presented by Patricia K. Youngman
This course is for rehabilitation therapists treating adults in an outpatient setting. The presenter is a speech-language pathologist, although the information covered may be useful for other disciplines as well. It is designed to identify the conditions under which the diagnosis of “mild” traumatic brain injury is used, to demonstrate how the term is not an accurate identifier of the impact of this injury, and to familiarize clinicians with the unique characteristics of adults with a diagnosis of mild traumatic brain injury/concussion. Areas addressed are the cognitive/communication deficits, behavioral/emotional changes and responses, and physical, social, and vocational issues that may arise, as well as the impact of such an injury upon the individual’s family unit. An initial case study will introduce the multiple areas of change in the life of one individual with this diagnosis. At the end of the second and third chapters, the case study of another individual will demonstrate how the deficits and losses reviewed were functionally manifested in her day-to-day life. The course will end with an interview of an individual eight years post mild traumatic brain injury, documenting her recovery process and experiences.
Patricia K. Youngman is a speech/language pathologist, certified by the American Speech-Language-Hearing Association and licensed in the state of Washington. Her professional background includes working as a speech-language pathologist in the public schools, acute care and rehabilitation hospital units, and skilled nursing facilities, and providing home health care speech-language services to individuals who were homebound. Additionally, she has participated on the treatment and management teams in two outpatient rehabilitation programs designed specifically for adults with traumatic brain injury. Patricia managed the Mild Brain Injury Program at the Center for Cognitive Rehabilitation (Good Samaritan Hospital) in Puyallup, Washington, a suburb of Seattle, in the 1990s, coordinating the cognitive/communication, psychosocial, and vocational components of the services provided. It was during this period that she discovered a passion for working alongside individuals with mild traumatic brain injury (mTBI), treating their cognitive/communication deficits and learning from them about the changes in their lives resulting from the brain injury they acquired. A deep respect developed for these individuals and the issues experienced post-injury, as well as the price they paid for “looking good,” while struggling to participate in lives they had easily managed pre-injury. It was during her time at the Center for Cognitive Rehabilitation that she had the privilege of working with McKay Moore Sohlberg, Ph.D. and Catherine Mateer, Ph.D., two pioneers in the rehabilitation of adults with traumatic brain injury.
In 1995, Patricia opened a private practice in Seattle, focusing on the cognitive/communication treatment of adults with mild traumatic brain injury. Over the last twenty-one years, she has enjoyed working with high functioning adults to treat specific impaired brain processes resulting from mTBI. Therapy included hierarchical treatment exercises combined with compensatory systems and strategies to work around the deficits as well as teaching the habits to support use of all systems developed. It is her deeply held belief that the goal of treatment must be to facilitate functional change in the life of each patient, and that clinicians must accept responsibility to find and measure ways to effect these changes. Her presentation provides education regarding how the cognitive/communication, behavioral/emotional, physical, social, vocational and family unit changes are manifested functionally as a way to assist clinicians in becoming familiar with this group of individuals.
This chapter provides other terms that are currently used interchangeably with “mild traumatic brain injury.” Incidence figures are given for the United States, with an explanation of why it is difficult to know actual numbers for this group. The most accepted definition of mild traumatic brain injury (mTBI) is provided, with an explanation of how it was developed. Common mechanisms of injury are reviewed, with information provided about some of the most clinically unique aspects of this population of individuals, including the lack of any “hard” evidence that exists when the diagnosis is given. The chapter ends with a case study review of one patient (Ann) with the diagnosis of mTBI, examining the many areas of functioning in which she experienced deficits and changes. A contrast is provided between the level of impairment she experienced functionally, and clinical use of the term “mild.”
This chapter will review and define typical cognitive/communication changes, noting ways in which the deficits can be functionally manifested on a day-to-day basis to familiarize the clinician with what to look and listen for. Additionally, we'll review behavioral/emotional issues and discuss the importance of recognizing when a referral to a counselor may be appropriate. The information reviewed will provide a window into the life of adults learning to adapt to the many layers of change they are experiencing. It ends with a case study of an actual patient (Mary) with mild traumatic brain injury, briefly covers her neuropsychological assessment results, and looks at what her life looked like post-injury in terms of cognition, communication, and behavioral/emotional functioning.
This chapter will explore the physical changes that are common post mild traumatic brain injury. It will look into the social effects and the common ways in which all of the kinds of changes discussed thus-far in the presentation may impact an individual’s employment. Financial implications are considered. The family unit is covered with particular attention given to how a spouse is impacted. The manner in which a mild brain injury can change a marriage becomes apparent through the discussion. A review is provided of the kinds of team members who can assist in moving the mild traumatic brain injury patient forward to the most complete and successful resolution possible. This chapter ends with a continuation of the examination of the patient from Chapter Two (Mary), exploring the impacts of her brain injury in terms of physical changes, social losses, and the effects on her job. Specific implications for her family life are covered.