No abstract

Background: Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication).Aim: To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. Methods & Procedures:The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. Main contribution:The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. Conclusions & Implications: Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication.

Purpose: Limited clinical and research evidence is available to support healthcare practitioners in the communication assessment and intervention of persons who are minimally conscious. This study placed a specific focus on the multimodal communication strategies familiar caregivers of persons who are minimally conscious observed, as well as the verbal and the nonverbal communication strategies they employed to build communication capacity. This may inform clinical practice as it provides valuable autobiographical information as well as familiar stimuli that may elicit responses from persons in a minimally conscious state. Method: A descriptive qualitative design employing in-depth semi-structured interviews with familiar caregivers was utilised to address the purpose of the study. Result: Familiar caregivers reported that they used both nonverbal and verbal communication strategies to obtain a response from persons who are minimally conscious. These caregivers also reported that these persons appeared to rely on nonverbal communication strategies to express 36 different communication functions. Conclusion: Based on the findings of this study, it is clear that caregivers can be beneficial to persons who are minimally conscious, if they are able to observe and capitalise on naturally occurring multimodal communication strategies and functions. This study emphasises that familiar caregivers respect and value the dignity of persons who are minimally conscious and want to improve their communication capacity, but often lack confidence in their own communication skills.