Purpose
The study purpose was to capture the clinical practice patterns of speech-language pathologists (SLPs) treating mild traumatic brain injury (mTBI; concussion). Study aims were to (a) characterize expert SLP practice patterns for the management of mTBI and (b) use qualitative content analysis to explore areas of quantitative variability within participants’ responses.
Method
Using a modified Delphi approach, SLPs completed an online survey, with Round 1 responses shaping questions for Round 2. Round 2 results were analyzed using a concurrent partially mixed-methods approach with quantitative and qualitative items. Quantitative consensus agreement levels were set prestudy at 75% agreement or higher. Topic-level items that did not reach consensus were analyzed using qualitative content analysis.
Participants
SLPs engaging in a specialty mTBI-SLP networking group were invited to participate. Round 1 had nine participants (United States: 4, Canada: 5). Round 2 had 18 participants (United States: 12, Canada: 6), with a mean of 15.7 years of experience in mTBI (range: 3–33) and a mean of 7.6 clients with mTBI seen weekly (range: 1–25).
Results
Nearly all topic-level practice items met quantitative consensus (42/45). Consensus areas included using conceptual frameworks, interprofessional teaming, assessment and intervention practices, goal setting, and outcomes. Functional, collaborative, and client-centered care anchored clinical practice. Areas lacking consensus included SLP roles in mTBI mental and somatic health symptoms, specific measurement tools, and intervention dosages. Qualitative themes that emerged included limited interprofessional awareness for the role of SLPs in mTBI and challenges in measurement selection.
Conclusions
Study aims were met with clear consensus on clinical patterns implemented by SLPs specializing in mTBI. Results will inform both current clinical practices and future practice guidelines. High-level guidance and advocacy are needed to clarify SLP practice concerns and advance interprofessional education. Future work should address identified gaps, including targeted assessment tools and consensus on intervention methods.
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Micro‐computed tomography (μ‐CT) scanners permit researchers to characterize the three‐dimensional structure of bone. They allow for the visualization of many bone structural parameters to be quantified with an extremely high degree of precision. Immunohistochemistry (IHC) (colorimetric) and immunofluorescence (IF) allows for characterization of DNA and RNA in fixed tissue sections. μ‐CT scanners along with IHC and IF allows processed tissue sections to be examined by a variety of different fixatives, in order to characterize the effects of fixation on bone morphology (i.e., adult chicken and mice), and preservation of different types of intact, non‐denatured nucleic acids (e.g., right‐handed B‐DNA, left‐handed Z‐DNA). Fixation was performed using 10% Neutral Buffered Formalin (NBF), Formalin‐Alcohol‐Acetic Acid (FAA), Davidson’s fixative, and Carnoy’s solution for 72 hours at room temperature. Both decalcified and non‐decalcified bone tissues were processed. Ultra‐pure molecular biological grade fixatives and water were used in order to ensure the best histotechnological data. Tissues processed in FAA resulted in hardening of tissue, but good fixation of intact DNA. Tissues processed in 10% NBF resulted in softer tissue, but poor fixation of intact DNA and required antigen retrieval (AR). Tissues processed in Carnoy’s solution resulted in hardened tissue, but excellent DNA IHC and IF. Tissues processed in Davidson’s fixative resulted in hardened tissues, but good preservation of DNA. We will try to correlate structural bone differences observed with the μCT scanner, relative to DNA isolation and IHC and IF staining of bone tissue sections with anti‐B‐DNA and anti‐Z‐DNA monoclonal antibodies. These results will better enable researchers to histotechnologically process tissue while obtaining data on DNA structure and function.
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