COGNITIVE ASSESSMENT TOOL IN YOUNG T.B.I. PATIENTS
- IOANNA PATIOU
- COLCHESTER 2004
The speech therapist who is involved in the creation of the appropriate assessment tool must operate with a plan. A plan of assessment will set boundaries to the specific techniques and the proceedings for intervention, which should be applied to every patient individually. The assessment plans are subjected to some rules:
- “1) To determine whether there is a problem that needs further assessment and intervention.
- 2) To determine the content/form/use/goals of intervention that is to indicate what the patient needs to learn and what should he be able to learn about language.
- 3) To suggest procedures of intervention, to indicate the factors that need to be taken into account for the child to be able to learn language skills more efficiently.
- 4) To determine what kind of progress can be expected in an intervention program in contrast to progress made without such a program.” ( Lahey 1998, pp 124)
Moreover in order to plan effective assessment tools, the speech therapist needs information about the patient’s language-including the use, the form, the content- and the role that the family and the friends play in the life of the language impaired person. The choice of the intervening programme will depend on the nature and the stage of recovery. This part of planning is the most important since a careful and successful intervention is crucial for the rehabilitation.
We should also mention the fact that all the kinds of assessment tools should be characterized by reliability, validity and sensitivity…
As far as it concerns the TBI, “the first measure normally applied is a scale indicating depth of coma, called Glasgow Coma Scale”. (Rose & Johnson 1996, pp 54) This scale of measurement is the most common used, although there is a great number of other scales which have been developed in order to assess the patient’s progress from coma to recovery. But, we should also bear in mind that “ the TBI patients are often not capable of meaningful cooperation in the first weeks or months post injury.” (Lezak 1995, pp191)
One assessment tool may differ from another, since the first may focuses on syntax, while the other one on lexicon, or on phonology or in any other area.
A stage of disorientation and confusion follows the TBI patient when he emerges from coma. Although several attempts have been made in order to find the appropriate assessment tools and measurements for this stage, it still has not been found an effective solution. The most used scale is the GOAT which measures the cognition and the awareness.
In this assignment we will try to plan an assessment tool for the particular area of cognition for young TBI patients, since a cognitive assessment, includes aspects of memory, learning, attention, reasoning, verbal and organizational abilities. So we suggest the following assessment tool:
The speech therapist reads a story from a book e.g. tale, like this one: “Once upon a time there was a young television, who was feeling very bored. So she decided to go for a walk in the forest. She was very happy because she was feeling free and relaxed. She started jumping and dancing. But her antenna was caught in the branches of a tree and fall down. The young television didn’t realize what had happened and kept on walking into the forest. When she realized that she had lost the most precious part of herself, that the antenna was missing, she started crying as loud as she could. Some children heard her cries and asked what had happened to her. When the young television explained why she was so unhappy, the children immediately began to look for her antenna, as they wanted to help her. And they did it! They found it and put it back above the young television. She thanked all of them and returned back to her house very happy.”
After this narrative story the speech therapist can make questions to the young patient which will be related to the tale in order to realize if the story had been understood e.g. Why was the young television unhappy?, Who helped her?, What happened afterwards?, How the story ends?, etc. Then the speech therapist can ask the patient to retell the tale using as much details as he can.When finishing with this exercise the speech therapist can present to the patient, different coloured pieces of paper which will show scenes from the story and ask the language impaired child to put them in the correct order so as to have a sequence. Furthermore he/she can also ask to give him/her the red card, or the yellow one, etc, while describing what is shown in the card. In addition to this he/she may asks the patient to describe the exact position of a certain card. For example: “Where is the red card?” –and the child will have to say: “It’s between the green and the blue card”.
In another exercise the speech therapist can have in pieces of paper drawings which will be related to the story, for example: a tree. Then he/she will show the picture to the child and will ask to name it. He/she can do it with many different drawings and pictures. Moreover, he/she can make in alternative exercise, write down sentences from the tale with a space, in order the young patient to try to find the word which is missing. It’s like the word finding exercise.
Lastly, the speech therapist can show to the patient a complicated abstract drawing, where the child will have to distinguish and find the relevant characters from the story. A drawing like that is the one presented in the next page. For example he may distinguish an antenna in the picture and he has to point it out to the speech therapist.
With all these exercises the speech therapists can reach to many interesting conclusions about the language impairment of the young child. First of all, he exams the cognitive level of the child, if the tale has been completely understood – what it was about? – and if the child comprehends the speech. Secondly, he/she provokes the child to speak, to express his/her ideas and his/her opinion, and reveal the verbal abilities he/she has in order to find out what “are the language impairments and speech problems, since such exercises provide information about how effectively the subject perceives and integrates the elements of the tasks”. (Lezak 1995, pp 543) It
Moreover, the speech therapist has the chance to examine the organizational and memory abilities of the child since exercises like the one where the patient has to put the pictures in the correct order, can offer important information about this section of investigation. Furthermore, he/she can realize if the child is able or not to pay attention and follow a conversation.
Also the speech therapist can check the perceptual abilities or disabilities of the language impaired child in order to plan the therapy for rehabilitation that most suits to the patient. Lastly, he/she can exam the vocabulary and the word finding problems which may underlie pragmatic difficulties.
Of course, all these exercises will be measures with a scale beginning from 0 grade until 5 grade and it will indicate the severity (5 grade) or the good language ability (0 grade) of the child.
This assessment tool which we presented is limited to the particular area of cognitive function, although it includes memory, verbal, learning, perceptual, organizational exercises. But all these parts are basics for a complete and full cognitive assessment.
We hope with this new assessment tool, to shed new light upon the heated debate subject of the TBI assessment and open new avenues for further investigations and more effective rehabilitation. A better understanding of the nature of TBI need to be established in order new assessment tools to be developed.
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