Objective: Communication with patients in the Post-Traumatic Confusional State (PTCS) is challenging because of patients’ impaired level of consciousness. Impaired consciousness may lead to difficulties participating in effective procedural interactions (routines with staff) and conversations. Additionally, communication disorders associated with acquired brain injury may require the communication partner to take on the burden of managing the interaction to maximize communicative success and minimize confusion and its associated consequences (e.g., behavioral difficulties). Communication partner training such as TBIexpress™ has been shown to be successful in more chronic stages of TBI, and the effect of Supported Conversation for Adults with Aphasia (SCA™) has been demonstrated for subacute and chronic stages in patients with stroke induced aphasia.  However, the effect and usefulness of CPT in subacute settings with patients in PTCS has yet to be explored. This study aims to evaluate a CPT program targeting interdisciplinary staff who works in a hospital with patients in PTCS.
Method: A pre-post survey design was used. A total of 104 interdisciplinary staff members at a subacute rehabilitation unit for patients with moderate to severe TBI attended a 3-hour SCATM training course and subsequent implementation support, consisting e.g. of follow-up meetings in the inter- and mono-disciplinary teams. Staff completed a pre and post implementation questionnaire. Items consisted of both quantitative (the degree of e.g. confidence in communication) and qualitative questions (e.g. perception of SCA techniques and non-successful/successful communication). 
Results: CPT based on SCATM successfully increases interdisciplinary staff’s perceived confidence and self-assessed ability to communicate with patients in PTCS. Even though communication is still experienced as difficult by participants, staff find it less time consuming, report communication to be more effective and to use tools and strategies related to the CPT. The nature of the strategies reported moved from more general approaches such as structuring the environment to more communication specific strategies such as writing to support verbal language. Participants found they could apply strategies to improve comprehension of information (reveal competence IN) and to confirm their understanding of a patient’s communication (VERIFY). However, participants reported applying strategies to enhance the patient’s own expression (reveal competence OUT) to be more challenging. 
Conclusions and implications for clinical practice: The results contribute in narrowing the knowledge gap as to whether CPT/SCA™ is perceived by staff to support them in communication with patients in PTCS in the subacute setting. Training staff to manage difficult communication may enhance their confidence and ability to interact with patients in PTCS and this study offers strategies staff perceive as helpful in their interactions. Further training may be needed to equip staff with skills to support people in PTCS to communicate their needs.

Communication Partner Training and Post-Traumatic Confusion