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Communication-oriented approach

Goal: Within six months, Jade will improve her ability to engage in meaningful conversations and express her needs and emotions effectively, as evidenced by increased speech clarity, vocabulary usage, and emotional expression.

Outcome measure: A multifaceted approach will be adopted to measure progress toward the SMART goal to enhance Jade's communication skills. First and foremost, regular speech clarity assessments will be conducted using standardised tools, permitting a quantitative evaluation of her speech articulation and pronunciation, revealing notable improvements throughout the goal period (Naqvi & Winters, 2020). The sessions will be arranged every morning at 11 AM for 4 weeks. Simultaneously, vocabulary usage will be diligently tracked by documenting the incorporation of new words into her conversations. Additionally, her capacity for emotional expression will be assessed, focusing on her ability to convey a diverse range of emotions effectively and appropriately (Rimehaug & Kårstad, 2022). These assessments will be complemented by progress reports from her dedicated speech-language therapist, offering insights into her participation in therapy sessions and the strategies employed to enhance her communication. Observations of Jade's interactions in various settings will provide real-world evidence of her progress, and feedback from both Jade and her support system will offer subjective perspectives on her evolving communication skills (Khosla et al., 2018). Milestone documentation will record significant breakthroughs and achievements in her communication journey (Matney et al., 2022). Regular team meetings involving Jade and her healthcare providers will serve as a forum to collectively review and discuss her advancements and make informed adjustments to her treatment plan (Eapen et al., 2022).

Rationale: Jade's severe traumatic brain injury (TBI) has presented notable barriers to effective communication with profound implications for her overall quality of life and active rehabilitation involvement. This goal aligns with her intrinsic values and preferences, recognising the pivotal role of efficient communication in expressing needs and emotions and fostering meaningful connections with her support network.

The chosen communication-oriented approach, Speaker Strategies, involves adapting the communication techniques of those interacting with Jade to improve understanding and responsiveness (Hoffman et al., 2023). Research in communication disorders consistently supports using tailored communication strategies to address cognitive communication deficits. This approach has proven effective in enhancing comprehension and daily life participation for individuals with TBIs, aligning closely with Jade's overarching rehabilitation objectives (Hou et al., 2023).

Jade's client data showcases the critical need for adjusted communication strategies, particularly regarding memory impairment, learning difficulties, and slow processing resulting from her TBI. Tailoring communication to her specific needs can bridge the gap between intent and effective expression, which is critical for her rehabilitation journey (Matney et al., 2022). The approach to Speaker Strategies aligns with Jade's strong preference for genuine human interaction over technology-based solutions. This preference is underpinned by extensive research demonstrating the significance of human connection and its positive impact on rehabilitation outcomes.

  • Speaker-oriented treatment approach
  • SHORT TERM GOAL for treatment block
  • Approach: Speech and Language Therapy (SLT), Cognitive-Behavioral Therapy (CBT), Communication Skills Training

Goal: By demonstrating an improvement in speech clarity and a decrease in emotional lability during communication, Jade will be able to have more productive, emotionally consistent, and well-structured interactions with her support network within six months. A decrease in forgetting during discussions and a drop in using memory aids are other signs of her enhanced memory and recall skills.

Rationale

The SMART goal established for Jade, aimed at improving her communication skills through enhanced speech clarity, emotional stability, and memory recall, is underpinned by a comprehensive rationale supported by various critical factors. Jade's client data paints a vivid picture of the profound impact of her severe TBI on her communication abilities, revealing notable deficits in these areas as significant barriers to her daily participation. Research evidence strongly corroborates the efficacy of the chosen therapeutic approaches, such as SLT, CBT, and behavioural strategies, in addressing communication challenges associated with TBI. These interventions have shown promise in enhancing speech clarity, regulating emotions, and bolstering memory functions (Yeates & Ashworth, 2019).

Furthermore, this goal respects and aligns with Jade's intrinsic values and preferences, focusing on personal, real-time communication rather than relying solely on technology-based solutions. This choice harmonises with her expressed preference for authentic human interaction, which has been taken into account. In the broader rehabilitation context, effective communication is a foundational pillar for improving overall patient well-being and functional capacity and fostering active engagement in rehabilitation. Leveraging the expertise of clinicians specialising in communication disorders, the goal focuses on the pertinent domains of the International Classification of Functioning, Disability, and Health (ICF).

Jade's communication enhancement plan is a multifaceted approach, and the hierarchy of this plan is structured to address her specific communication deficits effectively. Initially, SLT will focus on improving her speech clarity, articulation, and language comprehension through exercises and modelling (Hardin & Kelly, 2019). Concurrently, CBT will help Jade manage emotional lability, ensuring consistent and effective communication (Gómez-de-Regil, 2020). Memory enhancement strategies, including spaced repetition and mnemonic devices, will work to improve her memory and recall abilities. Communication skills training will be integrated to build her confidence and competence in various communication scenarios (Gopi et al., 2022).

Materials used in this approach may include speech therapy exercises, emotional regulation tools, memory aids, and communication training materials. Home practice will be encouraged to reinforce the skills learned during therapy (Barman et al., 2016).

The treatment dosage will be personalised to Jade's needs and progress, generally involving weekly or bi-weekly sessions for speech therapy and CBT. The treatment duration is expected to span several months, with ongoing assessments to track progress.

Formal and informal measures will be used to measure goal attainment. Formal assessments will include standardised tools to measure speech clarity, emotional stability, and memory recall abilities at specific intervals. Informal measures encompass real-life observations of Jade's communication, her ability to recall information, and her emotional stability during interactions (Khosla et al., 2018). Milestones, self-assessment, and feedback from Jade and her support system will further contribute to the ongoing evaluation of her progress (Matney et al., 2022).

Measurement/Data Collection

In a single session, Jade will effectively express her emotions and feelings to her family, indicating whether she is happy, sad, or angry, with at least 80% accuracy.

The short-term goal of enhancing Jade's ability to express her emotions clearly during interactions serves as a pivotal step towards the longer-term speaker-oriented goal of improving her overall communication skills. Clear emotional expression is fundamental to effective communication, providing a foundation for understanding and connecting with others (Šimić et al., 2021). Research by Byom et al. (2019) indicates that individuals with traumatic brain injuries may face challenges in recognising and expressing emotions, which can significantly impact their social interactions. By targeting this specific goal, we address a critical aspect that can enhance Jade's social engagement and the quality of her interactions with her support network.

Success in this area can boost Jade's confidence and motivation, making her more amenable to subsequent communication improvements. Moreover, this approach aligns with evidence-based practices, as researched by Milder (2019), support the efficacy of emotion recognition and expression training to improve social functioning and communication outcomes in individuals with brain injuries.

In the upcoming session, the clinician will guide Jade in enhancing her ability to express her emotions effectively. The activity will involve emotion cards depicting happiness, sadness, and anger. The clinician will discuss Jade's day or recent experiences and introduce the emotion cards at specific points. Jade's task will be to select an emotion card according to the Wisconsin Card-Sorting Test (WCST) that best represents her current stimulation and then describe why she chose that particular card, thus practising articulating her feelings.

If Jade finds the activity too easy, the clinician will introduce more complex emotions or encourage a more profound exploration of her feelings. If the activity seems challenging for Jade, the clinician will support and simplify the emotions on the cards (Gómez-de-Regil, 2020). The clinician will also offer more direct questions to help Jade express her emotions. Jade will receive constructive feedback and encouragement throughout the session to ensure her active participation and progress. This activity aligns with the broader goal of enhancing Jade's overall communication skills by focusing on her emotional expression abilities.

Data and outcomes in this session will be collected through direct observation and verbal interaction. The clinician will closely observe Jade's choice of emotion cards and her descriptions of her emotional states. The observation will provide valuable insights by assessing her ability to recognise and articulate emotions. Verbal interaction, guided by the clinician, will also play a crucial role in evaluating the clarity and accuracy of Jade's emotional expression.

The data collected will focus on the number of accurate emotional expressions made by Jade during the session. This quantitative measure will guide the assessment of her progress and determine whether the session's goal is successfully achieved. The feedback provided to Jade will be tailored based on the observed data, aiming to reinforce her strengths and address areas that may need improvement.

Reference List

Barman, A., Chatterjee, A., & Bhide, R. (2016). Cognitive Impairment and Rehabilitation Strategies after Traumatic Brain Injury. Indian Journal of Psychological Medicine 38 (3), 172-181. https://doi.org/10.4103/0253-7176.183086

Byom, L., Duff, M., Mutlu, B., & Turkstra, L. S. (2019). Facial Affect Recognition of Older Adults with Traumatic Brain Injury. Brain Injury 33 (3), 322. https://doi.org/10.1080/02699052.2018.1553066

Eapen, B. C., Bowles, A. O., Sall, J., Lang, A. E., Hoppes, C. W., Stout, K. C., & Cifu, D. X. (2022). The management and rehabilitation of post-acute mild traumatic brain injury. Brain Injury 36 (5), 693-702. https://doi.org/10.1080/02699052.2022.2033848

Gómez-de-Regil, L. (2020). Assessment of executive function in patients with traumatic brain injury with the Wisconsin card-sorting test. Brain Sciences 10 (10), 699. https://doi.org/10.3390/brainsci10100699

Gopi, Y., Wilding, E., & Madan, C. R. (2022). Memory rehabilitation: Restorative, specific knowledge acquisition, compensatory, and holistic approaches. Cognitive Processing 23 (4), 537-557. https://doi.org/10.1007/s10339-022-01099-w

Hardin, K. Y., & Kelly, J. P. (2019). The role of speech-language pathology in an interdisciplinary care model for persistent symptomatology of mild traumatic brain injury. In Seminars in Speech and Language (Vol. 40, No. 01, pp. 065-078). Thieme Medical Publishers. https://doi.org/10.1055/s-0038-1676452

Hoffman, R., Spencer, E., & Steel, J. (2023). A qualitative exploration of speech–language pathologists’ approaches in treating spoken discourse post-traumatic brain injury. International Journal of Language & Communication Disorders https://doi.org/10.1111/1460-6984.12866

Hou, Y., Zhou, A., Brooks, L., Reid, D., Turkstra, L., & MacDonald, S. (2023). Rehabilitation access for individuals with cognitive‐communication challenges after traumatic brain injury: A co‐design study with persons with lived experience. International Journal of Language & Communication Disorders https://doi.org/10.1111/1460-6984.12895

Khosla, S., White, R., Medina, J., Ouwens, M., Emmas, C., Koder, T., Male, G., & Leonard, S. (2018). Real world evidence (RWE) – a disruptive innovation or the quiet evolution of medical evidence generation? F1000Research https://doi.org/10.12688/f1000research.13585.2

Matney, C., Bowman, K., Berwick, D., & National Academies of Sciences, Engineering, and Medicine. (2022). Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury. In Traumatic Brain Injury: A Roadmap for Accelerating Progress . National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK580075/

Milders, M. (2019). Relationship between social cognition and social behaviour following traumatic brain injury. Brain injury 33 (1), 62-68. https://doi.org/10.1080/02699052.2018.1531301

Naqvi, Y., & Winters, R. (2020). Speech Assessment. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK559025/

Parola, A., Bosco, F. M., Gabbatore, I., Galetto, V., Zettin, M., & Marini, A. (2019). The impact of the Cognitive Pragmatic Treatment on the pragmatic and informative skills of individuals with traumatic brain injury (TBI). Journal of Neurolinguistics 51 , 53-62. https://doi.org/10.1016/j.jneuroling.2018.12.003

Rimehaug, T., & Kårstad, S. B. (2022). Communication and Emotional Vocabulary; Relevance for Mental Health Among School-Age Youths. Frontiers in Psychology 13 https://doi.org/10.3389/fpsyg.2022.847412

Šimić, G., Tkalčić, M., Vukić, V., Mulc, D., Španić, E., Šagud, M., Olucha-Bordonau, F. E., Vukšić, M., & Hof, P. R. (2021). Understanding Emotions: Origins and Roles of the Amygdala. Biomolecules 11 (6). https://doi.org/10.3390/biom11060823

Yeates, G. N., & Ashworth, F. (Eds.). (2019). Psychological therapies in acquired brain injury . Routledge. https://books.google.co.in/books

Related Topic:- Communication Intervention Plan Improved Speech Clarity and Emotional

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