Written by

Rakshitha S

Consultant Speech Swallow pathologist, Digital practitioner -SLP

Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object that goes through brain tissue, such as a bullet or shattered piece of skull, can also cause traumatic brain injury. Mild traumatic brain injury may affect your brain cells temporarily. More serious traumatic brain injury can result in bruising, torn tissues, bleeding, and other physical damage to the brain. These injuries can result in long-term complications or death.

Treatment in TBI

For treating individuals with TBI, the Clinician needs to establish a set of realistic, specific, and structured goals for treatment. The goals taken for treatment depend on the stage of recovery and identified treatment.

The issue of Candidacy for treatment:

Patients with severe injuries are not considered candidates for therapy if the neurobehavioral consequences of trauma are unlikely to respond to intervention. At the other end of the spectrum are those with relatively minor injuries, who are often discharged from acute hospital settings and denied access to rehabilitation services. In both cases, decisions as to the selection of candidacy for therapy have been derived by medically oriented consideration of the assessment impairment, rather than the activity limitation or participation restriction that may potentially be experienced by the individual. 

Principles of Goal Setting: 

The clinician needs to establish a set of realistic, specific, and structured goals that will depend on the stage of recovery, the identified impairments and limitations of communication, the accessibility of resources and support, the time frame available, as well as the motivation of the individual with TBI. Some of these principles include:

(1) Goals should be based on the assessment results.

(2) The person with TBI should contribute to decision-making regarding therapy targets.

(3) Goals should be realistic concerning the targets chosen and the timeline available.

(4) Goals should be clearly defined and measurable.

(5) Goals should be constantly monitored and modified.

Treatment for Cognitive deficits:

For the treatment of cognitive skills, specific activities need to be given according to the hierarchy of skills.

1) Attention

The treatment for attention impairment occupies a prominent place in training. The techniques that focus attention include: Addressing the patient by name before initiating a task, waiting for eye contact, touching the patient, and using the start-up phrase “Are you ready”. For improving sustained attention visual cancellation tasks, where the patient scans and crosses out the specified targets in visual array. In an auditory vigilance task, the patient pushes the button to sound a buzzer whenever they hear specified targets. 

2) Discrimination

Treatment for discrimination can begin with visual discrimination of colours, shapes, and sizes followed by discrimination of pictures, words, sentences, and situations. With recovery, the number and degree of similarity of stimuli should be gradually increased. The level of cognitive function of the patient should be considered. For ex. If the patient is able to discriminate only 2 items at a time, only 2 items should be given at a time.

3) Organization 

Treatment for improving organization skills includes activities like closure and sequencing tasks. Closure tasks include identifying missing elements of pictures, letters, words, sentences, stories, and conversation. Sequencing involves visual information from the smallest to largest, lighter to darkest, sequencing of letters, words, and even activities such as making coffee. Treatment must focus on gradual progression from sequencing of 2 steps to 3 steps and on.

4) Memory

There are two general approaches for the treatment of memory impairments:

– Internal retrieval strategies

– Provisional of external memory aids

Individuals who have TBI require both types of memory treatments.

Internal retrieval strategies involve recall strategies which include: Giving adequate explanation of items and objects to be recalled, giving visual imagery of objects, and chunking that information visually. Aurally organized and coinciding required to remember items. Rehearsal of information to be recalled is drilled: Mnemonics -> specific memory tricks; new words or memory info is chained or paired.

Provision of external memory aids: TBI Individuals can use similar types of memory aids used by nonbrain damage. Patients can be provided with calendars, appointment notes, diaries, alarms, etc. The most effective memory aid is an alarm for a person to look at his appointment book.

5) Reasoning and problem solving

Treatment for reasoning skills can be given through activities like inferring the meaning of idioms, proverbs, etc. Problem-solving skills can be taught through the following steps: 

• Identify problem 
• Think of several solutions
• Evaluate the feasibility and consequences of each solution.
• Choose the best solution.
• Apply it.
• Evaluate results.

Treatment of communication deficits

Language and communication impairment in TBI subjects are attributable to underlying impairment in cognitive processes such as attention, memory, reasoning, etc. The secondary effects of cognitive impairment on communication are most efficiently treated by treating underlying cognitive impairments. Few researchers support the direct treatment of communication impairments, which often target pragmatic aspects of communication. The general objective of direct treatment is to increase the appropriateness, relevance, and efficiency of TBI patients’ participation in conversation, enhance shifts in topics, etc.

The following treatment can be given to focus on language impairment in these subjects when specific deficits are seen.

• Difficulty with identifying word meaning

Patients can be taught to identify synonyms and antonyms, matching words with meaning. 

• Difficulty with semantic categorization

Activities can focus on identifying semantic features of categories, naming, and category members.

• Difficulty making inferences and conclusions

Choices for punch lines can be given, and cues can help the client choose the correct one.

• Difficulty resolving ambiguity

Semantic, syntactic, and pragmatic cues can be given to accurately interpret embedded multiple meanings.

• Difficulty with efficient production of organized, meaningful verbal expression

Sequencing tasks, summarizing tasks, story retelling and generation and analysis, and self-correction of recorded verbal expression can be used.

Compensatory techniques:-

When treatment leaves a patient with a residual impairment that interferes with daily life activities, the focus of treatment needs to shift to teaching the patient compensatory strategies. A Few compensatory strategies include:

• Keeping a daily log or journal in which patients record daily happenings to help orientation.
• Using printed maps or diagrams showing routes to and from the destination to those subjects who get lost easily.
• Asking for repetition or clarification when confused or uncertain about other instructions.
• Requesting extra time for performing tasks.

Interactive games and fun activities specifically designed to enhance cognition development during teletherapy sessions:

Interactive Games for Cognition Development

1. Lumosity:

– Features a variety of cognitive games targeting memory, attention, flexibility, speed of processing, and problem-solving.

– Games are personalized based on the user’s performance.

2. CogniFit:

– Provides scientifically designed brain games and cognitive training programs.

– Targets various cognitive skills like memory, concentration, and executive functions.

3. Peak:

– Offers engaging games designed to challenge and improve cognitive skills.

– Includes a personal trainer feature that adapts games to the user’s progress.

4. BrainHQ:

– Features exercises that adapt in difficulty to challenge the user and enhance cognitive functions.

– Focuses on brain speed, attention, memory, people skills, intelligence, and navigation.

5. Happy Neuron:

 – Includes a range of games targeting different cognitive domains, such as language, memory, executive functions, and spatial awareness.

– Provides personalized training programs.

Fun Activities for Cognitive Development

6. Kahoot!:

– Create custom quizzes and interactive games that can be played live with patients.

– Great for practicing memory, attention, and language skills in a fun and engaging way.

7. Boom Cards:

– Digital task cards that provide interactive and gamified learning experiences.

– Can be customized for specific cognitive exercises and offer immediate feedback.

8. Pictionary:

– Play an online version of Pictionary using tools like Skribbl.io or an online whiteboard.

– Enhances language skills, creativity, and problem-solving.

9. Sudoku and Crossword Puzzles:

– Use online versions of Sudoku and crossword puzzles to practice problem-solving, logic, and language skills.

– Websites like Puzzle Baron or NYT Games offer interactive puzzles.

10. Memory Games:

– Online memory card matching games can help improve short-term memory and attention.

– Websites like Memozor offer various memory games.

Interactive Storytelling and Language Activities

11. Storybird:

– Create and share visual stories to practice language and narrative skills.

– Engages creativity and language development.

12. Mad Libs:

– Play online Mad Libs to practice parts of speech, language skills, and creativity.

– Websites like Mad Libs Online offer interactive versions.

13. Virtual Escape Rooms:

 – Engage in virtual escape room challenges that require problem-solving, teamwork, and critical thinking.

– Websites like The Escape Game offer online escape room experiences.

Cognitive Exercise Apps

14. Elevate:

– Features a variety of games designed to improve speaking skills, processing speed, memory, math skills, and more.

– Personalized training programs based on user performance.

15. Fit Brains:

 – Offers brain training games designed by neuroscientists.

– Focuses on emotional intelligence, memory, speed, concentration, and problem-solving.

Interactive Brain Teasers and Puzzles

16. Jigsaw Puzzles:

– Use online jigsaw puzzle platforms like Jigsaw Planet to improve visual-spatial skills and problem-solving.

– Allows for collaborative puzzle-solving during sessions.

17. Logic Puzzles and Riddles:

– Websites like Logic Puzzles or Braingle offer various brain teasers, logic puzzles, and riddles.

– Enhances critical thinking and problem-solving abilities.

Incorporating these interactive games and activities into tele-therapy sessions can make the process enjoyable and engaging while effectively targeting cognitive development.

Summary:- 

The resulting deficits include attention, memory, reasoning, etc. Communication deficits include deficits in pragmatic skills. SLP’s contribution is to assess and give treatment to communicative consequences of cognitive and communicative impairments.

Rehabilitation:- 

Although the techniques for remediation of aphasic symptoms after a head injury may not differ fundamentally from the methods used for aphasics with CVAs. The speech therapist should be particularly sensitive to related problems in young patients recovering from CHI providing feedback to assist the head injured patients in monitoring linguistic errors and appropriateness of content may facilitate psychological functioning. This aspect of speech therapy assumes a prominent role. When we consider that neuropsychological impairment and behavioral disorder overshadow the contribution of focal motor deficit to chronic disability in head-injured patients.

The application of the technique for memory training of head-injured patients may also broaden the role of the speech therapist. Introduction to the patient to ensure visual images to integrate and retrieve verbal material has been the most widely studied technique. The employment of visual imagery as a memory would be useful in patients with focal left hemisphere injury.

Non-vocal communication devices should be considered for head-injured patients who are unable to communicate verbally if the patient possesses the cognitive and physical abilities necessary to utilize these devices.

Continuum of Care:- 

The ideal way to provide care for patients who have suffered traumatic brain injury is through a continuum that includes acute inpatient rehabilitation and outpatient services.

For more information Contact us today at +91 8921287775 to learn more about XceptionalLEARNING and our innovative Digital Activity Book. Our team is ready to provide personalized care and support to enhance learning and development. Reach out now!