Pediatric Traumatic Brain Injury

Roles and Responsibilities of the SLP

Speech-language pathologists (SLPs) do not diagnose TBI; however, they play a key role in the screening, assessment, and treatment of children and adolescents with TBI. The professional roles and activities in speech-language pathology include clinical services (assessment, planning, and treatment), prevention, and advocacy, as well as education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b).

Appropriate roles for SLPs include the following:

  • 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 children with TBI for hearing, speech, language, cognitive-communication, and swallowing difficulties
  • Determining the need for further and ongoing 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 individual, cultural, and linguistic variations
  • Gathering and reporting treatment outcomes, documenting progress, and determining appropriate discharge criteria
  • Facilitating the transition of services between medical, educational, community, and vocational settings
  • Counseling persons with TBI and their families regarding impairments across the SLP scope of practice and providing education aimed at preventing further complications relating to TBI
  • Providing training (e.g., in the use of augmentative and alternative communication [AAC] systems) to persons with TBI and their families, caregivers, and educators
  • Serving as an integral member of an interdisciplinary team working with individuals with TBI and their families/caregivers, including participating as a member of the school planning/individualized education program (IEP) team to determine eligibility, appropriate educational services, and transition planning
  • Consulting and collaborating with other professionals (e.g., teachers, neuropsychologists, occupational and physical therapists) to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate
  • Advocating for individuals with TBI and their families, particularly in school settings where cognitive-communication disorders may be mistaken for attitudinal or motivational problems
  • Educating other professionals, third-party payers, and legislators about the needs of children with TBI and the role of SLPs in diagnosing and managing speech, language, cognitive-communication, and swallowing disorders associated with TBI across settings
  • Remaining informed of research in the area of TBI and helping advance the knowledge base related to the nature and treatment of cognitive-communication and swallowing deficits associated with TBI

As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so.

Roles and Responsibilities of the Audiologist

Audiologists play a central role in the assessment, diagnosis, and rehabilitation of hearing and vestibular deficits in children and adolescents with TBI. See ASHA's Scope of Practice in Audiology (ASHA, 2004).

Appropriate roles for audiologists include the following:

  • Educating other professionals about the needs of children with hearing and vestibular/balance deficits post-TBI and the role of audiologists in diagnosing and managing them
  • Identifying hearing and vestibular/balance 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 child with TBI to other professionals as needed to facilitate access to comprehensive services
  • Evaluating children 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 the child with TBI and his or her family regarding the psychosocial aspects of hearing loss and other auditory processing dysfunction, modes of communication, and processes to enhance communication competence
  • Providing communication skills training for families and other professionals who interact with the child
  • Advocating for the communication needs of all individuals, including advocating for the rights to and funding of services for those with hearing loss, auditory disorders, and/or vestibular disorders
  • 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

As indicated in the Code of Ethics (ASHA, 2016a), audiologists who serve this population should be specifically educated and appropriately trained to do so.

Collaboration and Teaming

Collaboration and teaming are integral to speech-language pathology and audiology service delivery for children with TBI. Integration of knowledge and skills from a variety of disciplines is essential for identifying functional abilities; determining the levels of supports needed across clinical domains and service delivery settings; maximizing outcomes; and facilitating transition back to home, school, and community. Team members may include physicians, physical and occupational therapists, teachers, neuropsychologists, and school psychologists.

Team models vary (see ASHA's resource on collaboration and teaming). The model selected will depend on the needs of the child and his or her family. The role that each team member plays will evolve as the child or adolescent develops and as his or her needs change.

The roles of the SLP and audiologist will be guided by each profession's scope of practice, discipline-specific training, ethical considerations, and state licensure regulations. See ASHA's resource titled, Evaluating and Treating Communication and Cognitive Disorders: Approaches to Referral and Collaboration for Speech-Language Pathology and Clinical Neuropsychology and ASHA's State-by-State web page.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.