Traumatic Brain Injury and Swallowing: A Descriptive Study of Current Speech Language Pathologist Practice and Patient Outcomes in a Model Systems Rehabilitation Center

Traumatic brain injury (TBI) has many effects on its survivors, and has been recognized in previous research as a predisposing factor to dysphagia. Dysphagia, which is difficulty or inability to swallow food and/or liquid, can lead to many associated problems such as malnutrition, dehydration, pulmonary fibrosis, aspiration, pneumonia, decreased quality of life, and death. Speech language pathologists often address the dysphagia of TBI survivors housed in inpatient rehabilitation hospitals with a variety of treatment and therapy techniques. Little research, however, has addressed the efficacy of therapeutic techniques for swallowing disorders. This study describes and examines the practices of speech language pathologists concerning swallowing issues at Dodd Hall Rehabilitation Hospital. Data was extracted from approximately 115 TBI patients’ medical records who were hospitalized at Dodd Hall Rehabilitation Hospital in a 1 year period. Data regarding the injury severity, type of assessment, and therapeutic treatment was recorded for the 10 patients that received swallowing evaluations and interventions and was compiled into a database. The data was analyzed to address questions of what type and severity of swallowing problems were present in patients with TBI, what type of swallowing evaluations and therapeutic practices were provided to these patients, what relationships existed between treatment and functional independence measure (FIM) scores, and what relationships existed between severity of TBI and functional independence measure scores. The results of the study provide descriptive statistics about clinician practice and swallowing outcomes for patients with TBI. Fewer than 9% of the TBI patients presented with swallowing impairments, and all of those patients presented with impairments at multiple stages. Evaluations used to assess swallow function were the clinical bedside evaluation, the modified barium swallow study, and the fiberoptic endoscopic evaluation of swallowing. There were 8 different interventions offered for swallowing, and the patients received a mean of 13 sessions. All subjects’ functional independence measure scores improved by a mean (SD) of 2.8 (2.36), but the data lacked strong correlations to specific treatment variables. Further research is needed to draw conclusions regarding the efficacy of treatment variables, and to use the results of this study to provide preliminary exploratory data for designing a prospective study of the efficacy of various therapeutic techniques for patients with TBI. This research would provide clinicians with evidence for specific treatment strategies, and allow them to better serve TBI survivors.College of Arts and SciencesCollege of Social and Behavioral SciencesNo embarg