Stakeholder views on cognitive communication assessment and intervention for a person living independently in the community with severe traumatic brain injury.BACKGROUND
 Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living.  While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services.  Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD.  Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions.  Inadequate treatment provision and an under- or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention.


 To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI.  The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap.


 METHODS AND PROCEDURES
 A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case.  Data were evaluated using a thematic framework method.  Themes were inductively derived from the stakeholder narratives.


 OUTCOMES
 Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personal relevance.  Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services.


 CONCLUSIONS
 CCDs are under-recognised and this can have a devastating effect on people with CCD and on those around them.  Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI.  They also provide additional evidence of persisting barriers to accessing treatment.  Future research to explore ways to close this evidence-to-practice gap is required.


 What is already known on this subject Cognitive communication difficulties are a well-documented consequence of TBI.  There is evidence for the effectiveness of person-centred interventions for CCD across the recovery continuum.  International evidence-based practice recommendations are in place for CCD assessment and management.  Barriers to accessing SLT expertise for CCD have previously been reported.  What this paper adds to existing knowledge This investigation explores the views of a diverse group of stakeholders involved in a single case of a community-dwelling individual with severe TBI.  Stakeholders report positive real-world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team.  Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI.  What are the potential or actual clinical implications of this work?  CCDs are under-recognised, with devastating effect for people with CCD and those around them.  These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI.
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