Speech-language pathologists (SLPs) play a central role in the screening, assessment, and treatment of persons with TBI. The professional roles and activities in speech-language pathology include clinical/educational 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, 2016).
Appropriate roles for SLPs include:
- identifying risk factors for TBI, taking into account variability among individuals from different racial and ethnic backgrounds and culturally and linguistically diverse populations;
- 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 individuals with TBI for hearing, speech, language, cognitive-communication, and swallowing difficulties;
- determining the need for further 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/linguistic variations;
- gathering and reporting treatment outcomes, documenting progress, and determining appropriate discharge criteria;
- facilitating access to comprehensive services, including referral to other professionals as necessary;
- 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;
- consulting and collaborating with other professionals to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate;
- remaining informed of research in the area of TBI and helping advance the knowledge base related to the nature and treatment of TBI;
- serving as an integral member of an interdisciplinary team working with individuals with TBI and their families/caregivers;
- advocating for individuals with TBI and their families and educating other professionals, third-party payers, and legislators about the needs of persons with TBI and the role of SLPs in diagnosing and managing speech, language, cognitive-communication, and swallowing disorders associated with TBI;
- providing quality control and risk management.
As indicated in the
Code of Ethics (ASHA, 2016), SLPs who serve this population should be specifically educated and appropriately trained to do so.
Although SLPs are autonomous professionals, successful management of individuals with TBI typically requires the collaborative involvement of other professionals. For example, dysphagia management may include interdisciplinary teamwork between dietitians, nursing staff, and the SLP. SLPs may also collaborate with
- occupational therapists when assessing and managing swallowing disorders to determine an individual's functional ability for self-feeding,
- nursing staff to facilitate improved communication of medical needs between the individual with TBI and the team,
- physical therapists to promote carryover and insight for current limitations and safety.
Within the context of interdisciplinary collaboration, some domains of deficits may be addressed by different disciplines with different training emphases, who collaboratively engage in areas of distinct and common professional practice. For example, assessment and management of cognitive deficits may include neuropsychologists, occupational therapists, and other members of the interdisciplinary team, as well as SLPs. Best treatment outcomes may be achieved when cognitive rehabilitation is presented in a context of interdisciplinary rehabilitation (Schutz & Trainor, 2007). In these overlapping roles, clinical practice includes only those techniques and procedures included in discipline-specific training. In addition, individual practice may be limited by laws and ethical considerations. SLPs are responsible for consulting state licensure regulations.
Audiologists play a central role in the assessment, diagnosis, and rehabilitation of hearing and vestibular deficits in individuals with TBI. See ASHA's
Scope of Practice in Audiology (ASHA, 2004).
Appropriate roles for audiologists include:
- providing prevention information, promoting hearing wellness, and monitoring the acoustic environment;
- educating other professionals about the needs of adults with hearing and vestibular deficits post-TBI and the role of audiologists in diagnosing and managing them;
- identifying hearing and vestibular deficits post-TBI, including early detection and screening program development, management, quality assessment, and service coordination;
- conducting a comprehensive and culturally/linguistically sensitive assessment, using behavioral, electroacoustic, and/or electrophysiological methods to assess hearing, auditory function, vestibular and balance function, and related systems;
- referring the individual with TBI to other professionals as needed to facilitate access to comprehensive services;
- serving as an integral member of an interdisciplinary team working with individuals with TBI and their families/caregivers to provide input on management strategies for vestibular and balance disorders;
- evaluating individuals 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 individual 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;
- advocating for the communication needs of all individuals, including advocating for the rights to and funding of services for those with hearing loss, auditory, 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.
Interdisciplinary collaborations also form an integral part of audiology service delivery. Audiologists consult and collaborate regularly with professionals of related and/or allied services regarding communication management, vocational/educational implications, accessibility, and legal implications of hearing loss and/or other auditory and vestibular dysfunction.
As indicated in the
Code of Ethics (ASHA, 2016), audiologists who serve this population should be specifically educated and appropriately trained to do so.