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Paul Rao: Traumatic Brain Injury & Representative Gabrielle Giffords' SLP Care

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Uploaded on Feb 4, 2011

http://www.asha.org/SLP/clinical/TBI/

Dr. Paul R. Rao is president of the American Speech-Language-Hearing Association and vice president of in-patient operations and compliance at National Rehabilitation Hospital in Washington, DC. He is also a visiting professor at the department of hearing and speech sciences, at the University of Maryland. Dr. Rao discusses tramatic brain injury, and Representative Gabrielle Giffords' likely rehabilitation treatment.

TRANSCRIPT

Paul R. Rao:
"You know, after a brain injury, what can we predict with a speech-language pathologist and a person with brain injury?

Well first off, there are about five million people who have had brain injury in the community. Of that, 10 percent are the penetrating kind, similar to what Representative Giffords experienced. Let's talk about the person with traumatic brain injury, in general. They will have intense speech-language pathology for a variety of problems. It might be what we call dysphasia or swallowing disorders; it might just be dysarthria, which is a speech disorder, being able to understand what the person is saying; and then obviously the language and communication of that individual, their cognition, thinking, memory, awareness. All of these things are gonna be worked very intensely in individual and group, and acute rehab, which is four to six weeks. And then she will move to a day program, in which case she will have intense PT, OT, neuropsychology, speech-language pathology—coaching her on how best to get back into the community with all of her skills. And then finally, she will be in a fairly long regime—six to nine months—as an outpatient. This is in general. Now we don't know. Representative Giffords might be three months, might be six months, nine months. But we do know this, the traumatic brain injury is a life-long recovery, and it's a stair step recovery. She will progress, she will stabilize and plateau, she will progress. And the neat thing is these folks are gutsy, they are survivors, like our wounded warriors. They are making tremendous gains against tremendous odds.

The duration of treatment for speech-language pathology in rehab, typically...she is in the acute rehab phase. So she will be at TIRR (Texas Institute for Rehabilitation [and Research]) between four and six weeks, getting therapy six days a week from a speech-language pathologist. And then she will move to a day program, where she will receive daily treatment, PT, OT, and speech five days a week. And then that typically is four to six weeks. And then a long duration of outpatient speech therapy. So we're looking at least a year of intervention where we're working on attention, language, thinking, awareness, memory—all of these things that constitute what this huge brain is all about.

The manner that a speech-language pathologist works with a traumatic brain injured person is complex. She's now in a four to six week acute rehab program, where PT, OT, and speech-language pathology are working in an interdisciplinary fashion. So much of this is treating together, plus the one-on-one where we're working with the Representative, trying to improve on the language, the cognition, the thinking, the memory. An important component of brain injury rehabilitation is group. So Representative Gifford will be with three or four other individuals who have suffered similar injury. And the family will be part of this intervention as well. Family is key to see what's happening in therapy, and then carry over those language and communication skills at home."

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