It’s Think-It-Through-Thursday! Here’s a new series to give you and your SLP colleagues some food for thought. Feel free to print and discuss at lunch or use for continuing education or journal review! I will include a recent research article and some thoughts about how this relates (or doesn’t relate) to some of the practices we have in adult speech therapy!

Today’s topic: TBI Treatment Guidelines

*Spoiler Alert: Things that aren’t mentioned in this international review for best practices of TBI treatment in speech therapy:

*Card Games

*Board Games

*Worksheets

Article Link: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.888.932&rep=rep1&type=pdf INCOG Guidelines for Management of Cognition Following Traumatic Brain Injury, Part IV: Cognitive-Communication (Article in the Journal of Head Traumat Rehabilitation, Vol 29 (4) in 2014. Authors: Togher, L, Wiseman-Hakes, C, Douglas, J, Stergiou-Kita, M, Ponsford, J, Teasell, R., Byley, M, and Turkstra, L.)

This article is Part IV of the INCOG Guidelines in 2014: A review on literature and summary of best practices in treatment for TBI. I would highly recommend the other sections (Parts I, II, III) as well! Not only is this article written by International experts, it includes speech pathology’s very own Lyn Turkstra, whose works have been instrumental in my own learning about treatment in the acquired brain injury population.

True story: I first read this article 3 years ago and carried it with me everywhere I worked for a year! I could not believe how different the recommendations were from the things I was used to seeing in TBI rehab. Card games, board games, and worksheets don’t really have a place in the best practices!

A few key notes that stood out to me:

*Priorities differed for treatment when health professionals were interviewed vs the actual persons and families with TBI. Those with TBI included a desire for skills such as communicating in the workplace, appointments, social conversations in groups, and using the telephone! These real-life skills need to be directly addressed during in-context speech therapy.

*Key Guidelines #4 talks explicitly about the need to practice cognitive-communication skills in-context: That means in the actual situations each individual needs to practice. Improving at a card game does NOT generalize to improvement in real-life situations for work, home, or school.

*Outcomes (goal setting and measuring) should reflect real-world performance.

With this knowledge, how might this affect our evaluation?  Because standardized testing alone is inadequate and doesn’t speak to functional or in-context tasks, it is vital that our evaluation clearly discusses the life participation and activities of each person. We won’t know they are having difficulties ordering at the drive-through or listening to church sermons or giving reports at work unless our evaluation allows for this sort of discussion. When possible, we should simulate the high-level needs a patient describes during the evaluation (“Let me hear what you would say at the drive-through restaurant.” or “Give me a 5-minute summary about the work you are doing.”) We need to hear actual real-life discourse in our evaluations, and we also need to hear about a person’s unique life activities and participation. I’ve created checklists for skills and participation that are included in the Home Sweet Home and Back To Work Series if you need a jump start.

With this knowledge, how might this affect our treatment?  Impairment-level tasks will not be appropriate given the high-level of deficits, and the fact that they do not relate to specific activity or participation. Yes, this is a longer way of me saying “Toss the workbooks!” and “Close the game closets!” Treatment will want to be related to functional needs–thankfully, this is right up the alley of what Honeycomb Speech Therapy products are all about. I’ve created items that meet the needs that TBI patients and families expressed in the article:

*Workplace Communication (See Back To Work Series for tons of treatment ideas + accommodation ideas).

*Managing Appointments (See the Home Sweet Home Series for a whole section on schedule management)

*Social Conversations (Perhaps using Conversation Partner Training Packet to set-up real-life situations, train real partners, and score!)

*Telephone Calls (Freebie therapy ideas on past blog posts including Answering Phone Calls and Making Phone Calls)

*Writing and Measuring Real-Life Goals: Learn how to do this using the Writing Functional Goals Packet.

Thanks for thinking it through! After reading the article, what is one thing you could change in speech therapy to be more consistent with best practices for these brain injury patients?

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