Communication between rehabilitation staff and people with traumatic brain injury: Barriers, facilitators, and implications for the development of communication partner training intervention

This dissertation aims to identify challenges and supportive strategies in the communication between rehabilitation staff and people with cognitive-communication disorders following traumatic brain injury (TBI) and to analyze the implication of the identified challenges and strategies for the development of communication partner training (CPT) interventions. The dissertation consists of four studies.

Study I was a systematic review of 31 papers reporting on the communication between rehabilitation staff and people with TBI. The main finding of the review was that the extent to which the cognitive-communicative disorders of people with TBI caused challenges in the communicative interaction, was closely related to staff’s communicative approach. Thus, in interactions where staff took an acknowledging approach and used supportive communication strategies, fewer communicative challenges were identified. In Study II, 22 rehabilitation staff members and 4 managers were interviewed to explore their experiences of communication with people with TBI. Staff experienced socially inappropriate communicative behaviors in people with TBI (e.g. verbosity) as challenging the communicative interaction and causing negative emotional reactions in staff, e.g. powerlessness and frustration. However, these challenges were perceived differently depending on staff’s discipline, tasks, and work setting, and staff, who did not adapt their own communication found the interaction with people with TBI notably more demanding. In Study III, nine individuals with TBI were interviewed to explore their experiences when communicating with rehabilitation staff. The main finding of this study was that people with TBI experienced a lack of participation in communication regarding their rehabilitation (e.g. daily planning and goal setting) and a lack of recognition of their individual communication needs and interests. However, staff’s use of acknowledging and supportive communication strategies was perceived to reduce these challenges. Study IV was a content analysis synthesizing the findings from Study I, II, and III and identifying the communicative behaviors of staff that may either challenge or support communication. Furthermore, the study mapped the identified behaviors and the behaviors targeted in exiting CPT programs to underlying theoretical domains and compared these behaviors. The main finding of this study was that the communicative behaviors targeted by existing CPT programs did not fully cover the specific behaviors identified in the content analysis.

Overall, this dissertation concludes that the cognitive-communication disorders in people with TBI challenge the interaction between rehabilitation staff and people with TBI. However, challenges also arise due to problems in the communicative collaboration when the behavior of staff becomes a barrier to successful interaction, e.g. when staff do not use supportive communication strategies. Staff’s communicative behavior may be changed trough CPT, but for the intervention to be effective as well as successfully implemented, it must be tailored to the specific communication challenges taking place between staff and people with TBI in the rehabilitation context.

Nærværende afhandling har til formål at identificere udfordringer og understøttende strategier i kommunikationen mellem rehabiliteringspersonale og personer med kognitive kommunikationsforstyrrelser som følge af traumatisk hjerneskade (TBI) og at analysere de identificerede udfordringer og strategiers betydning for udviklingen af samtalepartnertræning (CPT). Afhandlingen består af fire studier.

Studie I var et systematisk review af 31 artikler, der omhandlede kommunikationen mellem rehabiliteringspersonale og personer med TBI. Studiets primære fund var, at det omfang, hvormed de kognitive kommunikationsforstyrrelser hos personer med TBI forårsagede udfordringer i den kommunikative interaktion, var tæt forbundet med personalets kommunikative tilgang. I interaktioner, hvor personalet havde en anerkendende tilgang og anvendte understøttende kommunikationsstrategier, var der således færre kommunikative udfordringer. I Studie II blev 22 personaler og 4 ledere interviewet for at undersøge deres oplevelser af kommunikationen med personer med TBI. Personalet oplevede, at socialt uhensigtsmæssig kommunikativ adfærd hos personer med TBI (fx overdreven talestrøm) var en udfordring i interaktionen og en årsag til negative følelsesmæssige reaktioner hos personalet fx afmagt og frustration. Udfordringerne blev imidlertid oplevet forskelligt afhængigt af bl.a. profession og opgaver, og personale, der ikke tilpassede deres egen kommunikation, fandt interaktionen med personer med TBI betydeligt mere krævende. I Studie III blev ni personer med TBI interviewet for at undersøge deres oplevelser af kommunikationen med personale. Deltagerne oplevede dels manglende deltagelse i kommunikationen med personalet om eksempelvis daglig planlægning og målsætning og dels en manglende anerkendelse fra personalet af deres individuelle kommunikationsbehov og interesser. Disse udfordringer kunne reduceres ved, at personalet anvendte bestemte typer af kommunikations-strategier. Studie IV var en indholdsanalyse med en syntese af resultaterne fra studie I, II og III og en identifikation af personalets kommunikative adfærd som henholdsvis udfordrende eller støttende for kommunikationen. Desuden kategoriserede studiet den identificerede adfærd og måladfærden i allerede eksisterende CPT-programmer i forhold til underliggende teoretiske domæner for at sammenligne de to typer af adfærd. Studiet fandt, at den kommunikative måladfærd i eksisterende CPT-programmer, ikke fuldt ud dækkede den specifikke adfærd, der blev identificeret i analysen.

Overordnet konkluderer denne afhandling, at de kognitive kommunikationsforstyrrelser hos personer med TBI udfordrer interaktionen mellem disse personer og rehabiliteringspersonale. Der opstår dog også udfordringer grundet problemer i det kommunikative samarbejde, hvor personalets adfærd kan blive en barriere for vellykket interaktion, fx når de ikke anvender understøttende kommunikationsstrategier. For at et CPT-program har potentiale til at ændre personalets adfærd effektivt og samtidig blive vellykket implementeret, skal det skræddersyes til de specifikke kommunikative udfordringer, der finder sted i kommunikationen mellem personale og personer med TBI i rehabiliteringen.