Select Page

Table 7.2 Effectiveness of Social Communication Skills Training

 
Author/ Year/ Country/ Study Design/ N Methods Outcomes
Westerhof-Evers et al. (2017) Netherlands RCT PEDro=7 NInitial=61, NFinal=56 Population: TBI; Mean Age=43.2 yr; Gender: Male=83, Female=17; Severity: Moderate to severe. Treatment: Participants were randomly assigned to receive Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo, n=30) protocol or Cogniplus (n=29) training. The TScEmo protocol is aimed at enhancing emotion perception, perspective taking, theory of mind, goal-directed social behaviour through 20 individual treatment sessions offered 1-2x/wk by neuropsychologists. Cogniplus is an individually administered computerized attention training aimed at improving general cognition. Outcomes were assessed baseline (T0), post-intervention (T1), and 3-5 mo follow-up (T2). Outcome Measure: The Awareness of Social Inferences Test (TASIT-short), Sixty faces test (FEEST), Cartoon test, Faux Pas test (FP), Wechsler Adult Intelligence Scale (WAIS-III digit span), Trail Making Test (TMT A and B/A), Test of Everyday Attention Lottery (TEA lottery), Dysexecutive Questionnaire-Social scales (DEX-Soc-self, DEX-Soc-proxy), Brock’s Adaptive Functioning Questionnaire-Social monitoring scale (BAFQ-SM-self, BAFQ-SM-proxy), BAFQ empathy scale (BAFQ-Emp-self, BAFQ-Emp-proxy), Role Resumption List (RRL), Quality of Life after Brain Injury (QOLIBRI satisfaction, QOLIBRI burden), Treatment Goal Attainment (TGA), Relationship Quality Scale (RQS-self, RQS-life partner).
  1. For the primary outcome of TASIT-short, there was no significant improvements over time in either group and no significant differences between groups.
  2. Significant Time x Group interactions from T0 to T1 were observed for FEEST (p=0.01), CT (p=0.02), RRL (p<0.01), and TGA (p<0.01). No significant interactions from T0 to T1 were observed for FP, DEX-Soc-self, DEX-Soc-proxy, BAFQ-SM-self, BAFQ-SM-proxy, BAFQ-Emp-self, BAFQ-Emp-proxy, QOLIBRI satisfaction, QOLIBRI burden, RQS-self, RQS-life partner, WAIS-III digit span, TMT A, TMT B/A, or TEA lottery.
  3. Significant Time x Group interactions from T0 to T2 were observed for FEEST (p<0.01), CT (p=0.02), BAFQ-Emp-proxy (p=0.02), RRL (p<0.01), QOLIBRI burden (p=0.04), RQS-life partner (p=0.02), and TGA (p<0.01). No significant interactions from T0 to T2 were observed for FP, DEX-Soc-self, DEX-Soc-proxy, BAFQ-SM-self, BAFQ-SM-proxy, BAFQ-Emp-self, QOLIBRI satisfaction, RQS-self, WAIS-III digit span, TMT A, TMT B/A, or TEA lottery.
Dahlberg et al. (2007) USA RCT PEDro=6 N=52 Population: TBI; Mean Age=41.17 yr; Gender: Male=44, Female=8; Mean Time Post Injury=9.67 yr; Severity: Severe=40, Moderate to mild=12. Treatment: Patients were randomly assigned to either the experimental (n=26) group or the control group (n=26). Individuals receiving the training focused on listening to others, communicating needs, and regulating their emotions during social interactions. There were 12 sessions each lasting 1.5 hr. The control group waited 3 mo before undergoing treatment. Patients were assessed 5 times: baseline (wk 0), end of treatment (wk 12), at wk 24, 36 and 48. Outcome Measure: Profile of Functional Impairment in Communication (PFIC), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Goal Attainment Scale (GAS).
  1. Results of the PFIC rating scale showed significantly greater improvements on 7 of the subscales included on the PFIC: general participation (p=0.001), quantity (p=0.024), internal relation (p=0.009), external relation (p=0.005), clarity of experience (p=0.024), social style (p<0.001) and aesthetics (p=0.014).
  2. The SCSQ-A showed significant improvement (p=0.005) for the treatment group compared to the control, pre- and post-intervention.
  3. Over time significant improvement were noted between baseline scores and post-treatment scores for all participants receiving training on the PFIC (21 of the 30 subscales: p<0.001). Significant improvement was noted on the SCSQ-A (p<0.001) as well.
  4. Significant improvements were made on the GAS from baseline to all post-treatment evaluations (p<0.001).
Finch et al. (2017) Australia Pre-Post N=8 Population: TBI; Mean Age=36.25 yr; Gender: Male=4, Female=4; Mean Time Post Injury=24.6 mo; Mean GCS=8.25; Severity: moderate=1, severe=7. Treatment: Participants received one 1 hr group and one 1 hr individual therapy session per wk for 8 wk. Therapy sessions were led by a speech-language pathologist and focussed on remediating impaired social communication skills using metacognitive strategy instruction training and goal-based therapy. Outcomes were assessed at baseline (4 wk baseline prior to intervention, pre-intervention, post-intervention, and 4 wk follow-up. Outcome Measure: Profile of Pragmatic Impairment in Communication (PPIC), LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scaling (GAS).
  1. For PPIC, only the literal content (p=0.005), general participation (p=0.02), internal relation (p=0.008), clarity of expression (p=0.026), and aesthetics (p=0.016) subscales showed significant improvement from baseline to 4 wk follow-up. No significant differences were observed for the quantity, quality, external relation, social style, or subject style subscores.
  2. For PPIC, only the aesthetics subscale was significantly improved (p=0.039) comparing post-intervention to pre-intervention.
  3. No significant differences for LCQ were observed when comparing baseline to 4 wk follow-up or pre- to post-intervention.
  4. During the intervention, participants identified between three and six goals each. Following the intervention, there was a significant increase in GAS goal T-scores (p=0.012).
Braden et al. (2010) UK Cohort Ninitial=30, Nfinal=17 Population: TBI; Mean Age=42.11 yr; Gender: Male=21, Female=9; Mean Time Post Injury=7.85 yr. Treatment: Participants received Group Interactive Structured Treatment (GIST) for social competence. This program was provided in a rehabilitation facility or in the community. A treatment workbook, developed specifically for GIST, was given to each participant. Each group member was asked to attend 13, 1.5 hr/wk sessions to discuss various topics related to effective communication. Patients were assessed at baseline, post-treatment, and at 3 and 6 mo. Outcome Measure: Profile of Pragmatic Impairment in Communication (PPIC), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Goal Attainment Scale (GAS), Satisfaction with Life Scale (SWLS).
  1. Social communication skills, as assessed by SCSQ-A, GAS and SWLS, improved significantly pre- to post-assessment (p<0.05).
  2. For those in the TBI+ group (those with a substance disorder, a psychiatric disorder, or other neurological complications) significant improvement was noted on their SCSQ-A, GAS, SWLS scores (p<0.01, p<0.000 and p=0.01 respectively).  The improvement on the PPIC was not significant (p=0.40).
  3. There were no significant differences comparing the groups (TBI only to TBI+) at baseline, post-intervention or 6 mo post-intervention for the PPIC, person ratings on SCSQ-A, GAS and SWLS.