Tutorial: The Speech-Language Pathologist's Role in Return to Work for Adults With Traumatic Brain Injury.

PURPOSE: Return to work (RTW) is a major life participation metric used for persons with a traumatic brain injury (TBI). Speech-language pathologists (SLPs) have clinical expertise in the cognitive-communication aspects of TBI. This clinical focus article aims to support the clinical practice of SLPs by summarizing key interprofessional vocational rehabilitation (VR) models and illustrating the role of the SLP throughout the RTW process with a case study. METHOD: This clinical focus article was written by the Academy of Neurologic Communication Disorders and Sciences TBI Research Group along with a VR expert. Authors engaged in deliberative, agenda-based discussions beginning with a literature review based on previous systematic studies. Discussions explored relevant VR and SLP practices. RESULTS: This clinical focus article presents key VR models in parallel with SLP assessment and treatment to illustrate best practice patterns in an RTW field with a dearth of SLP-specific literature. We summarize general VR approaches and four evidence-supported VR models for adults with TBI. We highlight how a model of interprofessional assessment can assist with planning and communication of important work-related concerns. We illustrate how the chronological model of work return can assist with developing goals and planning treatment. CONCLUSIONS: SLPs play an important role in identifying, managing, and collaborating with an RTW team following TBI. A working knowledge of VR models can assist with improving the dialogue between SLPs and VR professionals and can inform practice when working with persons with TBI who have work return as a goal.

Social Communication Following Adult Traumatic Brain Injury: A Scoping Review of Theoretical Models.

Purpose Social communication is the set of abilities that allows individuals to achieve relevant social goals across contexts. Speech-language pathology evaluation and treatment of traumatic brain injury (TBI)-related social communication problems should be informed by evidence-supported theories of social communication. The primary purpose of this article is to summarize the results of a scoping review of theoretical models that speech-language pathologists may apply to the evaluation and treatment of social communication problems of adults with TBI. Method A scoping review was conducted of PubMed, PsycINFO, and Embase for sources published in English between 1989 and 2020 that described human social communication and participation. Resulting sources were systematically examined for social communication models. Results Nine theoretical models were identified that speech-language pathologists may apply to their assessment and treatment of social communication abilities of adults with TBI. Identified models were categorized thematically into one of three classes: cognitive models, social competence models, and pragmatic models. Using a framework developed for the purposes of this article, each identified model was evaluated, and one exemplar model in each class is described in depth. Conclusions Social communication problems in adults post-TBI are common. The existence of multiple models empowers speech-language pathologists to select individual-focused assessment and treatment approaches to maximize intervention outcomes.

Social communication following traumatic brain injury part I: State-of-the-art review of assessment tools.

PURPOSE: The primary aim of this paper was to identify and describe current social communication assessment tools for adults with traumatic brain injury. METHOD: We conducted a state-of-the-art review to identify and categorise the range of social communication assessment tools found in the assessment and treatment literature that revealed 42 measures that were coded according to characteristics related to assessment types, psychometrics, and implementation. RESULT: Of the 42 assessments, 64% evaluated social cognition and the remaining 36% evaluated communication. Coding of implementation categories revealed that only 18/42 (43%) measures were ecologically grounded and 23/42 (55%) were available to clinicians by purchase or in the public domain. Only three measures incorporated questions or an assessment of the examinee's priorities or concerns. CONCLUSION: A number of factors limit current social communication assessment. The lack of tools that objectively and reliably evaluate communication or social cognition in ecologically valid ways remains problematic. Of particular concern is the lack of prioritisation of the individual's communication values and needs. Recommendations include a call to focus research on the development of more contextual, standardised assessments, consider availability and feasibility when tools are being developed, and evaluate assessment processes as well as discrete tools.

Social communication following traumatic brain injury part 2: Identifying effective treatment ingredients.

PURPOSE: Social communication deficits are a severely debilitating aspect of traumatic brain injury (TBI), and there is strong clinical and research interest in how social communication interventions work for this population. Informed by a companion paper targeting assessment of social communication impairments post-TBI, this paper reviews relevant treatment theories and provides an inventory of social communication treatment components. METHOD: We completed a mapping review examining 17 articles from recent literature reviews and 4 updated articles from a literature search to identify treatment targets and ingredients using the Rehabilitation Treatment Specification System (RTSS). RESULT: Social communication interventions are primarily based on behavioural and cognitive treatment theories. Common social communication treatment targets include changing skilled behaviours and cognitive or affective representations. We offer a menu of therapeutic ingredients and treatment considerations which represent the current state of social communication interventions. CONCLUSION: By reviewing the social communication intervention literature through a theoretical lens, we identify which treatment targets are missing, which targets are being addressed, and which therapeutic ingredients (i.e. clinician activities) are recommended. A hypothetical case study is provided as a supplement to demonstrate how speech-language pathologists may integrate treatment theory, ingredients, and targets into clinical practice.

Examining the Effects of Self-reported Posttraumatic Stress Disorder Symptoms and Positive Relations With Others on Self-regulated Learning for Student Service Members/Veterans.

OBJECTIVES: To examine the relationships between self-reported posttraumatic stress disorder (PTSD) symptoms, perceived positive relations with others, self-regulation strategy use, and academic motivation among student service members/veterans (SSM/V) enrolled in postsecondary education. PARTICIPANTS: SSM/V (N = 214), defined as veterans, active duty, or National Guard/Reservists of the US military, enrolled at 5 different institutions in Fall 2012. METHODS: Data were collected using an online questionnaire that included standardized measures of PTSD symptoms, perceived quality of personal relations, academic self-regulation strategy use, and academic motivation. RESULTS: PTSD symptoms were associated with lower self-efficacy for learning and maladaptive academic goal orientation. Additionally, PTSD symptoms were associated with lower effort regulation (ie, persistence) during academic work. Endorsement of more positive relations moderated the deleterious relationship between PTSD symptoms and maladaptive goal orientation. CONCLUSION: The results suggest that postsecondary personnel adopt a social-cognitive framework to develop social, mental health, and academic supports for SSM/V with PTSD.

College and combat trauma: an insider's perspective of the post-secondary education experience shared by service members managing neurobehavioral symptoms.

BACKGROUND: Enrolling in post-secondary education is common among military service members returning from combat deployments, but recent research shows service members who present with neurobehavioral symptoms consistent with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD) are at risk for psychosocial and academic difficulty. OBJECTIVE: This exploratory study was conducted to examine the academic experiences of service members through in-depth qualitative analysis. METHODS: An initial survey was conducted at a public university to measure self-reported academic achievement and neurobehavioral symptoms experienced by service members (n = 48). Then, follow-up interviews were solicited from a sub-sample (n = 5) of participants to gain an in-depth understanding of their transition, social, and academic experiences. RESULTS: The results revealed both the day-to-day challenges participants faced while adjusting to post-secondary life and how neurobehavioral symptoms associated with combat trauma interacted with their learning experiences. The findings indicated participants did not perceive neurobehavioral symptoms as particularly deleterious to their learning thereby highlighting the potentially integral role of coping strategies and motivation in post-secondary success. CONCLUSIONS: This study underscores the importance of understanding not only the adverse impact of neurobehavioral symptoms but the factors that promote resilience among military service members in post-secondary education.

Preliminary examination of the impact of traumatic brain injury and posttraumatic stress disorder on self-regulated learning and academic achievement among military service members enrolled in postsecondary education.

OBJECTIVE: Delineate the effects of self-reported traumatic brain injury (TBI) or posttraumatic stress disorder (PTSD) on self-regulated learning and academic achievement for university-enrolled military Service members. PARTICIPANTS: Students (N = 192) from 8 regionally diverse universities, representing an estimated 6% of Service members enrolled across schools. SETTING: Public universities that are members of the Servicemember Opportunity College consortium. DESIGN: Cross-sectional study evaluating the relationships between self-reported TBI, PTSD, and self-regulated learning variables and their contribution to academic achievement. MAIN MEASURES: Self-report of military service; symptoms of TBI and PTSD; self-regulation strategies including effort, time/environment regulation, and academic self-efficacy; and grade point average (GPA). RESULTS: There was no effect of self-reported TBI or PTSD on GPA, effort regulation, or time/environment regulation strategies; however, participants with TBI or PTSD reported significantly lower academic self-efficacy. Multiple regression analysis revealed self-efficacy was the strongest predictor of GPA among all participants, followed by military rank. CONCLUSION: The sample consisted of high achieving students responsive to a university administrator, which raises the possibility of sampling bias. Because of the low recruitment rate for this study and lack of published research on this subject, replicating the results is necessary before drawing generalizable conclusions about the population.