Speech pathology assessment of language and cognitive-communication following traumatic brain injury and developmental language impairment: a survey of international clinical practices

Abstract

Cognitive communication disorders subsequent to a traumatic brain injury (TBI) or a developmental language impairment (DLI) are two cognitively and linguistically different disorders. Speech Language Pathologists (SLPs) play a pivotal role in maximising the long-term educational, vocational, psychosocial, and social outcomes for the individual with such a disorder. Despite this acknowledgement, little is documented from an international perspective about the current assessment practices of SLPs in TBI or DLI. Assessment practices of SLPs in language and cognitive communication were compared across three clinical groups: adult TBI, paediatric TBI and DLI. Online survey methodology was utilised to investigate the SLPs’ use of communication assessments as well as their perceptions of the utility of communication assessments in clinical practice. Specific information was obtained from SLPs working in paediatric TBI and DLI about the use of one specific standardised developmental language assessment: the Clinical Evaluations of Language Fundamentals Fourth Edition (CELF 4). Results highlighted that SLPs working in adult TBI placed more focus on functional communication and tools for cognitive communication disorders whilst also using aphasia assessments incorporating word and sentence-level tasks. SLPs working in both paediatric TBI and DLI focused on receptive and expressive language. They also used the same tool e.g. the CELF 4, which specifically uses subtests measuring core, receptive and expressive language. There was little difference between SLPs working in either TBI or DLI populations in how the tests were used. Although discourse was not routinely assessed by any of the SLPs, when it was conducted, it was done informally via a conversation with the client and no data collection. The findings from the study highlight the need for standardised clinical guidelines in the assessment of language and cognitive communication disorders. Education about cognitive and linguistic difficulties specific to TBI is highlighted for SLPs with less clinical experience in this area. Additionally, assessment tools that target skills beyond traditional word and sentence-levels tasks are required in order to inform the SLP about the strengths and weaknesses of an individual’s communication skills.