2019 was, for me, a year to celebrate two significant milestones; two decades since qualifying as a speech and language therapist and one as an independent practitioner. It has been a time to reflect on the changes that unfolded, both in my practice and within the profession.
By way of illustration, I have a strong memory of delivering a presentation as an undergraduate during a module on acquired communications disorders. The topic was ‘subclinical aphasia’ as experienced following traumatic brain injury (TBI). This short label powerfully indicates how little was understood about communication difficulties following TBI back in the early 1990’s. We borrowed knowledge from the field of stroke and had a limited grasp on the myriad clinical features experienced by our clients. Fast forward to today and consider Sheila MacDonald’s 'Model of cognitive-communication competence’ which helps us to “[conceptualise] the full range of communication impairment after acquired brain injury“ (2017). This model draws together the many and varied clinical features involved in communication following TBI. This gives a theoretical background to what I see every day in practice - that the experience of cognitive communication difficulties is as unique as the individuals involved, influenced by their personal context as well as the injury.
Coming back to my presentation all those years ago, it sticks in my mind because it was one of the earliest opportunities I had to explore the barriers that existed for people with TBI as they tried to re-engage with their life roles. As the profession has developed in its understanding and management of people with brain injury, so have I. I have been able to work at every stage of the pathway from ITU to post acute rehabilitation. I now spend my working days alongside people who are living with cognitive communication impairment, together with family, friends, and sometimes their colleagues, as they aim to re-engage with social, work and leisure roles in their own community.
My goal is always to encourage and support my clients to live life to the full through the creative development of therapy programmes drawing on the evolving evidence base. Keeping up-to-date with research and other developments can be challenging enough but more so, working independently with less readily available spaces to share ideas with colleagues about application of theory in practice. Technology helps; Twitter is a fantastic window for discovering what colleagues are thinking about and doing in their work, almost in real time. Webinars provide remote access to more regular training and discussion with colleagues. Peer groups provide a safe space to have face to face discussions with trusted colleagues. The ever burgeoning body of blogs and vlogs allows speech therapists to share their ideas more widely, however, to date, I have not been able to find any fellow speech therapists blogging about their experience and practice in the area of cognitive communication following TBI.
2019’s milestones provided not only an opportunity for reflection but also the catalyst for seeking a new challenge. Having failed to discover anyone writing about the topic that interests me so much, I decided to become the answer to my own google search. In writing this blog, I hope to share some of my ideas about practicing as a speech and language therapist in the area of cognitive communication competence and invite conversation about how we as a profession can continue to address the needs of our clients creatively, especially as they return to family, leisure and work life. Where possible, I will give a space for my clients to ‘Give Voice’ by way of focusing on the most important people in this discussion and to provide hope for those who are starting out on their journey of recovery.
Amongst the topics I hope to explore are ways to explain the complexities of cognitive communication competence to clients and their families (especially in relation to clinical assessments), new research into the role of the cerebellum (van Dun et.al. 2016) in social communication, the broadening view of Diffuse Axonal Injury (McDonald et al. 2019) and what all this might mean for my clients.
I hope this piques your interest; please watch this space for blogs in the coming months and feel free to join the conversation using the comments box below.
Sheila MacDonald (2017) Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury, Brain Injury, 31:13-14, 1760-1780, DOI: 10.1080/02699052.2017.1379613