Traumatic Brain Injury in Adults

Roles and Responsibilities of the SLP

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 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:

  • Identifying risk factors for TBI, considering 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 the individual and to 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 Speech-language pathology scope of practice and providing education aimed at preventing further complications relating to TBI (see ASHA's resource on person- and family-centered care and ASHA's Practice Portal page on Counseling for Professional Service Delivery)
  • Providing training (e.g., in the use of augmentative and alternative communication [AAC] systems) to persons with TBI and their families and caregivers
  • Serving as an integral member of an interdisciplinary team working with individuals with TBI and their families/caregivers (see ASHA's web page on interprofessional education/interprofessional practice [IPE/IPP])
  • Consulting and collaborating with other professionals to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate (see ASHA's resource on collaboration and teaming)
  • 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
  • Remaining informed of research in the area of TBI and helping advance the knowledge base related to the nature and treatment of 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 individuals with TBI. See ASHA's Scope of Practice in Audiology (ASHA, 2018).

Appropriate roles for audiologists include the following:

  • 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 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 individual with TBI to other professionals as needed to facilitate access to comprehensive services
  • 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 individuals with TBI and their families/caregivers regarding the psychosocial aspects of hearing loss and other auditory processing dysfunction, modes of communication, and processes to enhance communication competence (See ASHA's Practice Portal page on Counseling for Professional Service Delivery)
  • Providing communication skills training for families and other professionals who interact with the individual
  • Serving as a 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 (see ASHA's web page on  interprofessional education/interprofessional practice [IPE/IPP] and ASHA's resource on collaboration and teaming)
  • Advocating for the communication needs of all individuals, including advocating for the rights of those with hearing loss, auditory, and/or vestibular disorders and the funding of such services
  • 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

Successful management of individuals with TBI typically requires collaboration and teaming with other professionals. For example, dysphagia management may include interdisciplinary teamwork between occupational therapists, dietitians, nursing staff, and the SLP. SLPs may also work with nursing staff (e.g., to facilitate communication between the individual and their medical team) and with physical therapists (e.g., to promote carryover and insight for current limitations and safety).

Interdisciplinary collaboration and teaming also form an integral part of audiology services to individuals with TBI. Audiologists consult and collaborate regularly with other professionals about the individual's communication management, accessibility to information, the vocational/educational implications of hearing loss and balance problems, and the legal implications of hearing loss and/or other auditory and vestibular dysfunction.

See ASHA's web page on interprofessional education/interprofessional practice (IPE/IPE) and ASHA's resource on collaboration and teaming.

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.