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.

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

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.

Collaborative storytelling with a person with aphasia

Introduction: This study explores practices employed by a person with aphasia (PWA) and his wife to organize collaborative storytelling in a multiparty interaction. We identify practices that further the PWA’s agency – his impact on action – while he is telling a story together with his wife. Method: Using conversation analysis (CA), we carried out a case study of a successful storytelling sequence involving a 39-year-old man with anomic aphasia during a conversation with friends. Analysis: The PWA contributed to the storytelling by initiating the story sequence and by producing short but significant utterances in which he provided essential information and displayed epistemic authority. The spouse aligned with the PWA’s initiated actions and supported his agency by giving him room to speak, for example, by gaze retraction. Discussion: The analysis offers insight into practices that allowed this PWA to achieve agency. Our findings show that communication partner training could benefit from implementing activities such as collaborative storytelling.

Exploring the usability of the andragogical process model for learning for designing, delivering and evaluating a workplace communication partner training

Purpose This study aims to explore the usability of the andragogical process model for learning to develop, deliver and evaluate training to improve communication between adapted transport drivers and people living with communication disabilities and to identify the successes and limitations of the model in this context. Design/methodology/approach Two aspects were considered to explore the usability of the andragogical process model for learning: a comparison between the elements of the model and the designing, delivering and evaluating processes of the training; and an appreciation evaluation. Findings The model was useful to systematically design, deliver and evaluate workplace training that was appreciated by the learners, even though most of the model’s elements were modified to meet the constraints of the trainer and the organization. Assessing the needs for learning, establishing a human climate conducive to learning and choosing appropriate training methods emerged as key elements that contributed to a successful appreciation of this training. Originality/value This study is one of the few that examines the possibility of a systematic application of the andragogical process model for learning to workplace training. Its results suggest that the model could be considered for application by non-professional trainers or external trainers from a workplace, but that organizational constraints must be considered when using it.

Yutesler_Faroqi-Shah

Background: Communication partners (CP) of persons with aphasia (PWA), such as their family members and significant others, need to adjust their communication patterns to accommodate the challenges of aphasia. They may choose to simplify their language or use more gestures to accommodate the language deficits of the PWA. Other behaviors, such as interruptions, corrections or showing frustration, could be deleterious to effective communication. Knowledge of communication behaviors of CPs and their attitudes towards communication is important for intervention planning. Prior research has shown that CP behaviors can be modified with intensive (7 hours or more) of communication partner training (CPT).Aims: The first aim of this study was to investigate patterns of communication behaviors exhibited by CPs of PWA. The second aim was to examine CPs attitudes towards communicating with PWA. Finally, this study examined the effect of a half-day training workshop on CP communication behaviors. Methods & Procedures: Eleven CP-PWA dyads participated in a training workshop that focused on identification and practice of facilitating, barrier and repair behaviors. A Caregiver Attitude Survey was administered. Ten minute semi-structured conversations between the CP and PWA recorded before and after the workshop. The conversations were analyzed for specific behaviors using conversation analytic approaches and compared from pre- to post- training.Outcomes & Results: Facilitating behaviors, such as head nodding and asking yes/no questions, were more frequent than barrier or repair behaviors in this group of participants. CPs expressed positive attitudes about communicating with PWA, although CP attitude ratings were not correlated with types of behaviors. Facilitative and repair behaviors increased and barriers decreased following communication partner training, especially for dyads in which the PWA’s aphasia severity was more than minimal. The behavioral change was not correlated with CP’s attitude ratings about communication. Conclusions: Conversation behaviors and attitudes were faciliatory and positive in this cohort of CPs, who self-enrolled in the communication partner training. A half-day training workshop has the potential for positively affecting communication behaviors in communication partners, especially when the aphasia severity is more than minimal. This study provides detailed conversational analysis procedures for future research and clinical application.

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

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.