Development of a measure to assess effective listening and interactive communication skills in the delivery of children’s rehabilitation services

Purpose: Therapists’ listening and communication skills are fundamental to the delivery of children’s rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. Method: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. Results: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. Conclusions: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills.

Implications for Rehabilitation

• Therapists’ listening and effective communication skills are essential to the successful delivery of children’s rehabilitation services, but few measures comprehensively assess these skills.

• Clinical encounters in pediatric rehabilitation involve various types of listening/communication skills: receptive listening, exploratory listening, consensus-oriented listening, and action-oriented listening.

• The ELICS is a valid and context-appropriate tool for the self-assessment of listening and communication skills in the context of pediatric rehabilitation practice.

• The ELICS allows clinicians (e.g., occupational, physical, and speech-language therapists) to assess and reflect on their listening/communication skills and may enhance the relationship-based practice of clinicians who provide therapy services to children with disabilities and their families.

     

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

Abstract

Purpose: To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. Methods: A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. Results: The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. Conclusions: Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome.

• Implications for Rehabilitation

• Communication aids were reported to increase and clarify communicative contributions from people with Rett syndrome.

• Systematic procedures and instruments for assessment, evaluation and partner instruction were used to a small extent.

• A limited range of communicative functions were targeted in the interventions.

• There is a need for developing best practice guidelines to support SLPs in the AAC process for this population should be clients with Rett syndrome.

     

Optimising leisure participation: a pilot intervention study for adolescents with physical impairments

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment. Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes. Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated. Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.

• Implications for Rehabilitation

• This ICF-based intervention model was applicable and practical to use in a community therapy setting.

• The majority of the adolescent’s leisure participation goals were achieved following engagement in the multi-strategy intervention.

• Adolescents with sufficient communication skills (CFCS Levels I–III) benefited from a group-based intervention in addition to individualised support.

     

Practical research-based guidance for motor imagery practice in neurorehabilitation

Purpose: The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process.

Method: We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation.

Results: Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application.

Conclusions: We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.

Implications for Rehabilitation

• Motor imagery has become a very popular technique for clinicians in neurorehabilitation; however, research reports provide insufficient information for clinicians to employ motor imagery in the clinic.

• The principles of motor learning can be used as a useful framework for employing motor imagery in neurorehabilitation.

• We provide clear guidance to deliver individual-tailored motor imagery in neurorehabilitation based on evidence.

     

Motivational interviewing: a novel intervention for translating rehabilitation research into practice

Purpose: Despite recent advances in rehabilitation research, moving evidence into clinical practice remains a challenge. This article explores a novel approach to knowledge translation (KT) – motivational interviewing (MI). MI is a style of communication that is typically used to facilitate health related behavior change in patients. Here we explore its potential use as a KT intervention aimed at clinicians. Methods: Commentary. Relevant literature on MI and KT is summarized and discussed by considering how MI could be used in a KT strategy aimed at rehabilitation clinicians. Results: Clinician motivation and readiness to change are key issues influencing implementation of evidence-based practice. We provide an argument suggesting that clinicians’ readiness to change clinical practices can potentially be enhanced through MI. The MI conceptual framework, principles, and strategies, typically used in patients, are discussed here in a novel context – enhancing clinician change in practice. Conclusions: MI is an effective intervention when the goal is to motivate individuals to change a current behavior. We suggest that MI is an evidence-based intervention that has been proven to be effective with patients and warrants study as a promising KT intervention.

Implications for Rehabilitation

• Despite recent advances in rehabilitation research, moving evidence into practice remains a challenge.

• Clinician motivation is one key issue influencing the implementation of evidence-based practice.

• Clinician motivation to implement evidence-based practice can potentially be enhanced through an approach called motivational interviewing (MI).

• Motivational interviewing is an evidence-based intervention that has proven to be effective in promoting behavioral change in patients, and warrants study in terms of its potential as a KT intervention.

     

Applications of the International Classification of Functioning,Disability and Health in goal-setting practices in healthcare

Abstract

Purpose: While evidence exists to support the adoption of collaborative goal-setting in healthcare, some clinicians feel that it is not feasible. This article proposes that the development of a standardized collaborative goal-setting approach using the framework and classification system of the International Classification of Functioning, Disability and Health (ICF) could address these feasibility issues. It is the objective of this article to understand the extent to which the ICF has been integrated into current goal-setting literature in order to assess its potential use in a standardized collaborative goal-setting approach. Methods: A scoping review of the literature published in English since 2001 was conducted in EMBASE, Medline and CINAHL. Articles were included in this review if they integrated the ICF into goal-setting practices in any healthcare discipline. Results: Nineteen articles were included in this review. Analysis of these articles revealed that the ICF has been integrated into goal-setting practices. The benefits associated with this integration suggest that integrating the ICF into goal-setting practices can standardize collaborative goal-setting. Conclusion: Evidence from this scoping review supports the use of the ICF in healthcare goal-setting practices because it provides clinicians and patients with specific steps to follow when attempting to set goals collaboratively.

• Implications for Rehabilitation

• Collaborative goal-setting.

• Collaborative goal-setting involves patients working with their clinicians to develop health outcome goals together and is a fundamental component of patient-centered care.

• Some rehabilitation disciplines have yet to fully embrace collaborative goal-setting due to feasibility issues.

• This article proposes that the integration of the International Classification of Functioning, Disability and Health (ICF) into goal-setting practices could standardize collaborative goal-setting in a way that would address these feasibility issues.

     

The potential impact of intelligent power wheelchair use on social participation: perspectives of users,caregivers and clinicians

Purpose: To explore power wheelchair users’, caregivers’ and clinicians’ perspectives regarding the potential impact of intelligent power wheelchair use on social participation. Methods: Semi-structured interviews were conducted with power wheelchair users (n?=?12), caregivers (n?=?4) and clinicians (n?=?12). An illustrative video was used to facilitate discussion. The transcribed interviews were analyzed using thematic analysis. Results: Three main themes were identified based on the experiences of the power wheelchair users, caregivers and clinicians: (1) increased social participation opportunities, (2) changing how social participation is experienced and (3) decreased risk of accidents during social participation. Conclusion: Findings from this study suggest that an intelligent power wheelchair would enhance social participation in a variety of important ways, thereby providing support for continued design and development of this assistive technology.

• Implications for Rehabilitation

• An intelligent power wheelchair has the potential to:

• Increase social participation opportunities by overcoming challenges associated with navigating through crowds and small spaces.

• Change how social participation is experienced through “normalizing” social interactions and decreasing the effort required to drive a power wheelchair.

• Decrease the risk of accidents during social participation by reducing the need for dangerous compensatory strategies and minimizing the impact of the physical environment.

     

A collaborative approach to supporting communication in the assessment of decision-making capacity

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.

     

Powered mobility intervention: understanding the position of tool use learning as part of implementing the ALP tool

Purpose: To explore the knowledge necessary for adoption and implementation of the Assessment of Learning Powered mobility use (ALP) tool in different practice settings for both adults and children. To consult with a diverse population of professionals working with adults and children, in different countries and various settings; who were learning about or using the ALP tool, as part of exploring and implementing research findings.

Method: Classical grounded theory with a rigorous comparative analysis of data from informants together with reflections on our own rich experiences of powered mobility practice and comparisons with the literature.

Results: A core category learning tool use and a new theory of cognizing tool use, with its interdependent properties: motivation, confidence, permissiveness, attentiveness and co-construction has emerged which explains in greater depth what enables the application of the ALP tool.

Conclusions: The scientific knowledge base on tool use learning and the new theory conveys the information necessary for practitioner’s cognizing how to apply the learning approach of the ALP tool in order to enable tool use learning through powered mobility practice as a therapeutic intervention in its own right. This opens up the possibility for more children and adults to have access to learning through powered mobility practice.

• Implications for rehabilitation

• Tool use learning through powered mobility practice is a therapeutic intervention in its own right.

• Powered mobility practice can be used as a rehabilitation tool with individuals who may not need to become powered wheelchair users.

• Motivation, confidence, permissiveness, attentiveness and co-construction are key properties for enabling the application of the learning approach of the ALP tool.

• Labelling and the use of language, together with honing observational skills through viewing video footage, are key to developing successful learning partnerships.

     

Moving research tools into practice: the successes and challenges in promoting uptake of classification tools

Purpose: In this paper, we present our experiences – both successes and challenges – in implementing evidence-based classification tools into clinical practice. We also make recommendations for others wanting to promote the uptake and application of new research-based assessment tools.

Method: We first describe classification systems and the benefits of using them in both research and practice. We then present a theoretical framework from Implementation Science to report strategies we have used to implement two research-based classification tools into practice. We also illustrate some of the challenges we have encountered by reporting results from an online survey investigating 58 Speech-language Pathologists’ knowledge and use of the Communication Function Classification System (CFCS), a new tool to classify children’s functional communication skills.

Result and conclusions: We offer recommendations for researchers wanting to promote the uptake of new tools in clinical practice. Specifically, we identify structural, organizational, innovation, practitioner, and patient-related factors that we recommend researchers address in the design of implementation interventions. Roles and responsibilities of both researchers and clinicians in making implementations science a success are presented.

• Implications for rehabilitation

• Promoting uptake of new and evidence-based tools into clinical practice is challenging.

• Implementation science can help researchers to close the knowledge-to-practice gap.

• Using concrete examples, we discuss our experiences in implementing evidence-based classification tools into practice within a theoretical framework.

• Recommendations are provided for researchers wanting to implement new tools in clinical practice. Implications for researchers and clinicians are presented.

     

Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective

Abstract

Purpose: Communication is powerful predictor of health-related quality of life and overall well-being, yet its role in promoting rehabilitation outcomes in spinal cord injury (SCI) is rarely mentioned. This article systematically analyzes and synthesizes literature from multiple disciplines according to a biopsychosocial perspective, providing an evidence base for clinical practice and clear direction for future research. Method: Systematic literature review and analysis, incorporating mapping to International Classification of Functioning, Disability and Health (ICF) codes. Results: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990–2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the complex interactions between communicative function with daily living after SCI. Conclusions: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research.

• Implications for Rehabilitation

• Communication fosters empowerment, independence and greater participation in life roles; recognized as a powerful predictor of health-related quality of life and overall well-being.

• The ICF framework elucidates influences to communicative function, and components which are influenced by communication, providing valuable insight for clinicians and researchers.

• Therapeutic and research endeavors guided by existing ICF core sets are at risk of failing to consider communication, thereby limiting rehabilitation outcomes.

• Tapping the potential of communication as a relative strength within SCI rehabilitation holds considerable promise, within integrative, strengths-based, multidisciplinary approaches to clinical practice and future research.

     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

“It’s got to be more than that”. Parents and speech-language pathologists discuss training content for families with a new speech generating device

Purpose: Although parent-implemented interventions for children with a speech-generating device (SGD) have been well researched, little is known about parents’ or speech-language pathologists’ (SLPs) views around parent training content. In this project, we aimed to identify areas that parents and SLPs consider should be included in training for families with a new SGD. Methods: Seven parents of children with an SGD and three SLPs who were new to the SGD field, participated in individual semi-structured interviews. Ten SLPs experienced in SGD practice took part in two focus groups. Data were analysed using grounded theory methods. Results: Participants identified the following areas suitable for inclusion in a family SGD training package: (a) content aimed at improving acceptance and uptake of the SGD, including technical guidance, customisation and reassurance around SGD misconceptions; (b) content around aided language development and (c) home practice strategies, including responsivity, aided language stimulation and managing children’s motivation. Conclusions: Participants identified diverse training targets, many of which are unexplored in parent-training research to date. Their recounted experiences illustrate the diversity of family capacity, knowledge and training priorities, and highlight the need for collaborative planning between families and SLPs at all stages of SGD training.

• Implications for Rehabilitation

• Training needs for families with a new speech generating device (SGD) are diverse, ranging from technology-specific competencies to broader areas, such as advocacy, teamwork and goal-setting skills.

• Each family with a new SGD will have a unique profile of training needs, determined by individual learning capacity, priorities, prior knowledge and experience, as well as their child’s current communication skills and future support needs.

• Parents and speech-language pathologists (SLPs) may hold different priorities concerning family SGD training, necessitating ongoing team discussion.

     

A multidisciplinary approach for developing an assessment tool for touch screen devices

Abstract

Aim: The aim of this study was to describe the processes of reaching consensus regarding the assessment of the user’s skills required to operate various touch screen devices. A five-step procedure was used to collect and validate the required skills by a multidisciplinary team of 52 experts. Content validity was calculated to determine the agreement levels between the experts. A comparison was made between the discipline groups in order to test correlation between each group and their choice of specific clusters of tasks.

Methods: The final consensus set by the experts' recommendations included 15 domains and 50 skills/measurements. The result of Cronbach's α test for the final assessment questionnaire (50 skills/measurements) was 0.94, which indicates a high degree of internal consistency. The results of Kruskal–Wallis’s test showed the lack of any significant difference between agreements of the clinicians and the technicians groups, but significant differences were found between the educators and the clinicians groups.

Conclusion: The assessment questionnaire, in its current form, can be used by clinicians and it is expected to help in developing an objective assessment tool to quantify the performance and touch characteristics of individuals with varying abilities and disabilities, in order to enhance accessibility of touch screen technology.

• Implications for Rehabilitation

• Collecting and creating the required knowledge needed for assessing the user's skills for operating touch screen devices.

• The created knowledge helps clinicians to focus on the essential skills and measurements needed for a comprehensive assessment of the individual's abilities and disabilities while operating touch screen devices.

• The results of the assessment can be used as recommendations for enhancing accessibility of touch screen devices for various disabilities.

• This knowledge is expected to help in developing an application that provides an objective assessment tool.

• The study emphasizes the importance of close collaboration with multidisciplinary teams for creating a valid assessment tool.

     

Social participation of children age 8–12 with SLI

Purpose: Two objectives are being pursued: (1) to describe the level of social participation of children aged 8–12 presenting a specific language impairment (SLI) and (2) to identify personal and family factors associated with their level of social participation. Method: This cross-sectional study was conducted among 29 children with SLI and one of their parents. Parental stress and family adversity were measured as risk factors. The measure of life habits (LIFE-H) adapted to children aged 5-3 was used to measure social participation. Results: The assumption that social participation of these children is impaired in relation to the communication dimension was generally confirmed. The statements referring to the “communication in the community” and “written communication” are those for which the results are weaker. “Communication at home” is made easier albeit with some difficulties, while “telecommunication” is totally preserved. A high level of parental stress is also confirmed, affecting the willingness of parents to support their child’s autonomy. Conclusions: The achievement of a normal lifestyle of children with SLI is upset in many spheres of life. Methods of intervention must better reflect the needs and realities experienced by these children in their various living environments, in order to optimize social participation, and consequently, to improve their well-being and that of their families. The need to develop strategies to develop children's independence and to reduce parental stress must be recognized and all stakeholders need to be engaged in the resolution of this challenge.

• Implications for Rehabilitation

• The realization of life habits of SLI children is compromised at various levels, especially in the domain related to “communication in the community” and “written communication”.

• Speech-language pathologists must consider providing ongoing support throughout the primary years of these children and during adolescence, to promote and facilitate the continued realization of life habits of SLI persons.

• Providing ongoing support throughout the primary years and thereafter is needed to facilitate the continuing realization of life habits of SLI persons.

• Parents of children with SLI experience considerable stress in relation to the exercise of their parental roles.

• It is important to intervene and to support parents to promote autonomy for their SLI children.

     

Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease

Purpose: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. Method: Five dyads consisting of a person with stroke-induced aphasia (n?=?4) or Parkinson’s disease (PD) (n?=?1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. Results: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. Conclusions: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training.

• Implications for rehabilitation

• Communication partner training can improve the communicative environment of people with communication disorders.

• For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker.

• An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders.

• The training also positively affected the perceived functional communication of the persons with communication disorders.