BACKGROUND Parkinson’s can impact on people’s speech, cognition, pragmatics and language, therefore significantly affecting conversation with others. The speech and language therapy approach Communication Partner Training (CPT) is effective for a range of communication difficulties. However, speech and language therapy intervention for people with Parkinson’s predominantly focuses on impairments, with little provision of CPT for this population. Better Conversations is a CPT approach that involves working with a dyad (the person with the communication difficulty and a conversation partner) to build conversation skills. It is effective at reducing barriers to conversation, and for some it significantly increases targeted facilitatory strategies. Some approaches to CPT have been adapted to be delivered via telehealth. This can maximise ecological validity and convenience. Furthermore, telehealth is widely acceptable as a delivery method for other interventions in Parkinson’s. This paper presents the protocol for a pilot feasibility study of a Better Conversations CPT delivered via telehealth to people living with Parkinson’s and their conversation partners (CPs) called Better Conversations with Parkinson’s (BCP). OBJECTIVE The primary aim is to evaluate the feasibility of the BCP programme delivered via telehealth with a treatment group from a collaborating NHS site, to establish for a main trial whether BCP can be delivered as intended in an NHS setting. The aim is to establish: • the acceptability of the programme for people living with Parkinson’s, family members, and speech and language therapists (SLTs) • the feasibility of delivering the BCP programme • recruitment and retention rates • preliminary outcomes for participants • a sample size calculation • the most appropriate primary outcome measure METHODS Ethical approval for this study was obtained from London – Central Research Ethics Committee (reference: 22/LO/0332). This case series feasibility pilot study will recruit 10-12 dyads to ensure 10 complete datasets. Participants will be recruited by a collaborating NHS site, located in England. Participants will be involved for 16 weeks (weeks 1-2 pre-intervention measures; weeks 3-8 intervention; weeks 10 – 12 post-intervention measures; week 16 follow up interview). Quantitative and qualitative methods will be used to analyse study data. Speech, communication and quality of life assessment data will be analysed statistically to determine a suitably sensitive outcome measure. Descriptive statistics will be used to report on recruitment, attendance and attrition. Finally, acceptability and feasibility will be evaluated using participant feedback, interviews and the reflective diary and feedback of the SLT administering the therapy (the research assistant/ first author). This data will be analysed using descriptive statistics and reflexive thematic analysis. RESULTS This study was approved for funding from Parkinson’s UK. Study recruitment commenced in July 2022. The results of data analysis are expected to be available by September 2023. CONCLUSIONS Insights from this study will provide valuable information about the acceptability and feasibility of a remotely-delivered Better Conversations CPT approach for people living with Parkinson’s and their CPs. An outcome of this study will be a manualised BCP programme coproduced by people living with Parkinson’s, their families, and a group of expert SLTs. The study results will guide the next stages of intervention development.

Background Parkinson’s can impact people’s speech, cognition, pragmatics, and language, significantly affecting their conversations with others. The speech and language therapy approach called communication partner training (CPT) is effective for a range of communication difficulties. However, speech and language therapy interventions for people with Parkinson’s predominantly focus on impairments, with little provision of CPT for this population. Better Conversations is a CPT approach that involves working with a dyad (the person with the communication difficulty and a conversation partner [CP]) to build conversation skills. It is effective at reducing barriers to conversation, and for some, it significantly increases targeted facilitatory strategies. Some approaches to CPT have been adapted to be delivered via telehealth. This can maximize ecological validity and convenience. Furthermore, telehealth is widely accepted as a delivery method for other interventions for Parkinson’s. This study presents the protocol for a pilot feasibility study of a Better Conversations CPT delivered via telehealth to people living with Parkinson’s and their CPs, called Better Conversations with Parkinson’s (BCP). Objective The primary aim is to evaluate the feasibility of the BCP program delivered via telehealth with a treatment group from a collaborating National Health Service (NHS) site to establish for a main trial whether BCP can be delivered as intended in an NHS setting. The aim is to establish: (1) the acceptability of the program for people living with Parkinson’s, family members, and speech and language therapists (SLTs); (2) the feasibility of delivering the BCP program; (3) the recruitment and retention rates; (4) a sample size calculation; and (5) the most appropriate primary outcome measure. Methods Ethical approval for this study was obtained from London-Central Research Ethics Committee (reference: 22/LO/0332). This case-series feasibility pilot study will recruit 10-12 dyads to ensure 10 complete data sets. Participants will be recruited by a collaborating NHS site located in England. Participants will be involved for 16 weeks (weeks 1-2 preintervention measures, weeks 3-8 intervention, weeks 10-12 postintervention measures, week 16 follow-up interview). Quantitative and qualitative methods will be used to analyze the study data. Speech, communication, and quality of life assessment data will be analyzed statistically to determine a suitably sensitive outcome measure. Descriptive statistics will be used to report on recruitment, attendance, and attrition. Finally, acceptability and feasibility will be evaluated using participant feedback, interviews, and the reflective diary and feedback of the SLT administering the therapy (by the research assistant who is the first author). This data will be analyzed using descriptive statistics and reflexive thematic analysis. Results This study was approved for funding from Parkinson’s UK. Study recruitment commenced in July 2022. The results of the data analysis are expected to be available by September 2024. Conclusions Insights from this study will provide valuable information about the acceptability and feasibility of a remotely delivered Better Conversations CPT approach for people living with Parkinson’s and their CPs. An outcome of this study will be a manualized BCP program coproduced by people living with Parkinson’s, their families, and a group of expert SLTs. The study results will guide the next stages of intervention development. International Registered Report Identifier (IRRID) PRR1-10.2196/41416

Background Face mask use has become widespread as a means of reducing transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Research suggests face coverings can impact speech discrimination, therapeutic alliance and the interpretation of non‐verbal cues. However, there is little research into the impact of face masks on people with communication difficulties (pwCD) post‐stroke. Aims To explore the perspectives of service users and staff on a stroke rehabilitation unit in order to understand the impact of staff wearing face masks on the experience of rehabilitation for pwCD. Strategies that might improve the experience of rehabilitation for pwCD were also explored. Methods & Procedures Semi‐structured interviews and a focus group were conducted with six pwCD and five health professionals (HPs) on a stroke rehabilitation unit. The data were analysed using reflexive thematic analysis. Outcomes & Results Four main interacting themes were identified from the data: (1) face masks as a barrier to effective communication; (2) face masks as a barrier to human connection and therapeutic relationships; (3) the impact of face masks on an individual is influenced by multiple internal and external factors; and (4) there is a need for service provision to evolve to meet pwCD's needs when using face masks. Conclusions & Implications Findings shed light on how face masks can act as a barrier for pwCD within the rehabilitative process, and emphasize that each individual with communication difficulties is likely to be affected to a differing extent, as a result of multiple interacting factors. HPs are encouraged to consider the individual holistically, tailor strategies and adapt to each individual's needs. Further research is required to understand how to optimize rehabilitation outcomes when face masks are used. WHAT THIS PAPER ADDS What is already known on the subject There is evidence face masks can affect speech discrimination, therapeutic alliance and interpretation of non‐verbal cues. The existing literature predominantly considers people with hearing impairments, mental health needs or the general public. The potential for face masks to impact pwCD post‐stroke is high, given pre‐existing communication barriers and evidence of increased social isolation. What this paper adds to existing knowledge This study is the first of its kind to explore how face mask use by HPs impacts the experience of rehabilitation for pwCD post‐stroke. The authors consider the need to tailor compensatory strategies to each individual and adapt them to meet service users’ needs. What are the potential or actual clinical implications of this work? HPs should monitor closely the impact of face mask use on pwCD with whom they are working, and consider what adaptations to ...