Nelson L, Hart T, Rabinowitz A, Ferraro M, Turkstra L. Evaluation of Staff Communication Before and After Implementation of a Training Protocol for Inpatients with Memory Impairments. American Academy of Neurology Annual Meeting; April 2020; Toronto, ON, Canada.

Objective: 

The study aimed to evaluate the impact of a training program on effective communication for inpatients with acute memory deficits following Traumatic Brain Injury (TBI). Staff were trained to avoid questions taxing explicit memory systems (which is impaired during post-traumatic amnesia: PTA), while capitalizing on intact implicit memory to facilitate procedural learning. Using an observational coding scheme adapted from a prior study,¹ this study compares communication patterns among inpatients with declarative memory impairments and rehabilitation staff members pre and post-training.

Background: 

Published clinical guidelines from international experts regarding management of individuals in PTA post TBI emphasize the importance of reducing or eliminating the amount of fact-based questions asked. This questioning style may have undesirable consequences, causing frustration, reinforcing incorrect responses, and increasing the risk of clinicians acting on inaccurate information provided by their patients.²

Design/Methods: 

Participants included 8 brain injury rehabilitation program inpatients in PTA, determined by an Orientation-Log score of <25. Observations were conducted before and after staff-wide training, with 4 participants per group. Communications were transcribed, noting time of interaction, speaker (patient/OT/PT/ST/nurse), who was spoken to, and interaction location (patient’s room/gym/cafeteria). Within the data, questions directed at the participant were coded by two independent raters into “S-type,” pertaining to current state, “I-type,” information retrieval from recent/remote memory, and “Q-type,” testing the patient’s memory.

Results: 

Significantly fewer I-type (p=0.04) and Q-type (p=0.04) questions were asked per hour post-training versus pre-training. No significant difference was noted with S-type questions (p=1.00).

Conclusions: 

The results support the effectiveness of the training protocol in reducing I- and Q-type questions staff asked patients in PTA. S-type questions, which query patients’ current states (not taxing impaired explicit memory) were unaffected, suggesting reduction in I- and Q-type questions was not due to fewer questions overall. Future research should evaluate whether these changes also have a positive impact on clinical care.

References:

1. Valitchka, L. and L. S. Turkstra (2013). “Communicating with inpatients with memory impairments.” Semin Speech Lang 34(3): 142-153.
2. Ponsford, J. et al., 2014. INCOG recommendations for management of cognition following TBI, Part I: Posttraumatic amnesia/delirium, Journal of Head Trauma Rehabilitation, 29, 4, 307.

Lauren Nelson, M3, Drexel University College of Medicine