3.3 Evaluate intervention strategies and assistive technology used to support communication

This guide will help you answer 3.3 Evaluate intervention strategies and assistive technology used to support communication.

Acquired brain injury (ABI) can affect a person’s ability to communicate. This may involve difficulty understanding language, expressing thoughts, reading, writing, or using non-verbal signals. Communication problems can impact independence, relationships, work and social interactions. Effective support often combines intervention strategies with appropriate assistive technology. Each approach must match the person’s needs, strengths, and preferences.

This guide evaluates methods and tools used to improve communication for people with an ABI. It considers their strengths, possible drawbacks, and how they can be best applied.

Understanding the Impact of Acquired Brain Injury on Communication

An ABI is any brain injury that happens after birth, excluding those linked to hereditary or degenerative conditions. The most common causes include strokes, traumatic brain injury from accidents, infections, tumours, and oxygen deprivation.

The impact on communication can vary:

• Aphasia – difficulty with language understanding or production
• Dysarthria – weak or uncoordinated speech muscles leading to unclear speech
• Apraxia of speech – difficulty planning and producing the movements needed for speech
• Problems with attention, memory, and processing speed that affect conversation

These challenges mean that interventions need to be flexible. No single method works for everyone and progress can be slow.

Speech and Language Therapy

Speech and Language Therapy (SLT) is one of the most recognised intervention methods. A speech and language therapist assesses the communication needs of the individual. They then plan structured therapy to address identified difficulties.

Common SLT interventions include:

• Language exercises to strengthen understanding and vocabulary
• Speech drills to improve pronunciation and clarity
• Role-play and conversation practice to build confidence
• Swallowing therapy where eating and drinking are affected

Strengths:

• Personalised sessions that address the individual’s specific needs
• Uses evidence-based methods recognised in clinical practice
• Builds confidence and social participation

Limitations:

• Progress may depend on the severity of the injury
• Requires regular attendance, which can be demanding for some
• Relies on motivation and support from the person and their network

SLT works well when combined with practice in daily settings. Therapists often involve family and carers to reinforce strategies in everyday life.

Cognitive Communication Therapy

This targets the thinking skills needed for communication. It is especially useful when ABI affects attention, memory, or processing.

Typical methods include:

• Exercises to improve concentration and listening
• Memory strategies like using prompts or structured notes
• Sequencing activities for organising thoughts before speaking
• Problem-solving tasks that involve communication

Strengths:

• Addresses the underlying thinking skills rather than only speech
• Can improve both verbal and non-verbal communication
• Supports functional communication in real-life tasks

Limitations:

• May require longer-term engagement
• Progress can be hard to measure if changes are small
• Needs skilled facilitation to match pace and ability

Social Communication Groups

These are group therapy sessions where individuals practise conversation in a supported setting. A facilitator helps guide interactions, corrects misunderstandings, and gives feedback.

Benefits:

• Builds confidence in a safe space
• Encourages peer support and learning from others
• Gives real examples of managing breakdowns in communication

Drawbacks:

• Not suitable for everyone, especially early after injury
• Group dynamics can affect participation
• May be less effective without individual follow-up

Environmental Modifications

Adjusting the environment can remove some barriers to communication. This is often an overlooked intervention strategy, but it can make a big difference.

Examples:

• Reducing noise and distractions during conversations
• Looking directly at the person and speaking clearly
• Using visual aids such as diagrams, pictures, or written notes
• Allowing extra time for responses

These strategies require cooperation from family, friends, and staff. Training carers in communication support techniques can make the changes sustainable.

Low-Tech Assistive Technology

Low-tech tools are simple aids that do not require complex programming or power. These can be very effective for someone with an ABI.

Examples include:

• Communication boards or books with pictures, words, or symbols
• Alphabet boards for spelling out words
• Cue cards for common phrases
• Drawings or diagrams to support explanations

Advantages:

• Easy to use and inexpensive
• Can be customised to the individual’s needs
• No reliance on technology that may fail

Challenges:

• Limited vocabulary unless boards are large or customised
• May be slower than speech
• Requires carrying the aid or having it nearby

High-Tech Assistive Technology

High-tech devices can offer more flexibility and independence for those with ABI. They are often used when speech is severely affected.

Common types:

• Speech Generating Devices (SGDs) that create spoken output when the user selects words or symbols
• Text-to-Speech Apps on tablets or smartphones
• Voice Banking for those who may lose speech, storing recordings for later use
• Eye-gaze technology for individuals with limited physical movement

Benefits:

• Can store large amounts of vocabulary
• Allows complex ideas to be expressed
• Portable options are available

Limitations:

• Can be costly to purchase and maintain
• Requires training to use effectively
• Technology problems may impact communication in critical situations
• Some users may find them tiring over time

Combined Approaches

Using a mix of strategies can give the best results. For example, a person with mild dysarthria might benefit from speech drills in therapy, using a low-tech communication book when tired, and an app on a phone for unfamiliar situations.

A key part of evaluating combined approaches is checking how well the person can switch between methods. Consistency and support from trained carers can help maintain success.

Training and Support for Assistive Technology

Both the person with ABI and their support network need training to use assistive technology confidently. This can include:

• Step-by-step instructions
• Practice during therapy sessions
• Troubleshooting techniques for when things go wrong
• Guidance on cleaning, storing, and charging the device

Without ongoing support, the risk is that devices are abandoned if they seem too complicated or frustrating.

Evaluating Effectiveness

To measure the value of an intervention or assistive tool, several questions can be asked:

• Does it allow the person to communicate their needs and preferences?
• Is it practical in their daily life?
• Does the person enjoy using it?
• Has social participation improved?
• Are misunderstandings reduced?

Evidence can be collected through observation, feedback from the individual and carers, and formal assessments by therapists.

Barriers to Success

Some common barriers include:

• Limited access to therapy due to budget or location
• Fatigue or fluctuating health that affects participation
• Difficulty remembering how to use devices or strategies
• Resistance to change from the individual or people around them

Addressing these barriers early can prevent wasted resources and support long-term success.

Ethical and Cultural Considerations

Communication support must respect the person’s preferences, privacy, and cultural background. This includes:

• Using the person’s preferred language and communication style
• Seeking consent for the use of assistive technology
• Avoiding approaches that might cause embarrassment or discomfort
• Considering literacy levels when using written aids

Role of the Care Worker

Care workers play a key role in maintaining strategies outside therapy sessions. They can:

• Encourage regular practice
• Prompt the person to use aids when needed
• Model clear and patient communication
• Give feedback to therapists about what works and what does not

Consistency between therapy and daily care makes interventions more effective.

Examples of Best Practice

Some examples include:

• A person with ABI and aphasia uses a picture board for ordering food in a café. Staff are trained to wait patiently and confirm their choices.
• A stroke survivor with severe dysarthria uses a tablet with text-to-speech in group meetings. Friends know how to adjust settings if needed.
• A man with memory problems after brain injury keeps a notebook with key phrases and daily schedules. This reduces stress in conversations.

Future Developments in Assistive Communication

While some tools are well-established, new devices and apps continue to appear. The main focus should remain on matching the person’s capability with the right tool rather than always choosing the newest option. Regular reviews are important as needs may change over time.

Final Thoughts

Supporting communication after an acquired brain injury requires patience, creativity, and collaboration. The right mix of intervention strategies and assistive technology can open up opportunities for social participation, learning, and independence.

Evaluating outcomes should always focus on the person’s quality of life, not just their speech clarity or vocabulary size. Including the individual in decision-making and reviewing strategies regularly will help maintain meaningful and effective communication support.