A1. Opening Plenary: Traumatic Brain Injury: Effects on Hearing, Memory, and Cognition
Anthony Cacace, PhD, CCC-A
Duration: 62 minutes
Review the diverse range of injuries caused by blast trauma, and explore the various imaging techniques currently used to research the physical and functional impact of traumatic injury on the brain. The importance of using a modality specific model when assessing auditory processing disorders in this population is emphasized.
After completing this session, you will be able to:
- describe the various “invisible” injuries incurred by blast trauma
- describe state of the art imaging methods that better describe the subtle changes that occur in brain tissue following blast trauma
- explain why a comprehensive model is necessary when considering the auditory processing symptoms observed in patients with head injury
A2. Overview of TBI: Symptoms and Classifications
Kyle C. Dennis, PhD, CCC-A
David W. Chandler, PhD, CCC-A
Duration: 62 minutes
Expand your knowledge base with an operational definition of TBI, an overview of injury and symptom classification, descriptions of various mechanisms of TBI, and detailed roles of audiologists and speech-language pathologists in the care of patients with mTBI.
After completing this session, you will be able to:
- identify the mechanisms and typical symptoms associated with TBI
- identify at least two areas of controversy in mTBI
- describe the roles of audiologists and speech-language pathologists in the identification, treatment, and management of mTBI
A3. Traumatic Brain Injury and Auditory Processing Disorders
James W. Hall III, PhD, CCC-A/SLP
Duration: 80 minutes
Patients with TBI are at considerable risk for peripheral and central auditory system disorders. This session reviews existing behavioral and electrophysiologic procedures for the identification and assessment of patients with auditory processing disorders (APD), secondary to TBI-related central auditory nervous system dysfunction.
After completing this session, you will be able to:
- list risk factors for auditory processing disorders in persons with TBI
- list behavioral procedures for assessment of APD in persons with TBI
- list electrophysiological procedures for assessment of APD in persons with TBI
- identify three techniques for management of APD in persons with TBI
A4. Hearing Dysfunction After Brain Injuries From Explosions
Carlos G. Tun, MD
Anne Hogan, AuD, CCC-A
Duration: 61 minutes
Since the fall of 2001, approximately 1.65 million U.S. troops have been deployed in Iraq. Traumatic brain injury as a result of explosive blasts has been described as the most common type of injury in this war. Moreover, a review of recent clinical findings shows that a significant percentage of soldiers report hearing dysfunction following their deployment. You'll review data from Boston VA Audiology and Polytrauma clinical research, and consider recently developed tools for assessment of brain injuries used in the field and in hospital settings.
After completing this session, you will be able to:
- list characteristics of hearing conditions caused by TBI as a result of warfare
- discuss assessment tools use by the VA for the diagnosis and classification of TBI, and the management of these patients using a "polytrauma team" approach
- explain the difference between TBI in the civilian population and injuries sustained during warfare
A5. Evaluation of Auditory Processing Disorders
Dennis J. McFarland, PhD
Duration: 68 minutes
Testing for APD has evolved into an overly simplistic activity that evaluates individuals with a battery of tests recommended by experts. Evidence for the reliability and validity of these tests is often meager. One way to validate tests of perceptual dysfunction is to demonstrate that effects are modality specific. Validation must also consider what types of real world problems are predicted by the test scores in question. These issues are particularly relevant to the complex pattern of effects associated with TBI.
After completing this session, you will be able to:
- discuss the nature of auditory and cognitive sequela to TBI
- describe the problems inherent in differentiating between auditory and cognitive effects of TBI
- evaluate the utility of tests for APD in the TBI population
A6. An MRI Protocol for Acquired Brain Injury: Susceptibility Weighted Imaging (SWI) and Diffusion Tensor Imaging (DTI)
E. Mark Haacke, PhD
Randall Benson, MD
Duration: 74 minutes
MRI provides a means to non-invasively probe the structure and function of the brain, and thus is an important means for studying patients with mild, moderate, and severe TBI. Susceptibility weighted imaging (SWI) and diffusion tensor imaging (DTI) are newer approaches used to image TBI, which are proving to be much more sensitive to TBI than conventional imaging. In this session, SWI is shown to reveal microbleeds, subarachnoid hemorrhage, deep perforator hemorrhage, increased venous prominence, and correlation of microbleeds with neuropsychological outcome, while DTI is shown to reveal diffuse or multifocal axonal injury.
After completing this session, you will be able to:
- recognize the role SWI data acquisition in MR imaging of TBI
- explain why SWI is sensitive to tissue damage in TBI, and under what circumstances SWI might improve diagnosis of TBI tissue damage
- discuss how DTI reveals injuries caused by stretch and shear, triggered by acceleration and deceleration mechanisms
A7. Neuropsychological Evaluation of mTBI
Aditya Bhagwat, PhD, ABPP-CN
Duration: 75 minutes
Review the process used at Walter Reed AMC for the diagnosis, evaluation, and treatment of mTBI. Topics include: the utility of the clinical interview for diagnosing mTBI, cognitive domains evaluated as part of a neuropsychological evaluation, specific instruments used for evaluation in each domain, differentiation between symptoms of traumatic brain injury and psychiatric illness (PTSD), and the referral processes used to optimize treatment for patients with traumatic brain injuries.
After completing this session, you will be able to:
- diagnose mTBI based on mechanism of injury and injury characteristics
- discuss the cognitive domains assessed in a neuropsychological evaluation, and detect deficits commonly associated with mTBI
- differentially diagnose symptoms related to psychiatric illness versus mTBI
A8. Principles of Human Memory: Considerations for Assessment and Treatment in mTBI
Fofi Constantinidou, PhD, CCC-SLP
Duration: 68 minutes
Memory impairment is one of the most common sequalae resulting from mTBI. Current theoretical models can be implemented to obtain thorough and reliable information on important aspects of memory (e.g., working memory, long term memory, and prospective memory). Other cognitive processes such as executive functioning, attentional mechanisms, and categorization abilities are discussed in light of their contribution to memory performance.
After completing this session, you will be able to:
- discuss current theoretical models of memory
- select memory assessments that relate to contemporary theories of memory
- integrate results of memory assessment to diagnose memory deficits in mTBI
A9. Windows to the Brain: The Neuropsychiatry of TBI as It Relates to Audiology and Speech
Robin A. Hurley, MD, FANPA
Duration: 66 minutes
This session covers the basics of mTBI from a neuropsychiatric perspective. Behavioral, emotional, and cognitive deficits that can occur after an injury are explored, as well as the basics of a TBI patient work-up, and how psychiatric symptoms can change an audiology and speech assessment and treatment plan.
After completing this session, you will be able to:
- identify basic emotion/memory and behavior circuits
- summarize the basic relationships of audiology and speech to behavior/emotion circuits and brain injuries
- describe why and how brain injuries can affect behavior, speech, and language
- describe how to change SLP assessment and treatment plans to account for psychiatric symptoms
A10. Managing Cognitive Impairments After mTBI: The Speech-Language Pathologist's Role
Mary R.T. Kennedy, PhD, CCC
Duration: 92 minutes
Speech-language pathologists have a rich history of providing cognitive rehabilitation services to individuals with TBI, but mTBI presents unique challenges. This session focuses on the SLP's role within an interdisciplinary team, highlighting structured interviews and hypothesis-driven assessment. Individualized treatment of everyday problems is discussed, with an emphasis on instructional approaches that capitalize on executive functions.
After completing this session, you will be able to:
- describe the role of the SLP in the context of the management team
- identify how assessing cognitive-communication disorders in individuals with mTBI differs from assessing these areas in individuals with more severe injuries
- select dynamic assessment techniques that lead to therapy goals
- describe how relative cognitive strengths of individuals with mTBI can be used to assist individuals with temporary or more permanent cognitive-communication problems
A11. Mild Traumatic Brain Injury and Tinnitus
Paula J. Myers, PhD, CCC-A
James A. Henry, PhD, CCC-A
Tara L. Zaugg, AuD, CCC-A
Duration: 69 minutes
Audiologists must be prepared to identify those at risk for mTBI or mental health problems, justify the need for screening and/or clinical referral for further evaluation of TBI and/or posttraumatic stress disorder (PTSD), and adapt tinnitus clinical assessment and management practices to this population. The effectiveness of different interventions varies from individual to individual, and none have been shown to be effective in all patients. Because tinnitus can be caused by many conditions, the approach to tinnitus management is interdisciplinary and progressive.
After completing this session, you will be able to:
- describe the Progressive Audiologic Tinnitus Management (PATM) framework
- describe common symptoms associated with mTBI
- describe how to modify tinnitus assessment and management protocols for adults with mTBI
A12. Vestibular Consequences of mTBI
Faith W. Akin, PhD, CCC-A
Duration: 62 minutes
Examine the vestibular consequences of mTBI: incidence of benign paroxysmal positional nystagmus secondary to head injury, evidence for loss of vestibular function related to mTBI or head injury, and postural instability related to mTBI. Includes a brief overview of vestibular anatomy and physiology, and a review of clinical vestibular assessment techniques.
After completing this session, you will be able to:
- discuss the incidence of dizziness in patients with mTBI
- discuss preliminary evidence for the effect of mTBI on vestibular function
- discuss evidence for the effect of mTBI on postural stability
A13. Vestibular Rehabilitation for Veterans With mTBI
Kim R. Gottshall, PhD, PT, ATC
Duration: 63 minutes
This session examines disorders of the balance system, particularly those seen with mTBI. Since treatment relies on rehabilitation, the fundamentals of vestibular rehabilitation are discussed and hypothetical treatment plans provided.
After completing this session, you will be able to:
- describe the basic physiology of the vestibular system
- list the basic disorders seen in active duty individuals with mTBI and balance disturbances
- develop an approach to treating balance disorders in active duty individuals with mTBI
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