The role of the Speech-Pathologist on Traumatic
Brain Injury Rehabilitation
Authors: Alexa Sennyey, Andreza Maciel dos Santos, Cibele Ricardi;
Country: São Paulo, Brazil.
Communication Disorders on TBI
Effective communication is the capacity that includes not only expressive language and comprehension, but also several other cognitive behaviors that are controlled on different parts of the brain. Following the definition of the American Speech and Hearing Association (ASHA), cognitive-communication are the processes that include executive function, attention, processing of information, memory, visual and space perception, problem solving ability and psychosocial behavior (ASHA, 1991).
Common Cognitive-Communication Disorders on TBI
Communication disorders on TBI patients are very heterogeneous. The lesions are usually difuse, caused by different types of impact, speed of impact and results of the injury also depend on pre-morbid aspects of the patient, age, cerebral dominance, education, socioeconomic status (Ruff and Camenzuli, 1991). Frontal and temporal lobe damage is the most common to happen. Frontal lobe has an important role in the organization and appropriatness of communication. Pre-frontal cortex damage results on cognitive-communication impairments such as attention, memory, perception, personality changes, apathy, lack of initiative, hyperactivity, inappropriate social behavior, impulsivity (Stuss and Benson, 1983, 1984; Blumer and Benson, 1975; Fuster, 1980; Gazzaniga, 1979). Left frontal and temporal lobe lesion on patients with left hemisphere dominance, can cause aphasia, although not so common and mostly transient (Sarno, 1980, 1984). Language disturbances associated with TBI includes word fluency, naming ability, comprehension, paraphasia and impairments of reading and writing (Heilman, Safran and Geschwind, 1971; Levin, 1981; Levin, Grossman and Kelly, 1976; Sarno, 1980). Right hemisphere damage can impact on communication regarding speech intonation, facial expression, attention, memory, pragmatic ability, orientation and perception (Burns, et al, 1985). Dysarthria is also a common symptom related to TBI patients (Groher, 1977; Najanson et al, 1978; Hagen, et al, 1979; Sarno, 1980).
Study done in the Hospital Arthur Ribeiro de Saboya, in São Paulo, will discuss common symptoms found in the population of TBI patients. This study was done during the years of 1998-1999 on Head Injury (HI) resulted from gun shot, and TBI. On the group of TBI, 37,7% presented some kind of aphasia (reception, emission, anomia); 14,3% dysarthria and 46,8% cognitive disturbances (memory, attention, orientation, etc). On the group of HI from gun shot, 62% presented some kind of aphasia (receptive, emission, anomia); 12,5% dysarthria and 62,5% cognitive disturbances (memory, attention, orientation, etc).
Functional treatment should have as goal the effectiveness communication, where language, cognition and psychosocial factors are considered. Discurse and social interaction ability should be evaluated, and therapy goals are based on the results. Therapy environment should take into account real-life needs and activities of daily-living. Strategies are based on residual capacities and compensatory abilities of the patient. Family members and friends should be active part of the rehabilitation process. Goals should be clearly defined with interdisciplinary participation. Patient should be included as much as possible to participate on treatment goals, evolution and needs of modification (Barco, et al, 1991; Adamovich, et al, 1985; Hartley, 1995). Cognitive rehabilitation is a difficult and sometimes a long process that involves overcoming a number of difficult obstacles (Sbordone, 1991) that have as the ideal and long-term goal the return to most of the pre-morbid responsibilities and activities.
Preliminary results of this research shows that a head injury, from severe to mild level, can leave the patient with cognitive communication disorders that will in some way will bring dificulties to his or her life when trying to achieve the maximum possible of the pre-morbid responsibilities. One of the professionals that has a very important role on the rehabilitation of this population is the Speech Language Pathologist, who has the expertise on the cognitive-communication abilities and rehabilitation.
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