The Role of Speech Therapy In Traumatic Brain Injury

Traumatic brain injury can cause about a lot of speech and language disorders that would entail the need of speech therapy. That’s why the role of speech therapy in the rehabilitation process of a traumatic brain injury patient is very vital.

What Speech And Language Problems TBI Brings About

A person may have loss of consciousness after a traumatic brain injury. This loss of consciousness can vary from seconds, minutes, hours, days, months or even years. The longer you are out of consciousness, the more severe your injury is. After a traumatic brain injury, you may suffer secondary consequences, which are considered to be more lethal and dangerous than the primary injury.

Some of these secondary consequences include damage to your brain’s meninges, traumatic hematoma, increased intracranial pressure, herniation, hyperventilation, ischemic brain damage, and cerebral vasospasm. When these brain damages occur, they tend to affect parts of your brain that are responsible for speech and language processing and production, thus you get speech and language problems.

Traumatic brain injuries can cause you permanent or temporary memory loss, orientation problems, lesser cognitive performance or slower processing of thought, attention problems, deterioration of skills in basic counting, spelling and writing. You can also have Aphasia, where you have a loss of words.

Traumatic brain injury can also cause you difficulty in reading simple and complex information. Your naming skills, of everyday seen objects, familiar others can also be affected. It can also bring about dysarthria, or problems with movement, that can cause you to have shaky movements leading to difficulty speaking and writing.

Speech Therapy For Traumatic Brain Injury Patients

Treatment for traumatic brain injury patients can be classified into three categories. There are different treatments for early, middle and late stages of a traumatic brain injury. There are also compensatory strategies taught for a TBI patient.

Early Stage Treatment

Treatment during the early stage of a traumatic brain injury would focus more on medical stabilization. A speech therapist would also deal more on establishing a reliable means of communication between the patient and the therapist. The patient is also taught how to indicate yes or no, when asked.

Another goal is for the patient to be able to make simple requests through gestures, nods, and eye blinks. The behavioral and mental condition of the patient is also treated. During the early stage, sensorimotor stimulation is also done. Where in the therapist would heighten and stimulate the patient’s sense of sight, smell, hearing and touch.

Middle Stage Treatment

The main goal during the middle stage treatment is for the patient to develop an increased control of the environment and independence. The adequacy of patient’s interaction to the environment is also increased. The therapist should also stimulate the patient to have organized and purposeful thinking. The uses of environmental prompts are to be diminished during this phase.

A lot of activities focusing on cognitive skills like perception, attention, memory, abstract thinking, organization and planning, and judgment, are also given.

Late Stage Treatment

During the late stage of treatment, the speech therapists’ goal is for the patient to be able to develop complete independence and functionality. Environment control is eliminated and the patient is taught compensatory strategies to cope with problems that have become permanent.

Some of these compensatory strategies are the use of visual imagery, writing down main ideas, rehearsal of spoken/written material, and asking for clarifications or repetitions when in the state of confusion.

Therapy Procedures for Speech Disorders

The terminal goal of speech therapy is for the client to spontaneously use the appropriate speech sounds of his or her linguistic culture in connected speech. In this context, therapy becomes a continuum of short-term goals designed to meet the terminal goal. And therapy procedures may either use the motor or traditional approach or the cognitive-linguistic approach.

Motor or Traditional Approach

This approach is structure-based and uses drills more. Drills are activities that have rapid rates of stimulus presentation and which puts much stress on accuracy of the patient’s response to the stimulus and the said response reaching various set criteria.

Under this approach is auditory training. Its proponent is Charles Van Riper. This procedure uses pictures and games as motivational events or events that serve as a way of presenting stimuli. Activities are mainly about speech sound discrimination. It highlights the awareness and detection of sound.

Another procedure is the exercise of the oral motor structures. It is used when an oral motor assessment shows muscle weakness or spasticity. For children, it should be made fun and functional. It also uses mirrors for visual feedback.

One other procedure under this approach is phonetic placement. Van Riper was also the proponent of this procedure. It provides clients with verbal descriptions or instructions regarding articulatory position and movements for target sound. It is usually used together with visual, auditory, tactile and kinesthetic cues.

Weiner’s contribution to this field is his modified sensory motor approach. It is where a word in which the target sound is correct in the final position is paired with a word in which the same sound is in error in the initial position. The words are produced without a pause to facilitate assimilation of the incorrectly produced sound.

In this line also is syllabication. It uses the syllable-by-syllable production of words. It is used in addressing weak syllable deletion or the deletion of the syllable in a word which is the least stressed.

One procedure that is closely related to syllabication is chaining. The client is first asked to say the whole word. If he says a syllable incorrectly, the therapist instructs the patient to look at his lips while he produces the word syllable by syllable with the patient following him after every syllable until he produces the word the same way that the therapist did.

Cognitive-Linguistic Approach

The first procedure under this approach is auditory bombardment, also known as cycles approach. There are treatment cycles which have their designated phonemes, taught in a span of 2-4 weeks. Auditory bombardment requires that the patient be bombarded with the phonemes that he needs to learn without him being aware of it.

Another procedure is auditory bombarding with PACT (Parents and Children Together). Here, production should not be over-emphasized. It may use funny, perceptually salient make-up words like ker-plunk, boing, shilly-shally or kaboom. All that matters is that the words contain the phonemes that are being targeted.

Modified cycles approach is also under this group. It requires the clinician to make purposeful and obvious lexical errors in words that contain target phonemes to make the patient correct the clinician, thus producing the target sound. Parental involvement is important for explanations of goals, procedures, and assignments.

Minimal contrast therapy, on the other hand, contrasts presence and absence of phonemes, establishing also the difference between phonemes. This procedure can be utilized in addressing perceptual or production difficulties when it comes to final sounds of words, establishing the difference between words like fee and feet.