TeleCPT: Delivery of a Better Conversations Approach to Communication Partner Training During a Global Pandemic and Beyond

Purpose: This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice. Method: We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies. Results: Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area. Conclusions: TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT.

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Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators

International Journal of Language & Communication Disorders ◽

10.1111/1460-6984.12421 ◽

2018 ◽

Vol 53 (6) ◽

pp. 1094-1109 ◽

Cited By ~ 11

Author(s):

Huey Fang Chang ◽

Emma Power ◽

Robyn O'Halloran ◽

Abby Foster

Keyword(s):

National Survey ◽

Current Practice ◽

Practice Patterns ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Communication Partner ◽

Communication Partner Training

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Communication partner training in traumatic brain injury: a UK survey of Speech and Language Therapists’ clinical practice

Brain Injury ◽

10.1080/02699052.2020.1763465 ◽

2020 ◽

Vol 34 (7) ◽

pp. 934-944

Author(s):

Nicholas Behn ◽

Jill J. Francis ◽

Emma Power ◽

Ellie Hatch ◽

Katerina Hilari

Keyword(s):

Traumatic Brain Injury ◽

Clinical Practice ◽

Brain Injury ◽

Speech And Language ◽

Communication Partner ◽

Communication Partner Training

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Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

BMC Geriatrics ◽

10.1186/s12877-021-02561-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Volkmer ◽

Aimee Spector ◽

Kate Swinburn ◽

Jason D. Warren ◽

Suzanne Beeke

Keyword(s):

Medical Research ◽

Research Council ◽

Medical Research Council ◽

Primary Progressive Aphasia ◽

Speech And Language ◽

Medical Research Council Framework ◽

Progressive Aphasia ◽

Primary Progressive ◽

Communication Partner ◽

Communication Partner Training

Abstract Background Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia. Methods The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement. Results Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future. Conclusions Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.

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Using the Medical Research Council Framework for the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

10.21203/rs.3.rs-228838/v1 ◽

2021 ◽

Author(s):

Anna Volkmer ◽

Aimee Spector ◽

Kate Swinburn ◽

Jason D. Warren ◽

Suzanne Beeke

Keyword(s):

Focus Groups ◽

Medical Research ◽

Research Council ◽

Medical Research Council ◽

Primary Progressive Aphasia ◽

Speech And Language ◽

Training Materials ◽

Communication Partner ◽

Communication Partner Training ◽

And Training

Abstract Background: Primary Progressive Aphasia (PPA) is a language-led dementia resulting in a gradual dissolution of language. PPA has a significant psychosocial impact on both the person and their families. Speech and language therapy (SLT) is one of the only available management options, and communication partner training (CPT) interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver CPT to people with PPA and their communication partners (CPs) called Better Conversations with PPA (BCPPA). Methods: The BCPPA manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Review of existing literature, 2. Consultation and co-production 3. Development of an initial draft 4. Review by a group of speech and language therapists, using consensus methods 5. Two focus groups to gather opinions of people with PPA and their families 6. Refinement.Results: The BCPPA manual and training program comprises seven modules, and four CPT intervention sessions. Eight important components of CPT were identified in the consensus work undertaken with speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Three themes arose from the focus groups with people with PPA and their families 1) Timing of intervention, 2) speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. Refinements to the manual included additional practice activities and useful strategies for the future. Conclusions: Using the MRC framework to develop an intervention that is underpinned by a theoretical rationale based on a review of the literature, increases the likelihood of behaviour change. Co-development of the manual and training materials ensures the intervention will meet the needs of people with PPA and their CPs. Gathering further data from speech and language therapists and people living with PPA and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.

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Case report: a child with cystic fibrosis and phenylketonuria

Russian Pediatric Journal ◽

10.15690/10.15690/rpj.v1i2.2092 ◽

2020 ◽

Vol 1 (2) ◽

pp. 38-44

Author(s):

Irina V. Vakhlova ◽

Anastasia D. Kazachina ◽

Olga A. Beglyanina

Keyword(s):

Cystic Fibrosis ◽

Case Report ◽

Clinical Practice ◽

Neonatal Screening ◽

Genetic Disorders ◽

Epileptiform Activity ◽

Autism Spectrum ◽

Speech Development ◽

Inherited Disorders ◽

Congenital Diseases

Background. In the international clinical practice there have been occasional reports of phenylketonuria (PKU) and cystic fibrosis (CF) found simultaneously in the same patient. Both PKU and CF are the inherited disorders characterized by autosomal recessive type of inheritance. Currently the combination of two or more inherited disorders in one patient is considered to be a clinical rarity.Case description. This is a clinical case of two genetic disorders, CF and PKU, combined in a 5-year old patient who had been followed up since birth. Owing to implementation of neonatal screening for inherited and congenital diseases into clinical practice, during the first month of life the infant was diagnosed with CF (diagnostically significant elevation of immunoreactive trypsin [IRT] at the initial [163.2 ng/mL] and repeat testing on day 21 of life [138.7 ng/mL]) and PKU (phenylalanine [PA] level 15.9 mg/dL). Both disorders have been confirmed by genetic tests, i.e., homozygous DelF508 mutation was found in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, and P281L mutation in the phenylalanine hydroxylase (PAH) gene was also present in homozygous state. Child’s parents strictly adhered to dietary and treatment recommendations. By the age of 5 years the child developed symptoms of neurological disorder and disorder of the respiratory system, cognitive impairment and delay in speech development, subclinical epileptiform activity with high risk of epilepsy, and chronic inflammation of the respiratory tract.Conclusion. This case report demonstrates the important role of neonatal screening in early diagnosis and timely start of therapy, and underscores the importance of continuous medication in such genetic disorders as CF and PKU. On the whole, such approach brings about a relative preservation of functioning of the most affected organs and systems. By the age of 5 years the child does not form bronchiectases, shows no signs of chronic hypoxia, nutritional deficiency or pronounced neurologic deficit, and is at low risk for the development of autism spectrum disorder. At the same time, the larger scale and longer-term observations are required in order to make the unequivocal conclusions about the prognosis of these diseases under conditions of modern-day medical follow-up.

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Combining paid work and family care for a patient at the end of life at home: insights from a qualitative study among caregivers in the Netherlands

BMC Palliative Care ◽

10.1186/s12904-021-00780-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Femmy M. Bijnsdorp ◽

Bregje D. Onwuteaka-Philipsen ◽

Cécile R.L. Boot ◽

Allard J. van der Beek ◽

Hanna T. Klop ◽

...

Keyword(s):

End Of Life ◽

Family Caregivers ◽

Healthcare Professionals ◽

Family Care ◽

Work And Family ◽

Similar Process ◽

Paid Work ◽

Health And Wellbeing ◽

Care Situation ◽

At Home

Abstract Background Population ageing, an emphasis on home-based care of palliative patients and policies aimed at prolonging participation in the labour market are placing a growing demand on working family caregivers. This study aimed to provide insight into experiences with combining paid work and family care for patients at the end of life, factors facilitating and hindering this combination, and support needs. Method Semi-structured interviews were held between July 2018 and July 2019 with 18 working family caregivers of patients with a life-threatening illness who were living at home. Transcripts were analysed following the principles of thematic analysis. Results Some family caregivers could combine paid work and family care successfully, while this combination was burdensome for others. Family caregivers generally experienced a similar process in which four domains — caregiver characteristics, the care situation, the work situation and the context — influenced their experiences, feelings and needs regarding either the combination of paid work and care or the care situation in itself. In turn, experiences, feelings and needs sometimes affected health and wellbeing, or prompted caregivers to take actions or strategies to improve the situation. Changes in health and wellbeing could affect the situation in the four domains. Good health, flexibility and support at work, support from healthcare professionals and sharing care tasks were important in helping balance work and care responsibilities. Some caregivers felt ‘sandwiched’ between work and care and reported physical or mental health complaints. Conclusions Experiences with combining paid work and family care at the end of life are diverse and depend on several factors. If too many factors are out of balance, family caregivers experience stress and this impacts their health and wellbeing. Family caregivers could be better supported in this by healthcare professionals, employers and local authorities.

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Language Modeling as an Efficacious Early Language Intervention Approach With Young Children Demonstrating Complex Communication Needs

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac18.1.21 ◽

2009 ◽

Vol 18 (1) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Patti Solomon-Rice ◽

Gloria Soto

Keyword(s):

Young Children ◽

Clinical Intervention ◽

Language Modeling ◽

Language Intervention ◽

Evidence Based ◽

Complex Communication Needs ◽

Communication Partner ◽

Aided Aac ◽

Communication Needs ◽

Communication Partner Training

Abstract This article highlights evidence supporting the efficacy of adult language modeling and child imitation, including use of aided AAC modeling, during language intervention with young children demonstrating complex communication needs. First, four evidence-based language intervention approaches that incorporate adult language modeling and child imitation with young children demonstrating language delays are described. Second, two additional evidence-based language intervention approaches that incorporate aided AAC modeling during communication partner training, and direct clinical intervention with young children using aided AAC are further discussed. The article concludes with suggestions for strategies to use during language intervention with young children who use aided AAC.

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Envenomation by neotropical Opisthoglyphous colubrid Thamnodynastes cf. pallidus Linné, 1758 (Serpentes:Colubridae) in Venezuela

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652004000500011 ◽

2004 ◽

Vol 46 (5) ◽

pp. 287-290 ◽

Cited By ~ 8

Author(s):

Fresnel Diaz ◽

Luis F. Navarrete ◽

Jaime Pefaur ◽

Alexis Rodriguez-Acosta

Keyword(s):

Case Report ◽

Marked Improvement ◽

Middle Finger ◽

Snake Bite ◽

Venomous Snake ◽

Left Hand ◽

At Home

This is a case report of a "non-venomous" snake bite in a herpetologist observed at the Sciences Faculty of the Universidad de los Andes (Mérida, Venezuela). The patient was bitten on the middle finger of the left hand, and shows signs of pronounced local manifestations of envenomation such as bleeding from the tooth imprint, swelling and warmth. He was treated with local care, analgesics, and steroids. He was dismissed from the hospital and observed at home during five days with marked improvement of envenomation. The snake was brought to the medical consult and identified as a Thamnodynastes cf. pallidus specimen. This report represents the first T. pallidus accident described in a human.

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Case report of von willebrand disease after tonsillotomy and adenotomy in a child

Russian otorhinolaryngology ◽

10.18692/1810-4800-2021-1-89-92 ◽

2021 ◽

Vol 20 (1) ◽

pp. 89-92

Author(s):

S. S. Makhmudov ◽

◽

A. A. Ochilzoda ◽

F. P. Dzhamolov ◽

A. Z. Mutalibov ◽

...

Keyword(s):

Case Report ◽

Clinical Practice ◽

Surgical Treatment ◽

Clinical Case ◽

Clinical Manifestations ◽

Von Willebrand Disease ◽

Rare Occurrence ◽

Von Willebrand

The authors present a clinical case of von Willebrand disease detected after tonsillotomy and adenotomy in a child. The peculiarity of this observation lies in the rare occurrence of von Willebrand disease in clinical practice, as well as the manifestation of the clinical manifestations of this pathology against the background of surgical treatment in a child.

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