Story-ABI-lity: Evaluating a story-based speech pathology intervention for people with traumatic brain injury in the hospital setting.

What is the intervention? Story-ABI-lity is a manualised, narrative-based speech pathology intervention designed to support cognitive-communication recovery in adults with traumatic brain injury (TBI) during inpatient rehabilitation. The intervention targets storytelling and narrative discourse skills through structured, supported activities delivered by a speech pathologist. Story-ABI-lity was co-designed with people with TBI, clinicians and researchers, developed for the hospital setting. Story-ABI-lity is informed by pragmatic communication principles, including Gricean maxims, and hierarchical storytelling approaches. Participants are supported to produce organised, relevant and contextually appropriate narratives using visual and conversational prompts, clinician modelling, scaffolding and guided practice. Gricean maxims are rules that guide effective and cooperative communication (Grice, 1975). These domains are Quality, Quantity, Relation and Manner, areas that guide conversations to be informative, truthful, relevant, and clear. Participants practice storytelling and are then guided to reflect on the informativeness, truthfulness, relevance and clarity of their communication using a simple Likert scale. Participants work with the therapist to identify a suitable strategy to address areas of concern. Hierarchical storytelling approaches begin with simple narrative organisation (e.g. beginning, middle, end) and build to more complex narrative components (e.g. orientation - who, where, when), and more elaborate story episodic structure. Visual and conversational prompts (e.g. use of photos, “what happened in the beginning”), clinician modelling (e.g. "You could start by talking about when it happened - Last week?”), scaffolding (e.g. visual scaffold with sections labelled beginning, middle and end) and guided practise (e.g. “Now have a go telling your story using the ‘stop, think, check’ strategy”). Who delivers it and their relevant expertise. The intervention is delivered by qualified speech pathologists trained in the Story-ABI-lity program, following a clinician manual and structured treatment protocol. How is it delivered? The intervention is delivered individually, face to face, within specialist inpatient brain injury rehabilitation service at Westmead Hospital. How often and for how long? Up to ten treatment sessions (minimum 30 minutes, maximum 1 hour/session). These will be scheduled to fit around the patient and therapists' schedules and will be a minimum of one and a maximum of four sessions per week. The maximum duration of the treatment will be 10 weeks. Data will be collected on planned sessions, session attendance, completion of key tasks, reasons for any tasks not completed, planned session duration and actual session duration. Clinician Training The program is manualised with each session based on a tailored session plan. The manual and materials will be provided at least 2 weeks prior to participant enrolment. Training includes clinical preparation time for the speech pathologist to independently review the treatment manual and materials (approximately 2 hours). The clinician will have the opportunity to ask the research team any questions about the treatment program, with a 1 hour online meeting offered by the research team for any further discussion of the treatment.