Communication partner training to support persons in a minimally conscious state : identifying and adapting an intervention programme

Abstract

Persons in a minimally conscious state (MCS+) often have fluctuating levels of alertness as well as varying self- and environmental awareness. They inconsistently follow concrete- one-step instructions, show a fluctuating understanding of yes/no questions, demonstrate the functional use of objects in an incongruent manner, use vocalisations inconsistently, and present with capricious intentional communication. Due to the dissonance of these behaviours, it is difficult for communication partners to observe early neuro-behavioural signs indicating signs of alertness and awareness as well as later unaided communication attempts. Although, communication partners indicate a willingness to interact with these persons, they may not have sufficient knowledge to identify the communication functions of unaided communication behaviours displayed by the person. Additionally, communication partners might not know which unaided communication behaviours to observe as these behaviours are subtle and consequently easily overlooked or misinterpreted by them. To support communication partners of persons in an MCS+, communication partner training is suggested as one possible intervention. Communication partner training typically focuses on equipping partners to observe, assess, and interpret unaided communication behaviours while also training them to provide appropriate responses. Furthermore, such an intervention may support partners to utilise their own communication strategies to facilitate communication with persons in an MCS+. The aim of this study is to identify and adapt an evidence-based intervention in the form of a communication partner training programme to facilitate interaction between communication partners and persons in an MCS+. This is achieved by empowering communication partners to observe, assess, interpret, and respond to the communication behaviours displayed by these individuals. A qualitative exploratory collective case study design with three sequential phases, each comprising distinct steps, is used to address this aim. From the findings of the study, the Connect+ was developed for communication partners of persons in an MCS+ based on E3BP principles. The clinical utility of this programme was also determined.