Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study

Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080

Individuals Who Use Augmentative and Alternative Communication and Participate in Active Recreation: Perspectives From Adults With Developmental Disabilities and Acquired Conditions

Purpose: The aim of the study was to gather the perspectives and lived experiences of 10 adults who use augmentative and alternative communication (AAC) and participate in active recreation. Active recreational participation includes individual sports such as adaptive skiing, surfing, and cycling, as well as unified team sports such as soccer, bocce, and basketball. Method: This research involved a qualitative study with two separate asynchronous online focus groups each conducted over a 6-week span. The focus groups included literate individuals who use AAC and engage in active recreational pursuits across the United States. One focus group included five individuals with acquired conditions, and the other group included five individuals with developmental disabilities. Results: Thematic analysis of the data from both focus groups revealed five primary themes with corresponding subthemes: barriers (intrinsic and extrinsic), supports (intrinsic and extrinsic), benefits (intrinsic and extrinsic), communication (methods), and recommendations for communication partners and people who use AAC. Conclusions: This study provides important information to individuals who use AAC and their communication partners about the benefits of active recreation and the supports needed to make these experiences successful. As a result of this study, speech-language pathologists, related professionals, and caregivers will gain a better understanding of how they can support recreational participation for people who use AAC with a specific focus on enhancing communication and expanding social networks. Supplemental Material https://doi.org/10.23641/asha.17701043

The Art of Intersubjective Dialogue: How to Make Partnership Sustainable

Since human beings communicate, dialogue is a central topic, mainly in terms of partnerships in private, political or business contexts. Often, however, dialogue means double monologue. In order to transform it into a real dialogue, particular strategies are helpful, which can be found during the last centuries. Modern communication partners, thus, can evaluate dialogue-experiences from Biblical time until today to make their relationship sustainable and to apply open, personal, and symmetrical communication as a kind of cultural participation. As demonstrated in this paper, all dialogue participants can draw benefit from such evaluation by transferring and transforming past experiences into current situations, Therefore, the article evaluates texts from both religious and psychological perspectives, and emphasizes both, religious and secular narratives, values, models, rituals and attitudes. Thus, it invites people to make experiences with communication strategies in their relationships and daily life.

Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study (Preprint)

BACKGROUND The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. OBJECTIVE This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. METHODS Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. RESULTS Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. CONCLUSIONS In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/35080

STRATEGIES IN CONVEYING INFORMATION ABOUT UNSHARED EVENTS USING AIDED COMMUNICATION

Describing events may be challenging for any child, but children who use communication aids may face unique linguistic, pragmatic, and strategic challenges in conveying information with the communication means they have available. This study explores strategies used by young, aided communicators when describing the content of a video unknown to their communication partners. The participants of the study were 48 aided communicators (aged 5;3–15;2) from nine countries and seven language groups and their communication partners (parents, professionals, and peers) who used natural speech. Descriptive and statistical analyses were utilized to investigate the relationships between individual characteristics, linguistic and non-linguistic factors, linguistic strategies, and performance in conveying the content of the video event. Analyses of the 48 videotaped interactions revealed the use of a variety of linguistic elements and multimodal strategies, demonstrating both creativity and challenges. Success in relaying messages was significantly related to age, mode of communication, and individual profiles, such as everyday communication functioning and comprehension of grammar. Measures of receptive vocabulary and non-verbal reasoning were not significantly related to communicative success. The use of shared context and negotiation of meaning of potentially ambiguous utterances demonstrate the shared responsibility of disambiguation and meaning construction in interactions involving aided and naturally speaking communicators.

Expanding Availability of Speech-Generating Device Evaluation and Treatment to People With Amyotrophic Lateral Sclerosis (pALS) Through Telepractice: Perspectives of pALS and Communication Partners

Purpose To examine the experiences of people with ALS (pALS) and their communication partners (cALS) regarding receiving speech-generating device (SGD) evaluation and treatment via telepractice. Method Eight pALS along with a primary cALS participated in telepractice SGD evaluation and treatment with an augmentative and alternative communication (AAC) specialist and representatives from multiple SGD vendors. Participants were interviewed postevaluation and post-SGD training to examine their experiences. Mixed methods data were collected through Likert scale responses and qualitative interviews. Results Telepractice SGD evaluation and training were feasible and resulted in all pALS receiving SGDs they were able to use to communicate. In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability. Suggestions for improving the telepractice experience were provided. Conclusions Telepractice should be considered as an option to provide vital SGD services to patients who are geographically remote, mobility impaired, unable to leave their home, experience fatigue with travel, or otherwise would not have access to these specialized services. Telepractice allows patients to preserve their time and energy for the assessment and treatment sessions, resulting in perhaps deeper and more frequent engagement in evaluation and training. Telepractice could serve as an alternative to outpatient, in-person evaluations, or be utilized in conjunction with in-person appointments. Supplemental Material https://doi.org/10.23641/asha.15094257

Indirect responses in natural conversation

By indirect answers we mean answers to general questions which do not correspond to “yes” and “no”, and answers to special questions which do not literally correlate with the question words who, what, where, etc. The article examines the types of indirect responses in different structural and semantic types of dialogue. The article analyzes the features of indirect answers determined by the predictive relationship of concepts: place-goal, place-time, etc. Particular attention is paid to answers containing assessment, not determineded by the content of questions, as well as question-answer turns with why and what for. The article focuses on the informative volume of indirect answers, their insufficiency and redundancy. Indirect questions are used rather frequently. It is not possible to classify all of them, but all of them are undoubtedly associated with certain types of dialogue, speech genres, speech situations and with the psychological type of communication partners. As noted earlier, the logical connection of the categories place-goal, placetime, goal-cause, etc. leads to reversibility and predictability of situations, and in certain speech genres to the interchangeability of designating categories in the form of indirect answers. A specific feature of the dialogue, observed in different speech genres, is the response containing the characteristic of the person mentioned in the question, instead of the information in which the speaker is interested. The analysis of these responses reveals the organic connection between the evaluation and the reason. The use of counter-questions, and first of all, why- and what for-remarks, is caused by the specific nature of this phenomenon, which, despite the thorough research of N. D. Arutyunova, allows to see some interesting features in it. The article uses recordings of oral speech and some works of fiction, reproducing spoken dialogue.

Sensitivity to Communication Partners During Naturalistic AAC Conversations in Cantonese Chinese

Previous studies have shown that graphic-based augmentative and alternative communication (AAC) output tend to be short and simple in structure with non-canonical word order, and that AAC users may show differences when communicating with peers compared to professionals such as speech therapists (STs). However, there was a lack of report for graphic-based AAC in the Chinese context, and the effect of communication partners had not been investigated systematically. In this study with 34 AAC users and 10 STs, we reported common and distinct features of free conversations in Cantonese graphic-based AAC, relative to AAC in other languages. We also found that AAC users were sensitive to different types of communication partners. In particular, when conversing with peers, AAC users produced long messages with equal proportion of questions and responses, which suggested active and bi-directional exchanges. In conversations with STs, AAC users showed high diversity in expressive vocabulary, indicating access to more semantic concepts. Results suggested that the base language and the communication partner are both influential factors that should be considered in studies of graphic-based AAC. The mobile AAC system facilitated free conversations in users with complex communication needs, affording an additional channel for social participation.