Positive outcomes: The Intensive Cognitive-Communication Rehabilitation Program for Young Adults with Acquired Brain Injury

(as published in American Journal of Speech-Language Pathology)

As a clinician, I’m always excited to learn about new treatment protocols and programs, and the Intensive Cognitive-Communication Rehabilitation Program at Boston University (BU) is no exception. The program focuses on young adults with acquired brain injury, and really hits home for me with its focus on practical and functional speech, language, and cognitive therapy.  

Read on to learn more about the results BU scientists Natalie Gilmore, Katrina Ross, and Dr. Swathi Kiran gleaned from the program thus far, and pick up a few tips you might be able to use in your therapy plans right away.

Program goals of the Intensive Cognitive-Communication Rehabilitation Program

• More and more young adults are falling victim to acquired brain injury (ABI), and this can significantly interrupt their academic progress both in high school and college.
• Currently, much of the support offered to young adults following an ABI focuses on job skills; however, college holds significant benefits too, including opportunities for problem-solving, peer interaction, and increased independence.
• Cognitive Rehabilitation is the current gold standard for treating ABI’s – it is either impairment-based (working on discrete skills such as attention) or functionally-based (working on more compensatory skills such as using a memory book).
  • Currently, there are few cognitive rehabilitation programs specifically focusing on helping young adults with ABI return to college, and even fewer programs with a holistic approach that includes psychosocial, environmental, and personal factors.
• The team at BU designed a program that relies on existing evidence and best practices, creating the holistic approach that young adults need to successfully return to academic instruction.
  • Four questions the study sets out to answer:
    • Do participants demonstrate changes in cognitive-linguistic skills as a result of this novel intervention?
    • Do participants improve in their classroom participation over time?
    • Do participants progress toward therapy and personal goals over the course of treatment?
    • Do participants demonstrate changes at the activity and participation levels, as well as changes to their quality of life (QOL), as a result of this program?

The takeaway – we need more programs that support young adults with ABI in returning to or initiating post-secondary education, and those programs need to include not only best practice cognitive rehabilitation but also be functional. 

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Method

• Participants – six individuals with ABI were enrolled, four male and two female, with ages varying from 18 to 34, and varied years of education and time post ABI; however all had an ABI after the onset of adolescence, and all were interested in post-secondary education but had cognitive and/or linguistic deficits that had previously made that impossible.
• Standardized assessments utilized:
  • Western Aphasia Battery – Revised (WAB-R) – assessed language function
  • Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) – assessed cognitive function
  • Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN) – assessed cognitive and linguistic skills
  • Discourse Comprehension Test (DCT) – assessed narrative level language 
  • Child and Adolescent Scales of Participation (CASP) – assessed participation at home, school, and in the community
  • TBI Quality of Life or Neurologic Quality of Life subtests – assessed communication, anxiety, positive affect and well-being, and cognitive function
• Program design
  • Participants completed both functional, academic content courses, utilizing online material with support, as well as speech-language-cognitive therapy as the impairment-based complement.
    • Academic content ranged from personal finance to psychology courses, obtained through open-source instruction.
    • Speech-language-cognitive therapy focused on attention, memory, executive functioning, auditory comprehension, verbal expression, reading comprehension, written expression, motor speech, social pragmatics, and/or augmentative-alternative communication, with short and long term goals designed based on case histories, client and caregiver reports, and formal testing.
    • Students also commuted to and from school as any typical college student would.
  • Each treatment phase consisted of a 12-week semester, for a total of 3 semesters, with patients receiving treatment 4 days per week at 6 hours per day with a 1-hour lunch break.  
  • Additional training included metacognitive therapy and technology skill training, including but not limited to training in Microsoft Office, Google Suite, and Constant Therapy.
  • Treatment data was collected through classroom performance and weekly quizzes.

The takeaway – participants worked with therapists and research assistants to not only target classic speech, language, and cognitive goals, but also worked on applying metacognitive and technology strategies in a simulated classroom environment.

Program results

• As the number of semesters participants completed increased, so did their scores on standardized assessments.
• All four experimental participants made statistically significant gains on at least one standardized assessment.
• Attendance was strong, and participants’ attendance increased over time.
• By the third semester, participants demonstrated more positive behaviors in the classroom setting (such as asking appropriate questions) than negative behaviors (such as asking inappropriate questions).
• All participants who did at least a full semester in the program were targeting more complex SLP goals by the end of the program relative to their initial goals.
• Participants who completed multiple semesters of the program also improved their school participation and improved on at least one aspect of their quality of life measures.

The takeaway – the participants made improvements! The improvements weren’t just on assessments, but also in terms of behavior and psychosocial availability for the school environment. One of the participants is now even enrolled in community college AND sought out supports at the community college to make sure of continued success. I call that a win!

Conclusions

• We need more programs and support for young adults with ABI to return to college, and this program was an exciting first step in that process, relying not only on classical speech, language, and cognitive therapy but also on functional applications and strategy acquisition.
• Given the small sample size, these results should be interpreted with caution, and the methods should be studied with a larger, more diverse sample size, hopefully including more sites and possibly including neuroimaging as another measure, and could eventually include exploring the effects of neuromodulation such as through using transcranial direct current stimulation (TDCS).

To learn more

• Check out the recent publication The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain Injury in the American Journal of Speech-Language Pathology.

Reference

Gilmore, N., Ross, K., & Kiran, S. (2019).  The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain Injury.  American Journal of Speech-Language Pathology, 28, p. 341-358.  Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30453329.