Incidence and Referral for Management of Communication Complaints in Mild Traumatic Brain Injury

Abstract

Research Objectives To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Design Pre-post design. Setting Outpatient specialty clinic. Participants Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Interventions Survey completion at first visit and discharge. Main Outcome Measures LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Results Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. Conclusions A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways. Author(s) Disclosures We have no conflict of interest to disclose. To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Pre-post design. Outpatient specialty clinic. Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Survey completion at first visit and discharge. LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways.