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JCPSLP
Volume 17, Number 2 2015
Journal of Clinical Practice in Speech-Language Pathology
That was a bit traumatic but I couldn’t do anything
about it anyway, so I just let it be” (Thomas, PWTBI), and
in general PWTBI or their SO reported the need to actively
seek out information on TBI, associated communication
impairments, and available rehabilitative services
independently, due to a perception that the information
provided by the speech pathologist was insufficient, biased
or confusing. To do so, they reported employing strategies
of personal networks, the internet, or other professionals.
As Mary reported: “I started googling, mainly because
we couldn’t get information, it was really hard getting
information. We were in limbo as to how we proceeded”
(Mary, SO).
When information was received participants reported
feeling confused and overwhelmed by the content,
relevance, and/or differing opinions of the professionals
providing the information. As Mitchell describes:
There was a group run by the neuropsychologist
and she was very good. But again, that was totally
voluntary, no one actually forces you to listen to this,
you work it out for yourself pretty much. It’s sorting
the chaff from the wheat. It’s all very confusing for
everyone involved. I mean, I didn’t know anyone who
had a brain injury and my family didn’t either so we
had no idea. All of my injuries or all of my problems
we’ve discovered since and obviously some people
in hospital have very set ideas on things.
(Mitchell,
PWTBI)
Future directions and clinical
implications
This study highlights facilitators and barriers to optimum
access and utilisation of SLP services for PWTBI in
Australia. The small sample size is acknowledged, and data
from this study should be interpreted as a preliminary
investigation into the perceptions of SLP service users. In
particular, it should be noted that all PWTBI included in this
study were male, and SOs were female. Participants
received services within two Australian states within the
past 15 years. Given that much has changed in the field of
rehabilitation during this time, a comparison of therapeutic
approaches and practice guidelines across this period may
be warranted. In addition, perceptions of service may differ
for individuals in other states, of different gender, of varying
severity levels, and those currently receiving SLP services
within Australia.
The parallels between service user experiences and
current recommendations for best practice are striking.
Participants highlighted key aspects associated with
perceptions of SLP services in concert with the literature,
including equity in access and utilisation of services; use
of a holistic, multidisciplinary, person-centred approach to
management; and the benefits of providing individuals and
their significant others with timely, accurate, non-biased,
and appropriate information. Crucial to satisfaction and
positive outcomes was a strong, collaborative clinician–
client relationship. These findings warrant investigation on
a larger scale, preferably of a prospective nature in order to
capture current practice of SLPs within Australia, and how
this relates to service users’ perceptions of care.
Acknowledgements
This research received no specific grant from any funding
agency, commercial or not-for-profit sectors.
Dimension 2: Alignment of intervention
with goals
While all participants remarked that they considered speech
therapy to be a beneficial component of their rehabilitation
and would recommend it to others in the future, not all
participants were satisfied with the intervention approaches
chosen by clinicians. In general, participants reported a
preference for functional activities, clearly aligned with
attaining relevant goals. “The most beneficial was doing a
lot of the return to work therapy” (Gordon, PWTBI).
Flexibility in approach, appropriate choice of task
difficulty, and speed of progression were reported to
influence clinician–client relationships, and impact
perception of overall standard of care.
I was put in front of a computer doing quizzes which
were testing my vocabulary and recall which I didn’t
have too much trouble with. It was essentially a
waste of time. I think the worst score I got was 8 out
of 10 but usually 9 or 10 out of 10. That went on for
months and months and I was like, what am I doing? It
seemed pretty stupid to me. I’ve a feeling the speechie
[SLP] didn’t realise that I was actually a semi-intelligent
sort of guy.
(Mitchell, PWTBI)
Communication between members of the
multidisciplinary team was also reported to influence
participant experience. When reflecting on care received
in the hospital system, Mitchell (PWTBI) stated: “I’m not
sure they work together as such, it was kind of like Chinese
whispers but I’m sure they had their way”. A similar theme
was reported by Gordon (PWTBI) who described his care
as being “Very subdivided, you see a psychologist and then
you see a speech pathologist and the speech pathologist
didn’t touch one ounce on the cognitive issues that I had”.
Dimension 3: Involvement of family members
Involvement of family members in rehabilitation is known to
positively impact quality of life, with support from significant
others recognised to form a key environmental factor in the
World Health Organisation’s International Classification of
Functioning – Disability and Health (WHO, 2011). Indeed,
inclusive communication with the family or primary caregiver
is considered essential when providing services to an
individual with a TBI (Forster et al., 2012). However, in the
course of this study, little evidence was found to show
families had been included in rehabilitation by an SLP. This
was perceived by participants as impeding quality of care,
demonstrating little concern of the impact of TBI on the
family, and inadequate recognition of their potential to assist
in the recovery process. Mitchell (PWTBI) stated: “I’ll say
that they [Mitchell’s family] came to one or two sessions
over the course of a year as an outpatient. The hospital?
No, not at all. Totally closed door”. Similarly, Mary (SO)
reported “My significant other and I were supposed to have
a meeting in the hospital with the doctors and the speech
pathologist and the physio [physiotherapist], but that never
ever happened”.
Theme 3: Searching for information
In line with previous research (O’Callaghan, McAllister, &
Wilson. 2012), participants reported deficits in the amount,
timing, and appropriateness of information provided by the
health care team to have a negative impact on their
perception of support and engagement in therapy. Lack of
information of possible symptoms resulted in undue anxiety
and distress in some cases, “My speech was … the TBI
had affected it. My talking sounds very different now.