Communication training for paid caregivers of people with traumatic brain injury (TBI)

Abstract

Communication impairments are common following traumatic brain injury (TBI) and affect the ability of a person with TBI to have successful conversations. Ylvisaker, Sellers and Edelman (1998) argue that training to improve the communication skills of an everyday support person would impact on the functioning of a person with TBI. Paid caregivers are often involved to support people with TBI, however, little attention has been focused directly on improving their interaction skills. Therefore, this thesis describes a study conducted to investigate the effect of a communication training program on improving the conversational interactions between paid caregivers and people with TBI. Participants were 10 paid caregivers randomly selected and allocated to either a control or training group. Treatment comprised a 17 hour program (across 6 weeks) that combined collaboration and elaboration conversational strategies (Ylvisaker et al., 1998) with discourse activities (Togher, McDonald, Code, & Grant, 2004). Two conversational interactions (i.e. structured and casual conversations) were videotaped pretraining, posttraining and at 6 months follow-up. The conversations were rated by two independent judges. In addition, focused interviews were conducted pre and posttraining to explore the experiences of trained paid caregivers. Training for paid caregivers improved their structured conversational interactions with people with TBI. Independent raters perceived these interactions to be more appropriate, more rewarding and more interesting compared to a control group. Trained paid caregivers made greater improvements in their ability to acknowledge and reveal the competence of a person with TBI. Improvements were maintained for six months. No significant changes were found for the casual conversational interactions. Findings from the focused interviews revealed that trained paid caregivers reported improvements in their knowledge of effective communicative strategies. This perceived improvement led to interactions reported as more enjoyable and successful and less frustrating. Trained paid caregivers also perceived increased confidence and ability to self-regulate their use of strategies when communicating with people with TBI. Aspects of the training program that were felt to promote or hinder learning were also identified. The findings from this study highlight the importance of training and educating paid caregivers to improve their communication skills. Training can have a significant impact on interactions that involve both paid caregivers and a person with TBI.