tabulas.com

Essential Question:

How can a speech language pathologist (SLP) help a client with a Traumatic Brain Injury (TBI) through various therapy methods?

Foundation Questions:

1. What is Traumatic Brain Injury (TBI)?

2. What are the different types of TBI?

3. What areas of the brain are at a higher risk for a TBI, and what are the functions of these areas?

4. Why does the age of the individual have an affect on the recovery rate of a TBI patient?

5. What effects does a TBI have on an indvidual's social, emotional, cognitive, psychological, and behavioral lifestyles?

6. What types of norm-referenced or cirterion-referenced tests are used to determine the severity level of a TBI patient?

7. What will a SLP focus on during a therapy session?

Tentative Point:

By researching Traumatic Brain Injury I hope to define TBI, explain why individuals who suffer from a head injury do not act or respond the same, describe what a TBI norm-referenced test measures, and figure out therapy methods that are used by a SLP.

Genres:

Genre 1: Webliography                                            
Voice: Clinician
Audience: General Public
Rationale: The webliography was created to provide the general public information about the clinician's interests.

Genre 2: Powerpoint Presentation
Voice: Clinician
Audience: General Public, Client, and Client's Family
Rationale: The powerpoint presentation will help everyone gain a better understanding of TBI.

Genre 3: Poem
Voice: Client
Audience: Client's Family and Friends
Rationale: The poem will inform the client's family and friends about the struggles she has while recovering, and she will also thank everyone who is part of her suppot group.

Genre 4: Pamphlet
Voice: Clinician
Audience: General Public, Client, and Client's Family
Rationale: The pamphlet will provide up to date information and facts about TBI in order for everyone to learn more about head injuries.

Genre 5: Email Exchange (three messages)
Voice: Client's Mother
Audience: Client
Rationale: The email exchange will be used to discuss the troubles the client is experiencing due to her TBI, and inform her mother about the evaluation that her speech language pathologist gave to her.

Genre 6: Jornal Entry (two entries)
Voice: Client's Spouse
Audience: Client
Rationale: The journal entries will allow the client's spouse to talk about the changes that have occured in his life since his wife's accident.

Genre7: Lesson Plan (three consecutive days)
Voice: Clinician
Audience: Client and Client's Family
Rationale: The lesson plans will provide the client and client's family information about what will be taking place during three consecutive therapy sessions.  The lesson plans will include objectives, procedures, results, and evaluations.

Anticipated Integration of the Genres:

I plan on creating a client who has suffered from a TBI. The client's family and her clinician will all be an important part of her life.  The powerpoint presentation and pamphlet will both be the starting point that will help inform everyone about TBI.  Next, the poem and journal entry will help explain how the client and her family's everyday lifestyles have changed.  Both of these genres will also help the client and her husband express their feelings.  The email exchange will bring the client's mother into the picture.  By reading this the client will again talk about her feelings and daily hassels that are due to her TBI.  In addition, the client will explain her evaluation that her speech language pathologists gave to her.  Last, the lesson plans will paint a broad picture for future therapy sessions.  

Tentative Resources:

Arroyos-Jurado, E., Paulsen, J.S., Merrell, K. W., Lindgren, S.D., & Max, J.E. (2000). Traumatic brain injury in school-age children: Academic and social outcome. Journal of School Psychology,36, 571-587. Retrieved September 25, 2005, from the ERIC database.

Baker, F., Wigram, T., & Gold, C. (2005). The effects of a song-singing programme on the affective speaking intonation of people with traumatic brain injury. Brain Injury, 19(7), 519-528. Retrieved October 1, 2005, from the PsychINFO database.

Cahill, L. M., Murdoch, B. E., & Theodoros, D. G. (2003). Perceptual and instrumental analysis of laryngeal function after traumatic brain injury in childhood. Journal of Head Trauma Rehabilitation, 18(3), 268-284. Retrieved September 25, 2005, from the Academic Search Premier database.

Garmoe, W., Newman, C., & O'Connell, M. (2005). Early self-awareness following traumatic brain injury: Comparison of brain injury and orthopedic inpatients using the Functional Self-Assessment Scale (FSAS). The Journal of Head Trauma Rehabilitation, 20(4), 348-358. Retrieved October 1, 2005, from the MEDLINE database.

Heinemann, A. W. (2000). Measuring rehabilitation outcomes. Technology and Disability, 12(2/3), 129-144. Retrieved September 28, 2005, from the Academic Search Premier database.                    

King, J.T., Carlier, P.M., Marion, & D.W. (2005). Early Glasgow outcome scale scores predict long-term functional outcome in patients with severe traumatic brain injury. Journal of Neurotrauma, 22(9), 947-954. Retrieved October 1, 2005, from the MEDLINE database.

National Information Center for Children and Youth with Disabilities. (2002). Traumatic brain injury: Fact sheet = lesion cerebral traumatica (TBI)(Report No. FS18-Sp). Washington, DC: National Information Center for Children and Youth with Disabilities. (ERIC Document Reproduction Service No. ED 470831) Retrieved September 25, 2005, from the ERIC database.

Netsell, R. (2001). Speech aeromechanics and the dysarthrias: Implications for children with traumatic brain injury. Journal of Head Trauma Rehabilitation, 16(5), 415-226. Retrieved September 25, 2005, from the Academic Search Premier database.

Rapoport, M.J., McCullagh, S., Shammi, P., & Feinstein, A. (2005). Cognitive impairment associated with major depression following mild and moderate traumatic brain injury. Journal of Neuropsychiatry & Clinical Neurosciences, 17(1), 61-65. Retrieved October 1, 2005, from the PsychINFO database.

Turkstra, L.S., & Flora, T.L. (2002). Compensating for executive function impairments after TBI: A single case study of functional intervention. Journal of Communication Disorders, 35(6), 467-482. Retrieved October 1, 2005, from the PsychINFO database.

Date: September 23, 2005

From: AMM212@aolcom

Subject: An update about how things are going

To: jen123@abc.com

Jen,

    Hey! I just checked my mail and realized that you emailed me several days ago.  I would have read your letter earlier but I forgot what my password was so I could not log onto my account.  Anyways, how have you been lately?  From your letter it seems like your entire family is getting along well.  Unfortunately, that is not the same for me.  I feel like I have become such a burden to mine since the car accident.  They always have to remind me where things are, who people are, and sometimes they have to tell me the words that I am trying to say.  I know forgetting things every once and while is normal, but when it occurs everyday it isn’t.  Well, it is really more or less several times a day!  I am to the point now that I do not even want to be around them because I feel like a pain.  To top my memory problems off I was told the other day that I do not know how to behave in public anymore.  When my mother took me to go grocery shopping the other day she found me trying to talk to every man that I passed.  I do not know why I was flirting with them, but I know for a fact that the accident is to blame.  I feel like my brain does not know how to work anymore. What should I do Jen?  Do you think I will ever be the same anymore?

                    Love, Andrea

Date:  September 29, 2005                     

From: jen123@aolcom

Subject: RE: An update about how things are going

To: AMM212@abc.com

Andrea,

   Hey hun.  It seems like you are taking one day at a time.  If you just keep doing that everything will work out the way you want it to be.  Sooner or later, you will see that the time you have spent trying to remember things and all of the hours you have argued with your husband and mother will be well paid off.  I know it may seem hard right now, but I know they truly understand what you are going through.  Also, I know they could not live without you in their lives.  You also need to keep in mind your little girl.  She is getting so big now, and one day she will grow up and you will be so thankful that you are still part of her life.  Just look at how big my oldest one is (I attached a picture).  The time is flying by so fast!  I can remember our first slumber party that we went to when we were in grade school. Who would even imagine that we would be friends forever?  Anyways I just think you need to keep your head up because one day you will be back to your old self again. 

        Love, Jen   P.S. I keep you in my prayers!!    

Date:  October 4, 2005

From: AMM212@aolcom

Subject: Just another letter.

To: jen123@abc.com

Jen,

     Thanks for the pictures.  Your girls look so much like you!  How old are they again? (I probably asked you this over 20 times now)  Anyways, I have some great news. I think I am going to receive some help from a speech therapist.  I went to visit one the other day.  Her name was…I am so terrible with names now, but  I do remember that she gave me a test to see how well I would perform on several tasks.  Talk about noticing where your weak areas are.  My memory is completely shot.  I could not even remember what month it was or when my accident occurred.  Maybe that last one is for the best though.  After we completed the session she asked Mike and me if we were willing to attend therapy.  I totally agreed because if she can help me improve in anyway it will be worth while.  Oh my gosh, I have to cut this letter short!  Mike has been telling me that I have to eat dinner for the past ten minutes.  I am not even hungry!  Plus whatever he made will probably taste terrible.  Why does he even try?  He never cooked before…or at least I do not think he did!  Hope to hear from you soon.         

         Andrea

September 27, 2005

When I awoke this morning I found Andrea sitting on the porch playing with our cat.  I cannot get over how she still calls him Smokey, which is the name of her first cat she had as a child.  I have been trying to correct her for the past few weeks, but I know it just isn’t sinking in.  In fact, I have been helping her remember everyone’s name by looking at old pictures.  I just thank God that she remembers mine and especially Sarah’s, our three-year old daughter.  

After I finally talked Andrea into coming inside to eat breakfast that I made, I realized that I still had to hurry up and get ready for work.  This waking up at five every weekday is really draining me down.  It never took me two and a half hours to get ready for anything, but things have changed a lot around here since the car accident.  I wake up every morning to find Andrea asleep on the couch or sitting on the porch swing.  I cook breakfast for her and Sarah hoping that neither of them argues with me about what I made.  You think the little one would be more picky but around here it is the opposite now.  Next, I try to get ready.  This takes over an hour because there are several interruptions from both of them.  Then around seven-thirty Andrea’s mother arrives as I walk out the door.  I do not know what I would do without Sandra.  She has been such a great support ever since this all started.  

Everyday that I arrive at work at least two of my co-workers ask how things are going at home and if there are any improvements with Andrea.  They all know the struggles that I endure everyday, and they remind me that they continue to pray for a full recovery.  I am just happy that Tom is always there to listen and help me research new information.  Just the other day he found a great pamphlet online that has some very informative information about closed head injuries. He is very supportive because he knows the changes that can occur after a loved one experiences a brain injury.  (His wife fell off of a horse and sustained a head injury three years ago.) 

After work I drove straight home to relieve Sandra.  Of course she stuck around for a while to tell me how the day went. She first showed me a poem that she found sitting on the kitchen table that Andrea wrote.  This poem made me realize that Andrea is blaming all of her changes and struggles on the accident, but on the positive side she is still very greatful that she is alive.  Next, Sandra told me how Andrea argued and yelled at her a few times.  I am always happy to hear this only because it allows me to realize that Andrea acts the same around everyone that is close to her.  I know that she still loves me even though she says she wants to divorce me everyday. (I pray that she still loves me!) We were so much in love before her car accident.  Ever since high school everyone knew that we were ment for each other.  I just hope she completely recovers because I am terrified that our lives might one day change if she doesn’t.

Later that evening we ate dinner and decided to rent a movie.  During the movie all three of us snuggled up on the couch like we used to. (I wish our relationship was like this all of the time.)  Of course Andrea’s attention span was lost half way through the movie.  Maybe we will be able to finish the movie tomorrow.  That is if she remembers it.

After I decided it was time for bed, Andrea wanted to tuck Sarah into bed.  I allowed her but still kept a close eye on her from the hallway.  She is a great mother, but I still want to make sure our little girl gets a good night kiss every night.  (Sometimes Andrea accidentally forgets simple things like this)  Next, I asked Andrea where she wanted to sleep.  After she answered, I prayed to God that I will lucky enough to wake up with her beside me in the morning.   

September 30, 2005

When I awoke this morning Andrea and Sarah were already up eating breakfast.  I accidentally made the mistake of teasing them by asking them were mine was.  (Andrea takes every comment that is said serious now.  She just cannot pick up on sarcasm anymore.)  After our small argument, I reminded her of what we had in store for the day.  (It was an appointment with a speech-language pathologist.)  After she complained for about an hour I helped her get ready.  We then left the house around nine and dropped Sarah off at Sandra’s house. 

Once we arrived at Wheeling’s Speech and Hearing Clinic I could tell that Andrea was becoming very frightened.  Therefore, I reminded her that her neurologist, Dr. Andrews, would not send a referral letter to a SLP that would not be concerned about her condition or not be able to help her with her recovery.  Once the SLP came to get us in the waiting room she politely introduced herself and lead us back to a therapy room.  She started out by telling us a little bit about her interests. She also informed us that we could find out more about her by checking out her webliography online at http://mupfc.marshall.edu/~miller255/webliography.html. Next, she explained how long the evaluation was going to take and summarized what would be taking place during it. 

The SLP first started out by asking several questions about Andrea’s accident, her family, her previous doctors, and what troubles her the most.  Andrea tried to answer the majority of the questions, but I chimed in whenever she needed help.  Next, the SLP gave me a rating scale to complete called the Profile of Executive Functioning.  This scale was used to help measure Andrea's functioning level (Protor, Wilson, Sanchez, & Wesley, 2000). While I was filling the profile out, a test was administered to Andrea.  It was called the Scale of Cognitive Ability for Traumatic Brain Injury.  It was used to establish the severity of her injury. After the test was completed the SLP asked her to do several other tasks.  Of course Andrea became frustrated and even outraged once when she could not remember the list of words that she was supposed to repeat back.  It seems like her short-term memory has been impaired the most since she awoke from her coma.  After all of the questions were asked and the tests were administered the SLP discussed Andrea’s strengths and weaknesses. She then provided me with me a link to a PowerPoint.  She told me that it included several communication, behavioral, and cognitive issues that take place after a closed head injury is sustained. In addition, she said it also explained several thearpy methods that can be considered when these type of issues occur. Last but not least, she suggested that Andrea should attend speech therapy twice a week. All three of us agreed that thearpy would be the right decision.

On our ride home Andrea talked up a storm about the SLP.  She kept saying over and over how nice and pretty she was.  I just hope that when she starts therapy that her therapist will be the same lady because that will be her motivation to go everyday.  We stopped by Sandra’s on our way home to pick up Sarah.  Once Sarah saw her mom she ran directly to her and hugged her.  I live for moments like this and do not know what I would have done if Andrea never woke up from her coma.  Thank you God for not taking her away from us!

November 11, 2005

It has been almost three months since the car accident, and I am starting to see some improvements with Andrea’s communication skills and memory problems.  I feel that this is because she has been attending speech therapy for about six weeks now.  I am really excited about all of this because I now know that she might have a chance for a complete recovery or I hope at least come close to one.

Andrea attends therapy two times a week, and each session last about 45 minutes each. Well, this usually depends on the mood that Andrea is in.  On Tuesdays I usually take her to the clinic to observe her session and talk to the SLP while on Thursdays Susan and Sarah go with her. After every session the SLP allows me to speak with her and ask any questions that I have.  She has been informing me about several of the methods that she has been using in order to improve Andrea’s communication and language skills.  Some of these include functional activites and compensatory strategies (Coelho & DeRuyter, 1996).  One compensatory strategy that the SLP recommends Andrea to use is a day planner.  The day planner helps her with her memory problems.  In addition to writing things in her planner, I believe Andrea developed her own compensatory strategy.  She prints off every email or article she reads on the internet. This allows her to read them again incase she forgets what they were about.  In fact, just the other day I found a large stack of journal articles that she must have read and several email exchanges that took place a few weeks ago between Andrea and her best friend, Jen.  As long as this helps her remember, I do not care how much ink or paper I have to buy.

This past Tuesday was her sixth week in therapy.  Therefore, the SLP scheduled a meeting with Andrea and I  to talk about the improvements she is making.  The SLP explained that her rapid improvements were a combination of her attending all of her therapy sessions, and the great effort that Andrea and I put forth at home with her so called “homework.”  Therefore, I am now more determined to complete every assignment or task with Andrea even if it is going to cause a disagreement or consume a majority of our time.

Resources:

Coelho, C.A., & DeRuyter, F. (1996). Treatment efficacy: Cognitive-communication disorders resulting form traumatic brain injury in adults. Journal of Speech & Hearing Research, 39 (5), 22-35. Retrieved October 5, 2005, from the ERIC database.

Proctor, A., Wilson, B., Sanchex, C., & Wesley, E. (2000). Executive function and verbal working memory in adolescents with closed head injury. Brain Injury, 14 (7), 633-647. Retrieved October 5, 2005, from the ERIC database.

                                Savor It All

Everyone thinks bad things happen to everyone else,

but one day I awoke and wasn’t quite myself.

I’m one of those people who would never believe

that this would be the reflection starring back at me.

I still look the same, but I am broken inside.

Tragedy has no favorites, you can never run and hide.

I’ve tired to suppress these secrets when I am out,

but whenever I speak I just want to pout.

I try to remember the words and names,

but whenever I can’t my accident is the blame.

The lessons I’ve learned from taking this fall.

Don’t take life for granted, savor it all.

Essential Question:

What are the most effective treatment methods a speech-language pathologist (SLP) can utilize when working with young adults who have closed head injuries?

Foundation Questions:

1. What is a closed head injury?

2. What effects does a closed head injury have on a young adult's cognitive and behavioral lifestyles.

3. What effects does a closed head injury have on a young adult's communication and language skills?

Genres:

Genre 1: Webliography                                            

Voice: Clinician

Audience: General Public

Rationale: The webliography was created in order to provide the general public with information about what the clinician is interested in.

Genre 2: Poem

Voice: Client

Audience: Client's Family and Friends

Rationale: The poem will help the client express how she feels that she has changed since her accident, and she will also inform her family and friends about the struggles she has been enduring.

Genre 3: Powerpoint Presentation

Voice: Clinician

Audience: General Public, Client, and Client's Family 

Rationale: The powerpoint presentation will help everyone gain a better understanding of a closed head injury. 

Genre 4: Pamphlet

Voice: Clinician

Audience: General Public, Client, and Client's Family

Rationale: The pamphlet will provide up to date information and facts about closed head injuries.

Genre 5: Email Exchange (three messages)

Voice: Client's Mother

Audience: Client

Rationale: The email exchange will be used to discuss the troubles the client is experiencing due to her closed head injury, and inform her mother about the evaluation that her speech language pathologist gave to her.

Genre 6: Jornal Entry (two entries)

Voice: Client's Spouse

Audience: Client

Rationale: The journal entries will allow the client's spouse to talk about the changes that have occured in his life since his wife's accident.  In addition, discuse his wife's evaluation that was completed by a speech-language pathologist.

Genre7: Lesson Plan (three consecutive days)

Voice: Clinician

Audience: Client and Client's Family

Rationale: The lesson plans will provide the client and client's family information about what will be taking place during three consecutive therapy sessions.  The lesson plans will include objectives, procedures, results, and evaluations.

Anticipated Integration of the Genres:

I plan on creating a client who has suffered from a closed head injury. The client's family and her clinician will all be an important part of her life.  The powerpoint presentation and pamphlet will both be the starting point that will help inform everyone about closed head injuries.  Next, the poem and journal entry will help explain how the client and her family's everyday lifestyles have changed.  Both of these genres will also help the client and her husband express their feelings.  The journal will also introduce an evaluation that was completed by her speech language pathologist. The email exchange will then bring the client's mother into the picture.  The client will again talk about her feelings and daily hassels that are due to her closed head injury.  In addition, the client will explain her evaluation in more depth.  Last, the lesson plans will paint a broad picture for future therapy sessions.  

Tentative Resources:

Arroyos-Jurado, E., Paulsen, J.S., Merrell, K. W., Lindgren, S.D., & Max, J.E. (2000). Traumatic brain injury in school-age children: Academic and social outcome. Journal of School Psychology,36, 571-587. Retrieved September 25, 2005, from the ERIC database.

Baker, F., Wigram, T., & Gold, C. (2005). The effects of a song-singing programme on the affective speaking intonation of people with traumatic brain injury. Brain Injury, 19(7), 519-528. Retrieved October 1, 2005, from the PsychINFO database.

Cahill, L. M., Murdoch, B. E., & Theodoros, D. G. (2003). Perceptual and instrumental analysis of laryngeal function after traumatic brain injury in childhood. Journal of Head Trauma Rehabilitation, 18(3), 268-284. Retrieved September 25, 2005, from the Academic Search Premier database.

Garmoe, W., Newman, C., & O'Connell, M. (2005). Early self-awareness following traumatic brain injury: Comparison of brain injury and orthopedic inpatients using the Functional Self-Assessment Scale (FSAS). The Journal of Head Trauma Rehabilitation, 20(4), 348-358. Retrieved October 1, 2005, from the MEDLINE database.

Heinemann, A. W. (2000). Measuring rehabilitation outcomes. Technology and Disability, 12(2/3), 129-144. Retrieved September 28, 2005, from the Academic Search Premier database.                    

King, J.T., Carlier, P.M., Marion, & D.W. (2005). Early Glasgow outcome scale scores predict long-term functional outcome in patients with severe traumatic brain injury. Journal of Neurotrauma, 22(9), 947-954. Retrieved October 1, 2005, from the MEDLINE database.

National Information Center for Children and Youth with Disabilities. (2002). Traumatic brain injury: Fact sheet = lesion cerebral traumatica (TBI)(Report No. FS18-Sp). Washington, DC: National Information Center for Children and Youth with Disabilities. (ERIC Document Reproduction Service No. ED 470831) Retrieved September 25, 2005, from the ERIC database.

Netsell, R. (2001). Speech aeromechanics and the dysarthrias: Implications for children with traumatic brain injury. Journal of Head Trauma Rehabilitation, 16(5), 415-226. Retrieved September 25, 2005, from the Academic Search Premier database.

Rapoport, M.J., McCullagh, S., Shammi, P., & Feinstein, A. (2005). Cognitive impairment associated with major depression following mild and moderate traumatic brain injury. Journal of Neuropsychiatry & Clinical Neurosciences, 17(1), 61-65. Retrieved October 1, 2005, from the PsychINFO database.

Turkstra, L.S., & Flora, T.L. (2002). Compensating for executive function impairments after TBI: A single case study of functional intervention. Journal of Communication Disorders, 35(6), 467-482. Retrieved October 1, 2005, from the PsychINFO database.