Traumatic Brain Injury (TBI) refers to neurological damage to the brain resultsing from the impact of external forces. Epidemiology studies show that TBI is a leading cause of death and disability in the United States. Given the frequent long-term medical, vocational, and social needs of affected individuals, TBI represents a substantial health care issue in the United States.

Characteristics of TBI

Head injuries are grouped by the nature of the injury, whether open-head or closed-head. Open-head injuries occur when the skull and the layers of tissue that encase the brain have been penetrated. Closed-head injuries is when the outer protection of the brain remains intact, but the brian is jostled within the skull, yielding diffuse injury.

The use of improvised explosive devices has created a new category of truamatic brain injury known as polytrauma. Polytrauma injuries refer to a mixture of open and closed-head injuries.

Regardless of the mechanism of injury, the cognitive and linguistic impacts of TBI vary considerably across individuals and are often not the only aspects of well being that are affected. TBI affects the psychosocial realm as well, including emotions, temperament, motivation, and self-awareness.

Identification of TBI

The speech-language pathologist works as a member of an interdisciplinary rehabilitation team to plan for treatment following a TBI. Many individuals who have sustained TBI are comatose and require advanced medical support to survive. Testing for communication recovery and potential for communication recovery relies on subjective, behavioral observations. Two instruments commonly used in the early phases of TBI recovery include the Glascow Coma Scale and the Rancho Los Amigos Levels of Cognitive Function.

The Glascow Coma Scale rates the best observed response for eye opening, verbal response, and motor response to characterize an individual's functioning, from severe TBI to mild TBI. The Rancho Los Amigos Levels of Cognitive Function use a subjective rating that outlines ten levels of cognitive functioning.

Treatment of TBI

Treatment interventions will vary according to an individual's level of impairment as reflected by the Rancho scale. In the early stages of recovery, stimulation treatment is common. The middle phase of recovery, tasks focus on establishing basic communication systems and enhancing the reliability of communication efforts. The later phases of recovery, it focuses on facilitating independence. Treatment stresses insight or judgement to solve problems encountered in daily activities.

Treating clients with TBI requires great flexibility on the part of the therapist to meet their individualized needs as they progess through the Rancho stages.

Adult Language Disorders and Cognitive-Based Dysfunction