Communication training

1.4 Speech pathologists should provide education about the characteristics of aphasia and training on supported communication techniques to all people involved in the care of people with aphasia.

Reference: Burns et al., 2015: Qualitative study; Cameron et al., 2019: RCT; Casey et al., 2023: Qualitative study; Finch et al., 2020: Qualitative study; Heard et al., 2017: Parallel randomised trial; Patel et al., 2022: Retrospective chart review; Power et al., 2020: RCT; Simmons-Mackie et al., 2010: Systematic review of 31 studies (11 group designs, 8 case studies, 7 SCED, 5 qualitative studies); Simmons-Mackie et al., 2016: Systematic review of 25 studies (11 group design, 11 case studies, 2 qualitative studies, 1 SCED)

NHMRC Level of Evidence: I

Rationale: Health professionals, especially those in a community setting, may have a lack of knowledge about aphasia and find it difficult to communicate well with people with language impairments to maximise health outcomes (Burns et al., 2015; Casey et al., 2023). For some professionals such as emergency medical services providers (paramedics) and emergency department nurses, a knowledge of aphasia is important to facilitate diagnosis of stroke through screening protocols (Patel et al., 2022). Understanding the characteristics of aphasia and how to communicate well with the person with aphasia may enhance health professionals’ communication with their clients and ensure appropriate referrals to a speech pathologist. 

Communication partner training can improve the knowledge, skills, and attitudes of communication partners of people with aphasia. For some communication partners, such as health professionals, students and volunteers, CPT can result in (Simmons-Mackie et al., 2010; Simmons-Mackie et al., 2016):
·        increased communication partner knowledge of the characteristics of aphasia, 
·        increased use of effective communication strategies, 
·        decreased use of non-supportive strategies, 
·        increased ability to obtain accurate information,
·        increased ability to establish rapport, and
·        increased self-confidence and positivity towards communication, all of which may enhance timely and appropriate referrals for people with aphasia.

Research has confirmed the CPT outcomes for unfamiliar partners are similar across varied modes of delivery including face-to-face, tele-delivery or online training formats (Cameron et al., 2019, Finch et al., 2020; Heard et al., 2017; Power et al., 2020).

Communication training programs

Communication training programs for all health service providers in the area of stroke are worthy of consideration (Dickey et al., 2010). Training programs have the potential to reduce language barriers to accessing appropriate stroke care. Additionally, these skills can assist in obtaining important information from a person with aphasia such as their medical history and improve their understanding of information for decision-making (Dickey et al., 2010).

Emergency response staff are likely to be one of the first communication partners during the onset of aphasia. Training and communication supports can be used to facilitate these interactions. Eadie et al (2013) has developed a communication board for Queensland Ambulance Service (QAS) paramedics to address communication needs of patients in the prehospital setting. The findings support the use of the tool as a viable option in supporting the communication between paramedics and a range of patients. The use of the board has had best results in Culturally and Linguistically Diverse (CALD) and children populations. 

Communication partner training

Simmons-Mackie et al. (2010) completed a review on conversation partner training interventions. Of the 31 included studies, 5 addressed training of health care providers or volunteers. Two of these studies (Kagan et al., 2001 & Legg et al., 2005) were randomised control trials. Both used strategies based on the principles of Supported Conversation for Adults with Aphasia (SCA) (Kagan et al., 2001). Results from this systematic review demonstrated that communication partner training is effective in improving communication participation of persons with chronic aphasia and that of their of trained communication partner. 

SCA is an intervention approach specifically design to help people with aphasia express their feelings and opinions in a way that makes them feel appreciated and heard.  SCA is a program which uses a set of techniques which aims to improve conversational interaction through body language and gesture, drawings, pictographs in addition to spoken and written words. This approach is based on the idea that the inherent competence of people with aphasia can be revealed through the skill of the conversation partner. Kagan et al. (2001) demonstrated that trained volunteers were significantly better at acknowledging and revealing competence of their partners with aphasia as compared to those that only had exposure to people with aphasia. Legg et al. (2005) demonstrated that 6th-year medical students who received communication training were significantly better at conducting a case history with an adult with aphasia (in terms of obtaining information and establishing rapport) than students who received theoretical information about aphasia only. Such findings provide motivation for communication skills training of healthcare professionals who interact with individuals with aphasia. Communication skills training in the studies mentioned about used techniques such as:

• acknowledging competence (e.g. talking naturally, avoid being patronizing and explicitly letting the person with aphasia know that his/her competence is not in question)
• ensuring the person with aphasia is given opportunities to express what he/she knows, thinks, or feels
• providing verification to ensure the conversation is on track from the perspective of the person with aphasia
• Using supports such as gesture, written key words, pictographic resources and drawing
• Videos to show the difference between an interaction with a person with aphasia (e.g. doctor performing a case history) before and after communication skills training
• Discussion-based learning around effective communication techniques
• Role-playing and reflection on ways to maximise communication

RESOURCES:

What resources can I access to assist with communication training?

1. Learn more about the Queensland Ambulance Service communication board
2. Supported Conversation for Adults with Aphasia (SCA) Kagan, A. Black, S. E., Duchan, F. J., Simmons-Mackie, N. & Square, P. (2001).
3. Learn more about Supported Conversation for Adults with Aphasia (SCA)
4. Read about AAC strategies for healthcare settings developed by Scope. This handout provides information on free resources, non-eletronic and electronic AAC devices that can be used in a healthcare setting to support communication. 
5. Download and display UK Connect's Ten Top tips for communicating with people with aphasia poster. 
6. Check out Supporting Partners of People with Aphasia in Relationships & Conversation (SPPARC) Lock, S. Wilkinson, R. & Bryan, K. (2008).  SPPARC is a resource specifically designed to provide clinically effective tools to work with people with aphasia and their communication partners.  The SPPARC manual consists of a manual, CD and DVD and provides practical resources to provide support and conversation training programs, conversation assessment and treatment materials and video extracts of everyday conversations which can be used as a resource.  
7. Help other professionals to understand aphasia by showing them the "Understanding aphasia" video - a free educational resource launched to increase awareness for 2014 National Stroke Week in  Australia.  

References:

1.  Burns, M., Baylor, C., Dudgeon, B. J., Starks, H., & Yorkston, K. (2015). Asking the Stakeholders: Perspectives of Individuals With Aphasia, Their Family Members, and Physicians Regarding Communication in Medical Interactions. American Journal of Speech-Language Pathology, 24(3), 341–357. https://doi.org/10.1044/2015_AJSLP-14-0051 
2. Cameron, A., McPhail, S., Hudson, K., Fleming, J., Lethlean, J., & Finch, E. (2019). Telepractice communication partner training for health professionals: A randomised trial. Journal of Communication Disorders, 81, 105914–105914. https://doi.org/10.1016/j.jcomdis.2019.105914 
3. Casey, K., O'Halloran, R., van den Berg, M. E. L., & Rose, M. L. (2023). "We got there in the end…. somehow, we got there": a qualitative study of healthcare professionals providing care in the community to people with chronic aphasia, and how technology could assist. Disability and Rehabilitation, 1–10. https://doi.org/10.1080/09638288.2023.2256666 
4. Finch, E., Lethlean, J., Rose, T., Fleming, J., Theodoros, D., Cameron, A., Coleman, A., Copland, D., & McPhail, S. M. (2020). Conversations between people with aphasia and speech pathology students via telepractice: A Phase II feasibility study. International Journal of Language & Communication Disorders, 55(1), 43–58. https://doi.org/10.1111/1460-6984.12501
5. Heard, R., O'Halloran, R., & McKinley, K. (2017). Communication partner training for health care professionals in an inpatient rehabilitation setting: A parallel randomised trial. International Journal of Speech Language Pathology, 19(3), 277–286. https://doi.org/10.1080/17549507.2017.1290137
6. Patel, M. D., Thompson, J., Cabañas, J. G., Williams, J. G., Lewis, E., Bachman, M., Al Masry, M., LaVigne, C., Morantes, L., Becske, T., & Kass-Hout, O. (2022). Performance of the vision, aphasia, neglect (VAN) assessment within a single large EMS system. Journal of Neurointerventional Surgery, 14(4), 341–345. https://doi.org/10.1136/neurintsurg-2020-017217
7. Power, E., Falkenberg, K., Barnes, S., Elbourn, E., Attard, M. & Togher L. (2020) A pilot randomized controlled trial comparing online versus face-to-face delivery of an aphasia communication partner training program for student healthcare professionals. International Journal of Language and Communication Disorders, 55(6), 852-866. Doi: https://doi.org/10.1111/1460-6984.12556
8. Simmons-Mackie, Nina, Raymer, Anastasia, Armstrong, Elizabeth, Holland, Audrey, & Cherney, Leora R. (2010). Communication partner training in aphasia: a systematic review. Archives Of Physical Medicine And Rehabilitation, 91(12), 1814-1837.
9. Simmons-Mackie, N., Raymer, A., & Cherney, L.R. (2016). Communication partner training in aphasia: An updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(2), 2202-2221. DOI: 10.1016/j.apmr.2016.03.023

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