final_Binder

Traumatic Brain Injury





1. Overview…………………………………………….170

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2. Signs and Symptoms
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935337&section=Signs_and_Sympt
oms
3. Assessment…………………………………………….197

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4. Treatment………………………………………………
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5. Resources……………………………………………….

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TRAUMA




• DESCRIBES SERIOUS OR POTENTIALLY LIFE THREATENING LEVELS OF PHYSICAL
INJURY







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TRAUMATIC BRAIN INJURY (TBI)


• DAMAGE TO THE BRAIN THAT OCCURS AS A RESULT OF AN EXTERNAL AND FORCEFUL
EVENT
• BRAIN INJURY FROM EXTERNALLY INFLICTED TRAUMA WHICH MAY RESULT IN
SIGNIFICANT IMPAIRMENT OF AN INDIVIDUAL'S PHYSICAL, COGNITIVE, AND
PSYCHOSOCIAL FUNCTIONING.





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INCIDENCE AND PREVALENCE


• ESTIMATED COST OF $76.5 BILLION INCLUDING DIRECT AND
INDIRECT MEDICAL EXPENSES
• IN 2006, OVER $2.8 BILLION WAS SPENT ON TREATING TBI IN
INDIVIDUALS OLDER THAN AGE 65 YEARS.


**CREATED BY ALAINA S. DAVIS, PH.D., CCC-SLP. THIS MATERIAL IS NOT TO BE DISTRIBUTED BEYOND THE 4
STUDENTS ENROLLED IN THIS CLASS WITHOUT INSTRUCTOR PERMISSION.
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INCIDENCE AND PREVALENCE

• APPROXIMATELY 1.4 MILLION INJURIES OCCURRING ANNUALLY AFFECTING
INDIVIDUALS OF ALL AGES, RACES/ETHNICITIES AND INCOMES.
• NEARLY 57 MILLION PEOPLE ARE LIVING WITH TBI-RELATED DISABILITIES
• CONTRIBUTES TO A THIRD (30.5%) OF ALL INJURY-RELATED DEATHS IN THE
UNITED STATES.






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INCIDENCE AND PREVALENCE


•2001-2010 (CDC),
• MEN HAD HIGHER TBI-RELATED HOSPITAL VISITS THAN WOMEN
• AT THAT TIME MEN HAD TWICE THE RATE OF TBI-RELATED DEATHS
THAN WOMEN






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INCIDENCE AND PREVALENCE


• RACE/ETHNICITY
• AFRICAN AMERICANS (74.1 PER 100,000)
• NON-HISPANIC WHITES (71.3 PER 100,000)
• AMERICAN INDIAN/ALASKAN NATIVE/ASIAN OR PACIFIC ISLANDERS, COLLECTIVELY (50.1
PER 100,000).
• NONHISPANIC WHITES (62.9 PER 100,000)






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INCIDENCE AND PREVALENCE



• SOCIOECONOMIC STATUS
• HEAD-INJURED PATIENTS IN LOW-INCOME COMMUNITIES ARE MORE LIKELY
• TO BE OLDER
• HAVE REPEATED HEAD INJURIES
• MAKE LOW WAGES
• BE UNEMPLOYED.





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AT RISK POPULATIONS
• MOST AT RISK POPULATION INCLUDE THOSE WHO ARE:
• UNDER THE AGE OF FOUR
• ABOVE THE AGE OF 75
• ADOLESCENT MALES (15-19 YRS)
• USERS OF ALCOHOL OR RECREATIONAL DRUGS
• LOWER SOCIOECONOMIC STATUS
• PREVIOUSLY EXPEREINCED TBI
• LAW ENFORCEMENT OR MILITARY PERSONNEL




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CAUSES OF TBI








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CDC.GOV

• ADOLESCENTS
• MVA (MOTOR VEHICLE ACCIDENTS)
• SPORTS-RELATED INJURIES
• ASSAULTS
• OLDER ADULTS
• FALLS
• ASSAULTS
• MVAS




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FALLS


• FALLS ARE THE MOST FREQUENT CAUSE OF TBI IN OLDER PERSONS
• 2/3 OF THOSE WHO HAVE A FALL WILL HAVE ANOTHER ONE WITHIN 6 MONTHS
• APPROXIMATELY 60% OF FALLS HAPPEN WITHIN THE HOME
• AT LEAST 1/3 OF THESE FALLS HAPPEN DUE TO ENVIRONMENTAL HAZARDS WITHIN
THE HOME






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RISK FACTORS FOR TBI DUE TO FALLS


• INCREASING AGE
• GENDER
• COGNITIVE IMPAIRMENT OR DEMENTIA
• PHYSICAL LIMITATIONS
• MEDICATIONS
• VISION IMPAIRMENTS
• INAPPROPRIATE FOOTWEAR




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ELDER ABUSE

• ELDER MALTREATMENT CAN LEAD TO SERIOUS PHYSICAL INJURIES
INCLUDING HEAD TRAUMA RESULTING IN LONG-TERM CONSEQUENCES.

• ELDER ABUSE IS OFTEN UNDETECTED, BECAUSE THE VICTIMS ARE OFTEN
AFRAID TO REPORT CASES OF MALTREATMENT TO FAMILY, FRIENDS, OR TO
THE AUTHORITIES.
• FRAIL, ELDERLY, COGNITIVELY COMPROMISED WOMEN OVER THE AGE OF 80
ARE PARTICULARLY AT RISK FOR ELDER ABUSE.




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MOTOR VEHICLE ACCIDENTS (MVA)


• AMONG ALL AGE GROUPS, MOTOR VEHICLE CRASHES WERE THE THIRD OVERALL
LEADING CAUSE OF TBI (14%). (CDC)
• WHEN LOOKING AT JUST TBI-RELATED DEATHS, MOTOR VEHICLE CRASHES WERE THE
SECOND LEADING CAUSE OF TBI-RELATED DEATHS (26%) FOR 2006–2010. (CDC)







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MOTOR VEHICLE ACCIDENTS (MVA)

• YOUNG ADULTS 15–24 HAVE THE HIGHEST PROPORTION OF TBI-RELATED
HOSPITALIZATIONS DUE TO MOTOR VEHICLE TRAFFIC-RELATED EVENTS.

• RISK FACTORS:
• DRIVING UNDER THE INFLUENCE
• SPEEDING
• DRIVING DURING BAD WEATHER
• NOT WEARING A SEATBELT




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ALCOHOL ABUSE

• ALCOHOL ABUSE IS A COMMON, BUT OFTEN UNDIAGNOSED PROBLEM AMONG OLDER ADULTS.
• SURVEYS INDICATE THAT 6 TO 11 PERCENT OF OLDER PATIENTS ADMITTED TO HOSPITALS AND 14
PERCENT OF ELDERLY PATIENTS IN EMERGENCY ROOMS EXHIBIT SYMPTOMS OF ALCOHOLISM.
• THE COMBINATION OF OLDER AGE AND ALCOHOLISM CAN ALSO DRAMATICALLY INCREASE DRIVING
RISK.
• SURVEYS CONDUCTED IN HEALTH CARE SETTINGS HAVE FOUND INCREASING PREVALENCE OF
ALCOHOLISM AMONG THE OLDER POPULATION WHICH PLACES THEM AT GREATER RISK FOR FALLS
AND REPEAT HEAD INJURIES.



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SHAKEN BABY SYNDROME
• 1,300 U.S. CHILDREN EXPERIENCE SEVERE/FATAL BRAIN TRAUMA FROM CHILD ABUSE EVERY YEAR
• SYMPTOMS
• VOMITING
• DIFFICULTY FEEDING
• LETHARGY
• ALTERED CONSCIOUSNESS
• IRRITABILITY
• RETINAL HEMORRHAGES
• IMPAIRED TRACKING OF EYES
• SEIZURES
• LACK OF SMILE AND VOCALIZATIONS
• RESPIRATORY DIFFICULTY


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SPORTS-RELATED TBI

• CONCUSSION
• SPORTS AT RISK
• AMERICAN FOOTBALL
• WRESTLING
• SOCCER
• HOCKEY
• BOXING
• CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE)



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CONCUSSION HTTPS://YOUTU.BE/YHGF4UHK_JW















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MILITARY BLASTS




• CONCUSSION IS THE “SIGNATURE INJURY” OF THE WAR
• POLYTRAUMA







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TYPES OF BLAST INJURIES

• PRIMARY –ABRUPT CHANGE IN ATMOSPHERIC
PRESSURE CAUSED BY THE BLAST.
• SECONDARY –OBJECTS PLACED IN MOTION BY THE
BLAST HITTING THE SERVICE MEMBER.
• TERTIARY –SERVICE MEMBER BEING PLACED IN
MOTION BY THE BLAST.
• QUATERNARY –OTHER INJURIES FROM BLASTS
NOT RELATED TO PRIMARY, SECONDARY, OR
TERTIARY.



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TYPES OF TBI









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TYPES OF TBI

• CLOSED HEAD INJURIES
• ACCELERATION-DECELERATION
• COUP-CONTRECOUP
• DIFFUSE AXONAL SHEARING
• IMPACT-BASED
• OPEN HEAD INJURIES
• ALSO CALLED “PENETRATING INJURIES”




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CLOSED HEAD INJURIES




• FORMS OF TRAUMA CAUSING BRAIN DAMAGE THAT DO NOT BREAK THE SKULL OPEN
OR PENETRATE THE CEREBRAL MENINGES SURROUNDING THE BRAIN
• SKULL REMAINS INTACT





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ACCELERATION-DECELERATION INJURIES



• WHEN A PERSON’S BODY (AND BRAIN) IS MOVING VERY FAST (ACCELERATING)
THROUGH SPACE AND THEN COMES TO A SUDDEN ABRUPT STOP (DECELERATES)
• BRAIN SLAMS AROUND WITH DAMAGING LEVEL OF FORCE AGAINST INSIDE OF THE
SKULL





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CONCUSSION MECHANICS
















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CONCUSSION MECHANICS
















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CONCUSSION MECHANICS
















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COUP-CONTRE COUP DAMAGE IN CHI


• DAMAGE FROM ACCELERATION-DECELERATION CLOSED HEAD INJURY
• MAY SUSTAIN IMPACT TO THE FRONT OF THE HEAD (COUP), THE BACK
OF THE HEAD/NECK AND FRONT OF THE HEAD AGAIN (CONTRE-COUP)
• MAY CAUSE DAMAGE TO ANTERIOR-INFERIOR PORTIONS OF THE
FRONTAL LOBES AND TEMPORAL LOBES AS WELL AS POSTERIOR
PORTION OF OCCIPITAL LOBES, CEREBELLUM, AND BRAIN STEM




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COUP-CONTRECOUP DAMAGE IN CHI
















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DIFFUSE AXONAL SHEARING

• DIFFUSE AXONAL INJURY (DAI)
• MAY OCCUR AS RESULT OF HIGH LEVELS OF G-FORCE IN COUP CONTRE-COUP
INJURIES
• NEURONAL CONNECTIONS ARE PULLED APART AND CREATE MICRO LESIONS
ACROSS LARGE AREAS OF BRAIN
• RESULTS IN GENERALIZED DAMAGE TO THE BRAIN AND BRAINSTEM THAT ARE
EXPOSED TO DAMAGING FORCES




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DAI








https://youtu.be/k_MktbTuEdI




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IMPACT-BASED TBI

• INJURY TO THE BRAIN THAT OCCURS AS A RESULT OF
STATIONARY HEAD BEING IMPACTED BY A MOVING OBJECT
• SUCH AS VIOLENT ASSAULT
• SKULL IS FORCED INWARDS AT THE SITE OF IMPACT WHICH
EXERTS COMPRESSIVE FORCES TO THE AREA OF BRAIN UNDER
THE SITE OF IMPACT
• COMPRESSIVE FORCES MAY BRUISE AND TEAR SURFACE OF
BRAIN
• MAY RESULT IN FOCAL DAMAGE TO THE BRAIN AT SITE OF
IMPACT



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OPEN HEAD TBI



• INJURY THAT PENETRATES THE SKULL INTO THE BRAIN
• BALLISTIC TRAUMA AND FALLS MAY RESULT IN FOCAL DAMAGE WHERE PENETRATION
INTO THE BRAIN OCCURRED






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PENETRATING BRAIN INJURY

• MOST FREQUENT CAUSES OF PENETRATING BRAIN INJURIES
• HIGH VELOCITY MISSILES (E.G. BULLET FROM A GUN, SHRAPNEL)
• LOW VELOCITY IMPACTS (E.G. A STAB WOUND, BLOWS TO THE HEAD).











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SECONDARY MECHANISMS OF DAMAGE

• INCREASED INTRACRANIAL PRESSURE
• AMOUNT OF INTRACRANIAL PRESSURE (AMOUNT OF PRESSURE IN SKULL EXERTED ON THE
BRAIN) BECOMES HIGHER THAN BLOOD PRESSURE
• MAY RESULT IN HYPOXIA OR ANOXIA
• CEREBRAL EDEMA
• SWELLING OF BRAIN TISSUE THAT MAY OCCUR FOLLOWING TRAUMA TO THE BRAIN
• MAY CAUSE INCREASED INTRACRANIAL PRESSURE





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SECONDARY MECHANISMS
OF DAMAGE (CON’T)

• TRAUMATIC HYDROCEPHALUS

• TRAUMATIC HEMORRHAGE
• BLEEDING OF BLOOD
VESSELS AS RESULT OF
TRAUMA
• INTRACEREBRAL
HEMORRHAGE
• SUBDURAL HEMORRHAGE
• EPIDURAL HEMORRHAGE


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SECONDARY MECHANISMS OF DAMAGE (CON’T)

• HEMATOMA
• GATHERING OF BLOOD OUTSIDE OF BLOOD VESSEL FOLLOWING
HEMORRHAGE
• SUBDURAL HEMATOMA
• EPIDURAL HEMATOMA
• POST-TRAUMATIC EPILEPSY
• SEIZURES THAT OCCUR CONSEQUENTLY TO TBI
• MOST OFTEN ASSOCIATED WITH OPEN HEAD TBI





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SYMPTOMS









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PHYSICAL/SOMATIC SYMPTOMS
• HEADACHES
• DIZZINESS
• VISUAL DISTURBANCES
• SENSITIVITY TO NOISE AND LIGHT
• WEIGHT GAIN/LOSS
• SEIZURES
• WEAKNESS
• IMPAIRED COORDINATION
• BALANCE PROBLEMS
• FATIGUE
• CHANGES IN SLEEP PATTERNS
• INSOMNIA



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NEUROBEHAVIORAL EFFECTS

• ALTERED CONSCIOUS
• SURVIVAL WITH NO RECOVERY OF CONSCIOUSNESS
• CONFUSION AND DISORIENTATION
• AMNESIA
• MEMORY PROBLEMS
• SPEECH DISORDERS
• DYSPHAGIA
• OTHER NEUROLOGICAL SYMPTOMS
• BEHAVIORAL AND PSYCHIATRIC CHANGES
(HEDGE, 2006)



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PSYCHOSOCIAL/BEHAVIORAL IMPAIRMENT

• INFLUENCES SOCIAL, VOCATIONAL, FAMILIAL, AND ACADEMIC REINTEGRATION

• DIFFICULTIES HAVE BEEN FOUND TO BE CRITICAL PREDICTORS OF VOCATIONAL
FAILURE AND POOR QUALITY OF LIFE
• NEGATIVE/AGGRESSIVE BEHAVIOR
• AWKWARD OR IMPULSIVE
• DIFFICULTY READING OTHERS EMOTIONAL STATES



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PERSONALITY CHANGES
• EMOTIONAL/BEHAVIORAL
• IRRITABILITY
• DEPRESSION
• ANXIETY
• DECREASED EMOTIONAL CONTROL
• LOSS OF INITIATIVE
• PERSONALITY CHANGES
• INAPPROPRIATE SEXUAL ADVANCES
• INAPPROPRIATE STATEMENTS AT INAPPROPRIATE TIMES
• LOSS OF AWARENESS OF SOCIAL AND CULTURAL CONVENTIONS, AND
MORE SUBTLE CHANGES SUCH AS PREFERENCES IN FOOD AND MUSIC



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POSTTRAUMATIC
STRESS DISORDER
(PTSD)
• RE-EXPERIENCING
• AVOIDANCE
• HYPERAROUSAL






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MOTOR DEFICITS

• SEVERE GROSS AND FINE MOTOR MOVEMENT DEFICITS
• BILATERAL PARESIS/PARALYSIS, OR CONTRALATERAL HEMIPLEGIA
• ABNORMAL MUSCLE TONE
• DAMAGE TO CEREBELLUM RESULTS IN ATAXIA
• SWALLOWING DISORDERS AND MOTOR SPEECH DISORDERS SUCH AS APRAXIA OF
SPEECH, SPASTIC, FLACCID, OR ATAXIC DYSARTHRIA, OR COMBINATION OF THE
FOUR MAY OFTEN BE PRESENT



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LANGUAGE DEFICITS

• DEPENDS ON LOCATION AND EXTENT OF DAMAGE TO THE BRAIN
• ANOMIA, APHASIA, DECREASED AROUSAL, AND COGNITIVE DEFICITS OFTEN FOLLOW
CLOSED HEAD TBI
• SPECIFIC LANGUAGE DEFICITS AND COGNITIVE DEFICITS MAY FOLLOW OPEN HEAD
TBI AND MAY NOT BE AS GENERALIZED AS CLOSED HEAD TBI






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LANGUAGE DEFICITS

• LANGUAGE
• MUTISM
• CONFUSED LANGUAGE
• ANOMIA
• PERSEVERATION OF VERBAL RESPONSES
• PRAGMATICS
• COMPREHENSION PROBLEMS
• PROBLEMS WITH READING AND WRITING
(HEDGE, 2006)



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COMMUNICATION IMPAIRMENTS

• SPEECH
• DYSARTHRIA
• PHONATORY ABNORMALITIES
• REDUCED SPEECH FLUENCY
• IMPAIRED PROSODY
• IMPAIRED THINKING, REASONING, AND PLANNING SKILLS
(HEDGE, 2006)



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COGNITIVE DEFICITS

• MAY AFFECT ANY LEVEL OF:
• ORIENTATION, ATTENTION, MEMORY, PROBLEM SOLVING, INFERENCING, PERSONALITY
CHANGES
• MAY DISPLAY IMPULSIVITY, EMOTIONAL LABILITY, LACK OF MOTIVATION, AND
UNDERESTIMATION OF DEFICITS
• COMA
• PERIOD OF UNCONSCIOUSNESS LASTING MORE THAN SIX HOURS WITH INDIVIDUAL IS
UNABLE TO BE AWAKENED AND IS UNRESPONSIVE TO SENSORY STIMULI




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COGNITIVE DEFICITS (CON’T)
• VEGETATIVE STATE
• PERSON IS MINIMALLY RESPONSIVE TO STIMULI BUT LACKING CONSCIOUSNESS AND
COGNITION
• MINIMALLY CONSCIOUS STATE
• PERSON DISPLAYS INCONSISTENT BUT DEFINITE BEHAVIORAL SIGNS OF CONSCIOUSNESS
• PERSISTENT VEGETATIVE STATE
• VEGETATIVE STATE CONTINUES LONGER THAN FOUR WEEKS
• POST-TRAUMATIC AMNESIA
• COMBINATION OF RETROGRADE AND ANTEROGRADE MEMORY LOSS IN THOSE WHO
RECOVER FROM COMAS AND VEGETATIVE STATES



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IMPAIRED ATTENTION/CONCENTRATION




• TYPES OF ATTENTION AND ASSOCIATED DEFICITS
• SUSTAINED
• SELECTIVE
• ALTERNATING
• DIVIDED



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ATTENTION: SPEED OF PROCESSING

•DEFICITS:
• DIFFICULTY PROCESSING VERBAL AND WRITTEN INFORMATION
• LEARNING AND INTEGRATING NEW INFORMATION
• EFFECTIVELY PARTICIPATING IN CONVERSATIONS
CICERONE ET AL. (2011)


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MEMORY

• TYPE OF MEMORY:
• SHORT-TERM (IMMEDIATE, RECENT)
• WORKING MEMORY
• LONG-TERM (REMOTE)
CICERONE ET AL. (2011), HARMON & KELLY (2012), PAYNE, WRIGHT-HARP, & DAVIS (2014)

• DEFICITS:
• FORGETTING APPOINTMENTS, DIRECTIONS, INSTRUCTIONS, AND NAMES OF
INDIVIDUALS, LOSING/MISPLACING ITEMS
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EXECUTIVE FUNCTION

•DEFICITS ASSOCIATED WITH EXECUTIVE FUNCTION:
• ORGANIZATION (SCHEDULES, LINGUISTIC ORGANIZATION)
• PROBLEM SOLVING/REASONING
• COGNITIVE FLEXIBILITY (SHIFTING IDEAS)
• PRAGMATIC COMMUNICATION (METAPHORIC LANGUAGE, CONVERSATIONAL
DISCOURSE)
• METACOGNITION (SELF-MONITORING)
SOHLBERG & TURKSTRA (2011); CICERONE ET AL (2011)
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SOCIAL COMMUNICATION

•DEFICITS:
• VERBAL AND NONVERBAL COMMUNICATION SKILLS
• EMOTION PERCEPTION AND EXPRESSION
• SOCIAL PROBLEM SOLVING
CICERONE ET AL (2011)


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DISCOURSE


• DEFICITS
• DIFFICULTY ORGANIZING LANGUAGE
• USED TO GIVE REPORTS OF WHAT HAPPENED OR IMAGINATIVE STORIES
• DISCONNECTED, NONCOHESIVE
• TANGENTIAL






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ASSESSMENT OF TBI









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NEUROPSYCHOLOGICAL VS. COGNITIVE-COMMUNICATIVE
ASSESSMENTS

• NEUROPSYCHOLOGICAL EVALUATIONS
• ASSIST WITH DIFFICULT DIAGNOSTIC SITUATIONS INCLUDING IMPAIRED ATTENTION IN
INDIVIDUALS WITH PTSD, SUSPECTED TBI, AND A POSSIBLE PRIOR HISTORY OF ADHD.
• COGNITIVE-LINGUISTIC ASSESSMENTS
• ASSIST WITH DIFFERENTIAL DIAGNOSIS IN THAT THE COMMUNICATIVE SYMPTOMS SEEN IN
MTBI.






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INTERDISCIPLINARY ASSESSMENT

¾SPEECH-LANGUAGE ¾NEUROPSYCHOLOGY
PATHOLOGY
¾AUDIOLOGY ¾SOCIAL WORK CASE MANAGEMENT
¾CRITICAL CARE NURSING
¾PHYSIATRY ¾CASE MANAGEMENT
(REHABILITATION
MEDICINE) ¾RECREATION THERAPY
¾NEUROLOGY ¾DRIVERS REHABILITATION
¾PSYCHIATRY ¾BLIND REHABILITATION
¾PSYCHOLOGY OUTPATIENT SPECIALTY
¾OCCUPATION THERAPY ¾OPTOMETRY
¾PHYSICAL THERAPY ¾ORTHODONTIST/PROSTHETIST


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ASSESSMENT OF AROUSAL
• GLASGOW COMA SCALE (GCS)
• LEVEL OF CONSCIOUSNESS
• 13-15 = MILD HEAD INJURY
• 9-12 = MODERATE HEAD INJURY
• 3-8 = SEVERE HEAD INJURY
• LESS THAN 8 IS CONSIDERED COMA
• RANCHOS LOS AMIGOS LEVELS OF COGNITIVE
FUNCTIONING SCALE
• ADELAIDE COMA SCALE (ACS)
• PEDIATRIC VERSION OF THE GCS



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OTHER RECOVERY SCALES
Stages of Recovery
Coma Unresponsive; eyes closed
Vegetative state No cognitive responses; gross wakefulness; responds to some commands
Minimally conscious state Purposeful wakefulness; responds to some commands
Confusional state Recovered speech; amnesic (PTA); severe attentional deficits; agitated;
hypoaroused; possible labile behavior
• SEVERITY OF INJURY (SOHLBERG & MATEER, 2001)
Postconfusional, evolving Resolution of PTA; cognitive improvement; achieving independence in daily
self-care; improving social interaction; developing independence at home
independence • GCS SCORE, COMA DURATION, LENGTH OF POSTTRAUMATIC AMNESIA (PTA)
Social competence, Recovering cognitive abilities; goal-directed behaviors; social skills;
community reentry personality; developing independence in the community; returning to
academic or vocational pursuits
Severity
Classification GCS Score Duration of Coma Length of PTA
Severe 3–8 Over 6 hours Over 24 hours
Moderate 9–12 Less than 6 hours 1–24 hours
Mild 13–15 20 minutes or less 60 minutes or less
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ASSESSMENT OF ORIENTATION





• ORIENTATION TO PERSON, PLACE, AND TIME IS ASSESSED BY ASKING SIMPLE
QUESTIONS REGARDING ORIENTATION






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ASSESSMENT OF AGITATION


• AGITATED BEHAVIOR SCALE
• DETERMINES THE LEVEL AND TRACKS CHANGES OF AGITATION OVER TIME

• OVERT AGGRESSION SCALE
• ASSESS THE PRESENCE OF VERBAL OR PHYSICAL AGGRESSION AGAINST OTHERS, ONESELF,
OR OBJECTS




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ASSESSMENT OF MEMORY
• LONG-TERM MEMORY
• ASSESSED THROUGH BIOGRAPHICAL QUESTIONS DURING INTERVIEW
• VISUAL MEMORY
• DRAW A PREVIOUSLY PRESENTED STIMULI
• BENTON VISUAL RETENTION TEST
• IMMEDIATE RECALL
• PRESENT UNRELATED STRING OF WORDS FOR REPETITION
• SHORT-TERM RECALL
• PRESENT UNRELATED STRING OF WORDS FOLLOWED BY DISTRACTER TASK
• RECITE DETAIL-HEAVY PARAGRAPH AND ASK TO RECALL DETAILS



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ASSESSMENT OF COMMUNICATION, LANGUAGE, AND COGNITION
• FORMAL ASSESSMENT
• ADULTS
• BRIEF TEST OF HEAD INJURY (BTHI; HELM-ESTABROOKS & HOTZ, 1991)
• BURNS BRIEF INVENTORY OF COMMUNICATION AND COGNITION (BURNS; 1997)
• COGNITIVE-LINGUISTIC QUICK TEST (CLQT; HELM-ESTABROOKS, 2001)
• FUNCTIONAL ASSESSMENT OF VERBAL REASONING AND EXECUTIVE SKILLS (FAVRES;
MACDONALD) 1998)
• SCALES OF COGNITIVE ABILITY IN TRAUMATIC BRAIN INJURY (SCATBI; ADAMOVICH AND
HENDERSON, 1992)
• PEDIATRIC
• PEDIATRIC TEST OF BRAIN INJURY (PTBI; HOTZ, HELM-ESTABROOKS, WOLF NELSON,
PLANTE, 2010)
• COMPREHENSIVE ASSESSMENT OF SPOKEN LANGUAGE, 2 ND EDITION (CASL-2; 2017)

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TREATMENT OF TBI









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THERAPY FOR TBI
• DECREASED AROUSAL
• TARGETED THROUGH SENSORY STIMULATION THERAPY, WHICH MAY OR MAY NOT BE
EFFICACIOUS
• VISUAL STIMULATION, ORAL STIMULATION, AND CUTANEOUS STIMULATION
• ATTENTION DEFICITS
• TARGETED SIMILAR TO ATTENTION THERAPY FOR RIGHT HEMISPHERE AND LEFT
HEMISPHERE DISORDERS





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ATTENTION

• STRATEGIES
• ATTENTION DRILLS WITH STRATEGY TRAINING AND FUNCTIONAL TASKS
• FACILITATE GENERALIZATION
• HELP TO IDENTIFY, ANTICIPATE, AND MODIFY SITUATIONS THAT MAY
RESULT IN COGNITIVE OVERLOAD AND COMPROMISE GOAL-ORIENTED
BEHAVIORS
• MINIMIZING DISTRACTIONS,
• ALLOWING AMPLE TIME TO COMPLETE TASKS
• REDUCING SIMULTANEOUS DEMANDS



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ATTENTION: SPEED OF PROCESSING

• DEFICITS:
• DIFFICULTY PROCESSING VERBAL AND WRITTEN INFORMATION
• LEARNING AND INTEGRATING NEW INFORMATION
• EFFECTIVELY PARTICIPATING IN CONVERSATIONS
• SLP TREATMENT
• COMBINED WITH ATTENTION TRAINING
• DRILLS
• DEVELOPMENT OF COMPENSATORY STRATEGIES
• ENVIRONMENTAL MODIFICATIONS
• COPING MECHANISMS FOR MANAGING CHANGES IN PROCESSING SPEED




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THERAPY FOR TBI (CON’T)



• WORKING MEMORY DEFICITS
• USE INSTRUCTIONS AND UTTERANCES THAT ARE SHORT
• USE FUNCTIONAL TASKS IN CONTEXT OF ADLS
• AVOID SPEAKING FAST, EMPHASIZE IMPORTANT WORDS/PHRASES
• INCREASE AUTOMATICITY OF RESPONSES
• BREAK DOWN COMPLEX TASKS INTO INDIVIDUAL COMPONENTS






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RESTORATIVE MEMORY APPROACH



• TO REHABILITATE LOST ABILITIES
• SPACED RETRIEVAL TRAINING
• PRESENTATION OF INFORMATION FOR RECALL OVER
INCREASINGLY GREATER INTERVALS OF TIME





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INTERNAL MEMORY STRATEGIES
• COGNITIVE ACTS THAT INCREASE THE LIKELIHOOD OF RETAINING INFORMATION
OVER SHORT TERM AND LONG TERM TO COMPENSATE FOR MEMORY DEFICITS

• REHEARSAL TRAINING
• TRAINING THE INDIVIDUAL TO REPEAT INFORMATION TO THEMSELVES TO INCREASE THE
LIKELIHOOD OF RETAINING THE INFORMATION
• IMAGING AND VISUAL ASSOCIATION
• TRAINING THE INDIVIDUAL TO CREATE A VISUAL IMAGE IN THEIR MIND OF THE
INFORMATION TO BE RECALLED



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EXTERNAL MEMORY STRATEGIES
• MATERIAL DEVICES USED TO ALLOW COMPENSATION FOR
MEMORY DEFICITS

• LOW-TECH DEVICES
• CHECKLISTS, ALARM CLOCKS, MEMORY PADS, CALENDARS,
SCHEDULES, MEMORY BOOKS, DIARIES
• HIGH-TECH DEVICES
• SMARTPHONES AND COMPUTERS




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EXECUTIVE FUNCTION/SELF REGULATORY SKILLS
• DEFICITS :
• ORGANIZATION (SCHEDULES, LINGUISTIC ORGANIZATION)
• PROBLEM SOLVING/REASONING
• COGNITIVE FLEXIBILITY (SHIFTING IDEAS)
• PRAGMATIC COMMUNICATION (METAPHORIC LANGUAGE, CONVERSATIONAL DISCOURSE)
• METACOGNITION (SELF-MONITORING)
• TREATMENT STRATEGY
• METACOGNITION AND PROBLEM SOLVING
• ESTABLISH GOALS
• INITIATE BEHAVIOR
• ANTICIPATE CONSEQUENCES OF
• ACTIONS
• PLAN AND ORGANIZE BEHAVIORS ACCORDING TO SPATIAL,
TEMPORAL, TOPICAL, OR LOGICAL SEQUENCES
• MONITOR AND ADAPT BEHAVIOR TO FIT A PARTICULAR TASK OR
CONTEXT
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SOCIAL COMMUNICATION
• DEFICITS:
• VERBAL AND NONVERBAL COMMUNICATION SKILLS
• EMOTION PERCEPTION AND EXPRESSION
• SOCIAL PROBLEM SOLVING
• TREATMENTS
• GROUP TREATMENT
• DIRECT TRAINING OF FAMILY AND FRIENDS
• REVIEW VIDEOS OF SOCIAL INTERACTIONS
• MODIFYING PATTERNS OF SOCIAL COMMUNICATION
• SOCIAL SKILLS TRAINING FOR COMPREHENDING AND RESPONDING TO
NONVERBAL SOCIAL CUES
• ROLE PLAY



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DISCOURSE IMPAIRMENT

• DEFICITS
• DIFFICULTY ORGANIZING LANGUAGE
• USED TO GIVE REPORTS OF WHAT HAPPENED OR IMAGINATIVE STORIES
• DISCONNECTED, NONCOHESIVE
• TANGENTIAL

• STRATEGIES
• STORY RETELL (NARRATIVES, EXPOSITORY)
• FIGURATIVE LANGUAGE: PROVERBS, FABLES, HUMOR
• SOCIAL GROUPS



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ENVIRONMENTAL FACTORS THAT INFLUENCE
LEARNING

•FACILITIES


•SOCIAL AND CULTURAL INFLUENCES
•COLLABORATION





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Right Hemisphere





1. All About RH ……………………………………202

Visit ASHA Website:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943798&section=Overview

2. Signs and Symptoms
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943798&section=Signs_and_Sympt
oms

3. Assessment……………………………………………

Visit the Website:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943798&section=Assessment

4. Treatment………………………………………………
Visit ASHA Website:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943798&section=Treatment
5. Resources……………………………………………….

Visit ASHA Website:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943798&section=Resources

3/3/2019




















Alaina S. Davis, Ph.D., CCC-SLP 1
Assistant Professor
COSD 561: Neurolanguage Disorders
Howard University
**Created by Alaina S. Davis,Ph.D., CCC-SLP. This material is not to be distributed beyond the
students enrolled in this class without instructor permission
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• What is RHD?
ƒ Damage to the right side of the brain.










2














• Site of speech in left-handers

• The hemisphere to take over functions after damage to
the left in children and some adults
• Hemisphere most likely to be implicated in denial or
neglect in hemiparesis




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1