Nonstandardized Assessment of Cognitive-Communication Abilities Following Pediatric Traumatic Brain Injury: A Scoping Review

Speech-Language Pathology Treatment of Cognitive-Communication Deficits in School-Aged Children With Traumatic Brain Injury: A Scoping Review

PURPOSE

The purpose of this scoping review was to synthesize the current evidence-based treatment practices used with school-aged children with any severity of traumatic brain injury (TBI) that could benefit the practice of speech-language pathologists (SLPs).

METHOD

A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels based on a modified version of the Rehabilitation Treatment Specification System.

RESULTS

A total of 27 articles that covered 16 different treatment approaches met inclusion criteria for this study. Most studies included adolescent or teenage participants with moderate-severe TBIs. Treatment targets included executive functioning (n = 15), social competence (n = 6), postconcussive symptoms (n = 5), behavior (n = 3), family functioning (n = 1), and health-related quality of life (n = 1). The majority of current interventions for school-aged children with TBI include a multidisciplinary approach and components of family involvement education.

CONCLUSIONS

Further research is needed on interventions that are specifically implemented by SLPs as well as protocols that include more heterogeneous samples (e.g., varied sociodemographic factors and injury severity) to allow for the development and testing of ecologically valid intervention practice. SLPs can use the results of this scoping review to individualize treatment based on the child's areas of need while considering individual characteristics and to provide person-centered intervention for children with school-aged TBI.

Cognitive, social, and health functioning of children with TBI engaged in a formal support program

BACKGROUND

Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS).

OBJECTIVE

To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students' participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project.

METHODS

Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate.

RESULTS

Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors.

CONCLUSION

The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS.

Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review

OBJECTIVE

To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research.

METHODS AND PROCEDURES

Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed.

OUTCOMES AND RESULTS

Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years.

CONCLUSIONS AND IMPLICATIONS

We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.

Community-based rehabilitation for adults with cognitive-communication disorders following traumatic brain injury: A mixed methods investigation

OBJECTIVE

To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI).

METHODS

An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI.

RESULTS

Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others.

CONCLUSIONS

These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group.

A Scoping Review of Cognitive Assessment in Adults With Acute Traumatic Brain Injury

PURPOSE

The purpose of this study was to describe and synthesize the current research regarding the prevailing cognitive domains impacted by acute traumatic brain injury (TBI) in adults. Standardized and nonstandardized assessments of cognitive function and comorbidities influencing cognitive function during the initial stages of recovery are presented to help guide clinical assessment.

METHOD

A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, was used to explore four electronic databases. Searches identified peer-reviewed empirical literature addressing aspects of cognitive domains impacted after TBI, cognitive assessment, and comorbidities impacting assessment in adults after acute TBI.

RESULTS

A total of 1,072 records were identified and reduced to 75 studies based on inclusion criteria. The cognitive domains most impacted in acute TBI were memory and executive function. The Glasgow Coma Scale (GCS) was the most frequently used tool to assess cognitive abilities, despite it being a measurement of consciousness, not of cognition. Psychological changes were the most commonly noted comorbidity impacting cognitive assessment.

CONCLUSIONS

Assessment of cognition after acute TBI requires a multifaceted approach that considers the typical profile of cognitive impairment, as well as patient-specific factors influencing cognitive abilities following initial brain injury. The present results support the generally held view that memory and executive function deficits are common cognitive difficulties associated with acute TBI in adults. The GCS remains the most widely used tool to assess function, though numerous tools are available that specifically address cognitive domains. Acute medical comorbidities common within this stage of injury are highlighted, as well as gaps of clinical knowledge that remain.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18372086.