Speech Therapy Following Traumatic Brain Injury (TBI)

[ Music ] >> The Brain Injury Guide
and Resources is a tool for professionals,
community members and family to understand traumatic
brain injury as well as how to promote better living for
those who live with a TBI. In this interview we will
talk with Barbara Brinkman, clinical associate professor in
the Department of Communication, Science and Disorders in the MU
School of Health Professions, to learn more about the role of speech therapy
after a brain injury. Barbara, thanks very
much for being with us. >> Barbara: Oh, I’m
happy to be here. >> Barbara, when does a speech
therapist become involved with a patient following
a traumatic brain injury? >> Barbara: They usually
get involved very early on after the accident. Sometimes they’ll even begin
working while the patient is still in a pretty deep coma
doing some stimulation to try to help get them out
of that stage of coma. And even in the early stages
of emergence we start to work. They have a lot of
social communication and just communication
problems in general, so we work on reading, writing,
listening, speaking, swallowing and speech disorders as well. >> What are the goals
of speech therapy? >> Barbara: You really want
to integrate the person back into their former life
as much as possible, so it depends on the patient. If it’s a school-aged child
you want to integrate them back into the school system. If it’s an adult, back into their work situation,
if possible. And, of course, for everybody
you want to help them get back into a social relationship
with their family and friends. >> What kinds of things
would a speech therapist do to help a person with a
traumatic brain injury? >> Barbara: Well, we’re going
to work on all those areas that I mentioned before but
there’s going to be a lot of emphasis on the social
communication domain. What we find is that
even when people start to recover their language
they have trouble using that in social situations, so they may have
difficulty understanding how to start a conversation, how to
maintain it, and how to end it. They may have trouble matching
the appropriate loudness level when they’re speaking to others and they don’t have good
self monitoring skills to modulate that. And, finally, they may
have trouble with things like figurative language or
higher level language skills, when the words don’t match the
message that they’re trying to convey, like sarcasm
or metaphors. >> Are there specific
techniques you would use with a typical client? >> Barbara: Well, I try to
use a lot of cueing systems that are other than
just listening since they may have some
problems comprehending, so I’m going to pair
cueing systems with visual things maybe
doing some video tape or audio tape review to help
increase their awareness of some of their deficits. If they’re not aware that there’s a deficit
they’re not going to be able to make many changes there. >> So, Barbara, is there a
difference between working with children and adults? >> Barbara: A lot of the
areas are going to be the same but one thing that’s really
important to keep in mind is that people who have had a
traumatic brain injury have trouble with learning
due information. So if you look at an
adult they’ve had many, many experiences that
they may not have lost but a child had fewer
opportunities to learn and they’re going to have
trouble learning all the new things that are going to come
up in school, so you really have to have a lot of
intervention with these kids. >> Barbara, how long would
the therapy typically last, or is there a typical length? >> Barbara: You know it’s really
hard to give any specifics for any particular patient
but I’d say probably at least one to two years. It depends on the
severity of their injury, it depends on what their goals
are too, are they just wanting to work at home or are
they wanting to get back into a workforce,
are they school-age, so all of those things are
going to come into play. >> Alright, well, let’s take a
look at how you might interact with a client if we could. >> Barbara: Okay, I’d
be glad to do that. [ Music ] >> And joining us now for
our demonstration is Leanna. Leanna, thank you very
much for being with us. And Barbara, at what point in
the therapy would Leanna be in our situation here? >> Barbara: She would
be about six months after her traumatic brain
injury, and we’re working a lot on her conversational
skills at this point. >> Alright, and what
therapy goals would you have for this session? >> Barbara: Well, we want
to increase her ability to communicate socially
with friends and family and that sort of thing. She has a little bit of trouble
keeping a conversation going and also sometimes she doesn’t
modulate her voice very well, so we are still working
on that too. >> Alright, show us how you
would work with this client. >> Barbara: Okay, great. Hi, Leanna, I haven’t seen you since last week how
was your weekend? >> Leanna: It was good. I saw my family. >> Barbara: Okay, Leanna, remember now we’re
having a conversation and do you remember this
chart from last week? When we started, I made a
comment and asked you a question and that came over to you and you made a comment,
and that was great. But you need to give the
conversation back to me. So, what do you need to do? >> Leana: I need
to ask a question. >> Barbara: That’s
exactly right. Okay, so let’s try
that again, okay? And look at the chart
if you need to to help you get through this. >> Leanna: Okay. >> Barbara: So I’m
going to start again. >> Leanna: Okay. >> Barbara: Hi, Leanna, I haven’t seen you
since last week. What did you do over
the weekend? >> Leanna: I saw my family what
did you do over the weekend? >> Barbara: That was perfect, that’s exactly what
I wanted you to do. That turns it back to me
and it keeps it going back and forth just like
a good conversation. Okay, now, pass me
that question again. >> Leanna: What did
you do this weekend? >> Barbara: I saw
my granddaughter, which is always a
lot of fun for me, and we put up our
Christmas tree. Are you putting up a tree? >> Leanna: I haven’t
yet but I’m going to. >> Barbara: Fantastic, that
was a really nice conversation that went back and forth
back and forth okay? Terrific, let’s move on now and
I want to work a little bit more on your voice and
how loud you are. Sometimes you’re a little too
loud and that’s way up here if we look at the scale and
sometimes it’s really hard for me to hear you, you
tend to get too quiet, okay? Somewhere in the middle is what
we want most of the time, okay? >> Leanna Okay. >> Barbara: So I’m going to demonstrate this
a little bit to you. I’m going to say a sentence
and I’m not going to tell you which one I want you to
tell me if it was too soft, just right, or too loud. >> Leanna: Okay. >> Barbara: You ready? Okay. Hi, Leanna, how are you? >> Leanna: That one
was too loud. >> Barbara: It was
too loud wasn’t it? How did it make you feel? >> Leanna: Made me a
little uncomfortable. >> Barbara: Yeah, and I
think that’s what happens when people don’t use
the right tone of voice. If it’s too loud or too
soft, people, you know, they get uncomfortable
with that. Okay, how about this one? Hi, Leanna, how are you? >> Leanna: I’d say
that one was too soft. >> Barbara: That’s right,
you’re exactly right. You’re getting really good at determining whether something
is too loud or too soft. So let’s see now if you can
produce it in the right way. I want you to ask me how
am I and I’ll tell you if I thought it was too soft,
too loud, or just right. >> Leana: How are you, Barbara: >> Barbara: That’s
was pretty good. It was a little bit soft. I’d put it right about in here. I’d like you to try
again and see if you can get it a little
bit closer to the just right. >> Leanna: How are you, Barbara? >> Barbara: That was very nice. That was just the right level. Can you do one that’s too loud? >> Leanna: How are you, Barbara? >> Barbara: That was
really loud, good. You’re really getting
good at judging and producing these;
that’s terrific. Thank you. >> Alright, Leanna and
Barbara thank you very much for being us we appreciate it. And we thank you for watching
this interview on speech therapy after TBI, a service of the Brain Injury
Guide and Resources.

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