Early speech-language pathology screening can aid in timely referral and treatment for memory, attention, organization problems post-concussion

By Sravya Valiveti. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Recent findings from a study published in American Journal of Physical Medicine and Rehabilitation rThis article was initially published in our Concussion Update newsletter; please consider subscribing.evealed that using a speech-language pathology screening checklist may prove beneficial in predicting the need for a speech-language pathology referral for pediatric concussions. Study authors Jessie Oldham et al. revised an “internally developed emergency department tool” into a brief, 13-question yes/no checklist. This checklist may help providers address problems associated with memory, attention, and organization early in the recovery period following a concussion. (Speech-language pathologists provide cognitive rehabilitation for concussion patients.)

The authors collected data from 60 concussion patients (age 18.3 ± 4.0 years) to evaluate predictors of a physician referral to a speech-language pathologist after a concussion after using the screening checklist. The screening checklist consisted of five domains––attention, memory/organization, social interaction, word finding, and executive function––with a few brief questions per domain, for a total of 13 questions. Results showed that providers referred 26, or about half, of the patients (43%) to SLP in their initial concussion treatment plan. Those who scored high in the symptom areas for attention and memory/organization domains were more likely to be referred to a speech-language pathologist; over 90% of the patients who received referrals reported these symptoms. 

Below is the checklist; these are yes/no questions, and patients are asked to note if the symptoms are new after their concussion:

• Attention

• Trouble with attention in busy environments

• Appear lost or confused when switching activities 

• Trouble maintaining attention to class or homework 

• Memory/organization

• Forgetting homework/chores/losing items

• Grades dropped/trouble studying

• Speed it takes to complete tasks has changed

•  Social interactions

• Changes in behavior, emotional, or irritable behavior 

Changes in friendships or relationships

•  Word finding

•   Call people/objects by the wrong name

• Struggling to have a coherent conversation

•  Executive function

• Difficulty with safety judgment

• Difficulty problem-solving or making decisions

• Issues impacting their day and/or success in school 

The study authors note that the patients would benefit from receiving a timely referral to a speech-language pathologist from their physicians as part of their initial concussion treatment plan to ensure early intervention and follow-up. The authors also highlight that speech-language pathologists are sometimes not involved in TBI treatment early on, and referrals to a speech-language pathologist are not provided to patients unless they’re experiencing significant symptoms of concern during recovery.  

In conclusion, a speech-language pathologist checklist can be a valuable diagnostic tool to help identify patients needing a referral to SLP. In addition, proactive involvement of speech-language pathology in TBI treatment can help address issues related to attention, memory, and organization early on and promote recovery in patients.