IMPACT - Intervention for Metacognition and Social Participation: An Acquired Cognitive-communication Disorder Treatment. Treatment Development and Preliminary Findings

Abstract

Objectives: Cognitive-communication disorders (CCDs) can have devastating lifelong impacts on individuals with acquired brain injury. Because of the interplay between cognition and communication, metacognitive approaches incorporating functional tasks have been recommended as the most appropriate treatments for this population. Yet few studies have been completed investigating the use of metacognition as a treatment for CCDs. In consideration of the important role of metacognition in cognitive-communication disorders, the authors of this paper developed an intervention called IMPACT (Intervention for Metacognition and Social Participation: An Acquired Cognitive-communication Disorder Treatment).

Method: To ensure a systematic approach to intervention development and implementation, the guidelines outlined by the Medical Research Council framework for the development of complex interventions (Craig et al., 2013) were followed throughout the first two phases of development and feasibility testing. During the development phase, literature describing the management of cognitive-communication disorders was reviewed and informed publication of a systematic review of social communication interventions in ABI (see Finch, Copley, Cornwell, Kelly, 2015). In addition, theories of change that may underpin the success of the intervention including adult learning theory (Knowles, Holton, Swanson, 2011), self-efficacy theory (Bandura, 1997) and theories of behaviour change (Prochaska & Clemente, 1982) were considered in developing the intervention methods and procedures.

Results: The intervention was then tested for feasibility in two small pilot studies (n=8 per pilot study) which indicated that it may be efficacious in improving receptive language and pragmatic language skills for individuals with CCDs (Copley, Smith, Savill, & Finch, 2016; Finch, Cornwall, Copley, Doig, & Fleming, 2017). Findings from these studies resulted in some changes to the intervention to make it more easily implemented into clinical practice and appropriate for SLPs and clients (for example updated training materials, adapted session frequency). Currently, IMPACT is a 6-week intervention that is preceded by a pre-assessment session and a goal setting session. Each intervention week includes 1 face-to-face individual session and 1 group session.

Conclusions: The aim of IMPACT is to explicitly train goal setting, self-regulation, and task analysis for functional communication activities. Findings from the feasibility testing suggesting that IMPACT successfully meets these aims. However, further larger scale research evaluating the effectiveness of IMPACT for individuals with CCDs is required.