Communicative and Cognitive Dysfunctions in TBI - Lecture Slides PDF

Lect. 3 Communicative and Cognitive Dysfunctions in TBI 1 Communicative and Cognitive Dysfunctions in TBI What is the connection between the biomechanics and pathophysiology of TBI and the cognitive and communicative impact on the TBI survivor?...

Lect. 3 Communicative and Cognitive Dysfunctions in TBI 1 Communicative and Cognitive Dysfunctions in TBI What is the connection between the biomechanics and pathophysiology of TBI and the cognitive and communicative impact on the TBI survivor? 2  Review Open Head Injury (OHI): Penetrating Injury Biomechanics Primary Damage Focal area of damage Secondary damage Hemorrhage Cerebral edema Ischemia Hypoxia Impact Deficits localized to the area of damage 3  Review Closed Head Injury (CHI): Nonpenetrating Injury Biomechanics: Key Processes Extent of Damage: Linear acceleration-deceleration forces Primary Damage: Focal Lesion Rotational forces Primary Damage: DAI Secondary Damage: Hemorrhage, cerebral edema, hypoxia, ischemia Impact: Deficits widespread 4 Communicative and Cognitive Dysfunctions in TBI Extent of Post-trauma Injury Responsible for heterogeneity in the deficits in the TBI population Impact on prognosis, continuum of care, and assessment tools Three key areas A. Distribution of injury B. Severity of the injury C. Underlying neuropathology 5 Communicative and Cognitive Dysfunctions in TBI A. Distribution of injury Focal vs. Multifocal lesions DAI 6 Communicative and Cognitive Dysfunctions in TBI B. Severity Size, location, and depth of lesions C. Underlying neuropathology Type and number of brain areas 7 Communicative and Cognitive Dysfunctions in TBI Extent of Post-trauma Injury Three key areas A. Distribution of injury B. Severity of the injury C. Underlying neuropathology Responsible for heterogenous deficit profiles in TBI population 8 Communicative and Cognitive Dysfunctions in TBI Communicative and Cognitive Dysfunctions in TBI Mild Moderate Severe Three Key Areas Distribution of injury Severity of the injury Underlying neuropathology Impact Responsible for heterogeneity in the deficits in the TBI population Impact on prognosis, continuum of care, and assessment tools 9 Questions What key factors impact on the severity of post-trauma injury? What does the severity of the TBI impact on? Why is it relevant to our work in SLP services for people who have experienced a TBI? 10 Communicative and Cognitive Dysfunctions in TBI Mild TBI (mTBI): Concussion Mild TBI: General Information  Only about 10-20% of mTBI experience persistent symptoms  Symptoms impact on life quality  Computed tomography (CT) and magnetic resonance imaging (MRI) don’t capture extent of diffuse axonal damage in mTBI.  Functional MRI (fMRI) can detect DAI 11 Communicative and Cognitive Dysfunctions in TBI Mild TBI (mTBI): Concussion Mild TBI (mTBI): Symptoms Physical symptoms e.g. dizziness Emotional symptoms e.g. depression, irritability Sleep-related symptoms e.g. hypersomnia, insomnia Cognitive symptoms e.g. limited concentration, slowed info processing Impact on language/communication? 12  Communicative and Cognitive Dysfunctions in TBI Moderate to Severe TBI Patterns & Stages Neuroradiologic Assessment Predictable pattern Computerized tomography Depending on individual severity of (CT) to reveal extent of injury injury (Douglas et al., 2018) Early Stage: Coma – no/minimal response Middle Stage: Alertness, activity Late Stage: Ultimate recovery 13  Communicative and Cognitive Dysfunctions in TBI Moderate to Severe TBI Early Stage: Coma - no or minimal response Middle Stage: Late Stage: Duration has prognostic Alertness, activity yet Ultimate recovery, support value disorientation, confusion, is minimized to  maximal Pervasive vegetative state agitated behavior. independence. (PVS) (Never regain consciousness) 14  Communicative and Cognitive Dysfunctions in TBI Common Indices of TBI Severity Classification Glasgow Duration of Length of PTA Coma Scale Coma Severe 3-8 Over 6 hours Over 24 hours Moderate 9-12 Less than 6 1-24 hours hours Mild 13-15 20 min or less 60 min or less PTA: Posttraumatic Amnesia – Length of time during which new learning cannot occur Sohlberg & Mateer (2001) in Coelho et al. (Johnson & Johnson, 2017) 15  Communicative and Cognitive Dysfunctions Glasgow Coma Scale (GCS) in TBI Assesses severity of injury during early post-trauma stages by rating Degree of eye opening Best verbal response Best motor response Severity ratings: Severe brain injury: 3-8 Moderate brain injury: 9-12 Mild brain injury: 13-15 16  Communicative and Cognitive Dysfunctions Ranchos Los Amigos Levels of in TBI Cognitive Functioning Scale (The Ranchos Scale) Another scale to assess extent of injury Used throughout the recovery process What differences do you find between GCS and the Ranchos Scale? (Homework) 17 Communicative and Cognitive Dysfunctions in TBI Stages of Recovery (32 ) Stages of Brain Injury – YouTube 18 Prognosis Factors Pre-injury Factors: Age: Younger persons tend to do better than older persons. Premorbid psychiatric and academic issues Health history Injury-related Factors Duration of coma Extent of posttraumatic amnesia Comorbidities Post-injury Factors Early medical intervention and rehabilitation Support by social/academic/occupational environment. Individual physical/psychological differences 19 Communicative and Cognitive Dysfunctions in TBI Major deficit areas in TBI Neurological Deficits Cognitive Deficits Language Deficits Behavioral Deficits Klein, E.R. & Mancinelli, J. M. (2021). Acquired language disorders: A case-based approach. Plural 20 Communicative and Cognitive Dysfunctions in TBI Neurological Deficits Seizures Paresis Coordination problems Perceptual problems We focus on cognitive, language, and behavioral complications in this course 21 Communicative and Cognitive Dysfunctions in TBI Cognitive Deficits  Memory  Executive Functions  Attention  Orientation  Awareness (Kimbarow & Wallace, 2024: Ch. 1, 2, 3, 8; Klein & Mancinelli, 2021) 22 Communicative and Cognitive Dysfunctions in TBI  Cognitive Deficits: Memory Post-traumatic amnesia (PTA) No memory of accident right after the episode Memory of event improves with recovery Classification Glasgow Coma Scale Duration of Coma 23 Communicative and Cognitive Dysfunctions in TBI Deficits: Memory Cognitive Declarative memory (conscious process) more impaired than procedural memory (unconscious process) Long-term Memory Declarative Memory Procedural Memory Conscious thinking Automatized/reflexive responses e.g. Recalling items in grocery list e.g. Running away from danger Explained content Getting keys out when getting home Impact on new learning? 24 Communicative and Cognitive Dysfunctions in TBI Cognitive Deficits: Memory & Executive Functions Memory depends on executive functions (metacognition) People with TBI experience limitations in executive functions Memory (Working M./Short-term M./Long-term M.) Lang. Comp’n/Prod’n WM/STM LTM Executive Functions (Reasoning, Problem-solving, Planning, Dual Tasking) How would problems in EFs impact language/comm? 25 Communicative and Cognitive Dysfunctions in TBI Cognitive Deficits (Cont’d)  Attention Focused/selective attention Sustained attention Alternating attention Impact on new learning and comm’n?  Orientation Person Place Time 26 Communicative and Cognitive Dysfunctions in TBI Cognitive Deficits (Cont’d)  Awareness Self knowledge e.g. Limitations and strengths Impact on interpersonal skills? Knowledge about others (Theory of mind) e.g. Others’ perspective and intentions Impact on daily communication? 27 Communicative and Cognitive Dysfunctions in TBI Language Aphasia deficits in early stages Aphasia in TBI Assessed like other aphasias Anomia is primary residual deficit. Limitations in cognitive areas (e.g. attention, memory, and exec. functions) Discourse is incoherent, irrelevant, disorganized (language of confusion) Difficulty with nonliteral/abstract language 28 Communicative and Cognitive Dysfunctions in TBI Behavioral Deficits Lack of self-regulation Irritability, impatience, anxiety Limited motivation Depression Emotional Changes After a Traumatic Brain I njury (TBI) InfoComic | BrainLine 29 Before Next Class… 1. Compare the Ranchos Los Amigos Levels of Cognitive Functioning Scale and the Glasgow Coma Scale How do they measure cognitive functioning in TBI What are the differences between the two scales 2. Turkstra LS, Politis AM, Forsyth R. (2015). Cognitive-communication disorders in children with traumatic brain injury. Developmental Medicine and Child Neurology, 57(3), 217-22. https://doi.org/10.1111/dmcn.12600 What is the impact on TBI on cognitive and cognitive-communication skills in children? What are some key points re: assessment and intervention that the article highlights? 30 Questions 1. What are some common indices of TBI severity? 2. What do the indices of TBI severity tell you about (a) extent of damage? (b) prognosis? 3. What is the difference between the GCS and the Ranchos Scale? 4. What prognosis factors would you triangulate to make a statement about individual recovery from TBI? 5. What are some cognitive and linguistic deficits in TBI? Why would someone with TBI have cognitive-communicative deficits? 6. How would behavioral complications in TBI have an impact on (a) interpersonal relationships? (b) treatment? 31 Key References Douglas DB, Ro T, Toffoli T, Krawchuk B, Muldermans J, Gullo J, Dulberger A, Anderson AE, Douglas PK, Wintermark M. (2018). Neuroimaging of Traumatic Brain Injury. Med Sci (Basel). Dec 20;7(1):2. doi: 10.3390/medsci7010002 Johnson, A. F., & Jacobson, B. H. (Eds.) (2017). Medical speech- language pathology: A practitioner’s guide (3rd ed.). Thieme. (Ch. 7) Kimbarow, M. L., & Wallace, S. E. (Eds). (2024). Cognitive communication disorders (4th ed.). Plural. (Ch. 1, 2,3, 7, 8) 32