Regardless of variations, TBI is the leading cause of disability and death in children ages 0–4 years and adolescents ages 15–19 years (CDC, 2015). National Institutes of Health. The SLP collaborates with a vocational rehabilitation therapist as appropriate, assessing and treating functional work and community-based skills in context and implementing necessary accommodations for maximum outcomes. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech [§300.8(c)(12)]. These teams include health care-based SLPs and school-based SLPs who attend IEP meetings and help plan for the child's return to school (Denslow et al., 2012; Glang, Tyler, Pearson, Todis, & Morvant, 2004; Newlin & Hooper, 2015; University of Oregon, n.d.; Ylvisaker, 1998; Ylviskaer et al., 1995, 2001). American Speech-Language-Hearing Association. Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury. Assistive Technology, 24, 56–66. Journal of Pediatric Rehabilitation Medicine, 3, 269–277. Rehabilitation Act of 1973, Section 504, P.L. Speech-language pathologists (SLPs) play a central role in the screening, assessment, and treatment of persons with TBI. Successful management of individuals with TBI typically requires collaboration and teaming with other professionals. Journal of Rehabilitation Medicine, 43, 216–223. STUDY. Journal of Pediatrics, 157, 889–893. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 22, 143–151. The goal of CPT is to improve the communication effectiveness of individuals with TBI by training communication partners to use strategies such as. individuals with severe traumatic brain injury 2. advocate for their child by providing important information about performance in home and school as the child progresses through transitions. (2013). The functional impact of TBI in children can differ from that in adults because the pediatric brain is still developing. The Journal of Head Trauma Rehabilitation, 20, 95–109. NeuroRehabilitation, 19, 219–231. Behavioral interventions are often used to decrease these unwanted behaviors and teach functional alternative behaviors. Feeney, T. J., & Ylvisaker, M. (2008). The ASHA Leader, 11, 8–36. Efficacy and usability of assistive technology for patients with cognitive deficits. See ASHA's Practice Portal page on Augmentative and Alternative Communication. Snoezelen: A controlled multi-sensory stimulation therapy for children recovering from severe brain injury. Hotz, G., Castelblanco, A., Lara, I., Weiss, A., Duncan, R., & Kuluz, J. Thurman, D. J., Alverson, C., Browne, D., Dunn, K. A., Guerrero, J., Johnson, R., . Masel, B., & DeWitt, D. (2010). Family-centered practice provides opportunities for family members and caregivers to. Togher, L., McDonald, S., Tate, R., Power, E., & Rietdijk, R. (2013). Each party is equally important in the relationship, and each party respects the knowledge, skills, and experiences that the others bring to the process. (2019). Computer-based cognitive rehabilitation for individuals with traumatic brain injury: A systematic review. Available 8:30 a.m.–5:00 p.m. A separate resource on mild traumatic brain injury will be developed in the future. McKinlay, A., & Anderson, V. (2013). Traumatic brain injury in the United States: A report to Congress. Compensatory approaches draw on the child's strengths to maximize his or her abilities, often through the use of external or internal aids (Blosser & DePompei, 2003; Shum, Fleming, Gill, Gullo, & Strong, 2011). The SLP can also support students with TBI transitioning to postsecondary education through individualized transition plans, interactive coaching, and environmental assessments that identify systems and services to facilitate studying, learning, organization, time management, social relationships, self-regulation, self-advocacy, and use of compensatory strategies (Kennedy & Krause, 2011; Turkstra, Gamazon-Waddell, & Evans, 2004; Volkers, 2015). For information about traumatic brain injury in children (ages birth through 21), see ASHA's Practice Portal page on Pediatric Traumatic Brain Injury. When selecting standardized assessments, consider the following: Functional or situational assessments (e.g., language sampling, analog tasks, and naturalistic observation) and anecdotal reports are particularly useful for supplementing data from standardized tests when assessing individuals with TBI. Journal of the Neuropsychological Society, 18, 1–19. The side effects of prescription drugs may affect test performance (e.g., due to excessive drowsiness). TIunication disability. Traumatic Brain Injury (Adults) Evidence Map, Counseling for Professional Service Delivery, interprofessional education/interprofessional practice [IPE/IPP, interprofessional education/interprofessional practice (IPE/IPE), interprofessional education/interprofessional practice (IPE/IPP), Collaborating With Interpreters, Transliterators, and Translators, assessment tools, techniques, and data sources, Augmentative and Alternative Communication, what to ask when evaluating any procedure, product, or program, Audiology Information Series: Hearing Assistive Technology, Blast-Related Ear Injury in Current U.S. Military Operations: Role of Audiology on the Interdisciplinary Team, Consumer Information: Traumatic Brain Injury, Cultural-Linguistic Considerations for Speech-Language Pathologists in Serving Individuals With Traumatic Brain Injury, Diagnosis of (Central) Auditory Processing Disorder in Traumatic Brain Injury, Interdisciplinary Approach to Dizziness: Roles of Audiology and Physical Therapy, Legislating Health Plan Coverage for Hearing Aids for Children, Cognitive Rehabilitation, and Autism Related Services, Patient Information Handouts: Audiology Information Series, Tinnitus Evaluation and Management Considerations for Persons With Mild Traumatic Brain Injury, American Physical Therapy Association—Mild TBI: Resources for the Management of Wounded Warriors, Brain Injury Association of America (BIAA), Centers for Disease Control and Prevention (CDC): Traumatic Brain Injury and Concussion, Defense and Veterans Brain Injury Center (DVBIC), Joint Committee on Interprofessional Relations Between ASHA and Division 40: Society for Clinical Neuropsychology of the American Psychological Association, National Institute of Neurological Disorders and Stroke (NINDS): Traumatic Brain Injury: Hope Through Research, U. S. Department of Veterans Affairs: National Center for PTSD, https://www.cdc.gov/traumaticbraininjury/pdf/mtbireport-a.pdf, www.cdc.gov/traumaticbraininjury/get_the_facts.html, https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf, www.nature.com/gimo/contents/pt1/full/gimo50.html, https://pubs.asha.org/doi/10.1044/nnsld14.3.19, https://doi.org/10.1044/leader.FTR2.20122015.46, https://pubs.asha.org/doi/10.1044/nnsld23.2.49, www.asha.org/Practice-Portal/Clinical-Topics/Traumatic-Brain-Injury-in-Adults/, Connect with your colleagues in the ASHA Community, Confusion associated with deficits in orientation, Neurological signs, such as brain injury observable on neuroimaging, new onset or worsening of seizure disorder, visual field deficits, and hemiparesis, Changes in level of consciousness, ranging from brief loss of consciousness to coma, Impaired movement, balance, and/or coordination, Motor speed and programing deficits (dyspraxia/apraxia), Reduced muscle strength (paresis/paralysis), Auditory dysfunction from injury to the outer ear, middle ear, inner ear, and/or temporal lobe, resulting in, Changes in perception of color, shape, size, depth, and distance, Problems with visual convergence and accommodation, Tactile—sensitivity or defensiveness to touch; changes in perception of pain, pressure, and/or temperature, Deficits in shifting attention between tasks, Impaired sustained attention (e.g., for task completion), Reduced processing speed (e.g., of rapid speech and/or complex language), resulting in confusion, Deficits in short-term memory that negatively affect new learning, Deficits in working memory that negatively affect following directions and task completion, Difficulty remembering to perform a planned action (prospective memory) such as remembering to take medication, Difficulty retrieving information from memory, Post-traumatic amnesia marked by impaired memory of events that happened shortly before the injury (retrograde), Lack of insight for monitoring one's strengths, weaknesses, functional abilities, problem situations, and so forth, Reduced awareness of deficits (anosagnosia), Deficits in orientation to self, situation, location, and/or time, Impaired spatial cognition that can affect ability to navigate and ambulate, Difficulty initiating conversation and maintaining topic, Difficulty inhibiting inappropriate language or behavior, Impaired ability to use nonverbal communication effectively (e.g., tone of voice, facial expression, body language), Impaired social cognition skills (e.g., regulating emotion; expressing emotion and perceiving emotion of others; ability to take the perspective of others and to modify language accordingly), Inability to interpret others' nonverbal communication, Decreased ability to formulate organized discourse or conversation, Difficulty understanding abstract language/concepts, Tendency to perseverate in verbal responses, Use of incoherent or confabulatory speech, Difficulty comprehending written text, particularly with respect to complex syntax and figurative language, Difficulty planning, organizing, writing, and editing written products, Aprosodia/dysposodia, marked by deficits in intonation, pitch, stress, and rate, Dysarthria characterized by reduced respiratory support, articulatory imprecision, and/or vowel distortions, Hypernasality secondary to paresis or paralysis of velopharyngeal muscles involved in speech, Aphonia/dysphonia resulting from intubation, tracheostomy, or use of mechanical ventilator, Neurogenic phonatory abnormalities resulting from injury to sensory or motor innervations to the vocal folds, Psychogenic phonatory abnormalities (e.g., related to post-traumatic stress disorder), Swallowing problems secondary to oral and/or pharyngeal sensory disorders and/or motor deficits (e.g., weakness or paralysis of oropharyngeal musculature, oral apraxia), Risk of aspiration while eating related to impact of cognitive impairment (e.g., poor memory, reduced insight, limited attention, impulsivity, and agitation; Logemann, 2006; Morgan, Ward, & Murdoch, 2004), Affective changes, including over-emotional or over-reactive affect or flat (i.e., emotionless) affect, Difficulty identifying emotions in others (alexithymia), Emotional lability and mood changes or mood swings, Excessive drowsiness and changes in sleep patterns, including difficulty falling or staying asleep (insomnia), excessive sleepiness (hypersomnia), Increased state of sensory sensitivity accompanied by exaggerated response to perceived threats (hypervigilance), Irritability and reduced frustration tolerance, Lack of initiation (e.g., for making choices, talking, moving), semantic/phonological paraphasias produced in the nontarget language; and, Identifying risk factors for TBI, considering variability among individuals from different racial and ethnic backgrounds and culturally and linguistically diverse populations, Providing prevention information to individuals and groups known to be at risk for TBI as well as to individuals working with those at risk, Screening individuals with TBI for hearing, speech, language, cognitive-communication, and swallowing difficulties, Determining the need for further assessment and/or referral for other services, Conducting a comprehensive assessment and diagnosing speech, language, cognitive-communication, and swallowing disorders associated with TBI with sensitivity to individual differences, including cultural and linguistic variations, Developing and implementing treatment plans involving direct and indirect intervention methods for maintaining functional speech, language, cognitive-communication, and swallowing abilities at the highest level of independence, with sensitivity to the individual and to cultural/linguistic variations, Gathering and reporting treatment outcomes, documenting progress, and determining appropriate discharge criteria, Facilitating access to comprehensive services, including referral to other professionals as necessary, Counseling persons with TBI and their families regarding impairments across the Speech-language pathology scope of practice and providing education aimed at preventing further complications relating to TBI (see ASHA's resource on, Providing training (e.g., in the use of augmentative and alternative communication [AAC] systems) to persons with TBI and their families and caregivers, Serving as an integral member of an interdisciplinary team working with individuals with TBI and their families/caregivers (see ASHA's web page on, Consulting and collaborating with other professionals to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate (see ASHA's resource on, Advocating for individuals with TBI and their families, and educating other professionals, third-party payers, and legislators about the needs of persons with TBI and the role of SLPs in diagnosing and managing speech, language, cognitive-communication, and swallowing disorders associated with TBI, Remaining informed of research in the area of TBI and helping advance the knowledge base related to the nature and treatment of TBI, Providing prevention information, promoting hearing wellness, and monitoring the acoustic environment, Educating other professionals about the needs of adults with hearing and vestibular deficits post-TBI and the role of audiologists in diagnosing and managing them, Identifying hearing and vestibular deficits post-TBI, including early detection and screening program development, management, quality assessment, and service coordination, Conducting a comprehensive and culturally and linguistically sensitive assessment, using behavioral, electroacoustic, and/or electrophysiological methods to assess hearing, auditory function, vestibular and balance function, and related systems, Referring the individual with TBI to other professionals as needed to facilitate access to comprehensive services, Evaluating individuals with hearing and vestibular deficits post-TBI for candidacy for amplification and other sensory devices, assistive technology, and vestibular rehabilitation, Fitting and maintaining amplification and other sensory devices and assistive technology for optimal use, Developing and implementing an audiologic and/or vestibular rehabilitation management plan, Creating documentation, including interpreting data and summarizing findings and recommendations, Counseling individuals with TBI and their families/caregivers regarding the psychosocial aspects of hearing loss and other auditory processing dysfunction, modes of communication, and processes to enhance communication competence (See ASHA's Practice Portal page on, Providing communication skills training for families and other professionals who interact with the individual, Serving as a member of an interdisciplinary team working with individuals with TBI and their families/caregivers to provide input on management strategies for vestibular and balance disorders (see ASHA's web page on, Advocating for the communication needs of all individuals, including advocating for the rights of those with hearing loss, auditory, and/or vestibular disorders and the funding of such services, Remaining informed of research in the area of TBI and helping advance the knowledge base related to the nature, identification, and treatment of hearing and vestibular deficits post-TBI. Bethesda, MD: Author. Environmental accommodations for a child with traumatic brain injury.