Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders

From the Coordinator: Updates

Wambaugh, J. L. — 2009-05-22

CE Introduction

Roth, C. — 2009-05-22

An Interdisciplinary Treatment Approach for Soldiers With TBI/PTSD: Issues and Outcomes

Schneider, S. L., Haack, L., Owens, J., Herrington, D. P., Zelek, A. — 2009-05-22

Purpose: While the co-morbidity of symptoms associated with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) in the injured military population is currently being discussed and researched, those of us in the rehabilitation fields need to be ready now to serve this complex population. We are challenged to provide the best services with limited research and evidence-based practices to guide us. This article presents an interdisciplinary approach to treatment for soldiers with TBI.

Method: We compare and contrast the blast-induced brain injury acquired in the military population, designated as the "signature injury of this war," to "typical" TBI populations.

Results and conclusions: We share what we have learned by serving this population and present each discipline's assessments, treatment strategies, outcome measures, and suggestions for navigating the military "mindset" of the soldiers being served.

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

Parrish, C., Roth, C., Roberts, B., Davie, G. — 2009-05-22

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.

Treatment of Cognitive-Communicative Disorders Following Blast Injury

de Riesthal, M. — 2009-05-22

Purpose: Mild traumatic brain injury (mTBI) following exposure to a blast is the signature injury of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The purposes of this article are to describe the characteristics of the service members who experience blast injuries, the cognitive-communicative deficits they present, and the role of the speech-language pathologist (SLP) in managing these deficits.

Method: Demographic data for the service members who have experienced blast injuries in OIF/OEF are reviewed and reported. The literature on treating cognitive-communicative disorders following mTBI is reviewed and is discussed in the context of managing the deficits reported by service members returning from Iraq and Afghanistan.

Results and conclusions: Information regarding the effects of blast exposure on the human body continues to emerge. Data regarding the most effective treatment for cognitive-communicative deficits following blast injury are needed. For now, SLPs must rely on the best evidence from the civilian mTBI literature, clinical expertise, and the personal values of the individual with TBI to develop effective treatment programs targeting the cognitive-communicative disorders experienced by these individuals.