Bannigan, Katrina

Griffiths, Sarah

Plymouth Marjon University Repository

Bulletin April 2016 | www.rcslt.org20FEATUREPARKINSON DISEASEPeople with Parkinson’s disease describe diffi  culties participating in everyday communication (Miller et al, 2006). However, SLTs report a lack of clinical tools targeting everyday interaction, as opposed to impairment, for these clients (Collis and Bloch, 2011). Research into everyday conversations has identifi ed potential diffi  culties (eg Griffi  ths et al, 2012) and eff ective repair strategies (eg Saldert et al, 2014; Griffi  ths et al, 2015). Th erapists could use this knowledge to advise families on the most effi  cient methods for enabling rewarding conversations.A literature review suggested that SLTs and occupational therapists (OTs) jointly might be best placed to provide a new, conversation-focused intervention. Th e intervention would initially focus solely on relatives of individuals with communication diffi  culties associated with Parkinson’s disease; eventually the focus will be on people with Parkinson’s disease and relatives together. Relatives support groupWe developed a six-session, two-hour, weekly support group programme for relatives and recruited six women via the Parkinson’s UK local branch. One participant had to withdraw due to her partner’s health. Th e project had a favourable ethical opinion from the University of St Mark and St John ethics committee. An SLT led the sessions, with one involving an OT. In these sessions we encouraged group members to share strategies for managing everyday conversation diffi  culties as well as develop new strategies. Th e sessions involved:■ Discussions: eg ‘What happens when you do not understand your partner?’ and ‘Encouraging participation in conversations’. ■ Watching and discussing dramatised video clips of diffi  culties that can occur in conversation. ■ Keeping diaries to record critical incidents in the week, as a basis for discussion.We collated a summary of strategies generated by the group for participants to take away as a record of their learning (http://tinyurl.com/gnk5en8). Th e theoretical approach was ‘Solution-focused therapy’ (de Shazer et al, 2007) involving a goal-directed approach to change. For example, we encouraged participants to search their life experiences for ‘exceptions’ or instances where a particular goal was at least partially achieved, and used these as a basis for co-constructing solutions.EvaluationWe conducted a feasibility study; an essential phase of developing a complex healthcare intervention (Medical Research Council, 2008). Th is provided evidence that the intervention has potential for further investigation. Participants took part in pre- and post-intervention data collection, one week prior to and one week following the intervention. Measures included: ■ Communicative eff ectiveness survey (CES) (Yorkston et al, 1999) (self-report measure).■ Short general health questionnaire (GHQ-12) (Goldberg and Williams, 1988) (self-report measure).■ Goal attainment scale-Light (GAS-Light) (Turner-Stokes, no date): scored by participants.■ Audio recorded interview.In the fi rst interview, participants answered questions to establish their primary concerns regarding communication and expectations regarding the group. In the second, they gave their opinion on how practical it was for them to attend, what benefi ts (if any) they had derived from attending and what suggestions they had for Enabling rewarding conversationsSarah Griffi  ths and Katrina Bannigan discuss a conversation-focused support group for relatives of people with Parkinson’s diseaseILLUSTRATIONS BY Martyna Wójcik-ŚmierskaApr16 020-021_Feature Griffiths.indd   20 18/03/2016   11:39April 2016 | www.rcslt.org  Bulletin 21FEATUREPARKINSON DISEASEimproving the group. Th e transcribed audio data was analysed using content analysis. FindingsTable one shows the data collected from the participants. Four of the CES scores showed improvement and four GHQ-12 scores improved or maintained. Th e consensus was that the number and length of sessions was ideal. Table two shows the individual ‘GAS’ goals collaboratively constructed and shaped from the participants’ responses in the pre-group interview.We have summarised the participants’ views post-group (the fi gures show the number of participants sharing each view): ■ It was helpful to share ideas and sometimes this led to a change in behaviours (5).■ Th e group gave them an excuse to talk about communication with their partners; this had been too sensitive before (3).■ Some found the diaries helpful as a focus for discussion (3). Others found it too diffi  cult to unpick complex critical incidents from memory (2).■ Th e dramatised video examples were helpful. All felt there would be benefi ts to discussing videos of their own conversations in therapy (5).■ Th e OT session was helpful in revealing strategies not previously considered (5).■ Th e strategies summary was valued (5).Next stepsParticipants received the sessions well, tolerated the battery of measures and noted positive changes with each outcome measure. Th is is encouraging in terms of conducting further research, but it is too early to suggest eff ectiveness. Th ere are a number of possible biases, including gender. Th ere was also no control group, so fi ndings may be due to a source other than the intervention. Th e participants’ partners were receiving speech and language therapy, which may account for the outcomes. Th e next step is to conduct a full pilot study.  ■ Table one: Summary of outcome measures Outcome measure Pre-group Post-groupCES (%) High scores = client perceived as communicating very effectively in a variety of situationsP1 41 94P2 59 81P3 46 68P4 38 69P5 69 66GHQ-12 High scores indicate psychological distress. More than 15 = cause for concernP1 16 10P2 6 6P3 9 13P4 11 5P5 14 10GAS-Light scores Five-point scale (-2 to +2). If expected goal attainment is achieved, post-intervention score is 0. More than expected outcomes scored at: +1 (a little more) or +2 (a lot more)P1 -1 +1P2 -1 +1P3(2 goals)-1-1+1+0.5P4 -1 +2P5 -1 0Table two: Participant goals, collaboratively constructed from the pre-group interviewsParticipant Goal/sP1 ‘My partner and I will be able to have proper in-depth conversations where he doesn’t give up/we don’t get frustrated.’P2 ‘I will have greater knowledge of strategies for helping communication, which may be helpful in the future.’P3 Goal 1: ‘When I can’t understand my partner I will respond encouragingly.’ Goal 2: ‘I will give my partner more of a chance to speak.’P4 ‘I will be prompting/reminding/‘talking for’ my partner less.’P5 ‘I will make more of the time when I have my partner’s attention, so that communication feels worthwhile.’References & resourcesCollis J, Bloch S. Survey of UK speech and language therapists’ assessment and treatment practices for people with progressive dysarthria. International Journal of Language and Communication Disorders 2012; 47:6, 725-737.de Shazer S, Dolan Y. More than miracles: The state of the art of solution-focused brief therapy. New York: Routledge, 2007. Griffi  ths S, et al. Potential causes and consequences of overlap in talk between speakers with Parkinson's disease and their familiar conversation partners. Seminars in Speech and Language 2012; 33, 27-43.Griffi  ths S, et al. Multiple repair sequences in conversations involving people with Parkinson’s disease, International Journal of Communication Disorders 2015; 50: 6, 814-829. Medical Research Council. 2008, Developing and evaluating complex interventions: new guidance. http://tinyurl.com/hnqcpewMiller N, et al. Life with communication changes in Parkinson’s disease. Age and Ageing 2006; 35, 235-239.Saldert C, Ferm U, Bloch S. Semantic trouble sources and their repair in conversations aff ected by Parkinson’s disease. International Journal of Language and Communication Disorders 2014; 49 (6), 710-721.Turner-Stokes L. GAS – Goal Attainment Scaling in Rehabilitation. http://tinyurl.com/jypeqdjYorkston KM, et al. (Eds). Management of motor speech disorders in children and adults. Austin, TX: Pro-Ed, 1999.Dr Sarah Griffi  ths, Senior Lecturer in Speech and Language Th erapy, University of St Mark and St John, email: sgriffi  ths@marjon.ac.ukDr Katrina Bannigan, Associate Professor (Reader) in Occupational Th erapy, Plymouth University, email: katrina.bannigan@plymouth.ac.ukApr16 020-021_Feature Griffiths.indd   21 18/03/2016   11:39

Enabling Rewarding Conversations

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Enabling Rewarding Conversations

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