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2011 Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK

2011 Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK. Linda Jones and Claire Layfield (Group Co-Leaders) Lyndsey Nickels - Academic Member Presented by Linda Jones and Lauren Kovesy. Communication partner training for people with aphasia.

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2011 Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK

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  1. 2011Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK Linda Jones and Claire Layfield (Group Co-Leaders) Lyndsey Nickels - Academic Member Presented by Linda Jones and Lauren Kovesy

  2. Communication partner training for people with aphasia Systematic review by Simmons-Mackie, Raymer, Armstrong, Holland and Cherney defined communication partner training as “an intervention directed at people other than the person with aphasia with the intent of improving the language, communication, participation, and/or wellbeing of the person with aphasia.”

  3. BACKGROUND TO CLINICAL QUESTION In developing this years clinical questions • 1) The group read and discussed a recent systematic review on the topic • (Simmons-Mackie et al 2010) • 2) Considered feedback from a Local Area Clinical Network Project • Questions arose around specific implementation and most appropriate candidates for this type of treatment

  4. CLINICAL QUESTIONS 2011 1. Which communication partner training methods are effective in facilitating communication activities and participation for people with aphasia? AND 2. Which patient and/or communication partner characteristics lead to better outcomes in communication partner training?

  5. 2011 CAPS • Initial searching by the group found 37 articles • From these 14 were believed to answer one or both of the clinical questions

  6. 2011 CAT Development • 1) Group • Mix of experienced and new members • Buddy system for CAPS • CAPS completed and peer reviewed by pair with mixed levels of experience • Also involved group in development of CAT • From CAPS group members optionally completed a table of key features from which the final CAT was developed

  7. 2011 CAT Development • 2) Qualitative Research • Qualitative research uses data-gathering techniques that are focussed on observations made in a study rather than the raw numbers themselves • The aim is a complete, detailed description NOT a statistical analysis of a pool of group data. • Results are often subjective – uses participant observation, in-depth interviews, and focus groups as methodology • This approach is very different to interpret from previous topics which have generally used more quantitative methods

  8. The Evidence: Intervention • Variability in service delivery model • Participants • Individual clinician + dyad • Group of Dyads • Group of communication partners • Frequency and duration of therapy • x14 1hr weekly therapy sessions with individual dyad of PWA and carer • x1hr/week 12 weeks for 5 dyads • 4 week support program, 6 week conversation partner training program, 2hrs each session facilitated by x2 SPs and clinical psychologist

  9. The Evidence: Intervention • Variability in intervention content • Some studies involved providing individual feedback regarding communication breakdowns and facilitative strategies (direct therapy) • from video recordings of conversations • during actual interactions • during role-play activities • Some studies had a more educational focus (indirect)

  10. The Evidence: Measurement • Variability in measurement outcomes • Functional measures • Psycho-social measures • Conversation analysis/video analysis • Informal participant surveys/ratings • Majority of articles report immediate post treatment outcomes

  11. The Evidence: Participants • Variability in both PWA and communication partners • Relatives/carers vs. volunteers • No correlation between treatment efficacy and • Type of aphasia • Severity of aphasia • Time post onset • Relationship with communication partner

  12. The Evidence: Overall Results • All studies CAPed reported positive outcomes for PWA on at least one of the following dimensions • Impairment • Activity • Participation • However, it is difficult to confidently draw conclusions about best practice due to: • the qualitative nature of the studies • methodological weaknesses in study designs • variability in treatment styles

  13. Applying these results to clinical practice • Communication partner training • appears to facilitate more successful communicative exchanges • can increase participation and confidence for PWA • What remains unclear is: • the most effective way to train communication partners (group vs. individual, frequency, content) • whether these techniques are more beneficial than other therapy techniques • usefulness for varied clinical populations (incl. acute patients, CALD, PPA)

  14. Future Research • Research investigating • communication partner training in group vs individual settings • outcomes from acute and chronic phases of therapy • which aspects of the training are essential • communication partner training techniques vs other techniques (which is controlled for therapy intensity) • would all be helpful to determine the extent and nature of the therapy benefits reported in the literature to date.

  15. Questions……..

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