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BACKGROUND & AIMS: The present retrospective study examines veterans and military personnel who have sustained a cognitive-communication deficit/disorder (CCD) and/or aphasia secondary to traumatic brain injury (TBI). The prevalence of each disorder secondary to TBI is identified and demographic factors are analysed to determine whether specific characteristics (age, gender, race and/or ethnicity) differentially influenced diagnosis (CCD or aphasia). METHODS & PROCEDURES: A retrospective analysis examining the prevalence of CCD and aphasia among US service personnel with a complicated mild-to-severe TBI treated over a 4-year period (1 January 2016-31 December 2019) was conducted. Medical diagnoses and demographic factors were obtained from administrative data repositories and a logistic regression was performed to identify the relationship between demographic factors and diagnoses. OUTCOMES & RESULTS: Analyses revealed that 8.8% of individuals studied had a secondary diagnosis of CCD (6.9%), aphasia (1.5%) or both (0.4%). This signifies 6863 cases of CCD, 1516 cases of aphasia and 396 cases of CCD and aphasia (dual diagnosis) per 100,000 individuals who have sustained a complicated mild-to-severe TBI. The proportion of cases observed with these diagnoses was consistent with the racial, gender and ethnic demographics of those diagnosed with TBI. Statistical modelling revealed that increased age is predictive of a diagnosis of aphasia relative to CCD. CONCLUSIONS & IMPLICATIONS: Service personnel sustaining TBIs are at increased risk of communication impairments with deficits observed across all gender, racial and ethnic demographics. CCD is more commonly observed than aphasia, though clinicians should be cognisant of both when performing assessments. Age is a factor that can influence diagnosis. WHAT THIS PAPER ADDS: What is already known on the subject Military personnel are at increased risk of communication disorders (CCDs) with TBI associated with multiple types of communication impairments including CCD, aphasia, dysarthria and apraxia of speech. What this paper adds to existing knowledge This paper examines CCD and aphasia occurring following TBI. The proportion of observed cases of CCD and aphasia secondary to TBI are calculated over a 4-year period and the prevalence of these disorders is provided. Additionally, statistical modelling is used to identify differences in the diagnosis of CCD relative to aphasia using the demographic factors of age, racial identity and ethnicity. What are the potential or actual clinical implications of this work? CCD is a frequently occurring issue following TBI, and the findings of this study demonstrate that it is a concern observed across gender, racial and ethnic lines. Advanced age is linked with the diagnosis of aphasia relative to CCD following TBI and should be a consideration during evaluation of patients who have sustained significant head trauma.

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Background: Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods: This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion: While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.

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BACKGROUND: Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI. AIMS: To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations. METHODS & PROCEDURES: This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision-making. Participants were recruited through national and international SLP professional bodies, TBI-specific or SLP special-interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses. OUTCOMES & RESULTS: There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self-monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings. CONCLUSIONS & IMPLICATIONS: Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal-based approach. Factors affecting the use of discourse in practice included client-specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision-making for SLPs working in TBI. WHAT THIS PAPER ADDS: What is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal-based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI-specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice.

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INTRODUCTION: Discourse impairments are common sequelae following TBI. Even though handling discourse is thought to be a basic requirement for social participation and quality of life, few test procedures to assess discourse disorders have been developed so far. OBJECTIVE: The main aim of this prospective cohort study was to evaluate the use of the MAKRO Screening for detecting deficits in discourse production and reception in a group of participants with TBI in the post-acute and chronic phase and their relation to executive functions (EF) and severity of brain injury. METHOD: Twenty individuals with TBI and a control group of healthy speakers performed on the MAKRO and on tests of EF (Regensburger Verbal Fluency Test; Tower of London; WAIS-IV digit span index). Group performance was evaluated on the basis of a scoring system and qualitative discourse analysis with focus on main concepts and coherence. Further, MAKRO scores were correlated with measures of EF. OUTCOMES: Individuals with TBI demonstrated significantly poorer performance within all MAKRO subtests. Discourse analysis revealed fewer main concepts and more frequent use of thematically inappropriate utterances. Performance can be partly explained by severity of initial injury and executive disorders. MAKRO presents a reliable and functional measure for discourse impairments.

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BACKGROUND: Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined. OBJECTIVES: To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment. METHODS: A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge. RESULTS: The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge. CONCLUSIONS: People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment.

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There is limited evidence for cognitive-communication reading comprehension (CCRC) interventions for adults following acquired brain injury (ABI), particularly during sub-acute rehabilitation. The purpose of this study was to investigate the clinical practice of speech-language pathologists (SLPs) with CCRC deficits during sub-acute ABI rehabilitation and compare it to the best available evidence. An electronic survey was used to gather information from clinicians across Australia regarding clinical practice in the areas of assessment, intervention, treatment hierarchies and service delivery; survey questions were developed from an extensive review of the literature and expert clinician opinion. Survey findings were then compared with the literature in the form of a systematic review. Surveyed clinicians provided multiple interventions for CCRC rehabilitation, including impairment based (94.7%), activity based (94.7%) and reading strategy interventions (100.0%). Five strategies were used by >94% of SLPs (highlighting, identifying main points/wh- questioning, re-reading, summarising, reducing visual load). When compared with the literature, strong similarities were found for strategy-based interventions and individual service delivery, with broad similarities for functional and impairment-based interventions, and impairment based treatment hierarchies. Strong differences in assessment were identified. Strategy use reported in clinical practice (100.0% SLPs) was higher than in the literature. Further investigation into the effectiveness of specific reading strategies for people with ABI is warranted.

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PURPOSE: This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). METHOD: Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. RESULTS: Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. CONCLUSION: There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals. IMPLICATIONS FOR REHABILITATION: All clinicians have an obligation to maximise client autonomy and participation in decision-making. Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient. The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder. Impairments in different aspects of auditory comprehension require different accommodations.

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