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JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
us, the experience and clinical expertise of SLPs working
within BIRUs may be utilised to help develop a knowledge
base. The purpose of this study was to begin to investigate
current service delivery practices of SLPs working within
BIRUs in Australia, with a focus on identifying types of
intervention provided by SLPs, as well as investigating how
SLPs provide their services within BIRUs. This research
grew from a SLP quality activity and benchmarking project
within a BIRU service, responding to a clinical service need
to identify service delivery and therapeutic intervention
practices within other BIRUs, to assist in reviewing and
maximising BIRU SLP services.
Methods
This study had ethical clearance from the Queensland
Health Metro South Human Research Ethics Committee.
Participants
Participants were SLP teams or services (n = 8) within
dedicated adult inpatient/sub-acute BIRUs within Australia.
Individual SLPs working within BIRUs were identified by the
investigator from online databases (e.g., professional and
health service websites), previous benchmarking contacts,
SLP brain injury interest groups, phone and email contacts.
SLPs that identified their service provided other service
delivery models for adult brain injury rehabilitation (e.g.,
acute/critical care; outpatient, community or transition
services, vocational services) were excluded.
Of the ten BIRU centres identified, SLPs from eight
centres participated in this study. This included seven
BIRUs and one inpatient rehabilitation centre that identified
itself as providing significant statewide service to adults with
brain injury, but was not an exclusive brain injury service.
The centres included private and publically funded units
from five states across Australia.
Procedure
SLPs who had been identified as working within Australian
BIRUs were contacted via email and/or telephone and
invited to participate in a survey regarding their SLP team’s
service delivery practices in BIRU. SLPs approached from
all ten units agreed to participate in the survey, and were
sent the survey electronically (via email), with one response
from each unit requested. Reminder emails to participants
were utilised to maximise the response rate. SLPs from
eight units returned completed responses and consented
to participate in this research. Surveys were completed by a
member of the BIRU SLP team; respondents included both
clinicians and managers who reported on the practice of
their SLP team. Survey responses were returned
electronically or mailed in hard copy and were identifiable to
the investigator; results were de-identified for reporting.
Instrument/Measure
The survey was designed to investigate a range of aspects
of clinical service delivery of SLPs in BIRUs, and record and
reflect the responses of the SLP team working within each
BIRU (not those of the individual therapist). Survey
questions were designed to incorporate aspects of service
delivery and clinical practice reported in international SLP
brain injury guidelines and service documents (ASHA, 2004;
RCSLT, 2006), and were influenced by Brougham et al.’s
(2011) study into SLP therapy practice in inpatient
rehabilitation in adult spinal cord injury rehabilitation.
SLP practice in brain injury
rehabilitation
Within Australia, national professional guidelines do not
exist to govern speech-language pathology (SLP) clinical
practice within ABI/TBI rehabilitation. Consequently, clinical
practice and “best practice” guidelines from international
colleagues help guide SLP practice in Australian BIRUs
(Academy of Neurologic Communication Disorders and
Sciences [ANCDS], 2013; American Speech-Language-
Hearing Association [ASHA], 2004; ASHA, n.d.a; ASHA,
n.d.b; Katz et al., 2002; Royal College of Speech Language
Therapists [RCSLT], 2006; Ylvisaker, Hanks & Johnson-
Greene, 2003). While these guidelines provide direction for
SLP service provision during rehabilitation for adults with
ABI/TBI, including assessment, goals and types of inter
ventions, they are not specific to the Australian health system.
Overall, there is limited research internationally regarding
specific SLP rehabilitation practice and service delivery during
sub-acute brain injury rehabilitation; information regarding
types of interventions utilised by SLPs during this timeframe
is scarce. One multidisciplinary study from the Traumatic
Brain Injury Models System (TBIMS) into rehabilitation
outcomes and therapy intensity in TBI investigated the
service delivery practices of allied health staff (including
SLPs) in three brain injury specific rehabilitation centres over
a seven year period (Cifu, Kreutzer, Kolakowsky-Hayner,
Marwitz & Englander, 2003). Cifu et al. (2003) identified that
94% of all patients accessed SLP services, and that the
average intensity of SLP services was 35 minutes per day
(including direct and indirect patient contact times);
however, specific aspects of service delivery including types
of therapeutic interventions and prioritisation methods were
not reported. More recently, Steel, Ferguson, Spencer and
Togher (2013) have investigated the clinical practice of
Australian SLPs in early (inpatient) TBI rehabilitation. This
study, however, focused primarily on SLP assessment of
patients with cognitive-communication disorders during
post traumatic amnesia, rather than general service
provision, and was not specific to sub-acute rehabilitation.
Specific recommendations are available for evidence-
based SLP interventions in ABI/TBI, including cognitive-
communication disorders, cognition and executive
functioning interventions (Cicerone et al., 2011; Cullen et
al., 2011; MacDonald & Wiseman-Hakes, 2010; Welch-
West, Ferri, Aubut & Teasell, 2011). This research, however,
tends to encompass patients beyond the sub-acute phase
of rehabilitation (i.e., patients who are further along in their
recovery and participating in therapy at an outpatient or day
hospital setting). The validity and clinical efficacy of utilising
these interventions has not been formally investigated
within the inpatient setting. This is not surprising, given the
challenges of investigating therapy interventions during the
“spontaneous recovery” timeframe.
With health services increasingly under pressure to
deliver efficient, evidence-based and cost-effective services,
there is a need begin to identify those interventions and
practices that provide the best rehabilitation outcomes for
patients during sub-acute rehabilitation. Before research
into the effectiveness of specific treatments within a BIRU
setting can occur, information regarding current service
delivery models and clinical practice activities needs to be
known. While formal studies are currently unable to guide
Anna Copley
(top) and Emma
Finch
