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Key points

  • The presence of cognitive/communication difficulties leads to vulnerability and increased problems in social participation
  • Paediatric brain injury often does not resolve completely; difficulties can persist or emerge, which may have an impact on education and social integration later in life

What is a brain injury?

An acquired brain injury (ABI), is defined as ‘any trauma to the head which disrupts the function of the brain’ (NICE 2007). It may involve the scalp, the skull, the brain or its protective membranes. The injury can result in speech, language, communication and swallowing difficulties.

Acquired brain injury can be grouped into two main types, according to cause:

Traumatic Brain Injury (TBI) results from a trauma to the head, e.g. from a road traffic incident, assault or a fall. Traumatic brain injury, also referred to as ‘head injury’, results from an outside force and subsequent complications which can follow and further damage the brain. These include a lack of oxygen, rising pressure, and swelling within the brain.

Non-traumatic (or traumatic brain injury), these are events going on inside the body, such as, (CARF, 1996):

  • Strokes and other vascular accidents
  • Tumours
  • Infectious diseases
  • Hypoxia
  • Metabolic disorders, e.g. liver and kidney diseases or diabetic coma
  • Toxic products taken into the body through inhalation or ingestion

SLTs make a unique contribution to the differential diagnosis of communication and swallowing problems following an ABI:

  • Assessing the individual’s residual and emerging abilities, including those factors that can aid or impede recovery.
  • Identifying the breadth of communication interactions available.
  • Promoting functional communication at each stage of rehabilitation. 

Role of speech and language therapy for brain injury

Speech and language therapy intervention aims to support the recovery after a brain injury and to help the individual succeed in their environment and to enable them to participate in their community.

Speech and language therapists support people who have a brain injury with communication and eating, drinking and swallowing difficulties that can arise from it.

Adults

Speech and language therapists work with adults who have acquired a brain injury. They:

  • Assess the speech, language, communication, social interaction and eating, drinking and swallowing abilities
  • Contribute to diagnosis
  • Provide individualised treatment interventions
  • Plan appropriate therapeutic interventions to address the speech, language, communication and swallowing difficulties
  • Advise on devices that can make communication for the person easier
  • Train individuals and their families and/or carers in methods of promoting communication and where necessary using assistive or alternative communication aid devices
  • Work jointly with other members of the inter-professional team (medical, social and voluntary bodies)
  • Provide well-planned and goal-oriented rehabilitation in a specialist setting by expert professionals working in a coordinated inter-disciplinary team
  • Educate and work with family members, carers and relevant staff to provide an understanding of the nature of the difficulties and strategies to optimise function and independence
  • Train relevant people to work with the individual and provide support to them over a long period of time
  • Advise, demonstrate, practise and provide strategies on the most effective way to engage the individual in verbally and communication mediated interventions and to minimise the effects of the communication difficulties where possible
  • Reduce the barriers to interaction to individuals and their social environment.

Children

Speech and language therapists also work with children who have acquired a brain injury. They:

  • Assess the infant/toddler/child’s early communication interactions and pre-speech language functioning, and eating, drinking and swallowing functioning
  • Contribute to diagnosis
  • Provide advice on the development of social communication skills
  • Plan and provision of appropriate therapeutic interventions to promote communication and eating, drinking and swallowing. This includes providing individualised treatment intervention.
  • Advise on assistive or alternative communication aid devices
  • Work jointly with other members of the inter-professional team (educational and medical) to support communication and behaviour modification
  • Provide advice on the demonstration and practice of the most effective way to engage the child in verbally mediated interventions and to minimise the effects of the communication difficulty where possible
  • Bring about a safe environment to enable the vulnerable brain injured child to maximise their potential
  • Advise on strategies to reduce dependency on others and developing independence
  • Provide ongoing review and intervention at points of transition in the child’s development.

Resources

Giving Voice - Communication & Swallowing in the Hospital

 

Adult Speech and Language Therapy at Darent Valley Hospital, Kent, UK

 

Key Organisations