This document describes a study investigating the reliability and validity of using telehealth (Skype) to assess social communication abilities after traumatic brain injury (TBI) compared to in-person assessments. A pilot study was conducted comparing in-person and Skype administration of several communication assessment tools. Preliminary findings suggest Skype is adequate for assessment, participants became more positive about Skype after using it, and main concerns were technical rather than privacy issues. Next steps include a reliability study and potential randomized controlled trial of in-person versus Skype delivery of a communication skills treatment program for people with TBI.

1. Rachael Rietdijk1,2,3, Leanne Togher1,2,3 & Emma Power1,3
1 Discipline
of Speech Pathology, Faculty of Health Sciences, University of Sydney, Australia
2 NHMRC CRE
in Brain Recovery (Moving Ahead)
3NHMRC CCRE
in Aphasia Rehabilitation
Acknowledgement: Australian Postgraduate Award, Institute for
Safety Compensation and Recovery Research, NHMRC CRE in Brain
Recovery (Moving Ahead) Seed Grant

2. Why investigate using telehealth with TBI?
Service access barriers for TBI (O’Callaghan et al., 2011):
1. Location of specialist services (centralised expertise)
2. Cognitive impairments (organisation, motivation)
3. Mobility impairments (transport, carer burden)
4. Population demographics (working, caring for children)
The focus of our project:
- Assessing social communication after TBI using Skype
2

3. Reliability Study: In-Person vs Skype Assessment
› Participants: People with TBI and family members / close friends
› Procedure: Communication assessment protocol completed during both an inperson and Skype session. Order of assessment randomly allocated. Sessions
at least one week apart.
- Primary outcome measures:
- Measure of Participation in Conversation (Adapted) (Togher et al., 2010)
- Measure of Support in Conversation (Adapted) (Togher et al., 2010)
- Secondary outcome measures
- Global ratings of conversational quality (Bond & Godfrey, 1997)
- La Trobe Communication Questionnaire (Douglas et al., 2007)
- Impact on Participation and Autonomy Questionnaire (Cardol et al., 2001)
- Communication Confidence Rating Scale for Aphasia (Babbitt et al., 2011)
- Communicative Access Measures for Stroke (Adapted) (Aphasia Institute, 2010)
3

4. Qualitative Study: In-Person vs Skype
- Satisfaction and qualitative data
- Pre-assessment preferences
- Post-Skype assessment questionnaire
- Semi-structured qualitative interview after participants
had completed the two sessions
4

5. Three preliminary findings from pilot data
1. Skype has been adequate for conducting the
assessment sessions.
2. People tend to become more positive about Skype
after experiencing it.
3. Main concerns about Skype are about the quality of
the connection, and the interaction with the
therapist, rather than privacy.
5

6. Next steps
› Reliability study
- Analysis will occur in consultation with a stakeholder reference
group including key people working in the field of TBI within NSW
Health
- Use results to assist planning an RCT of in-person vs. Skype
communication skills treatment for TBI (adapting the existing
treatment manual TBI Express, Togher et al., 2010)
6

7. Collaboration
› Areas of interest
- Suitability of Skype for telehealth purposes?
- Screening of communication skills over telehealth by other
healthcare workers
- Exploring patient-led models of service planning around use of
telehealth
- Comparing clinical discourse between in-person vs. telehealthbased sessions
7

8. Contact details
› Rachael Rietdijk, PhD student; rman7827@uni.sydney.edu.au
› Professor Leanne Togher, Professor of Communication Disorders
Following Traumatic Brain Injury, Senior NHMRC Research Fellow;
leanne.togher@sydney.edu.au
› Dr Emma Power, Lecturer in Neurogenic Communication
Disorders, emma.power@sydney.edu.au
8

9. References
› Aphasia Institute. (2010). Communicative access measures for stroke.
› Babbitt, E. M., Heinemann, A. W., Semik, P., & Cherney, L. R. (2011). Psychometric properties of the Communication Confidence
Rating Scale for Aphasia (CCRSA): Phase 2. Aphasiology, 25(6-7), 727-735.
› Bond, F., & Godfrey, H. P. D. (1997). Conversation with traumatically brain-injured individuals: A controlled study of behavioural
changes and their impact. Brain Injury, 11(5), 319-329.
› Cardol, M., de Haan, R. J., de Jong, B. A., van den Bos, G. A., & de Groot, I. J. (2001). Psychometric properties of the Impact on
Participation and Autonomy Questionnaire. Archives of Physical Medicine and Rehabilitation, 82(2), 210-216.
› Douglas, J. M., Bracy, C. A., & Snow, P. C. (2007). Measuring perceived communicative ability after traumatic brain injury: The
reliability and validity of the La Trobe Communication Questionnaire. Journal of Head Trauma Rehabilitation, 22(1), 31-38.
› O'Callaghan, A. M., McAllister, L., & Wilson, L. (2011). Experiences of care: Perspectives of carers of adults with traumatic brain injury.
International Journal of Speech-Language Pathology, 13(3), 218-226.
› Togher, L., McDonald, S., Tate, R., Power, E., Ylviskaker, M., & Rietdijk, R. (2010). TBI express: A social communication training
manual for people with traumatic brain injury (TBI) and their communication partners. Sydney: Australian Society for the Study of Brain
Impairment (ASSBI).
› Togher, L., Power, E., Tate, R., McDonald, S., & Rietdijk, R. (2010). Measuring the social interactions of people with traumatic brain
injury and their communication partners: The adapted Kagan scales. Aphasiology, 24(6-8), 914-927.
9