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[ Music ]
>> The Brain Injury Guide and Resources is a tool
for professionals, community members and family
to understand traumatic brain injury as well as how
to promote better living for those who live with a TBI.
In this interview we will talk with Barbara Brinkman,
clinical associate professor in the Department of Communication,
Science and Disorders in the MU School of Health Professions,
to learn more about the role
of speech therapy after a brain injury.
Barbara, thanks very much for being with us.
>> Barbara: Oh, I'm happy to be here.
>> Barbara, when does a speech therapist become involved
with a patient following a traumatic brain injury?
>> Barbara: They usually get involved very early
on after the accident.
Sometimes they'll even begin working while the patient is
still in a pretty deep coma doing some stimulation to try
to help get them out of that stage of coma.
And even in the early stages of emergence we start to work.
They have a lot of social communication
and just communication problems in general,
so we work on reading, writing, listening, speaking, swallowing
and speech disorders as well.
>> What are the goals of speech therapy?
>> Barbara: You really want to integrate the person back
into their former life as much as possible,
so it depends on the patient.
If it's a school-aged child you want to integrate them back
into the school system.
If it's an adult, back
into their work situation, if possible.
And, of course, for everybody you want to help them get back
into a social relationship with their family and friends.
>> What kinds of things would a speech therapist do
to help a person with a traumatic brain injury?
>> Barbara: Well, we're going to work on all those areas
that I mentioned before but there's going to be a lot
of emphasis on the social communication domain.
What we find is that even when people start
to recover their language they have trouble using
that in social situations,
so they may have difficulty understanding how
to start a conversation, how to maintain it, and how to end it.
They may have trouble matching the appropriate loudness level
when they're speaking to others
and they don't have good self monitoring skills
to modulate that.
And, finally, they may have trouble with things
like figurative language or higher level language skills,
when the words don't match the message that they're trying
to convey, like sarcasm or metaphors.
>> Are there specific techniques you would use
with a typical client?
>> Barbara: Well, I try to use a lot of cueing systems
that are other than just listening
since they may have some problems comprehending,
so I'm going to pair cueing systems
with visual things maybe doing some video tape
or audio tape review to help increase their awareness
of some of their deficits.
If they're not aware
that there's a deficit they're not going to be able
to make many changes there.
>> So, Barbara, is there a difference between working
with children and adults?
>> Barbara: A lot of the areas are going to be the same
but one thing that's really important to keep in mind is
that people who have had a traumatic brain injury have
trouble with learning due information.
So if you look at an adult they've had many,
many experiences that they may not have lost
but a child had fewer opportunities to learn
and they're going to have trouble learning all the new
things that are going to come up in school, so you really have
to have a lot of intervention with these kids.
>> Barbara, how long would the therapy typically last,
or is there a typical length?
>> Barbara: You know it's really hard to give any specifics
for any particular patient but I'd say probably
at least one to two years.
It depends on the severity of their injury,
it depends on what their goals are too, are they just wanting
to work at home or are they wanting to get back
into a workforce, are they school-age,
so all of those things are going to come into play.
>> Alright, well, let's take a look at how you might interact
with a client if we could.
>> Barbara: Okay, I'd be glad to do that.
[ Music ]
>> And joining us now for our demonstration is Leanna.
Leanna, thank you very much for being with us.
And Barbara, at what point in the therapy would Leanna be
in our situation here?
>> Barbara: She would be about six months
after her traumatic brain injury, and we're working a lot
on her conversational skills at this point.
>> Alright, and what therapy goals would you have
for this session?
>> Barbara: Well, we want to increase her ability
to communicate socially with friends and family
and that sort of thing.
She has a little bit of trouble keeping a conversation going
and also sometimes she doesn't modulate her voice very well,
so we are still working on that too.
>> Alright, show us how you would work with this client.
>> Barbara: Okay, great.
Hi, Leanna, I haven't seen you
since last week how was your weekend?
>> Leanna: It was good.
I saw my family.
>> Barbara: Okay, Leanna,
remember now we're having a conversation
and do you remember this chart from last week?
When we started, I made a comment and asked you a question
and that came over to you
and you made a comment, and that was great.
But you need to give the conversation back to me.
So, what do you need to do?
>> Leana: I need to ask a question.
>> Barbara: That's exactly right.
Okay, so let's try that again, okay?
And look at the chart if you need
to to help you get through this.
>> Leanna: Okay.
>> Barbara: So I'm going to start again.
>> Leanna: Okay.
>> Barbara: Hi, Leanna,
I haven't seen you since last week.
What did you do over the weekend?
>> Leanna: I saw my family what did you do over the weekend?
>> Barbara: That was perfect,
that's exactly what I wanted you to do.
That turns it back to me and it keeps it going back
and forth just like a good conversation.
Okay, now, pass me that question again.
>> Leanna: What did you do this weekend?
>> Barbara: I saw my granddaughter,
which is always a lot of fun for me,
and we put up our Christmas tree.
Are you putting up a tree?
>> Leanna: I haven't yet but I'm going to.
>> Barbara: Fantastic, that was a really nice conversation
that went back and forth back and forth okay?
Terrific, let's move on now and I want to work a little bit more
on your voice and how loud you are.
Sometimes you're a little too loud and that's way up here
if we look at the scale and sometimes it's really hard
for me to hear you, you tend to get too quiet, okay?
Somewhere in the middle is what we want most of the time, okay?
>> Leanna Okay.
>> Barbara: So I'm going
to demonstrate this a little bit to you.
I'm going to say a sentence and I'm not going to tell you
which one I want you to tell me if it was too soft,
just right, or too loud.
>> Leanna: Okay.
>> Barbara: You ready?
Okay. Hi, Leanna, how are you?
>> Leanna: That one was too loud.
>> Barbara: It was too loud wasn't it?
How did it make you feel?
>> Leanna: Made me a little uncomfortable.
>> Barbara: Yeah, and I think that's what happens
when people don't use the right tone of voice.
If it's too loud or too soft, people, you know,
they get uncomfortable with that.
Okay, how about this one?
Hi, Leanna, how are you?
>> Leanna: I'd say that one was too soft.
>> Barbara: That's right, you're exactly right.
You're getting really good
at determining whether something is too loud or too soft.
So let's see now if you can produce it in the right way.
I want you to ask me how am I and I'll tell you
if I thought it was too soft, too loud, or just right.
>> Leana: How are you, Barbara:
>> Barbara: That's was pretty good.
It was a little bit soft.
I'd put it right about in here.
I'd like you to try again and see
if you can get it a little bit closer to the just right.
>> Leanna: How are you, Barbara?
>> Barbara: That was very nice.
That was just the right level.
Can you do one that's too loud?
>> Leanna: How are you, Barbara?
>> Barbara: That was really loud, good.
You're really getting good at judging
and producing these; that's terrific.
Thank you.
>> Alright, Leanna and Barbara thank you very much
for being us we appreciate it.
And we thank you for watching this interview on speech therapy
after TBI, a service
of the Brain Injury Guide and Resources.