title: Community-Based Rehabilitation for Adults with Cognitive-Communication Disorders following Traumatic Brain Injury
Creators: name: Fell, Crystal
Publisher: name: Griffith University
Year: 2024
Subjects: subject: traumatic brain injury (TBI)
subject: cognitive-communication disorders
subject: community-based rehabilitation
subject: speech pathology

description: A traumatic brain injury (TBI) can occur in an instant and, due to the multi-focal nature of the injury, lead to a broad range of negative implications. Communication disorders are common following moderate to severe TBI due to the complex interplay that occurs when impairments affect a person's cognitive, emotional, linguistic, and behavioural skills. Rehabilitation is crucial for this clinical population to remediate their skills and optimise their level of functioning to, where possible, return to previously held life roles. For many, this is a period of 'post-traumatic growth' whereby their values and goals shift to activities and roles vastly different to those they had prior to their injuries (Silva et al., 2011). Community-based rehabilitation (CBR) services play a crucial role in assisting adults following TBI and their support people to maximise their activity and participation in daily activities. Further exploration is required as to how speech pathology services in CBR settings support this population, with the view of enhancing current and future services. The overall objective of this thesis was to (1) explore the processes and practices of speech pathologists when working with adults with cognitive-communication disorders (CCDs) in CBR settings following TBI. In addition, (2) identification of the long-term impacts of CCDs was needed, as well as (3) investigation of the lived experiences and perspectives of adults with CCDs following TBI and their support people when receiving CBR services. The lived experiences and perspectives of key stakeholders based in Australia and New Zealand were explored through a combination of quantitative and qualitative methodologies across four research studies. An explanatory sequential mixed methods design was used to address the first aim, whereby initially quantitative data, followed by qualitative data, were collected and reported in two studies. The first study (Chapter 2) outlines an online survey that was completed by speech pathologists (n = 51) who had experience working with adults with CCD following TBI in CBR settings. One-on-one interviews were then conducted with a smaller group of clinicians (n = 14) and analysed using content analysis. The findings from the study highlighted the need for a flexible service delivery approach, meaningful therapy, and the inclusion of significant others to meet the rehabilitation needs of people in CBR settings following TBI. The key features required to achieve this included utilising a flexible service delivery approach, implementing meaningful therapy, and including support people. Following this study, Chapter 3 highlights more of the qualitative findings from the speech pathologist interviews (n = 14). The overarching theme identified was that a 'client-centred and inclusive approach to community-based rehabilitation services' is required. The three subthemes to emerge from the data included the importance of utilising a (1) flexible service delivery approach, with (2) meaningful therapy focus, and (3) collaboration with multidisciplinary team members and support people when treating this client group. The clinicians in this study highlighted the need for CBR services to include these recommendations whenever possible. The second aim of this research project was addressed by exploring the perspectives of adults with CCD following TBI and their support people (Chapter 4). A qualitative descriptive approach grounded in phenomenology was used whereby one-on-one interviews were conducted with the adults with TBI participant group (n = 16) and the support person group (n = 12). Reflexive thematic analysis revealed an overarching theme: 'The pervasive and unyielding impacts of cognitive-communication changes on daily life following TBI'. Three subthemes were identified and included (1) self-awareness of communication changes, (2) fatigue, and (3) self-identity and life roles. These findings demonstrated the significant and long-term impacts of CCDs and the importance of clinicians working with this population to be aware of the effects on their daily lives. Finally, the lived experiences and perspectives of adults following TBI and support people when receiving CBR services were investigated to address the third aim (Chapter 5). The same participant interviews highlighted in Chapter 4 were used to explore their experiences receiving CBR services. Qualitative data collected from the interviews were analysed using reflexive thematic analysis. Four themes were identified as the core pillars of CBR models of care. They included the importance of (1) accessible and inclusive CBR services, (2) specialised clinical skills and treatment approaches, (3) knowledge is power, and (4) peer networks and support. The participants highlighted the complex needs of this heterogeneous population and emphasised the importance of including these recommendations in future models of care. The findings from this thesis emphasise the importance and ongoing need for high-quality CBR services for adults following TBI. The key stakeholders in this study highlighted the value of individualised management approaches to meet their specific goals and long-term needs. Speech pathologists and other health professionals working with this population should consider how their services can incorporate these recommendations whenever possible. Consideration is also required at a health service level to reduce logistical barriers and funding constraints to enhance CBR services for this clinical population and the people who support them.