Moderate to Severe TBI
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Assessment of Children With Moderate to Severe TBI
Speech, Language and Cognitive Skills
12-18 YEARS
When assessing the adolescent 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, Memory, Executive Process
- Have a tape recorder or radio playing in the background, preferably with
music of interest to the child.
- Ask the child questions about personal information, his injury, why he is
being seen, his deficits since the injury and his strengths and weaknesses.
- Ask the child how well he thinks he will do today on certain activities.
- Note any distractions from the background music, memory for past and recent
information and events, orientation, self-awareness and insight into his
deficits. Compare how well he judged his expected performance to how well he
actually did.
Memory/Learning
- Selective Reminding Test. Have 10 objects in a bag. Ask the child to close
his eyes, pull out an object and name it. Repeat this process until all 10
objects have been removed from the bag and identified. Then, remove the objects
from sight and go on with other testing. After 10 minutes, ask the child to
recall all the items in the bag. Remind him of the ones he missed. Ten minutes
later, ask him again to recall all the items that were in the bag. Again, remind
him of the ones he missed. Continue with other testing, and after 20 minutes
have him recall the items from the bag a final time. Note the number of items
recalled each time, any patterns in his recall (e.g., last items seen recalled
first), the effectiveness of your cueing, the effectiveness of the repetition,
diminished recall over time, etc.
- Woodcock-Johnson Psychoeducational Battery Visual-Auditory Learning Subtest
- Word Fluency Test. Ask the child to recall all the different colors,
animals, girls'/boys' names and sports he can in 60 seconds. With the older
child, ask him to think of as many words as he can starting with a certain
letter of the alphabet. Note any pattern of recall, whether the items are broken
down into smaller groups and whether all the words are recalled within the first
15 seconds or evenly throughout the time limit.
- Ask the child to tell you the facts recalled from a paragraph read to him.
- Ask the child to follow verbal and/or written directions of increasing
length and complexity.
Organization, Reasoning
- Woodcock-Johnson Psychoeducational Battery Concept Formation Subtest
- Ask the child to explain likenesses and differences in objects such as a car
and a boat, an arm and a leg, a quarter and a dollar, and an apple and an
orange.
- Ask the child to tell you how to perform an activity such as making a
sandwich, making his bed, brushing his teeth, etc. Note the sequence and need
for cueing.
- Ask the child to tell you the main idea from a paragraph read to him.
- Ask the child to draw conclusions based on a paragraph read to him.
- Ask the child to explain a proverb, idiom or analogy.
- Ask the child to write a telegram picking out the most important words from
a sentence given to him.
- Give the child some age/grade-appropriate math word problems to solve.
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.
- Boston Naming Test (Kaplan, Goodglass, Weintraub, 1983). This test measures
the child's ability to identify pictures, accounts for delays in naming and
builds structured cues into the testing situation.
- Scales of Cognitive Ability in Traumatic Brain Injury (SCATBI, Adamovich
& Henderson, 1992)
- 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.
- 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.
- Woodcock-Johnson Psychoeducational Battery-Revised, Tests of Cognitive
Ability, Visual-Auditory Learning and Concept Formation Subtests (WJ-R,
Woodcock-Johnson, 1989)
- 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