Professional Insights: The Role of a Speech-Language Pathologist in Concussion Treatment
To highlight the work of our members and associates, we are launching our Professional Insights Communiqué Interview Series. We have invited a number of SAC members and associates to share their unique professional experiences, promoting the importance of the professions in communication health.
For Speech and Hearing Month, we are kicking the interview series off with two interviews spotlighting concussion management, as well as a profile of one of our communication health assistant associates.
For our speech-language pathologist (S-LP) feature, we interviewed Elizabeth Skirving, an S-LP in London, Ontario. The interview discusses Elizabeth’s role as an S-LP and her experience treating concussion, highlighting the important role that S-LPs play in concussion management and treatment.
Read Elizabeth’s interview below!
Q1: Can you share some details about where you work and what your role as an S-LP entails?
I’m an S-LP in a private practice in London, ON. I primarily work with children, teenagers and adults who have sustained a concussion or brain injury as a result of a motor vehicle collision. My role includes the assessment and treatment of cognitive and communication difficulties that have resulted from an injury. I work with clients, family members, partner, educators, lawyers and rehabilitation professionals to provide education and support for the impact of the cognitive and communication difficulties on the client’s ability to function at home, at work, at school and in the community.
While I work alone in my practice, most of my clients have a community health team so I often collaborate with occupational therapists, physiotherapists, social workers, psychologists, audiologists, vision therapists and rehabilitation support workers, and sometimes educational assistants and tutors. It’s quite a vast role in terms of education, communication and collaboration.
Q2: What experience do you have treating concussion?
I’ve worked in brain injury rehabilitation for more than 25 years and concussion has always been a part of that, although we referred to a concussion as a “mild brain injury.” Since about 2012, concussion has become a familiar term, especially in relation to sports. It is understood that approximately 80% of individuals who sustain a concussion will fully recover from their injury. Unfortunately, there are 15-20% of people who have prolonged post-concussion symptoms, and these are the individuals that we see in our practice.
Most of my work has been community-based. I’ve been able to work with people in their homes, in their schools, at work and in the community to integrate cognitive and communication strategies into meaningful tasks and roles. I have also been fortunate to take on some contracts with an outpatient rehabilitation team, where my main focus was collaborating with the team to assist clients in returning to learn, returning to work and returning to their roles and relationships at home and in the community.
Q3: What are the most common signs of concussion from an S-LP’s point of view?
For an S-LP, our primary focus is on the cognitive and communication challenges that occur after a concussion. Prolonged post-concussion symptoms that impact cognition and communication include sensitivity to light, noise and motion, headaches, pain, fatigue and irritability. Cognitive and communication difficulties that are typical after a concussion include: poor attention and concentration, memory difficulties, problems listening and retaining information, word finding and retrieval problems, difficulty organizing thoughts and ideas for conversation and writing, reading comprehension and remembering what was read, understanding social communication cues, and slower rate of processing information. It is our role to understand the impact of the cognitive and communication difficulties in addition to post-concussion symptoms on our clients’ ability to manage daily activities, on social relationships and on their overall well-being.
Clients describe feeling like they can’t keep up with conversation and tend to feel overwhelmed when they are in a busy environment, which often leads to social isolation.
Q4: What can happen if these symptoms are undiagnosed or untreated?
The focus of early concussion intervention is usually on physical symptoms and recovery. It is not until clients have pain and mobility concerns under control that they may become more aware of cognitive changes. Often there is an emotional reaction to the awareness of problems like paying attention and remembering things, struggling to think of words and feeling overwhelmed with multistep tasks. Clients often express feelings of frustration, embarrassment and reduced confidence. When these difficulties are not identified and explained, clients can experience big feelings of failure and there can be an increase in withdrawing from social situations. Problems with self-regulation and emotional control tend to increase when education and support have not been provided as a component of the concussion rehabilitation program. Clients often report that they feel like their S-LP was the first person that really listened and understood how they were feeling after a concussion.
Q5: Are there ever any instances where you encounter a patient who isn’t taking these prolonged symptoms seriously and doesn’t seek treatment right away?
If a client doesn’t recognize or understand their prolonged post-concussion symptoms, it is often because they are still in a “fog” or because they have not been involved in activities that have provided a cognitive challenge yet. Sometimes it is friends and family members who notice the changes in cognition and communication first. Other times, the client is aware of the difficulties they are experiencing but those around them try to minimize the problems, by saying things like, “it’s just a concussion, get over it.” This highlights how important it is to include education and support as part of treatment after a concussion.
Q6: If you had to choose one takeaway to emphasize to the public surrounding speech-language pathology and concussion treatment, what would it be?
The thing I would like people to know is that S-LPs are important members of concussion rehabilitation teams and we can provide assessments, education, intervention and support to individuals and families. S-LPs understand the impact of cognitive and communication difficulties on daily functioning. We treat clients with concussions across the lifespan and value the ability to provide support and advocacy for a greater understanding of communication and cognition and the impact of concussions on our client’s ability to resume meaningful functioning at home, at school, at work and in life.
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