sign130

7.1.6 TRAINING COMMUNICATION PARTNERS
A systematic review and an RCT suggest that training communication partners to improve communication
with people after ABI is beneficial. 51,129 Two of the studies related to stroke. In the study focusing exclusively
on TBI, there was only a small number of participants. The systematic review suggested that interventions
that focus on training the communication partners of individuals with severe ABI were effective. It also
showed communication strategies used by those who work with individuals who have sustained an ABI are
effective in improving communication exchanges. 51
7.1.7 DySARTHRIA
Six studies focus on the treatment of dysarthria in adult patients, one Cochrane review, 130 three other
systematic reviews 51,131,132 and two non-comparative studies. 133,134 The Cochrane review identified no
appropriate studies. Two of the reviews did not allow conclusions to be drawn regarding patients with TBI
because they took as their topic the diagnosis of stable dysarthria, as opposed to any single aetiology. 131,132
This body of evidence provides some evidence of the benefits of Lee Silverman Voice Treatment (LSVT)
(an intensive programme of voice exercises which aims to improve loudness, quality and variation, and
promotes self-monitoring) but otherwise no conclusive evidence for the management of dysarthria in patients
following brain injury. One of the systematic reviews identified studies which suggested that combination
treatment incorporating LSVT-type exercises, direct respiration treatment, and physiotherapy exercises has
a mild and inconsistent effect on outcome. Three further studies indicated that LSVT has some potential in
treating dysarthria in individuals with ABI. 51 Further research using a control group is needed. This review
also identified evidence that external pacing techniques (eg metronome, pacing board) are effective in
increasing intelligibility through rate reduction outcomes in patients with ABI.
One non-comparative study investigated the use of LSVT for improving dysarthria in seven patients with
TBI and three with stroke. It assessed patients at baseline, after treatment and at six months follow up but
did not compare LSVT with another treatment. Positive results were described, but there were limitations
in study design including a lack of treatment comparison. 133 The authors assumed stability of the patients’
dysarthria simply because the participants were six months or more post onset, but did not test this with
initial assessment. Several of the outcome measures required judgements made by the participants, their
carers and their therapists, introducing an element of bias. There were only seven participants with TBI.
A further case series explored the suitability for and benefits of commencing individualised dysarthria
treatment for people with TBI whilst in later post-traumatic amnesia (PTA). 134 The authors report on two cases
and state that PTA did not preclude the provision of therapy but certain neurobehavioural characteristics
affected the quality of the therapy. They report improvement in the dysarthria over the period of intervention
(which extended from later PTA until emergence from PTA), but note that as parameters other than those
included in therapy also improved, the improvement could be due to spontaneous recovery rather than
the therapy itself.
Although this treatment approach looks promising, there are few studies and small numbers of participants.
In addition, LSVT requires a specially trained therapist and very intensive input which may not be realistic
for some clinicians.
7.1.8 OTHER INTERVENTIONS
7 • Communication and swallowing
A systematic review identified evidence which suggested that some patients with severe head injuries
may improve their ability to communicate yes/no responses after undergoing consistent training and
environmental enrichments. 51 This review also identified evidence which suggested that pragmatic
interventions including role playing improves a variety of social communication skills as well as self concept
and self confidence in social communications, and evidence which suggested that peer-group training of
pragmatic language skills may benefit individuals with communication deficits following brain injury. For
patients in minimally responsive states, there was evidence that structured intervention does have a positive
effect on an individual’s ability to communicate.
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