Moderate to Severe TBI
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Assessment of Children With Moderate to Severe TBI
Speech, Language and Cognitive Skills
6-11 Years
12-18 Years
2-5 YEARS
When assessing the young child with suspected speech, language and cognitive
disorders resulting from acquired brain injury, we have no single, formal,
standardized assessments to rely on. Rather, using a variety of assessment tools
and focusing on the processes involved, we are able to identify the child's
needs. Keep in mind also that in the earlier stages of recovery these
impairments will change as the child's brain heals and will require constant
monitoring so that treatment approaches can be adapted appropriately. The
following are some suggestions for assessing these needs. Head Injury Rehabilitation, Children and
Adolescents, edited by Mark Ylvisaker, offers some excellent information to
expand on these ideas.
Attention and Memory
- Show the child a group of five objects, taking one at a time from a bag.
Then add a new group of toys to play with. After about five minutes, ask the
child to help put the first group of toys away in a bag. Note memory for the
first group of toys, attention to task, distractions in the room, etc.
- Ask the child to tell you all the colors or all the animals he knows, all
his friends, his family members, etc. Note the number of items/names recalled.
Does he stay on task? Does he veer off onto other topics? Keep in mind
developmentally age-appropriate behaviors.
Organization and Executive Control
- Have the child help you sort a group of blocks by size, shape and color.
Note the amount of assistance or cueing required.
- Have the child build something with the blocks (e.g., a train, house, tower,
etc.). Note how he plans, organizes, executes, adjusts and corrects his actions.
Reasoning
- Accidentally drop a cup or pen on the floor in view of the child. Then start
to cause the accident to happen again and see if the child does anything to stop
it. You may need to talk about the first "accident" initially, so the child
realizes its importance.
- Give the child an animal from a farm set or a character from a play set and
have him show you all of the different things it can do. Note appropriateness,
judgement and safety. Discuss choices as the child is able.
Knowledge Base, Speech and Language
The following assessments are
helpful in determining any specific speech and language disorders that need to
be a focus of remediation. The suggested standardized measures will help
establish a baseline of performance, provide for reassessment as the child
improves and allow us to monitor for evidence of skill stabilization following
the brain injury.
- Parent Interview. It is vital to include the parent or main caregiver in our
assessments, so we can get a more complete understanding of the child's
pre-injury status, including development, life experiences, education, learning
styles, behavior and personality. In other words, we need to know who this child
is and what differences the caregivers see in him.
- Conversational Speech. A wealth of information is gained through play and
conversation with the child. We are able to note attention, eye contact with the
examiner or other communication partner, ability to maintain a topic,
age-appropriate articulation, phonology, semantics and grammar.
Suggested Standardized Measures
- Peabody Picture Vocabulary Test (PPVT: III A or B, Dunn & Dunn, 1997).
This tool measures the child's ability to understand the words he hears.
- Expressive One-Word Picture Vocabulary Test (EOWPVT-R, Gardner, 1990). This
test is helpful in determining an expressive vocabulary level as well as word
retrieval problems. Testing with and without cueing such as first sound cues or
short, familiar phrase cues is helpful in distinguishing between word retrieval
and vocabulary deficits. Also interviewing the parents to get their impression
of the child's ability to identify the pictures now compared to pre-injury is
most important.
- Test of Auditory Comprehension of Language (TACL III, Elizabeth
Carrow-Woolfolk, 1999). This tool is helpful in identifying the child's ability
to understand the structure and syntax of spoken language.
- Goldman Fristoe Test of Articulation (GFTA, Goldman & Fristoe, 2000). If
there are concerns regarding developmental articulation problems versus acquired
motor speech disorders, an articulation test such as this would be appropriate.
- Kaufman Speech Praxis Test (KSPT, Kaufman, 1995) Focal Lesions can result in
difficulties with coordination of movements for speech. This test provides
assistance in evaluating motor speech proficiency
- Comprehensive Oral-Motor Assessment. Evaluation of the muscles of the lips
and tongue, velopharyngeal function, laryngeal function and respiratory support
for speech may also be required, particularly for the more involved child.