social communication skills training
after traumatic brain injury: A randomized treatment and
deferred treatment controlled trial. Archives of Physical
Medicine and Rehabilitation, 88(12), 1561–1573.
Flanagan, S., McDonald, S., & Togher, L. (1995).
Evaluating social skills following traumatic brain injury: The
BRISS as a clinical tool. Brain Injury , 9 (4), 321–338.
Togher, L., & Grant, S. (1998). Community policing: A
training program for police in how to communicate with
people with traumatic brain injury. Unpublished manuscript.
Togher, L., Hand, L., & Code, C. (1997). Analysing
discourse in the traumatic brain injury population:telephone
interactions with different communication partners. Brain
Injury, 11(3), 169–189.
Togher, L., McDonald, S., Tate, R., Power, E., & Rietdijk, R.
(2009). Training communication partners of people with TBI:
Reporting the protocol for a clinical trial. Brain Impairment ,
10(2), 188–204.
Ylvisaker, M., Feeney, T. J., & Urbanczyk, B. (1993).
Developing a positive communication culture for
rehabilitation: Communication training for staff and family
members. In C. J. Durgin, N. D. Schmidt, & L. J. Fryer (Eds.),
Staff development and clinical intervention in brain injury
rehabilitation (pp. 57–81). Gaithersburg, MD: Aspen.
Ylvisaker, M., Sellars, C., & Edelman, L. (1998).
Rehabilitation after traumatic brain injury in preschoolers.
In M. Ylvisaker (Ed.), Traumatic brain injury rehabilitation.
Children and adolescents (pp. 303–329). Newton, MA:
Butterworth-Heinemann.
are too frequently affected following the injury. This area
requires further study and consideration, and it is hoped that
the development of practical clinical tools may assist
clinicians in more easily in their clinical practice working with
families, friends and others in the social network of the
person with TBI.
Acknowledgements
We would like to thank all our participants in this study, the
staff from Liverpool Brain Injury Unit, particularly Dr Grahame
Simpson, Dr Adeline Hodgkinson, Manal Nasreddine, and
Box B. Messages for communication partners
1. Approach conversations with the goal of collaborating with each
other to reach a common understanding or decision. Conversations
need a balance of asking questions, listening and understanding,
and sharing information about your own ideas and experiences.
Participant: “I realised I just asked questions all the time like
‘Did you enjoy the holiday, and what did we do?’. Now I use
comments and give her time to spark her own memory. I say,’
“It was a great holiday, my favourite day was the zoo and the
white tiger, he was amazing’. When I give her a little bit of
information she can build on it.”
2. Use conversations as a way of introducing new and more complex
information and ideas (elaboration). People with traumatic brain
injury may have a limited range of topics they can talk about.
By talking about new topics in daily conversations, people with
TBI can expand their knowledge of the world and have more
interesting things to talk about with other people.
One of our participants found that by introducing her son to
other topics in the world and exploring those more, he was
able to provide many opinions she thought he wasn’t capable
of expressing. He also reduced the amount of time he spent on
the same topic and subsequently, also the frustration his family
experienced with his repetition.
3. Use thinking supports as part of daily conversations. For example,
make reference to a diary when planning for the future, look back
at photos when talking about past events, use a written organiser
with headings (e.g. who, what, where, when) when talking about
planning for an event.
Rather than saying “no, we can’t have the BBQ here, there’s too
many people, we’ll have it at a community centre”, use helpful
“conversational guides” that encourage the person with TBI to
think it through in collaboration. For example, “now I’m thinking
we’ve got a lot of people coming, our place is pretty small [see
if this triggers a response] … let’s think of bigger places we
could have it ...[wait for response]”.
4. Avoid asking questions to which you already know the answer.
Instead, try to use real questions which explore ideas, feelings
and opinions. This creates a more natural, adult conversation and
gives more confidence to the person with TBI in front of others.
One participant said: “He went to the movies and I knew what
he saw. Before the course I would have asked him, did he
remember what it was called and who went with him. How
boring! Now I ask him, what was the best bit of the movie, or
did he prefer the other Die Hard movies or this one, how were
they different? It’s amazing what he remembers then. It’s not
perfect but wouldn’t you rather talk about that … I would!”
5. Give specific, positive feedback when you have a successful
conversation with the person with TBI, or when you notice the
person having a successful conversation with someone else.
For example: “It was great talking about the news this evening,
you’re giving me more detail about your opinions, and I enjoy
the chat.”
Associate Professor Leanne Togher is a speech pathologist and
NH&MRC senior research fellow at the Faculty of Health Sciences,
University of Sydney. Her research interests include the training
communication partners of people with acquired neurogenic
communication disorders. Dr Emma Power is a speech pathologist
and research associate at the Faculty of Health Sciences, University
of Sydney, Australia. She is the project manager and senior clinician
for the TBI express clinical trial. Professor Skye McDonald
is a neuropsychologist and professor & director of the Masters
(Clinical) Psychology Program at the School of Psychology, UNSW.
Professor Robyn Tate is a neuropsychologist and professor at
the Rehabilitation Studies Unit, Northern Clinical School, Faculty
of Medicine, University of Sydney, and Royal Rehabilitation Centre
Sydney. Ms Rachael Rietdijk is a speech pathologist and the TBI
express clinical trial research clinician.
Correspondence to:
Associate Professor Leanne Togher PhD
Speech Pathology, Faculty of Health Sciences, University of Sydney
PO Box 170, Lidcombe NSW 1825 Australia
phone: +61 2 9351 9639
fax: 61 2 9351 9163
email: