Interdisciplinary care for persistent symptoms of mild TBI is becoming increasingly common, and care models for chronic symptomatology continue to evolve. One specialized intervention model incorporates medicine, physical therapy, behavioral health, integrative modalities, and speech-language pathology for a three-week intensive outpatient program (IOP). Speech-language pathology has three key roles within the care program. 1) At the onset of the program, each patient meets individually with a speech-language pathologist to facilitate broad goal planning that subsequently integrates all care modalities. A conversational approach, using motivational interviewing, helps the patient identify a key need that will be followed throughout the program. Motivational interviewing is beneficial to allow patients to set their own goals as well as helping to define realistic goals that can be applied both for a brief program and for one year of follow-up care through case management. Patients may initially consider goals that are too specific for multidisciplinary care - “improve my memory” – or those that are overly broad – “be more present.” The speech-language pathologist helps to facilitate and hone this overarching goal into something applicable and targeted across disciplines, such as “be more productive at work.” Patients are educated as to how intervention activities and tasks for all care modalities directly relate to their primary goal. In addition, speech-language pathology creates a visual representation of these goals and activities, thereby decreasing the verbal memory load for each patients’ care plan. Sending a primary, unified message has helped with patient buy-in during intensive intervention, as well as keeping providers focused key long-terms needs identified by the patient. 2) Patients engage in traditional, individual speech-language-cognitive therapy two to three times per week. The evidence informed treatment plan is personalized depending on patient need, although common areas of focus include: auditory processing/functional auditory comprehension, verbal memory, social communication, and nearly all areas of executive functioning. Somewhat surprisingly, the speech-language pathology team also treats a disproportionately high number of functional motor speech disorders including psychogenic stuttering and voice disorders compared, with national prevalence rates. 3) The speech-language pathologists also facilitate a weekly transdisciplinary group specifically designed for generalization of strategies outside the clinical setting. Physical therapy, behavioral health, integrative modalities, as well as speech-language pathology all are familiar will the offsite locations that patients will visit and recommend goals each week depending on what a patient is doing in therapy. Based on the providers recommendations, patients choose on what areas they would like to focus. Each group member will likely have both overlapping and unique goals based on their care trajectory. The two-hour sessions are spent divided into an initial planning time, which incorporates metacognitive strategy instruction, participating in the activity, and a follow-up debrief. These three implementation sessions offer support in the real-world, rather than within the clinical bubble. Overall, this model offers an evolving vision for speech-language pathology in the care of those with the persistent effects of mild TBI.

Integrated intensive speech-language pathology services for persistent symptoms of mild traumatic brain injury