[Approximately 15-20% of patients with concussion/mTBI have persistent cognitive symptoms up to six months or longer. Problems with working memory, divided attention, processing speed, and executive functions are common (Belanger & Vanderploeg, 2005; Mott, McConnon, & Rieger, 2012; Rabinowitz & Levin, 2014). Patients often report how these problems negatively impact communication. Although neurocognitive tests are frequently used to identify persistent symptoms, perhaps tests that not only assess cognition but also communication would be better at identifying functional deficits. Patients with 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., 2011; Cornis-Pop et al., 2012). Cognitive-communication is the relationship between cognition and its influence on verbal and nonverbal communication (ASHA, 2007). Current therapies for concussion/mTBI have limited empirical evidence supporting their use (Cornis-Pop et al., 2012). The working hypotheses are: 1) screening tools for cognition and communication given at two and four weeks post-injury will identify persistent symptoms of concussion/mTBI. 2) Subjects with persistent deficits one month post-injury who receive early cognitive-communication therapy, once a week for four weeks, will report positive changes based on pre- and post- therapy functional outcome scores.
The Specific Aims are: 1) Screening measures: Determine if the SCAN-A Competing Sentences subtest, the FAVRES Sequencing subtest, the WJ-III Tests of Cognitive Abilities Visual Matching 2 subtest, and/or the RBMT (3rd edition) Story- Immediate and Story-Delayed Recall administered at two and four weeks post-injury will be able to predict persistent [cognitive and communication symptoms. 2) Therapy: Pre- and post- therapy scores on the Awareness Questionnaire will assess the effectiveness of cognitive- communication therapy with an early therapy group as compared to a delayed therapy control group. Therapy will target working memory strategies, executive function and divided attention, environmental changes, and identification of problematic cognitive-communication situations.] Significance: [Results of this study will increase understanding in the use of cognitive and communication tests to identify persistent symptoms related to concussion/mTBI and provide information about clinical trials for early cognitive-communication intervention.]
This study is relevant to public health because 1) findings may predict which patients are at risk for persistent cognitive [and communication] symptoms after concussion/mTBI and 2) knowledge will be acquired regarding early cognitive-communication therapy and how it can affect outcome.
