Approximately 42 million people worldwide experience mild traumatic brain injury (mTBI) each year. Even if they don’t exhibit verifiable cognitive symptoms, they might experience cognitive inefficiency in their daily lives. How can health care professionals, such as speech-language pathologists and psychologists, help them?
The Joint Committee on Interprofessional Relations of ASHA and the American Psychological Association (APA) suggests taking a person-centered approach to treatment that focuses on education, counseling, and use of compensatory strategies to help patients re-engage in meaningful daily activities.
A person-centered approach to mTBI treatment understands that people with mild brain injury can identify their symptoms and challenges. This ability allows them to use facilitative therapeutic support from SLPs or psychologists to overcome those challenges.
When providing such support, clinicians:
- Exhibit genuineness while discussing issues with the patient or client.
- Hold the person in positive regard.
- Empathize with the person.
- Provide a supportive and proactive environment.
In such an environment, people with mTBI will likely engage in activities leading to successful outcomes.
Try the following strategies to achieve this holistic approach:
Motivational interviewing (MI)
With MI, the clinician can guide patients to self-identify behaviors they wish to change with methods that work for the patient. This promotes patient empowerment and change becomes more readily accepted. MI allows patients to self-identify challenges and elicits self-motivating statements leading to behavioral changes.
The clinician using MI adopts a nonjudgmental, collaborative communication style with techniques including:
- Asking open-ended questions.
- Providing affirmations to reinforce positive expectations for recovery.
- Offering reflections helpful in shaping goals.
- Summarizing information to identify goals, develop strategies to achieve goals, and support self-efficacy.
Goal attainment scaling (GAS)
GAS is an effective method of measurement that actively engages patients through individualized goals and interprofessional collaboration. The approach allows clinicians to remain flexible when measuring and monitoring patient progress in reaching the patient’s self-defined goals. It involves identifying:
- A specific target behavior, with the current level used as an anchor, and additional quantitative anchors associated with incremental qualitative descriptions of the behavior.
- Clear steps between the present level and the target to measure progress incrementally.
Acceptance and commitment therapy (ACT)
ACT addresses the ability to handle life challenges while maintaining a definition of self, emphasizing the patient’s core values. There are six core processes of ACT:
- Acceptance (acknowledging emotion without letting the emotion take control of the person).
- Cognitive defusion (seeing thoughts merely as internal language that may or may not be helpful).
- Being present (using mindfulness).
- Self as context (cultivating the observer-self perspective).
- Values (identifying what matters to the patient).
- Committed action (choosing to pursue valued activities in spite of experience of opposing thoughts or feelings).
Although SLPs don’t engage patients in formal psychotherapy or fully introduce or implement this model of care, facilitation of underlying principles in the context of engaging patients in cognitive-communication treatment is likely to help patients maximize attainment of rehabilitation goals and improved quality of life.
The approaches discussed above will be presented by the APA/ASHA Joint Committee on Interprofessional Relations during a seminar the 2018 ASHA Convention. Committee members will present real-world examples of these techniques.
When? Nov. 16, 2018 1–2 p.m., session 1463
Where? Westin Boston Waterfront, Burroughs Room
An excellent resource for management suggestions is “Clinician’s Guide to Cognitive Rehabilitation in mTBI: Application for Military Service Members and Veterans,” developed by SLPs, neuropsychologists/rehabilitation psychologists, and occupational therapists.
Relevant references on mild traumatic brain injury include:
Gardner, R. C., & Yaffe, K. (2015). Epidemiology of mild traumatic brain injury and neurodegenerative disease. Molecular and Cellular Neuroscience, 66, 75–80.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.
Kiresuk, T. J., & Sherman, R. E. (1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4(6), 443–453.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Third edition. New York: Guilford.
Written by the Joint Committee Members: Diane Paul, PhD, CCC-SLP, ASHA director of clinical issues in speech-language pathology, firstname.lastname@example.org. Katharine Seagly, PhD, neuropsychologist and clinical faculty member at University of Michigan; Lisa Milman, PhD, CCC-SLP, assistant professor at Utah State and affiliate of ASHA Special Interest Group 2, Neurogenic Communication Disorders; Pauline Mashima, PhD, CCC-SLP, adjunct professor at University of Hawaii, Manoa, and affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders, 14, Cultural and Linguistic Diversity, and 18, Telepractice; Teresa Ashman, PhD, ABPP-Rp, rehabilitation psychologist in private practice and a research scientist affiliated with the Center for Health Assessment Research and Translation at the University of Delaware.; Brigid Waldron-Perrine, PhD, ABPP-ABCN, rehabilitation neuropsychologist at the Rehabilitation Institute of Michigan; Raksha Mudar, assistant professor in speech and hearing science at the University of Illinois at Urbana-Champaign. and affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders, 6, Hearing and Hearing Disorders: Research and Diagnostics, and 15, Gerontology.