The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury

Abstract

The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients receive advanced medical care, imaging, speech-language pathology, physical therapy, behavioral health, neuropsychology, and clinical pharmacy for a cohesive diagnostic and intervention plan. Nationally, speech-language pathologists report challenges with best-practice options for concussion, particularly in the domain of assessment practices. At the MIBH, speech-language pathologists begin their assessment with a structured clinical interview that focuses on patients' needs and concerns. Evaluation modalities focus on hearing, communication, and functional cognition to guide therapeutic treatment planning. The intensive outpatient care program at MIBH incorporates both individual sessions targeting patient-centered goals and group care, where speech-language pathologists work transdisciplinarily to generalize care from all disciplines out into the community. Care practices for concussive injuries continue to evolve rapidly; speech-language pathology at the MIBH offers one such vision for excellence in clinical care.

The Cognitive-Communication Checklist for Acquired Brain Injury: A Means of Identifying, Recording, and Tracking Communication Impairments

“…, school (Haarbauer-Krupa et al, 2017;Hardin & Kelly, 2019;Kennedy & Krause, 2011;Lundine & Hall, 2020), and social participation (Meulenbroek et al, 2019;Sohlberg et al, 2019;Steel et al, 2013Steel et al, , 2017Togher, McDonald, & Code, 2014;Togher et al, 2010;Wiseman-Hakes et al, 2020). Other communication impairments that occur with less frequency include motor speech or articulation difficulties (e.g., dysarthria, apraxia; 1%-33%); aphasia (1%-2% traumatic brain injury [TBI], 68% stroke or aneurysm); voice disorders or difficulties with pitch, loudness, or quality (1%); and speech fluency difficulties (1%; MacDonald, 2017; Norman et al, 2013).…”

Understanding Cognitive Communication Needs in Pediatric Traumatic Brain Injury: Issues Identified at the 2020 International Cognitive-Communication Disorders Conference

“…Both multidisciplinary and interdisciplinary team assessment and management are becoming more prominent in the health care model, particularly for concussion (Bazarian, 2019;Collins et al, 2016;Ellis et al, 2016;Hardin & Kelly, 2019). Multidisciplinary health care teams include members from a variety of backgrounds who all provide services to a client to meet their varied needs.…”

“…In contrast, interdisciplinary care represents a step-up from this model of each member contributing their expertise to the care of a person with concussion and instead integrates care to encourage pooling of expertise, ideas, and resources. Practitioners regularly meet either formally or informally to synthesize knowledge and treatment practices (Hardin & Kelly, 2019). Such an interdisciplinary approach allows for the whole to be more than the sum of its parts and for intervention to be harmonized across disciplines to the benefit of the client.…”

“…Such an interdisciplinary approach allows for the whole to be more than the sum of its parts and for intervention to be harmonized across disciplines to the benefit of the client. Although "speech therapy" is identified in some instances as a specialty to be involved with people who have cognitive complaints after concussion (Bazarian, 2019;Hardin & Kelly, 2019), a description of CCDs and involvement of SLPs is not offered in many publications describing either multidisciplinary or interdisciplinary models (e.g., Bailey et al, 2019;Scratch et al, 2019). Furthermore, even though many SLPs are aware of CCDs, most assessments used by interdisciplinary partners in TBI care, including concussion, do not include tools or items that would highlight CCDs that would then easily lead to referral for SLP services.…”

“…Barriers may also exist around caseloads for SLPs in schools, so team-based work may not be protected time. Work that highlights the role of SLPs as part of an interdisciplinary concussion team is emerging (Dachtyl & Morales, 2017;Hardin & Kelly, 2019;Ketcham et al, 2017;Knollman Porter et al, 2014), but far more work is needed to understand and overcome barriers toward SLPs being full members of interdisciplinary teams managing the short-and long-term management of pediatric TBI. To help tie together the themes of terminology, training, and interdisciplinary teams specifically related to CCDs in pediatric TBI, two case examples are provided below.…”