Overcoming Knowledge Barriers for Inclusion of School-Based Speech-Language Pathologists in the Management of Students with Mild Traumatic Brain Injury

AbstractSchool-based speech-language pathologists (SLPs) can play an important role in the recovery of children who have sustained a mild traumatic brain injury (mTBI). Two types of knowledge barriers are described here that impact the beliefs and ability of SLPs to respond to the needs of these students. Foundational knowledge is relatively stable over time, and encompasses basic definitions and understanding of the injury. In contrast, flexible knowledge addresses clinical management, including assessment and treatment, and should be regularly updated to align with current best practice recommendations. Clinicians are sensitive to this difference, seeking clinically applicable continuing education. However, general poor understanding of pediatric mTBI paired with rapidly advancing research in the field has led to widespread inaccuracies in both foundational and flexible knowledge. Suggestions are provided for educational initiatives and for advocacy of the role of SLPs in the care of students with mTBI.

Download Full-text

First-Line Health Care Providers' Reported Knowledge of and Referrals to Speech-Language Pathologists for Clients With Mild Traumatic Brain Injury

American Journal of Speech-Language Pathology ◽

10.1044/2021_ajslp-20-00373 ◽

2021 ◽

pp. 1-14

Author(s):

Kelly Knollman-Porter ◽

Jessica A. Brown ◽

Tracey Wallace ◽

Shelby Spitz

Keyword(s):

Health Care ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Health Care Providers ◽

Multidisciplinary Teams ◽

Care Providers ◽

First Line ◽

Speech Language Pathologists

Purpose People with mild traumatic brain injury (mTBI) may experience deficits in cognition or communication that go unnoticed by first-line health care providers (FHPs). Speech-language pathologists (SLPs) assess and treat these domains yet are often underrepresented on mTBI multidisciplinary teams. This study's aim was to evaluate FHPs' reported knowledge of and referral practices to SLPs for individuals across the life span with mTBI. Method Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers ( n = 126) completed an online survey, including two Likert scale questions and one free response question relating to SLPs' role in mTBI. Results More than half of FHPs rate their knowledge of the SLP's role in mTBI management as low (somewhat knowledgeable, 29%; not very knowledgeable, 23%). Similarly, nearly two thirds of FHPs indicated rarely (19%) or never (44%), referring to SLPs for management of patients with mTBI. The majority of FHPs' open responses on the role of the SLP in mTBI management were incomplete, with many including domains that were not relevant to an SLP's role in the management of mTBI (e.g., dysphagia). Within the article, we provide results overall and according to individual profession. Conclusions Results suggest a majority of FHPs lack knowledge in the role of the SLP in the management of mTBI, which may underpin the low referral patterns reported by FHPs for SLP services. Future educational efforts for FHPs regarding the role of SLPs in mTBI care are necessary.

Download Full-text

Mild traumatic brain injury (MTBI): assessment and treatment procedures used by speech-language pathologists (SLPs)

Brain Injury ◽

10.1080/02699050210128870 ◽

2002 ◽

Vol 16 (9) ◽

pp. 773-787 ◽

Cited By ~ 41

Author(s):

Melissa C. Duff ◽

Adele Proctor ◽

Katarina Haley

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Speech Language Pathologists ◽

Assessment And Treatment ◽

Treatment Procedures

Download Full-text

The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0296 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1363-1370 ◽

Cited By ~ 2

Author(s):

Jessica Brown ◽

Katy O'Brien ◽

Kelly Knollman-Porter ◽

Tracey Wallace

Keyword(s):

High School ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Disease Control ◽

Mild Traumatic Brain Injury ◽

School Age Children ◽

School Age ◽

Speech Language Pathologists ◽

Control And Prevention ◽

Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

Download Full-text

Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.2.47 ◽

2009 ◽

Vol 19 (2) ◽

pp. 47-57 ◽

Cited By ~ 10

Author(s):

Christine Parrish ◽

Carole Roth ◽

Brooke Roberts ◽

Gail Davie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Psychological Health ◽

Communication Disorders ◽

Service Members ◽

Patient Questionnaire ◽

Speech Language Pathologists ◽

Test Protocol ◽

Communication Deficits

Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

Download Full-text

Perceived Recovery and Self-Reported Functioning in Adolescents with Mild Traumatic Brain Injury: The Role of Sleep, Mood, and Physical Symptoms

Developmental Neurorehabilitation ◽

10.1080/17518423.2020.1858456 ◽

2020 ◽

pp. 1-7

Author(s):

Brittany Wright ◽

K. Wilmoth ◽

S.B. Juengst ◽

N. Didehbani ◽

R. Maize ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Physical Symptoms

Download Full-text

Evaluating mild traumatic brain injury management at a regional emergency department

Injury Prevention ◽

10.1136/injuryprev-2018-042865 ◽

2018 ◽

Vol 24 (5) ◽

pp. 390-394

Author(s):

Ashlee Maree Brown ◽

Dara M Twomey ◽

Anna Wong Shee

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Best Practice ◽

Medical Service ◽

Regional Health ◽

Diagnosis Codes ◽

Retrospective Audit ◽

Concussive Injury

BackgroundEmergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.AimThe aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.MethodsThis was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.ResultsFewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.Discussion/conclusionSeveral key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

Download Full-text