7/19/19

1

Improving cognitive function after TBI

Jessica Hsaine MA, CCC-SLP

August 1, 2019 5:45-9:00 pm

Hauppauge, New York

LISHA

Jessica Hsaine is a medical SLP at Mercy Medical Center, an adjunct instructor at Molloy College CSD and is completing her Ph.D. at Adelphi University.

Jessica Hsaine has no financial nor non-financial conflicts of interest to disclose.

• 5:30-5:45 Registration/Light Refreshments

• 5:45-6:00 Components of cognition

• 6:00-6:30 TBI background

• 6:30-7:15 Functional cognitive tasks

• 7:15-7:30 Break

• 7:30-8:00 Cognitive strategies

• 8:00-8:30 Research based cognitive therapy

• 8:30-8:45 Additional support

• 8:45-9:00 Questions and Answers

Improving Cognitive function after TBI

7/19/19

2

Cognition components• Attention/concentration/focus

- sustained- continuous amount of time- alternating- back and forth between 2 tasks- selective- 1 task and filter distractions- divided- multi-tasking….2 or more tasks

• Temporal and spatial orientation

• Memory• Problem solving

• Organization• Planning

• Sequencing• Categorization

• Reasoning (basic, deductive, numerical, abstract)

TBI symptoms • isolation

• frustration

• irritability

• poor insight

• anger and/or abusive behaviors

• poor anger management

• anxiety and stress

• overwhelmed

• low self confidence

• dizziness, nausea, vomiting

• Apathy/ flat affect

• depression

• emotional

• poor motivation, disinterest

• poor safety awareness

• difficulty with sensory stimuli

• poor flexibility

• pain – headache

• sleep deprivation

• PTSD (Sauer, Parks, & Hehn, 2010)

• reduced reading and writing skills

• reduced vision and hearing

(Chi et al., 2014) (Temkin, Dikme, MacHamer & Corrigan, 2009) (Cornis-Pop, 2012)

Memory: First function to notice and the last function to be regained in the recovery of TBI

(Barman, Chatterjee, & Bhide, 2016)

• Short-term memory: hold a limited amount of information for a brief period of time: typically 5-7 items without distractions, ability to hold on to information long enough to store it into LTM (Sohlberg & Mateer, 2001)(Sohlberg &Turkstra, 2011)

• Working memory: hold information in conscious thought and manipulate it for storage or retrieval: provides the mental work space for complex learning, reasoning, comprehension, planning, organization, sequencing and metacognition

• Long-term memory: hold information in a permanent store and have an unlimited capacity (Sohlberg & Mateer, 2001)(Sohlberg & Turkstra, 2011)

• Prospective memory- remember and implement plans for the future, requires cues to remember the calendar (Chu et al., 2014)

• Sensory- quick snapshot of three seconds of what we just saw, smelled, heard, felt or tasted.

(Cornis-Pop et al., 2012)

7/19/19

3

Declarative vs. procedural memory

Executive functioning• learning and remembering, regulation of behavior and impulsivity, self awareness, social

judgement, initiation of activities, temporal sequencing, planning and organizing, prospective memory

• Goal direction and purposeful behaviors for all our ADLs (Cicerone et al., 2008)

• initiating an activity- choosing the first task

• Stopping an activity- often perseverate on a topic during a conversation

• Mental or behavioral shifts- reduced sensitivity to social cues

• Awareness of self or others- reduced empathy, reduced humor and/or sarcasm

• Both families and individuals with TBI describe frustration and anxiety resulting from difficulties with time management.

(Mateer, 1999)(Chu et al., 2014)

Divergent vs. Convergent thinking

7/19/19

4

Prevalence• At least 1.7 million people sustain a (TBI) annually in the U.S.

• 52,000 mortalities

• 275,000 hospitalized

• 1.4 million are treated and released from an Emergency Department (National Center for Injury Prevention and Control, 2010)

• 3.17 million individuals are living with long-term disability (Zaloshnja, Miller, Langlois, & Selassie, 2008)

• Sport-related concussions in the U.S.: 1.6–3.8 million annually, 50% of concussions may go unreported (Doolan et al., 2012; Harmon et al., 2013).

• occurs primarily among previously healthy young people, who must deal with the disabilities for the rest of their lives (Langloie, Rutland-Brown & Wald, 2006)

(Chu et al., 2014)

Pocket guideof severity TBI

Concussion- Mild TBI

• “a brain injury [and] complex pathophysiological process affecting the brain, induced by biomechanical forces” (McCrory et al., 2013, p. 250).

• Recent guidelines support the use of mTBI and concussion interchangeably (S. Marshall, Bayley, McCullagh, Velikonja, & Berrigan, 2012).

• Clinical, pathological, or biomechanical injury for concussions: • direct blow to head, neck or face, direct blow to the body causing the head to be affected• rapid onset (over minutes or hours), short-lived, and neurological impairments are

spontaneously resolved

(Sohlberg & Ledbetter, 2016)

7/19/19

5

Concussion/ mTBI

• Causes physical, behavior changes, cognitive impairments, and/or sleep disturbances (McCrory et al., 2013).

• Common symptoms: fatigue, lightheadedness, persistent headaches, sensitivity to light and sound, irritability, emotional lability, *attention deficits, *memory problems, anxiety and depression (Chachad & Khan, 2006; Eisenberg et al., 2014; C. M. Marshall, 2012).

• Post concussive symptoms: (PCSs) symptoms for longer than 3 to 6 months postinjury.

• persistent PCSs: symptoms last longer than 12 months. (Cornis-Pop, 2012)• 5%–15% have ongoing cognitive and somatic symptoms persisting 90 or more days following a

concussion (Barlow et al., 2010; De Beaumont, Henry, & Gosselin, 2012; Eisenberg, Meehan, & Mannix, 2014).

• longer recovery is needed with impaired processing, visual memory, verbal memory, and amnesia (Cancelliere et al., 2014).

• “The goal of cognitive rehabilitation following TBI is to enhance the persons' ability to process and interpret information and to improve the person's ability to perform mental functions.”

(Barman, Chatterjee & Bhide, 2016, p.173)

• Overly repetitive and boring therapy could be a reason for the high drop out rate for TBI patients ( Savulich et al., 2018)

• Repetitive memory drills without the teaching of compensatory strategies have little or no efficacy (Helmick, 2010).

• Personalized approaches that consider the patient’s different characteristics and injuries must be targeted in order to maximize the best quality of life and wellbeing. (Savulich et al., 2018)

• Therapy sessions should provide training that can be carried over to functional situations and environments for successful generalization (Cornis-Pop et al., 2012).

• Therapy should include direct instruction combined with strategy instruction and errorless learning techniques (Sohlberg & Turkstra, 2011).

• Collaborative evaluations and treatments with physicians, audiologists, speech language pathologists, occupational therapists, physical therapists, vision specialists, psychologists, neuropsychologists, teachers, and vocational rehabilitation specialists may be needed (Cornis-Pop et al., 2012)

7/19/19

6

functional therapy

errorless learning

metacognitive strategies

compensatory strategies

direct instruction

COGNITIVE THERAPY

Basis for functional therapy:• executive function interventions are relevant to the individual and the person’s everyday

life.

• provide a context in which the individual can succeed, using a mentoring approach.. It focuses on the goals that are most relevant to their personal identity

• take advantage of their strengths, help build confidence to achieve their goals • hypothesis-testing approach: methods are attempted, modified, discarded, or retained

based on the client’s progress • Errorless learning

(Ylvisaker & Feeney, 1998)

Direct Instruction Model (DI)• principles of applied behavior analysis that include pacing, frequent opportunity to respond, feedback,

and reinforcement to ensure learning

• Steps for the DI method:• Select a meaningful goal or skill the student will need to learn • Provide a simple rationale

• Give clear directions, ask the student to repeat or paraphrase the directions (teach back)• Break tasks into small steps and model each step

• Provide opportunities for student response and allow processing

• Provide immediate positive feedback and error correction • Use verbal praise and encouragement

• Allow sufficient practice and review• Allow for strategies and generalizations

(Engelmann & Carnine, 1982) (Glang, Singer, Cooley, & Tish, 1991)

7/19/19

7

Functional home activities

• Leaving each morning safely• Paying bills, managing checkbook,

checking debit card, budgeting• Laundry

• Cleaning• Grocery shopping, coupons, sequencing

how to get to the store

• Online shopping, online passwords• Moms: lunch for kids, water bottles, baths,

laundry, family schedule

• Take care of pets• Television times

• Safety awareness• Home improvements

• Weekly chores, lawn• Errands around town

• Time management• Cooking

• Garbage days

Functional activities• Newspaper

• magazine

• Travel book, vacations

• Current event cards- metagame

• PT/OT safety awareness

• Rehab schedule and safety

• Stocks and bonds

• Coupons

• Target advertisement

• Lists of doctors with phone numbers

• Cards, games

• Visiting MD, paying copays

• List of meds with doses and times

• What to order from menu, tips

• Birthdays, holiday shopping and gifts

• Planning for a party

• Grocery store shopping

• TV shows, remote

• Movies, Broadway show

Functional job related activities• Sequencing how to get to work

• Alphabetizing files

• Home care schedule

• Organization of day

• Double checking work

• Passwords

• when to take breaks

• Alternating attention and then begin divided attention

• Taking notes (Cornell note taking)

7/19/19

8

Functional school related activities

• Class periods, bells, schedules for different days

• How to get to school• Checklist for daily supplies, books, lunch and water bottles

• Double checking• Portable file folder

• Money

• Time management• Asking for help

• Taking initiative

Functional school related strategies

• Multiple choice instead of recall on worksheets and tests• Allow more time on tests• Reduce amount of work• Take breaks• Quiet seating• Dictate responses• Daily planner• Pass fail grades instead of letter grades• Precision commands-giving clear statements of when to start, only expect 2-3 steps, allow time to follow through, give

praise and encouragement (Rhode, Jenson & Reavis, 1993)(Mateer et al., 1997).

Community access training

• Simple-complex functional tasks

• Filling prescriptions

• Route finding

• Daily schedules

• Community outings

• Return to school and work

(Beautieu et al., 2015)

7/19/19

9

Functional numerical reasoning

• Basic arithmetic for checkbooks and bank accounts

• Telling time/ Time span calculations

• Making change/counting

• Functional math problems needed for the home

• Buying items online/ in store

• Budgeting

• Discounts, % off,

• Giving tips at restaurants, salon

(Beaulieu et al., 2015)

examples

• MD/ pharmacist- convert lb. to kg. for meds

• Construction worker- measurements and square feet

• Photographer-sequencing steps for development

• Cook-GMO’s, food safety, expiration dates

• Home care social worker: manage files, scheduling home visits

Compensatory strategies

• Pts. need to be aware of the factors that contribute to their difficulties, learn strategies to optimize the execution of everyday activities, and promote generalizations to varied contexts

• Educate patients regarding where and when breakdowns or inefficiencies occur.

• Educate patients to help the patient identify, anticipate, and modify situations that are likely to result in cognitive overload and compromise goals.

• develop compensatory strategies specific to limitations and situations, environmental modifications, and coping mechanisms for managing changes in processing speed (Vanderploeg, Belanger & Curtiss, 2009).

• speed of processing (e.g., conceptual or semantic processing)

(Cornis-Pop et al., 2012) (Malia et al., 2004).

7/19/19

10

Compensatory strategy training• Daily schedule

• Take a break• Preferential seating• Choose face to face interactions• Prepare ahead of time• Close your eyes

• Ask for demonstrations• Go to a quiet room• Go to the bathroom stall• Breathing exercises• Know when you get a headache and stop prior

• Window strategy• Make lists

• beginning and end times for events• Its OK to say no

• What makes you happy?• motivating quotes book

• Memory book• Medical alert bracelet

• Post-its around the house• List of what you need prior to leaving home

• Minimize distractions• Music break (mojo song)

• Reminders in advance, maybe a few days ahead• Avoid multi-tasking

• Allow extra time to get ready and extra time for tasks

(Cornis-Pop et al., 2012)

Memory strategies-pneumonic devices• C-• R-• A-• V-• E-• D-

• P-• O-• W-

Errorless Learning (EL) Strategy• Declarative learning- what….

• procedural learning- how….

• discrimination training with early prompting and support that is systematically faded to ensure successful responding.

• individuals are not allowed to guess on recall tasks, but are immediately provided with the correct response, instructed to read the response, and write it down (Mateer et al., 1997).

• If errors do occur, nonjudgmental corrective feedback is provided (Ylvisaker et al., 2001).

1.

2.

3.

7/19/19

11

Metacognitive strategies• encourages self-instruction, self-monitoring, reflection and internalization about their performance

using strategies. (Sohlberg & Turkstra, 2011)(Cicerone et al., 2005)(Kennedy & Coelho, 2005).

• step- by-step metacognitive strategy instruction with young to middle-aged adults with TBI improves problem- solving skills, planning, and organization for ADLs (Kennedy et al., 2005).

• Step-by-step intervention procedures can include

• (1) formulating goals related to the everyday needs of the client

• (2) determining how to initiate the goals

• (3) self-monitoring and self-recording performance

• (4) choosing and revising strategies based on goals and performance

• (5) reformulating decisions or plans based on self- assessment

• (6) reviewing what was successful and unsuccessful

(Kennedy et al., 2005)( Kennedy & Coelho, 2005)(Cornis-Pop et al., 2012)

Compensatory technology strategies

Human support is always a necessity, technology could fail and ‘‘a real life person backup is always going to be important’’. (Chu et al., 2014, p.283)• Limit features on phone, some are too complex• Call, text, set reminders, set alarms, emails, cameras on phones to take pics of places, invitations, faces

• Spreadsheets, google calendar• visual impairments could cause difficulty with computer screen lights • may need larger phone screen and/or buttons for fine motor impairments • reading or writing errors can cause challenges• digital recording devices for classrooms

• Smart pens for notetaking (Chu, 2014) (Cornis-Pop et al., 2012)

Strategies for students

• Cornell note taking strategy

• Study agenda

• Conversation marking strategy

• Smart pen for notes

• E-reader

• Google calendar

7/19/19

12

Additional Strategies

• face-name associations

• hierarchical organization

• method of loci

• PROMPT

• chaining

Evidence Based Practice

• (1) best available current evidence

• (2) clinical expertise

• (3) clinical judgment

• (4) reflect the patient and family’s preferences, values, interests, needs and goals to provide high-quality services

(ASHA, 2005)(Montgomery & Turkstra, 2003)(Cornis-Pop et al., 2012)

Short-Term Executive Plus (STEP) cognitive rehabilitation program

• improves executive dysfunction after TBI

• SWAPS for problem solving

• Emotional cycle

(Cantor et al., 2014)

7/19/19

13

SWAPS for problem solving

• Problem-solving training consisted of 5-step problem-solving approach • 1. Stop! is there a problem?

• 2. What is the problem? • 3. any alternatives and options to solve the problem?

• 4. pick and plan the chosen option • 5. Are you satisfied with the outcome of the plan?

(Cantor et al., 2014)

Treatment executive functioning

Intervention in this domain often focuses on two skills: metacognition skills and problem solving.

(1) establish goals

(2) initiate tasks

(3) anticipate consequences of actions

(4) plan and organize behaviors according to spatial, temporal, topical, or logical sequences

(5) monitor and adapt behavior to fit a particular and functional task (Sohlberg & Turkstra, 2011).

(Cornis-Pop et al., 2012)

Treatment memory• Instructional practices that have been experimentally validated and promote learning for individuals:

(1) clearly delineating targets with use of task analyses

(2) errorless learning (3) providing sufficient practice

(4) distribute practice within sessions and across sessions (5) using variations or multiple examples

(6) using strategies and metacognitive strategies(7) selecting and training functional targets

(8) distributed practice- gradually lengthening time between probes for new memory strategies. (9) after initial acquisition, practice with distractors similar in their ADLs.

(Sohlberg & Turkstra, 2011)(Cornis-Pop et al., 2012)

7/19/19

14

Spaced retrieval therapy

• Visual imagery, errorless learning, spaced retrieval, and the use of external aids have shown improvements in daily life activities, self- perception of their own memory, emotions, mood, and quality of life (Simon, Yokomizo, & Bottino, 2012).

• Results last from several months to up to 2 years following intervention (Unverzagt et al., 2007).

1.

2.

3.

Attention treatment

• Attention training has been the subject of well-designed research, and numerous studies have confirmed its benefit (Helmick, 2010).

• recommend treatment of attention using direct and metacognitive training to promote development of compensatory strategies and lead to generalization to real-world tasks

• Repeated use of computer-based tasks without intervention by a clinician is not recommended (Cicerone et al., 2011)

(Cornis-pop et al., 2012)

Attention process training (APT)

• Attention Process Training, Second Edition (APT-II) improves attentional impairments via repetitive and hierarchically organized exercises.

• restorative program

• improve visual and auditory attention for everyday functioning

• improves 5 components of attention

• promotes generalization

• (Tsaousides & Gordon, 2009)

7/19/19

15

Neural plasticity treatment• neural plasticity is relevant in pursuing higher education

• younger brains may change more and faster than aging brains, although both are responsive to experience),

• intensity (i.e., increase length and frequency of treatment),

• salience (i.e., stimuli must be interesting and engaging)

• repetition (i.e., need an adequate number of times for learning).

• provide intensive, repetitive practice of functional targets

• promotoes generalization, and personal factors (Sohlberg & Turkstra, 2011)

(Gilmore, Ross & Kiran, 2019)

Should we do more advanced cognition therapies?

• ST activities that involved problem-solving, math or money, and memory earlier in therapy was associated with higher discharges and higher 9-month FIM motor and cognitive scores.

• Challenging activities may be more meaningful, familiar and motivating to patients (e.g., communicating to a waitress and calculating the tip, rather than calculating math problems in the rehab room )

(Horn et al., 2015)

Cognitive pragmatic treatment CPT

• improving several communication modalities, theory of mind, and cognitive components such as awareness and executive functions.

• Communicative-pragmatic deficits• excessive talkativeness

• poor topic maintenance

• Repetitiveness• difficulties in starting and maintaining a conversation

• poorly organized and structured discourse• tangential

• Reduced eye contact

• impaired ability to understand sarcasm, irony, and indirect requests.

• low levels of social appropriateness • insensitivity,

• poor social judgment

• inadequate intimacy with their interlocutors • impaired ability to understand the prosodic aspects of

speech- turn taking

• recognize emotional prosody• understand facial expressions

(Gabbatore, 2015)

7/19/19

16

Pragmatic communication skills

• Social communication problems associated with TBI are thought to reflect underlying cognitive rather than linguistic impairments (Prigatano et al., 1985).

• Overall, adults with TBI have been rated as less rewarding, appropriate and interesting conversation partners than their peers (Bond & Godrey, 1997).

(Byom & Turkstra, 2017)

Vision restoration therapy (VRT)

• Visuospatial cues to improve perception and neglect

• 12 x 12 frame

• Window strategy

• Enhances neural plasticity

(Poggel and Sabel, 2004)

Reality orientation

• Improve temporal and spatial orientation

• Discuss current events

• Conversations about clocks, calendars, television shows

• Display an orientation board

7/19/19

17

Self-awareness

• Verhaeghen and Goossens (1992) noted that improved intervention effects could be achieved by increasing an individual’s awareness and knowledge (metamemory).

• deficits

• strategies

• communication skills

• Initiation

• accomplishments

Visual cues to improve cognition

• Mind mapping

• Home diagram

• Venn diagram

Additional treatment approaches

1. Reminiscence therapy

2. psychoeducational supports.

3. Social behavior guidance

7/19/19

18

Rapport is so important.• Therapeutic working alliance- partnership between the clinician, the client, and family.

achieve change, establish goals together, agreement on tasks

• Allow time to build the personal bond between the clinician and client

• Establish trust and credibility

• Listen, listen, listen

• Take notes of what they told you and discuss it in later sessions.

• Patient’s concerns and experiences should be validated (Department of Veteran Affairs, 2009)

(Bordin, 1979)(Schonberger, Humle, Teasdale, 2006)(Schonberger, Humle, Teasdale, 2007) (Sherer et al., 2007)(Cornis-Pop et al., 2012)

CounselingAspects of the supportive counseling approach (Department of Veteran Affairs, 2009)

(1) caring and empathy (e.g., sincerity, listen, viewing perspectives of others)

(2) competence and expertise (e.g., training, experience, professional, knowledge)

(3) dedication and commitment (e.g., altruism, involvement, motivation)

(4) honesty and openness (e.g., truthfulness, candidness, objectivity).

(Cornis-Pop et al., 2012)

Counseling• “It is at the heart of our professional responsibilities to empower our clients and their

families” (Luterman, 2008)

• Counseling begins immediately at the IE and continues each session

• Counseling is under our scope of practice as per ASHA

• Must be compassionate, nonjudgmental, and empathetic

• Must be engaged and present

• Must be good listeners of the patients and family members

• Balance of empathy and information

• The patient and their families must be the first priority

• Don’t say “should” or tell the clients how to feel

(Stein-Ruban & Fabus, 2012) (Hall, 2019)

7/19/19

19

ONLINE

• BrainHQ

• Lumosity

• Expedia/Craiglist/ search for functional info

• Online shopping

• stayingsharp.aarp.org

• Fat brain Toys

NUTRITION

EXERCISE CONNECT with family and friends

RELAXATION

LEARN NEW THINGS

Don’t forget about these:

Beneficial cognitive tasks1.2.

3.4.

5.6.

7.8.

9.10.

7/19/19

20

“When you know better...You do better.”

― Oprah Winfrey

ReferencesAmerican Speech-Language-Hearing Association. (2005). Knowledge and skills needed by speech- language pathologists

providing services to individuals with cognitive-communication disorders. Rockville (MD): American Speech-Language-Hearing Association.

Barman, A., Chatterjee, A., & Bhide, R. (2016). Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury. Indian journal of psychological medicine, 38(3), 172–181.

Beaulieu, C. L. (2015). Occupational, Physical, and Speech Therapy Treatment Activities During Inpatient Rehabilitation for Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 96(8), pp. S222-S234.

Belanger HG, Kretzmer T, Yoash-Gantz R, Pickett T, Tupler LA. Cognitive sequelae of blast-related versus other mechanisms of brain trauma. J Int Neuropsychol Soc. 2009;15(1):1–8.

Ben-David, B. M. (2016). Sensory source for stroop effects in persons after TBI: Support from fNIRS-based investigation. Brain Imaging and Behavior, 10(4), pp. 1135-1136.

Bond, F. and Godrey, H. P. D., (1997), Conversation with traumatically brain injured individuals: a controlled study of behavioural changes and their impact. Brain Injury, 11, 319 – 329.

Bordin ES. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy.16(3):252–60.

Byom, L., Turkstra, L.S. (2017). Cognitive task demands and discourse performance after traumatic brain injury. International Journal of Language & Communication Disorders, 52(4), pp. 501-513.

ReferencesCantor, J., Ashman, T., Dams-O’Connell, K., Dijkers, M.P., Gordon, W., Spielman, L., Tsaousides, T., Allen, H., Nguven, M., Oswald, J. (2014).

Evaluation of the Short-Term Executive Plus Intervention for Executive Dysfunction After Traumatic Brain Injury: A Randomized Controlled Trial With Minimization. Archives of Physical Medicine and Rehabilitation, 95(1), pp. 1-9.e3.

Chu, Y. (2014). Cognitive support technologies for people with TBI: Current usage and challenges experienced. Disability and Rehabilitation: Assistive Technology, 9(4), pp. 279-285.

Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil. 81(12):1596–1615.

Cicerone KD. (2002)Remediation of “working attention” in mild traumatic brain injury. Brain Inj. 16(3):185–95. Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA,

Catanese J. (2005). Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil. 86(8):1681–92.

Cicerone KD, Mott T, Azulay J, Sharlow-Galella MA, Ellmo WJ, Paradise S, Friel JC. (2008). A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 89(12):2239–49.

Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. (2011). Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil. 2011;92(4):519–30.

Coelho CA, Youse KM, Le KN. (2002)Conversational discourse in closed-head-injured and nonbrain-injured adults. Aphasiology. 16(4–6):659–672.

Coelho CA, Grela B, Corso M, Gamble A, Feinn R. (2005). Microlinguistic deficits in the narrative discourse of adults with traumatic brain injury. Brain Inj.19(13):1139–1145.

7/19/19

21

ReferencesCopley, A. (2015). Does metacognitive strategy instruction improve impaired receptive cognitive-communication skills following acquired

brain injury? BRAIN INJURY, 29(11), 1309-1316.Cornis-Pop, M., Mashima, Pauline A,Roth, Carole R, MacLennan, Donald L,, Picon, L, Hammond, Carol Smith, Frank, Elaine M,. (2012).

Cognitive-communication rehabilitation for combat-related mild traumatic brain injury. Journal of Rehabilitation Research and Development, 49(7), xi-xxxii.

Department of Veterans Affairs, Department of Defense [Internet]. VA/DoD clinical practice guide-lines: (2009). Management of concussion-mild traumatic brain injury (mTBI). Washington (DC): Department of Veterans Affairs.

Doolan, A. W., Day, D. D., Maerlender, A. C., Goforth, M., & Gunnar Brolinson, P. (2012). A review of return to play issues and sports-related concussion. Annals of Biomedical Engineering, 40(1), 106-113.

Engelmann, S., & Carnine, D. W. (1982). Theory of instruction. New York: Irvington.Etherton JL, Bianchini KJ, Heinly MT, Greve KW. (2006). Pain, malingering, and performance on the WAIS- III processing speed index. J

Clin Exp Neuropsychol. 28(7):1218–37.Evans K, Hux K. (2011). Comprehension of indirect requests by adults with severe traumatic brain injury: contributions of gestural and

verbal information. Brain Injury. 25(7–8):767–776.Frencham KA, Fox AM, Maybery MT. (2005). Neuropsy-chronological studies of mild traumatic brain injury: a meta-analytic review of

research since 1995. J Clin Exp Neuropsychol. 2005;27(3):334–51.Gabbatore, I. (2015). Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals. JOURNAL OF

HEAD TRAUMA REHABILITATION, 30(5), pp. E14-E28.Galetto V, Andreetta S, Zettin M, Marini A. (2013). Patterns of impairment of narrative language in mild traumatic brain injury. J

Neurolinguistics. 26(6):649–661.

ReferencesGaudreau G, Monetta L, Macoir J, Laforce R Jr, Poulin S, Hudon C. (2013). Verbal irony comprehension in older adults with amnestic mild

cognitive impairment. Neuropsychology. 27(6):702–712.Gilmore, N. (2019). The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain

Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY, 28(1), 341-358.Glang, A., Singer, G., Cooley, E., & Tish, N. (1992). Tailoring direct instruction techniques for use with elementary students with brain

injury. Journal of Head Trauma Rehabilitation, 7, 93–108.Glosser G. (1993). Discourse production patterns in neurologically impaired and aged populations. In:Brownell HH, Joannette Y, eds.

Narrative Discourse in Neurologically Impaired and Normal Aging Adults. San Diego, CA: Singular; 191–211.Hall, N, (2019). Clinical Observation in Communication Sciences and Disorders: San Diego: Plural Publishing.Hartley LL. (1995). Cognitive-communicative abilities following brain injury: A functional approach. San Diego (CA): Singular Publishing

Group. Helmick K. (2010). Members of Consensus Conference. Cognitive rehabilitation for military personnel with mild traumatic brain injury and

chronic post-concussional disorder: Results of April 2009 consensus conference. NeuroRehabilitation. 26(3):239–55. Horn, S. D. (2015). Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and

9 Months Post-discharge. Archives of Physical Medicine and Rehabilitation, 96(8), pp. S304-S329.Joanette YE, Brownell HH. (1990). Discourse Ability and Brain Damage: Theoretical and Empirical Perspectives. New York, NY: Springer-

Verlag Publishing.

ReferencesJohnson JE, Turkstra LS. (2012). Inference in conversation of adults with traumatic brain injury. Brain Inj. 26(9):1118–1126.Jordan, B. (2013). The clinical spectrum of sport-related traumatic brain injury. NATURE REVIEWS NEUROLOGY, 9(4), pp. 222-230.Kennedy MR, Coelho C. (2005). Self-regulation after traumatic brain injury: a framework for intervention of memory and problem solving.

Semin Speech Lang. 26(4):242–55. Kennedy MR, Coelho C, Turkstra L, Ylvisaker M, Moore Sohlberg M, Yorkston K, Chiou HH, Kan PF. (2008). Intervention for executive

functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. Neuropsychol Rehabil. 18(3):257–99.

Langlois JA, Rutland-Brown W, Wald MM. (2006). The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21:375.

Luterman, D. M. (2008). Counseling persons with communication disorders and their families (5th ed.). Austin, TX: PRO-ED.Maas AIR et al. (2017) Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology

16, 987–1048.MacDonald, S. (2016). Assessment of higher level cognitive-communication functions in adolescents with ABI: Standardization of the student

version of the functional assessment of verbal reasoning and executive strategies (S-FAVRES). BRAIN INJURY, 30(3), pp. 295-310.McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., ...Sills, A. (2013). Consensus statement on concussion in

sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47, 250–258.

McDonald S. (1992). Differential pragmatic language loss after closed-head injury: ability to comprehend conversational implicature. ApplPsycholinguist. 13:295–312.

7/19/19

22

ReferencesMcDonald S, Togher L, Code C, (1999). Communication Disorders Following Traumatic Brain Injury. Hove, UK: Psychology press.McDonald S. (2000). Neuropsychological studies of sarcasm. Metaphor Symb. 15(1–2):85–98.Malia K, Law P, Sidebottom L, Bewick K, Danziger S, Schold-Davis E, Martin-Scull R, Murphy K, Vaidya A. (2004). Recommendations for

best practice in cognitive rehabilitation therapy: acquired brain injury. Exton (PA): The Society for Cognitive Rehabilitation. Marini A, Galetto V, Zampieri E, Vorano L, Zettin M, Carlomagno S. (2011). Narrative language in traumatic brain injury. Neuropsychologia.

49(10):2904–2910.Mateer, C. A., Kerns, K. A., & Eso, K. L. (1997). Management of attention and memory disorders following traumatic brain injury. In E. D.

Bigler, E. Clark, & J. E. Farmer (Eds.), Childhood traumatic brain injury (pp. 153–176). Austin, TX: Pro-Ed.Milders M, Fuchs S, Crawford R. (2003). Neuropsychological impairments and changes in emotional and social behavior following severe

traumatic brain injury. J Clin Exp Neuropsyc. 25(2):157–172.Montgomery EB, Turkstra LS. Evidence-based medicine: Let’s be reasonable. J Med Speech Lang Pathol. 2003;11(2):ix–xii. Peach, R. (2013). The Cognitive Basis for Sentence Planning Difficulties in Discourse After Traumatic Brain Injury. AMERICAN JOURNAL

OF SPEECH-LANGUAGE PATHOLOGY, 22(2), pp. S285-S297.Poggel DA, Kasten E, Sabel BA. (2004).Attentional cueing improves vision restoration therapy in patients with visual field

defects. Neurology. 63:2069–76.Prigatano, G. P., Roueche, J. R. and Fordyce, D. J., (1985), Nonaphasic language disturbances after closed head injury. Language Sciences, 7, 217 – 229.Riedeman, S. (2018). Knowledge, Confidence, and Practice Patterns of Speech-Language Pathologists Working With Adults With Traumatic

Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY, 27(1), pp. 181-191.Rhode, G., Jenson, W. R., & Reavis, H. K. (1993). The tough kid book. Longmont, CO: Sopris West.

ReferencesSavulich, G. (2018). Personalized treatments for traumatic brain injury: Cognitive, emotional and motivational

targets. PSYCHOLOGICAL MEDICINE, 48(9), pp. 1397-1399.

Sauer AL, Parks A, Heyn PC. (2010). Assistive technology effects on the employment outcomes for people with cognitive disabilities: a systematic review. Disabil Rehabil Assist Technol 5:377–91.

Scho ̈nberger M, Humle F, Teasdale TW. (2006). Subjective outcome of brain injury rehabilitation in relation to the therapeutic working alliance, client compliance and awareness. Brain Inj. 20(12):1271–82.

Scho ̈nberger M, Humle F, Teasdale TW. (2007). The relationship between clients’ cognitive functioning and the therapeutic working alliance in post-acute brain injury rehabilitation. Brain Inj. 21(8):825–36.

Seel, R. T. (2015). Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury. Archives of Physical Medicine and Rehabilitation, 96(8), pp. S235-S244.

Sherer M, Evans CC, Leverenz J, Stouter J, Irby JW Jr, Lee JE, Yablon SA. (2007). Therapeutic alliance in post-acute brain injury rehabilitation: predictors of strength of alliance and impact of alliance on out- come. Brain Inj. 21(7):663–72.

Simon, S., Yokomizo, J., & Bottino, C. (2012). Cognitive intervention in amnestic mild cognitive impairment: A systematic review. Neuroscience and Behavioral Reviews, 36, 1163–1178.

Sohlberg MM, Mateer CA. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York (NY): Guilford Press.

ReferencesSohlberg, MM, Johnson, L., Paule, L., Raskin, S., Mateer. C. (2001). Attention Process Training (APT-II) manual. Lash and

Associates, Wake Forest.

Sohlberg MM, Ehlhardt L, Kennedy M. (2005). Instructional techniques in cognitive rehabilitation: a preliminary report. SeminSpeech Lang. 26(4): 268–79.

Sohlberg MM, Turkstra LS. (2011). Optimizing cognitive rehabilitation: effective instructional methods. New York (NY): Guilford Press.

Sohlberg, M. (2016). Management of Persistent Cognitive Symptoms After Sport-Related Concussion. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY, 25(2), pp. 138-149.

Stein-Rubin, C., & Fabus, R. L. (2012). A guide to clinical assessment and professional report writing in speech-language pathology. CiliftonPark, NY: Cengage Learning.

Temkin NR, Dikmen SS, MacHamer J, Corrigan JD. (2009). Social functioning after traumatic brain injury. J Head Trauma Rehabil 24:460–7.

Temkin, N., Corrigan, J., Dikmen, S., & Machamer, J. (2009). Social Functioning after Traumatic Brain Injury. The Journal of Head Trauma Rehabilitation, 24, 460-467.

Tombaugh TN, Rees L, Stormer P, Harrison AG, Smith A. (2007). The effects of mild and severe traumatic brain injury on speed of information processing as measured by the computerized tests of information. Arch Clin Neuropsych. (1):25-36.

Trudel TM, Nidiffer FD, Barth JT. (2007). Community- integrated brain injury rehabilitation: treatment models and challenges for civilian, military, and veteran populations. J Rehabil. Res Dev. 44(7):1007–16.

7/19/19

23

ReferencesTrudel TM, Nidiffer FD, Barth JT. (2007). Community- integrated brain injury rehabilitation: treatment models and

challenges for civilian, military, and veteran populations. J Rehabil. Res Dev. 44(7):1007–16.

Tsaousides T, Gordon WA. (2009). Cognitive rehabilitation following traumatic brain injury: Assessment to treatment. Mt Sinai J Med. 76:173– 81.

Turkstra, L. S. (2002). Compensating for executive function impairments after TBI: A single case study of functional intervention. Journal of Communication Disorders, 35(6), pp. 467-482.

Unverzagt FW, Kasten L, Johnson KE, Rebok GW, Marsiske M, Koepke KM, (2007). Effect of memory impairment on training outcomes in ACTIVE. J Int Neuropsychol Soc. 13(6):953–960.

Vanderploeg RD, Belanger HG, Curtiss G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Arch Phys Med Rehabil. 90(7):1084–93.

Wauters, L. (2019). Disorders of Emotional Communication in Traumatic Brain Injury. Seminars in Speech and Language, 40(1), pp. 013-026. chart 1 in screen shots

Ylvisaker, M., & Feeney, T. J. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego, CA: Singular Publishing Group Inc

Verhaeghen P, Marcoen A, Goossens L (1992) Improving memory performance in the aged through mnemonic training: a meta-analytic study. Psychol Aging 7: 242–251.

Zaloshnja, E., Miller, T., Langlois, J. A., & Selassie, A. W. (2008). Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. The Journal of Head Trauma Rehabilitation, 23(6), 394-400.

chu

(Chu et al., 2014)