Cognitive-Communication Screening and Early Therapy for Adults With Mild TBI
Condition: Concussion; Mild Traumatic Brain Injury; Cognitive Communication Disorder
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion; Communication Disorders
Study type: Interventional

Summary: 
      Approximately 15-20% of patients diagnosed with a concussion/mild traumatic brain injury
      (mTBI) have persistent symptoms that continue up to six months or longer. Typical problems
      identified by these patients include difficulty with memory, multi-tasking, the ability to
      complete tasks quickly, and higher executive functions (e.g., inhibition, initiation,
      insight, motivation) (Belanger & Vanderploeg, 2005; Mott, McConnon, & Rieger, 2012,
      Rabinowitz & Levin, 2014). If these symptoms persist they can not only affect thinking, but
      also communication abilities (e.g., verbal and nonverbal interactions, reading, and writing)
      (ASHA, 2007). Therefore, it is hypothesized that screening measures that evaluate both
      thinking and communication can better identify individuals at-risk for persistent symptoms at
      two week and four weeks post-injury. Also, if cognitive-communication therapy was
      administered earlier post-injury, then outcomes related to return to daily activities, work,
      and/or the academic setting could possibly change. This study intends to investigate the use
      of cognitive and communication screening measures for the identification of persistent
      symptoms and the provision of early cognitive-communication therapy if problems persist.
    

Detailed description: 
      Approximately 15-20% of patients with concussion/mild traumatic brain injury (mTBI) have
      persistent cognitive symptoms up to six months or longer. Problems with working memory,
      divided attention, processing speed, and executive function are common (Belanger &
      Vanderploeg, 2005; Mott, McConnon, & Rieger, 2012, Rabinowitz & Levin, 2014). Patients often
      report how these problems negatively impact daily communication. Although neurocognitive
      tests are frequently used to identify patients at-risk for persistent symptoms, perhaps tests
      that not only assess cognition, but also communication would be better at identifying more
      functional deficits. Patients at-risk for persistent symptoms could then begin therapy
      earlier to address problems affecting work, school, or everyday activities. Speech-language
      pathologists are uniquely qualified to evaluate and treat patients with concussion/mTBI and
      cognitive-communication disorders (ASHA, 2005; Cicerone, et al.; Cornis-Pop et al., 2012).
      Cognitive-communication is the relationship between cognition and its influence on verbal and
      nonverbal communication, reading, and writing (ASHA, 2007). At this time, practice guidelines
      are emerging for cognitive-communication intervention related to concussion/mTBI (Cornis-Pop
      et al., 2012), yet there is still much research to be done. Typically, in recovery following
      a concussion/mTBI, patients are referred for cognitive-communication intervention if they are
      failing or struggling at work, school, or in daily activities. Some patients will not be seen
      for up to six months based on the assumption by healthcare professionals that most persistent
      cognitive and communication symptoms will resolve on their own. The wait period before
      referral for additional services is currently being investigated in the literature.
      Additionally, therapy for cognitive-communication will only be provided if patients report
      difficulties to their physicians and are referred for services. If services are not sought
      out, problems in cognitive-communication will go unrecognized as being a result of the
      concussion/mTBI.

      The specific aims of this study are: 1) Determine if screening measures that evaluate
      symptoms of concussion/mTBI frequently used by speech-language pathologists administered two
      and four weeks post-injury will be able to predict individuals at-risk for persistent
      cognitive and communication symptoms, and 2) Will an early treatment group with persistent
      cognitive-communication deficits one month after injury differ in pre- and post-therapy
      functional outcome measure scores as compared to a delayed therapy group beginning services
      at two months post-injury?

      Significance: Results of this study will increase the understanding in the use of cognitive
      and communication screening measures frequently administered by speech-language pathologists
      to identify patients at-risk for persistent symptoms related to concussion/mTBI and provide
      information about the outcomes of cognitive-communication intervention delivered early in
      recovery.
    

Intervention name(s): Early cognitive-communication therapy
Intervention type(s): Other
Other intervention name(s): Early therapy 1 month post-injury; Waitlist therapy 2 months post-injury
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Each participant diagnosed with concussion/mild traumatic brain injury will be screened for cognitive and communication abilities at two weeks post-injury and then four weeks post-injury. Standardized scores of the screening measures will identify subjects that are below one standard deviation below the mean. Subjects that continue to exhibit deficits after one month will be randomly placed into an early cognitive-communication therapy group (one month post-injury) or waitlist control group who receive therapy two month post-injury.
Masking: None (Open Label)
Primary purpose: Screening