Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: I look at research a lot, especially during the initial stages of treatment.&nbsp; One of the biggest things - and this is for community reintegration - is functional outcome measures. What does a patient need to do to be a productive member of society?&nbsp; Do they want to return to work?&nbsp; Do they want to return back to school or run their household as they did prior to their brain injury? These are all functional and are able to be worked on within speech pathology sessions.&nbsp; One of my idols in the therapy world is Sarah Barr of Honeycomb Speech Therapy, and she is great for coming up with tests and ideas for functional needs for patient-centered care. Evidence-based practice for the goal-plan-do-review-model is used by many different disciplines, not just speech pathologists.&nbsp; But this works on being able to select a goal, coming up with the plan to achieve it, and then identifying the barriers that could arise and then actually executing the goal. This is great for giving a patient time to reflect on what could have gone better, what would they have done differently, are there any strategies that I should introduce. This is one of the most valuable tools that I use with patients who are about to or have returned to work or school or their normal daily activities. I use this at least once a day with my patients.

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;&nbsp;That is such a deep question for me. I read a lot of research and out of all the research that I've read from the beginning of becoming a therapist until now, there are two things that really stick with me. One is a documentary I mentioned last week about neuroplasticity. There were children who were five years old who were having severe seizures, so severe that they couldn't function. They couldn't go to school and their seizures were life-altering. In order to treat them, they did surgery that took out half of the brain that was being affected by the seizures. They put a filler into the skull and left the other half intact. They finished the surgery, did rehab with the kids, and then sent the kids on their way. They came back and followed up with the kids five years later, so now they're all 10 years old and you could not tell the difference between those children's function and the other children who hadn't had that surgery.&nbsp;&nbsp;To me, that is just so poignant. Both as a therapist and as a mom, I can't imagine making the choice to send my kids to have that sort of surgery. Then, knowing that their brains were able to heal and recreate all of these pathways to be able to do everything a “normal kid” can do with half a brain to me is just amazing. As a therapist, it gives me so much hope for the recovery that we can make these injuries. This was possible all because of neuroplasticity. The way our brains work is that one-half of the brain controls a certain number of functions as well as the opposite side of the body. You would think that if you took out half of it, it would be like recreating a stroke. However, what they found was that especially because they were kids and they were such young little brains, their brains were able to reprogram and rewire. They could create pathways so that they could use their whole body.&nbsp;Another one that sticks with me and that scientists continue to do research on with the answer continuing to remain the same relates to patients that have had strokes. There are so many of these articles out there and I could mention many of them, but they do a lot of research around stroke. The biggest reason is that there are a lot more similarities amongst patients who have had strokes as far as their function goes. In the way they clinically appear, brain injury can become very diverse. Brain injury can look so many different ways, which makes it harder to do standardized research. In the article I read, these patients that have had strokes were given a certain number of tests. We call them objective measures, and they put the patients through a certain number of tests and look at their performance six months after stroke, one year after stroke, five years, and ten years. Now, they're doing research up to 20 years post-stroke, and they are showing that if you send patients to physical therapy and you have them do exercises that are specific to them and their needs, these objective measures will improve. This means that even 20 years later, they can do exercises and still improve upon their performance from five, 10, and 15 years ago.&nbsp;&nbsp;Again, that just really validates my job and really makes me feel good about when I'm “torturing” patients and they're complaining that they're tired. I’d say “okay, well we have a goal and so we have to do what we have to do to reach these goals, and that means me pushing you”. A lot of research will show you that you cannot just do exercises that are comfortable, easy, and gentle. We have to really put patients into uncomfortable positions to see these gains, but the gains are there to make, so that really drives me every day when I work with a patient. It also I think validates that no matter what your age is, you can still be making improvements many years later. The children are maybe one thing because they have young brains and correct me if I'm wrong on this, but stroke survivors I think tend to be a little bit older. As neuro therapists, we are still bound by the same insurance regulations and the same productivity regulations in the clinic. Sometimes progress in neuro patients is slower, so I have to stand up for my patients and say this is why we need to work on this. When I say stand up I mean to the insurance companies and corporate leadership and I have to be able to explain myself and show this progress. It can be a downer when you're trying to just do what you think is best for your patients, but reading research like that and actually seeing progress, for example, patients saying I haven't been able to get in the bathtub for years and yesterday I took a bath, is just such a driving force for me and keeps me excited about my job.

Senior physical therapist

Speech-Language Pathologist

What recent research has inspired you the most and changed how you practice as a physical therapist?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: Yes, as a speech-language pathologist, I work with patients on cognition. What I work on depends on where you are in your recovery.&nbsp; If you’re newly injured after a brain injury, speech-language pathologists will take a rehabilitative approach - that's where we target skills directly through more structured tasks. For attention, for example, there's attention process training - a whole system to follow to order to build up attention.&nbsp; There are short term and working memory exercises, direct coaching, direct feedback, errorless learning - where that feedback is almost instantaneous so they can correct the actions. Later on in recovery, we tend to move toward the compensatory approach to treatment.&nbsp; That means finding the strategies that will improve functioning in daily life.&nbsp; There are two sets of those strategies.&nbsp; The first is external - like implementing a calendar or a planner to help to recall appointments, charts to manage bills, writing notes, to-do lists, sticky notes, memory journals, things like that.&nbsp; Then there are the internal strategies which happen inside of you. That can be associations you can make to help recall people's names. For instance, if you met someone at a friend's house whose name is Tony and he was tall, that's “Tall Tony”.&nbsp; These strategies can help you to remember their name later. Many things center around a goal-plan-do-review model.&nbsp; That is for patients that I help to set reasonable goals with their input.&nbsp; They will plan how to accomplish that goal, reflect on it, execute it, and follow through with the task.&nbsp; I feel that's really helpful to improve awareness and also self-esteem, knowing that you're able to accomplish a goal after you planned it out. Family involvement is also key for that, especially with working on functional skills.&nbsp; The therapist can't be in the home 24 hours a day, so I coach families through some things and provide homework or activities that they can do within the home. I’ll also help patients to establish systems like timers on the stove so you don't burn your food or introduce the planner and make sure that they fill it out. I also recommend just engaging in cognitively stimulating tasks at home, but know your limits so you don't overdo it, take breaks to prevent overload and cognitive fatigue.

Answer transcribed from <a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank">Brightway's interview with physical therapist Susan Little</a>: ﻿It's definitely not the bread and butter of my practice as a physical therapist. When I lecture to students, I always laugh that I need books of cognition for dummies because it's not the main part of my therapy. The main part of my education with brain injury covers recovery cognition rules. If you can imagine somebody at a very low level of responsiveness, as a physical therapist, I sure as heck am working in the context of my therapy on their ability to follow verbal commands and their ability to respond to commands as that individual progresses through their recovery. This includes challenging them from a memory point of view in the context of my mobility tasks, such as having them go on a scavenger hunt where they have to remember the items in the list. Just like how as you're going into the grocery store, you might have to remember that you need peanut butter, bread, and milk, they need to work on their memory while they're working on their mobility.&nbsp;In a brain injury team, we cross disciplines often. I don't pretend to be an expert on cognition, that's the rest of my buddies in my “village”. I'll ask the occupational therapist how our client is doing with their vision and if I give them this challenge with their walking, is that a difficult but doable thing to do. I'll ask the speech therapist if it’s reasonable for me to ask them to work on a certain memory or language task in the context of my mobility tasks. My point being is we work together. None of us are experts in all of the areas required for recovery from brain injury. We all have our area of expertise but we lean on each other and incorporate all of those challenges because it takes a village to encourage recovery and to maximize recovery from brain injury.&nbsp;&nbsp;I would say that the speech therapist or the neuropsychologist are the two that do most of the cognitive rehab. I have to say occupational therapy as well will work an awful lot on incorporating those skills with activities of daily living. Again, we cross the lines, but if I had to name the expert, I would say the speech therapist and the neuropsychologist. The second place would be the occupational therapist. Way down in tenth place would be the physical therapist but we do our best.

Physical Therapist

Absolutely. As a speech-language pathologist, one of the questions I answer during an initial assessment is if the person's ready for cognitive therapy. Neuroplasticity lets us view our brain as a muscle, so to work on cognition we want to exercise our cognitive abilities and challenge ourselves - it should be difficult. I use a lot of puzzles like deductive reasoning puzzles, which targets many cognitive processes.&nbsp;It looks sort of like a sudoku.&nbsp;Process of elimination is used to solve the puzzle, and there are some views that are presented that are straightforward, and some that are more difficult.&nbsp;So we're looking for the brain to make connections and eliminate something that's unnecessary and get to the answer. I also do mental manipulation.&nbsp;For example, alphabetizing random words.&nbsp;So I would give you apple, cat, banana, and would ask you to put them in alphabetical order.&nbsp;Or if I give you three numbers, you would put them in the correct order.&nbsp;Mental manipulation or mental flexibility is computation of a problem. You could do numeric computations or work with words to tap into the memory and processing. We also work on abstract reasoning and inferencing, deductive reasoning, divergent reasoning, and convergent reasoning.&nbsp;For example, I might be asking a patient to name as many items belonging to a specific category given one minute, like as any as many animals as you could think of in one minute.&nbsp;And we always start from simple and concrete and move to more complex and abstract. Problem solving and cause and effect are needed for daily living, so these get incorporated into all of our exercises.

speech language pathologist

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/11%3A-recreational-therapy-for-cognition-with-clinical-specialist-marlene-rivera" target="_blank">Brightway Answers interview with clinical specialist Marlene Rivera</a>: Yes, recreational therapists do address cognitive issues. When we think about free time management, what we're doing is evaluating an individual's cognitive capacity to effectively manage their free time.&nbsp; We may be looking at their ability to effectively engage in a specific recreation and leisure pursuit, as your cognition may be impacted in how you're able to successfully participate in these activities.&nbsp; There are also individuals who have a difficult time generating ideas about what they want to do. We look at what kind of compensatory strategies we can introduce to help with these things. It may be presenting individuals with written information, it may be communicating in a different way.&nbsp; Initially we will conduct an assessment and based on the outcome of that assessment, a recreation therapist will test and implement maybe some adaptive equipment or compensatory strategies that match an individual's current interests and their current abilities.

Clinical Specialist

Do you address cognitive issues as a therapist? If so, what do you do?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: I'm going to focus on the speech and language side of this question, but check out my answer about cognitive symptoms to learn more about how to improve memory. I’ll start with the language side first.&nbsp; To work on receptive language (that's the understanding of language), speech-language pathologists can target simple directions all the way to multi-step, complex directions depending on the level of where you are at the time. For expressive language, we use lots of visual supports and supported conversation when strategies can then be established.&nbsp; I’ll also pick apart things that are motivating and functional in your environment - we're not going to be working on basketball terms when you might have no knowledge of basketball. Some of the more descriptive areas - for word finding in particular - is through semantic feature analysis.&nbsp; This is the ability to use semantic features or meanings of words to assist in accessing the actual word.&nbsp; For instance, if you're having difficulty finding the word “dog”, you may able to get to it by saying “it has four legs, it barks, it's a man's best friend” - “oh, that's a dog”.&nbsp; Another area in word finding is VNST, which is verb network strengthening treatment.&nbsp; This focuses on verbs or action words to help formulate full sentences, and there's a wide protocol to help train individuals and their caregivers in in these areas. Speech pathology has a role in training caregivers to be supportive communication partners and I feel this is really important, especially in those early stages of recovery.&nbsp; A speech-language pathologist will strategize and come up with a lot of things to implement in any setting.&nbsp; And all of these skills can be carried over into the home environment.&nbsp; A tip that I usually tell families of those I work with is to keep conversation going.&nbsp; It can be socially isolating following a brain injury, so being able to practice speech language or cognitive skills in a functional setting - whether it's at home, at a doctor's office, at a restaurant - can be so helpful and meaningful.

Apps like Tactus Therapy, Lumosity, Brain HQ and Constant Therapy are definitely something to try. We also have something called the WALC series - this is a series of cognitive rehabilitation books - there's WALC 1 through 10.&nbsp; They specialize in different speech and language areas and different cognitive areas.&nbsp; I would recommend WALC 2, 3, 9, and 7.&nbsp; The PDFs are free to download - you can just google “WALC books”.

Answer transcribed from <a style="background-color: rgb(255, 255, 255);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/2%3A-dr.-thomas-franz-pt-2" target="_blank">Brightway's interview with Dr. Thomas Franz</a>: I don't have a particular online therapy that I endorse or that I have worked with extensively enough to say that oh you ought to go to this website or use this app. Although I'm working with some people to develop some that may be useful in the future, I don't have a particular site that I endorse right now.&nbsp;There have been a lot of these that have been developed over the years and what I would say is look at the ones that are out there. If they have you practicing real-world tasks like recalling a grocery list or taking you through some sort of simulation of a shopping trip, things you might do in your actual life, those are going to be more useful than just memorizing lists of words or playing video games. This is because what we do know is that you get better at what you practice, so if you practice memorizing and reciting lists of words that's the skill you develop. If you practice playing a video game, and unless that video game has some grounding in a real-world task, you're just getting better at playing the video game. You want something that has a connection to what you want to do in your day-to-day activities to make it translate to what we call generalized. You want to pick a task that will help you with the cognitive things you want to do in your day. Similarly, you wouldn't try to strengthen a weakened leg by working your thumb because that would be very little benefit. It might strengthen your thumb but it's not going to help you with the task at hand.

Division Director PM&R

What online or other type of therapy that can be done at home do you recommend to stimulate memory and speech?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: This is really important.&nbsp; First of all, when you come into the speech office for a session with me or another speech-language pathologist, we do what's called script training.&nbsp; This could be preparing a patient for a trip to the doctors office, or calling a local business for more information, or ordering off of a menu at a restaurant. We would be able to rehearse those scripts so you’d know what to expect and how to role play in those different areas.&nbsp; And these scripts can be used in a variety of settings. The next step would be actually going and doing those things. We can go out into the community and put the training to the test.&nbsp; My job as a speech-language pathologist allows me to travel with clients to doctors offices, coffee shops, grocery stores, etc to practice those skills in real time. Joining a support group can do wonders for social stimulation and self-esteem as well. At home, just being able to know how to call friends and family, or to write emails professionally if you're planning to return back to work or school.&nbsp; Texting with friends is a big one that I help my patients quite often with - how to respond appropriately to text messages - I feel like we can all use that sometimes. There are always ways to work on both the social aspect of communication as well as the language and cognitive part. One of the big things I do and also encourage family members to do is to provide honest but constructive feedback.&nbsp; Offering suggestions without sounding too pushy.&nbsp;&nbsp; I also provide visual or verbal cues that can signal breakdowns in communication.&nbsp; I have a few clients that don’t want to be told up front that they did something wrong, but a little sign or a hand wave to know that they may have had a breakdown in conversation and they can try to repair it. That goes along with awareness too.

Who did you see?  What was it like?

Has anyone done therapy to work on social skills?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: Here are a few suggestions based on how I work with my patients. The first thing to consider is what vocabulary would be most useful for your friend and to relate it to their hobbies, like food they like, music, past job, or experiences that you had together.&nbsp; Use that as a starting point to develop a list of words throughout the time spent with them.&nbsp; If it's on a zoom call you can use a whiteboard or a word document to write the words as you go so that this person can refer to them as needed for the rest of the conversation. You can always have google available - I use google a lot in each session to look up pictures to support the communication. Visuals can help with recall which is really nice. Some favorite games and activities that I use: Categories is a huge one - you can play it online for free.&nbsp; I use that a lot for virtual appointments for those who have to work on word finding. There's a game called Anomia, and then Catchphrase as well.&nbsp; Those are three that I really enjoy.

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;I love this question. I see a lot of my patients in this, so there are so many games that already incorporate communication without even knowing it. There are a lot of games where you come up with a word in a category, games like Five Second Rule Topple that can be really fun, so coming up with a category name. Keep in mind that if your friend gets stuck during these games, maybe ask if they might want clues first and then give clues to words that can be supportive to them. Let's say your category is food. Tell them “I'm thinking of a red fruit” and maybe if that's not helping, offering up that it's something that starts with an “A” so we're giving the initial sound of the word.&nbsp; There are a lot of games like Catchphrase and Taboo, where you're describing a specific word, which is actually a strategy that a lot of speech therapists teach to help with word finding. You can incorporate speech into a lot more games than you think. I think even games you don't normally think of, for instance playing Uno and making a new rule that every time you play a card, you have to name the cards. You have to say what color it is and what number. Another really great game is Go Fish. The whole premise of Go Fish is that it's like structure, repetition, and matching. This can be really helpful and supportive to somebody with a brain injury and somebody that's got difficulties with communication. I think no matter what game you choose, trying to start out by removing any parts of the game that might cause extra pressure, like time constraints and buzzers, is always a big helpful tip. I never want to cause pressure in a situation where somebody's having difficulty with their communication. But again, I think you can incorporate it into anything that you want. Just focusing on that aspect of repetition can be really supportive.

My friend had a bad accident a couple of years ago. I talk to her a few times a week, but she doesn't remember many words.

Is there a way I can help to enrich a survivor’s vocabulary in a fun way?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: Every brain injury is completely unique in the way that they recover and how long it takes to recover.&nbsp; There's no set of instructions for recovery, so unfortunately I don't have an exact answer to how long this would take. There are different types of awareness.&nbsp; The first one is intellectual awareness - so knowing that there is a problem.&nbsp; The second is emergent awareness, which is knowing why a problem occurred. There's also anticipatory awareness, which is knowing that a strategy can help. Every task and every skill level may be different but those are the different types of awareness that you can push for through recovery. It’s also worth focusing on what motivates your husband.&nbsp; Does he need more education on brain injury and how it can affect his behavior or his cognitive functioning?&nbsp; Does he need more strategies introduced, like alarms on his phone or sticky notes as reminders? Sometimes just being honest and reviewing his strengths and challenges can help.&nbsp; Those are all tips and tricks that can help with the awareness piece.&nbsp; Being able to explain things in a concrete manner - and as much as you may sound like you're a broken record - I would suggest repeating the challenges but also the strengths to make sure to capitalize on his strengths. I wouldn't say awareness can necessarily be sped up.&nbsp; There are different areas where we can introduce a task and have someone estimate how they will do on it.&nbsp; For instance they'll say they’ll get 100%, I can do the task with no problem, but then they do the task and get 40%. That will probably not make them very happy, but might bring about some awareness.&nbsp; But this is something I don't do very often because it causes anger and frustration, which can be counterproductive.

I'm four years post TBI, I have fully accepted my memory deficit and to some I am still a bit "in denial" about the extent of it. But the pushing him to do things is good, I believe we need so much encouragement to do things at times. But what has helped me some, especially during my early recovery was being on a stimulant, i currently take Adderall and they started me out on Ritalin.

My guy is eight months post accident. He’s just starting to realize the seriousness of what happened. However, there are days that he just refuses to except he is injured. And that he needs to heal.I have found it very helpful, to have clinicians tell him where he’s at, and how he is doing. It seems to have more of an Effect that if we tell him. Is your guy a member here? He might find it helpful.My guy has found it helpful reading other people’s posts, when they’ve had an accident kind of like his, to realize how far along he has come. Good luck

My husband is 11 months post TBI. So far, I think he is still in the Denial phase - he doesn’t see that he has severe memory and cognitive issues. And from what I understand, he can only get better after he becomes aware of his deficits , and starts using strategies to compensate for those. Right now he is very passive in his recovery , and I have to constantly push him to do brain exercises that speech therapist gives him. Otherwise, he could be just sitting on the couch watching videos on his phone all day long ....(

I have a question about AWARENESS - how long does it take to get to that phase of recovery?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: This happens quite a bit in my current position as a speech-language pathologist.&nbsp; We have a lot of long-term survivors - two, three, ten years post brain injury, so they switch therapists a lot.&nbsp; That can be frustrating but it can also be a positive thing - it's almost like a breath of fresh air with new treatment ideas, new areas that they might want to work on. I do a thorough case review prior to the patient’s first appointment. I’ll review progress notes from the last speech pathologist, their recent neuropsychological reports, and feedback from other clinical team members.&nbsp; When I meet the patient, I’ll summarize the case history as much as possible instead of having them repeat their case history again to me. I then ask them or the family member if there's anything specific that is missing. Motivational interviewing, a person-centered approach to assessment, is also important to make the patient feel heard.&nbsp; During treatment I give open-ended questions like “what is important to you?”, “what are your goals?”, “what do you want to improve on?”, and this can guide therapy goals and sessions. Having my patient provide as much input into their therapy as possible is important - if they don't want to work on a certain goal that I have for them, I'm not going to work on that. If they don't want to get better in an area, then we'll find something else that is more meaningful to them. Motivation seems to play a very large part in how successful recovery is.

It's hard to stay engaged with a new therapist because there may be some overlap, or they focus on something tangential to what the patient wants to work on.

As a therapist, how would you handle taking over a case where a patient has worked with other therapists already?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: As a speech-language pathologist, I see a number of symptoms unfortunately but I'll talk about the most common ones. The biggest thing I look at when I first meet a patient is their attention - so are they able to focus on one thing at a time.&nbsp; It could be two minutes, it could be a half hour.&nbsp; I look at if they’re able to switch between tasks, like if you were working on an email, could you pick up the phone and call someone and then go back to writing that email after.&nbsp; There's also multitasking.&nbsp; So if you're cooking dinner, are you able to hold a conversation with your spouse or significant other? Secondly, memory is a huge component of cognitive communicative functioning.&nbsp; There are different types of memory: immediate, short-term memory, or delayed recall can be a huge challenge and then also the long-term memory side. For cognitive communication, executive functioning skills are huge, and this is where I see a lot of deficits.&nbsp; Executive functioning skills are housed right in that frontal lobe of the brain and can encompass a lot of skills: planning, initiation, problem solving, organization of thought, judgment.&nbsp; Being able to judge a situation is very important in life and often brain injury survivors aren't able to do that.&nbsp; Reasoning, impulse control, time management, and awareness.&nbsp; There’s also metacognition, which is the awareness of one's own thought processing, so like knowing what you know - and that can be a challenge too. Another big thing I work on with survivors is working memory - being able to take in information, manipulate it in your mind, and then express it in a different way.&nbsp; So for instance if you read a news article you can hold on to that information and maybe you're able to answer questions about it later - that's working memory. Two other common things are cognitive rigidity and cognitive fatigue.&nbsp; Cognitive rigidity is the inability to be flexible, so adapting to new situations or understanding the perspective of others.&nbsp; That's one of the biggest things that I see in my rehab practice.&nbsp; Cognitive fatigue is if we work a muscle hard enough we're going to tire it out.&nbsp; Our brain is like a muscle, so we can get what's called brain fog.&nbsp; I’ll talk to my patients about when to take a break and for how long in order to recover to be able to go back to what they were doing.

Let me begin by saying that I don't know if my answers are "common" and happen to every TBI victim. But I do know that I suffered from them after my own injury, and there is substantial research available online for them, so clearly the symptoms aren't solely isolated to me alone. Specifically, the first symptom is (1) memory loss. After asking I had zero memory capacity for about 5 months. Then very poor memory for up to 2 full years. Even still, 6 years later, I'm not confident my memory is fully restored. (2) The most noticeable side effects for me is my right side peripheral vision loss, so I can longer drive or play most sports. (3) Third most noticeable are muscle spasms and involuntary muscle flexion. (My left bicep, shoulder, and ring finger, as well as my jaw all flex involuntarily throughout the day, every day). (4) Perhaps most concerning for third parties is the reduced emotional control and stability. These days I can get really irritated by seemingly irrelevant, almost unnoticeable factors. What's more, during my five months of no memory, apparently I flew into uncontrollable rages for no reason whatsoever and thus alienated some of my best friends from college. (5) Lastly, I incurred seasonal allergy symptoms despite not ever having allergies to anything before. I take some OTC allergy treatmen meds that do seem like they work, so unclear if it really is allergies or not. Also I think that this last symptom is the least likely to be a common problem for TBI victims, but I bring it up because I think alterations in a person's immune response and general body functioning is likely quite ubiquitous. Hope that helps!

What are the most common cognitive symptoms caused by brain injury?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: There is a wide variety.&nbsp; There is aphasia, or the inability to understand or express language.&nbsp; This can be verbally through reading or writing, we can see difficulty following directions, and also expressing thoughts and ideas.&nbsp; Many patients that have had a brain injury have difficulty understanding figurative language and they're very literal in their thinking. Problems with word-finding are also very common.&nbsp; Along those same lines agraphia or dysgraphia can occur - this is the impairment of written language and can range from mild to severe.&nbsp; Finally, alexia which is the impairment of reading out loud or understanding written language. On the speech side, there's apraxia, which is the inability to or difficulty with coordinating muscle movements for producing speech.&nbsp; This can manifest through distorting sounds, slowing your rate of speech, or exaggerated movements, which we call groping.&nbsp; Another one is dysarthria, which is weakness in the muscles, which makes speech difficult to produce and understand. There are a variety of types, but usually we see a slurred speech, their intonation may be off, their rate / rhythm of speaking, and then some breathing difficulties as well. There's also neurogenic stuttering, which is stuttering that is caused from some sort of neurological disorder like a brain injury or stroke.&nbsp; Finally I see social communication challenges on the language side - you may have difficulty following rules of conversation, like talking too much, interrupting others, bringing up inappropriate topics, or trouble initiating conversation.

What are the most common speech or language symptoms caused by brain injury?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: There are a few things that I see as a speech-language pathologist. One is difficulty following the general rules of conversation, or what we perceive as rules.&nbsp; Some of my patients may not wait and tend to interrupt or jump in whenever they see fit, and that's not always going to fly in various settings that you're in. Sometimes talking too much or too little is a problem.&nbsp; Inappropriateness in conversation is something I see every day. Common goals I work on with my patients are to identify appropriate topics or to be able to carry on that topic without interjecting something completely inappropriate or random.&nbsp; Turn taking and not interrupting, letting others speak, and maintaining topics are also things I work on, as my patients tend to jump around a lot and introduce tangential conversation. I also see perseverations, which is where someone gets stuck on a word or a sentence or even a story and repeats it over and over again.&nbsp; Unfortunately with brain injury comes a wide range of behavioral and emotional changes as well.&nbsp; I see a lot of irritation, anger, frustration, and sometimes aggression during my sessions with patients. I also see some impulsivity - saying before thinking - and that often goes with inappropriate comments. Picking up on social cues is also sometimes a challenge.&nbsp; If someone were to cross their arms, we may think of that as being standoffish or they don't want to speak anymore, but that can be difficult for a brain injury survivor. My patients with a brain injury or who have suffered a stroke also often feel isolated and lose their friendships and social networks, so it's very important to keep those going. Besides awareness, support from friends and family members is a significant predictor of recovery.&nbsp; So you want to maintain those relationships as much as possible and reach out if you do need help. I work with individuals who are five ten you know even more years post their accident and they are sometimes still recovering socially. One of the biggest things that we try to encourage is to join a support group. Being able to at least talk with somebody is very important.&nbsp; Your local Brain Injury Association chapter would probably be a good start to find these groups.

akloessSLP's Answers