Research Assessment #5

Date: October 20, 2016

Subject: Speech Language Pathology
MLA Citation:
@ASHAWeb. "Traumatic Brain Injury (TBI)." Traumatic Brain Injury (TBI). ASHA, n.d. Web.
20 Oct. 2016. <http://www.asha.org/public/speech/disorders/TBI/>.
Assessment:
In this article, the author evaluates the effects of traumatic brain injuries or TBIs on a
person's behavior, communication, and cognitive/sensory deficits. They cover topics such as
what TBIs are and how they are caused. There are many different ways you can get a TBI, and
results vary in relation to the injury as far as damage to the cognitive brain and communication
skills. According to the article, the different deficits that can occur are: physical problems,
sensory deficits, behavioral changes, cognitive deficits, and communication/swallowing deficits.
Although a speech pathologist would focus mainly on the communication and swallowing
problems, they would also have to take into account all of the others problems the patient may be
facing. For example they may have to alter their treatment plans in order to be considerate
towards the other problems they have undergone. The role of a speech language pathologist in
this situation is to first help with them gaining more ways of expressing themselves, and also
working towards gaining their independent lives back. Not only do they focus on the patient, but
a speech pathologist would also meet with loved ones to help inform them on how to act and
help their injured loved one after the accident.
This article was incredibly interesting and tied in an informational interview I went on a
few days ago. I visited the Callier Center in Dallas and got to observe therapy sessions with

victims of TBIs from the gallery. After my visit I became very intrigued and wanted to learn
more about this and I came across this article. I had no idea how much a speech language
pathologist would do for the patient outside of just regular therapy sessions. I would really enjoy
this branch of the field because its very unique to all of the other ones. It's on the more medical
side and you never know what you're going to get because the combinations of deficits is
different for every injury and every patient. I would be able to go on home visits and take field
trips with my patients to regain their ability to do word association with objects in everyday life.
One of the things that may prove to be very difficult for me in this branch would be the
emotional strain of seeing these patients going through a very difficult time and seeing their
frustration of not being able to communicate. These patients can get very hard to deal with, but
that makes the breakthroughs and successes that much more rewarding.
This branch is very different than all of the others ones that I have researched in the past
mainly due to the fact that the patients suddenly go from having a normal life to not knowing
how to cope with their new way of living, whereas the patients in the other areas of speech
language pathology are born with their diseases or disorders so they don't know any different.
This article will also help me with my original work project because I am researched TBI
patients and autistic kids.

Traumatic Brain Injury (TBI)

TBI?

What is traumatic brain injury (TBI)?

What causes TBI?
How common is TBI?
How is TBI diagnosed?
What deficits result from TBI?
What does a speech-language pathologist do when working with people with
What other organizations have information about TBI?

What is traumatic brain injury (TBI)?

Traumatic brain injury (TBI) is a form of brain injury caused by sudden damage to the brain.
Depending on the source of the trauma, TBIs can be either open or closed head injuries.
Open Head Injuries: Also called penetrating Injuries, these injuries occur when an
object (e.g., a bullet) enters the brain and causes damage to specific brain parts.
Symptoms vary depending on the part of the brain that is damaged.
Closed Head Injuries: These injuries result from a blow to the head (e.g., when the
head strikes the windshield or dashboard in a car accident).
Irrespective of the cause of the trauma, TBIs result in two types of damage to the brain: primary
brain damage, which is damage that occurs at the time of impact (e.g., skull fracture, bleeding,
blood clots), and secondary brain damage, which is damage that evolves over time after the
trauma (e.g., increased blood pressure within the skull, seizures, brain swelling).
What causes TBI?
The Centers for Disease Control and Prevention has identified the leading causes of TBI to be

falls,
motor vehicle and pedestrian-related accidents,
collision-related (being struck by or against) events,
violent assaults.

Sport-related injuries and explosive blasts/military combat injuries are other leading causes of
TBI. Acquiring a brain injury may predispose an individual to additional brain injuries before the
symptoms of the first one have resolved completely.
How common is TBI?
The Centers for Disease Control and Prevention reports that every year at least 1.7 million TBIs
occur in the United States (across all age groups), and TBIs are a contributing factor in about a
third (30.5%) of all injury-related deaths. Older adolescents ages 15 to 19 years, adults ages 65
years and older, and males across all age groups are most likely to sustain a TBI (Faul et al.,
2010).
How is TBI diagnosed?
TBI is diagnosed by physicians based on a combination of patient reports, clinical presentation,
and brain imaging studies (such as CT scans and MRIs). A form of TBI called mild traumatic

brain injury (mTBI) is typically diagnosed only on the basis of the individual's (or caregiver's)
report and clinical signs and symptoms. Brain imaging findings are typically normal in mTBI.
Though the medical diagnosis of TBI is made by the physician, the specific deficits resulting
from TBI are diagnosed and managed by an interdisciplinary team. Depending on the needs of
the individual, the team often includes speech-language pathologists, audiologists, doctors,
nurses, neuropsychologists, occupational therapists, physical therapists, social workers,
employers, and teachers.
What deficits result from TBI?
The consequences of TBI may include physical, sensory, cognitive-communication, swallowing
and behavioral issues. These problems significantly impair the affected person's ability to live
independently. The problems vary depending on how widespread the brain damage is and the
location of the injury.
Physical problems may include loss of consciousness, seizures, headaches,
dizziness, nausea/vomiting, reduced muscle strength (paresis/paralysis), and impairments
in movement, balance, and/or coordination, including dyspraxia/apraxia.
Sensory deficits can involve all sensory modalities depending on the areas of the
brain that are involved. A stroke can result in the individual's being either less or more
sensitive to sensations, experiencing altered sensations, or being unable to synthesize
sensations to identify his or her own location in space.
Behavioral changes include changes in experiencing or expressing emotions,
agitation and/or combativeness, anxiety or stress disorder, and depression. Individual
with TBI can also experience mood swings, impulsivity, irritability, and reduced
frustration tolerance.
Cognitive deficits (impairments in thinking skills) may involve changes in
awareness of one's surroundings, attention to tasks, reasoning, problem solving, and
executive functioning (e.g., goal setting, planning, initiating, self-awareness, selfmonitoring, and evaluation). Although new learning is impacted by memory deficits,
long-term memory for events and things that occurred before the injury, however, is
generally unaffected (e.g., the person will remember names of friends and family). The
person may have trouble starting tasks and setting goals to complete them. Planning and
organizing a task is an effort, and it is difficult to self-evaluate work. The individual often
seems disorganized and needs the assistance of family and friends. He or she also may
have difficulty solving problems and may react impulsively (without thinking first) to
situations.
Communication deficits are often characterized by difficulty in understanding or
producing speech correctly (aphasia), slurred speech consequent to weak muscles
(dysarthria), and/or difficulty in programming oral muscles for speech production
(apraxia). It may be an effort for individuals with TBI to understand both written and
spoken messages; they may behave as if they are trying to comprehend a foreign
language. They may also have difficulty with spelling, writing, and reading. Some
individuals may also have difficulty in social communication, such as difficulty taking
turns in conversation and problems maintaining a topic of conversation. Most frustrating
to families and friends, individuals with TBI may have little or no awareness of just how
inappropriate their behaviors are.

 Swallowing deficits (dysphagia) may also result from a stroke due to weakness
and/or incoordination of muscles in the mouth and throat.
What does a speech-language pathologist do when working with people with TBI?
The SLP completes a formal evaluation of cognitive-communication and swallowing abilities
using a variety of formal and informal measures. An oral examination may also be completed to
check the strength and coordination of the muscles that control speech. Understanding and use of
grammar (syntax) and vocabulary (semantics), as well as reading and writing, are evaluated.
Social communication skills (pragmatic language) may be evaluated with formal tests and the
role-playing of various communication scenarios. The person may be asked to interpret/explain
jokes, sarcastic comments, or absurdities in stories/pictures (e.g., "What is strange about a person
using an umbrella on a sunny day?").
The SLP will assess cognitive-communication skills, including attention and orientation. Recent
memory skills are assessed, such as whether the main details in a short story are retained. The
SLP assesses the patient's ability to plan, organize, and attend to details (e.g., completing all of
the steps for brushing teeth). The person may be asked to provide solutions to problems
(reasoning and problem solving; e.g., "What would you do if you locked your keys in your car?
How can this problem be avoided in the future?"). For more information about when to refer
someone for a cognitive-communication evaluation, see Cognitive-Communication Referral
Guidelines for Adults.
If problems are observed, the SLP will evaluate swallowing and make recommendations
regarding management and treatment. The focus of this evaluation will be to ensure that the
individual is able to swallow safely and receive adequate nutrition. Additional swallowing tests
may be recommended as a result of this evaluation.
A treatment plan is developed after the evaluation. The treatment program will vary depending
on the stage of recovery, but it will always focus on increasing independence in everyday life.
In the early stages of recovery (e.g., during coma), treatment focuses on:
getting general responses to sensory stimulation,
teaching family members how to interact with the loved one.
As an individual becomes more aware, treatment focuses on:
maintaining attention for basic activities,
reducing confusion,
orienting the person to the date, where he or she is, and what has happened.
Later on in recovery, treatment focuses on:

finding ways to improve memory (e.g., using a memory log);

learning strategies to help problem solving, reasoning, and organizational skills;
working on social skills in small groups;
improving self-monitoring in the hospital, home, and community.

Eventually, treatment may include:

 going on community outings to help the person plan, organize, and carry out trips
using memory logs, organizers, checklists, and other helpful aids;
working with a vocational rehabilitation specialist to help the person get back to
work or school.
If the person is learning how to use an augmentative or alternative communication device,
treatment will focus on increasing efficiency and effectiveness with the device.