Age and developmental skill level at the time of injury are important considerations when designing feeding and swallowing treatment protocols and providing intervention, especially in infants and young children who can change so quickly (Mendell & Arvedson, 2016). Service delivery decisions are made based on the child's communication and/or swallowing needs relative to his or her family, community, school, social, or work setting. Salvatore, A. P., & Fjordback, B. S. (2011). Sim, P., Power, E., & Togher, L. (2013). Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. Wild, M. R. (2013). See ASHA's Practice Portal pages on Pediatric Dysphagia and Adult Dysphagia. A referral for a full audiologic evaluation is necessary if the child fails the hearing screening or if hearing loss is suspected. The comprehensive assessment typically results in one or more of the following: Assessments are sensitive to cultural and linguistic diversity and are completed in the language(s) used by the individual with TBI (see ASHA's Practice Portal pages on Bilingual Service Delivery, Cultural Competence, and Collaborating With Interpreters ). Children who are unable to use natural intelligible speech for communication (e.g., due to severe dysarthria or a voice disorder) may need long-term AAC (Doyle & Fager, 2011). New York State Education Department. See ASHA's Practice Portal page on Cultural Competence. For example, mnemonics and visual images can help improve recall for names (Kashel et al., 2002; OʼNeil-Pirozzi, Kennedy, & Sohlberg, 2015). The role of the SLP is to identify communication-related deficits, determine how they might affect the individual in various settings, and design treatment approaches to minimize the impact of these deficits. ), Treating neurodevelopmental disabilities: Clinical research and practice (pp. Cassaundra N. Miller, MS, CCC/SLP. World Neurosurgery, 91, 497–509. Rates of hospital admission vary widely and are higher in the United States than in other countries (Dewan, Mummareddy, Wellons, & Bonfield, 2016). Therefore, consider the effects of repeated brain injury when determining prior level of function and baseline skill levels. The Journal of Head Trauma Rehabilitation, 23, 394–400. American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS). ), The handbook of memory disorders (pp. Assessment and rehabilitative management of individuals with disorders of consciousness. Retrieved from https://doi.org/10.1044/leader.FTR2.20122015.46, Wild, M. R. (2013). (2011). (2005). Balance testing. Attention to behavioral symptoms such as those listed above is critical (Cox, 2016). Journal of Rehabilitation Medicine, 45, 637–645. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. This is likely an underestimate of the problem, as patients with mild TBI—who are often treated outside the hospital setting or are not treated at all—are not included in most estimates. Hearing screening is within the scope of practice for SLPs. Available 8:30 a.m.–5:00 p.m. Strategic learning interventions for older children and adolescents focus on improving the ability to abstract gist-based meaning. Duff, M. C., & Stuck, S. (2012). External aids are used to facilitate improved attention, time management, organization, and recall of events and information (Burns, 2004; Teasell et al., 2013). (2003). Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Gerrard-Morris, A., Taylor, H. G., Yeates, K. O., Walz, N. C., Stancin, T., Minich, N., & Wade, S. L. (2010). Speech-language pathology management of TBI in school-aged children. If signs and symptoms of depression are present or suspected, the individual is referred to a neuropsychologist, clinical psychologist, or psychiatrist for follow-up. For information about traumatic brain injury in children (ages birth through 21), see ASHA's Practice Portal page on Pediatric Traumatic Brain Injury. Traumatic brain injury and AAC: Supporting communication through recovery. This law protects a qualified individual from discrimination based on their disability. Long-term consequences of repetitive brain trauma: Chronic traumatic encephalopathy. (2006). Examples include mnemonics, visual imagery, association, elaborative encoding, and chunking. EBP Briefs, 10, 1–8. Intervention for dysarthria associated with acquired brain injury in children and adolescents. Volkers, N. (2015, December). Interventions for children with premorbid deficits in knowledge and skills will differ from interventions for children who have not yet developed certain knowledge or skillsets (Turkstra et al., 2015). Screening may result in recommendations for rescreening, comprehensive assessments, or referral for other examinations or services. See ASHA's web page on interprofessional education/interprofessional practice (IPE/IPE) and ASHA's resource on collaboration and teaming. Behavioral interventions are often used to decrease these unwanted behaviors and teach functional alternative behaviors. Cognitive-communication treatment methods can include direct remediation (e.g., breaking the target into discrete steps and sequentially completing a task) or strategy-based training and accommodations (e.g., training the individual to develop internal strategies to perform complex tasks; making changes in the classroom). . Washington, DC: Author. Barriers—decreased confidence in one's ability to communicate; presence of cognitive deficits; visual and motor impairments; lack of awareness of disability. identify treatment goals and implement techniques and strategies to facilitate generalization of therapy gains to everyday life and improved function in the home and community; exchange information with professionals to learn from one another and make informed decisions that will maximize treatment outcomes; and. See ASHA's Practice Portal pages on Bilingual Service Delivery and Cultural Competence, and Collaborating With Interpreters, Transliterators, and Translators. responding with "yes" instead of raising a finger or pressing a button. The TBI prevalence in the general population is 16.7% among males and 8.5% among females. cognitive-linguistic deficits (e.g., auditory processing and memory loss) that can affect learning, recall, and use of compensatory swallowing; neurobehavioral deficits (e.g., impulsivity, agitation); perceptual deficits (e.g., visual field neglect); physical limitations that can affect motor control and posture; and. Rehabilitation of children and adults with cognitive-communication disorders after brain injury [Technical Report]. SLPs and audiologists do not diagnose TBI. San Diego, CA: Plural. Managing memory and metamemory impairments in individuals with traumatic brain injury. Dual task training focuses on improving task complexity by targeting the ability to carry out two competing tasks simultaneously. See ASHA's Practice Portal page on Adult Dysphagia. New York, NY: Guilford. See ASHA's Practice Portal Page on Telepractice. Shum, D., Fleming, J., Gill, H., Gullo, M. J., & Strong, J. Guidelines for concussion/mild traumatic brain injury and persistent symptoms. Goal attainment scaling (GAS) is one collaborative approach for identifying and quantifying individualized, meaningful treatment outcomes using a point scale to objectively measure goal achievement (Kiresuk, Smith, & Cardillo, 2014). Augmentative and alternative communication (AAC) involves supplementing or replacing natural speech and/or writing with aided symbols (e.g., Picture Exchange Communication System [PECS], line drawings, Blissymbols, speech-generating devices, and tangible objects) and/or unaided symbols (e.g., manual signs, gestures, and finger spelling). Educational considerations in traumatic brain injury: The role of the speech-language pathologist. Assessment, Treatment, and Rehabilitation Strategies for Concussion and Mild TBI. Denslow, P., Doster, J., King, K., & Rayman, J. Retrieved from http://www.carf.org/programdescriptions/med/ [PDF]. These individuals not only are responsible for making decisions that affect the child's life and education but also provide long-term supports (Roscigno & Swanson, 2011). GAS is particularly applicable in TBI treatment that targets executive functions because it can help children identify their own goals, then plan and manage their related behaviors while engaging in everyday life activities (Grant & Ponsford, 2014). Other professionals (e.g., physical therapists or occupational therapists) may also be involved in co-treatment of deficits. Report to Congress on traumatic brain injury in the United States: Epidemiology and rehabilitation. Successful management of individuals with TBI typically requires collaboration and teaming with other professionals. Aphasiology, 19, 353–364. Columbus, OH: Ohio State University. Factors that influence the selection and use of AAC systems following TBI include the child's communication abilities and needs as well as his or her cognitive, neurobehavioral, motor, sensory, and perceptual impairments (Fager & Spellman, 2010). Others continue to have long-term difficulty learning new information and negotiating more complex social interactions due to impairments in cognitive functions (Anderson, Godfrey, Rosenfeld, & Catroppa, 2012; Turkstra, Politis, & Forsyth, 2015). American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS). The professional roles and activities in speech-language pathology include clinical services (assessment, planning, and treatment), prevention, and advocacy, as well as education, administration, and research. The full extent of deficits may become evident only as the child's brain matures and expected skills fail to develop or emerge more slowly (McKinlay & Anderson, 2013). Journal of Pediatric Rehabilitation Medicine, 3, 269–277. Screening results will indicate how likely it is that a past history of TBI is affecting your patient's behavior today. Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury. AAC intervention is an ongoing and dynamic process because the needs of the child following a TBI will vary over time, depending on the stage of recovery, presence of cognitive–behavioral changes, and communication needs in particular settings. In-person versus telehealth assessment of discourse ability in adults with traumatic brain injury. This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. Older children return to school, where long-term rehabilitation services are provided (Haarbauer-Krupa, 2012a, 2012b). Comptche, CA: Wild Iris Medical Education. Perspectives on Augmentative and Alternative Communication, 23, 140–147. The effects of TBI can be temporary or permanent, and no two children present with the same pattern. American Psychiatric Association. American Speech-Language-Hearing Association. See the Assessment section of ASHA's Practice Portal pages on Permanent Childhood Hearing Loss and Hearing Loss—Beyond Early Childhood. considers input from the family/caregivers and other professionals involved in the individual's care. Learn. See ASHA's Practice Portal pages on Hearing Loss—Beyond Early Childhood, Hearing Aids for Adults, Balance System Disorders, and Tinnitus and Hyperacusis. TBI can result from a primary injury or a secondary injury (see common classifications of TBI for more details). For example, impairments in processing speed, working memory, and executive function may contribute to deficits in language (Ewing-Cobbs & Barnes, 2002). You do not have JavaScript Enabled on this browser. Report to Congress on mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Job stability in skilled work and communication ability after moderate–severe traumatic brain injury. See also ASHA's resources titled Hearing Assistive Technology (HATS) and Audiology Information Series: Hearing Assistive Technology. Children and families bring different cultural backgrounds, medical and developmental histories, learning styles, and experiences to the treatment setting. What are best practices and assessment and intervention for children and adults with traumatic brain injury, and what's the role of speech, language, pathology and audiology and intervention for individuals with mild traumatic brain injury in civilian and military settings, in addition to the online. If the individual wears hearing aids, an audiologist should inspect the hearing aids to ensure that they are in working order, and the individual should wear the hearing aids during screening. Incidence and descriptive epidemiologic features of traumatic brain injury in King County, Washington. Interdisciplinary collaboration and teaming also form an integral part of audiology services to individuals with TBI. duration of ventilation and endotracheal intubation and/or presence of a tracheostomy; impairments in positioning and motor control that affect self-feeding; physical damage to the oral, pharyngeal, and/or laryngeal structures; presence of oral and/or pharyngeal sensory disorders; presence of oral and/or pharyngeal movement disorders; and. Evidence-based practice for the use of internal strategies as a memory compensation technique after brain injury: A systematic review. Compensatory approaches focus on adapting to deficits by learning new or different ways of doing things to minimize difficulties (National Institutes of Health [NIH], 1998). Clinicians also consider the child's cognitive-communication skills, oral–motor function, physical and sensory–perceptual limitations, behavioral deficits, and environmental supports in targeting dysphagia (Morgan, 2010; Morgan, Ward, & Murdoch, 2004; Morgan, Ward, Murdoch, & Bilbie, 2002). Strategic learning intervention is the ability to organize, combine, and synthesize details from texts, lectures, or conversations in order to abstract the most important concepts. Management can include the use of hearing aids, sound masking, counseling, and cognitive-behavioral interventions. Rather than reporting scores, results can be stated descriptively (e.g., number and types of errors made on various assessment tasks.) the individual's abilities in domains for which there are no, or limited, standardized tests; the individual's abilities within functional contexts and activities of daily living; strategies and task modifications to maximize the individual's functional abilities in various communication contexts; helpful information for communication partners; and. The development of cognitive-communication skills continues to be monitored through high school and during the transition to postsecondary educational or vocational settings. Dettmer, J., Ettel, D., Glang, A., & McAvoy, K. (2014). Dosage refers to the frequency, intensity, and duration of service. 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