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Micaela Cornis-Pop, The ASHA Leader (page 2 of 2) Page 2 of 2
At the PRCs, SLPs are members of the core polytrauma teams and have standing orders to assess cognitive-communication and swallowing functions within 24 to 48 hours of admission and then to treat the patients as indicated throughout their stay in rehabilitation. Initially, clinicians may participate in structured sensory stimulation, or may help establish basic communication, which could involve gestures or use of communication aids.
Swallowing and voice production are other important initial goals. As patients progress, SLPs begin to address functional communication, orientation to environment, attention, and memory skills. Behavioral issues, including agitation, aggression, and psychological trauma related to the war experience and adjustment to disabilities, may interfere with treatment plans at this stage of recovery. SLPs have to be knowledgeable about management of such problems and be able to work together with the treatment team, including the patient's family, to minimize their impact and duration.
With higher-level patients, speech-language treatment will concentrate on community and/or academic re-integration and may include goals related to pragmatics of verbal communication, attention and executive function skills, and compensatory strategies for organizational and memory problems using planners and electronic prosthetic devices.
Guidelines Underway
At the request of the VA Audiology and Speech-Language Pathology Field Advisory Board, clinicians from the PRCs and WRAMC have started working together to develop best practice guidelines for assessment and treatment of persons with polytrauma. In the past six months, these clinicians have been collecting information regarding principles and procedures for the assessment and treatment of polytrauma sequelae, including emergence from minimal responsiveness; functional communication; attention and memory disorders; problems with executive function, awareness, and pragmatics; visual impairments; prescription and training for assistive technology; and a model for comprehensive audiologic evaluation for polytrauma.
Results of this project will be disseminated to SLPs and audiologists working in the VA through upcoming professional conferences. These best practice guidelines, however, are relevant to SLPs and audiologists working in a variety of settings in communities throughout the country as the war injured return home and seek service beyond the VA and military treatment facilities.
When patients leave the PRCs, 77% of them go home. Some are almost fully recovered, but for others swallowing may still be a milestone. When he was discharged from the Richmond PRC, Sgt. Wade had made remarkable progress, but a long road to recovery was still ahead. At first he spent a few months in rehabilitation in a VA long-term care program, after which he went home with Sarah. They were married last year and have made rehabilitation a family affair ever since. There is continued need for services which they receive at the local VA Medical Center, at WRAMC, and at a private facility in their community. They both feel that retired Sgt. Wade continues to make progress and that without rehabilitation progress might stall or even reverse.
Since our last phone call, Ted and Sarah Wade have returned from their ski trip with renewed energy and continued determination, believing their lives are a work in progress. The VA's PRCs also remain works in progress, sharing lessons with one another and with the major military hospitals by videoconferencing and by pushing clinical care to address the myriad, often invisible, effects of explosive blasts.
Micaela Cornis-Pop is a speech-language pathologist and Rehabilitation Planning Specialist in the VHA/PM&R Headquarters at the HH McGuire VAMC in Richmond, VA. Contact her at Micaela.Cornis-Pop@va.gov.
From Blast injuries: A new kind of patient for speech-language pathologists by M. Cornis-Pop.. The ASHA Leader, 11(9), 6-7, 28. Copyright 2006 by American Speech-Language-Hearing Association. Reprinted with permission. All rights reserved. www.asha.org/about/publications/leader-online/archives/2006/.
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