McHenry, M. & Wilson, R. (1993). The challenge of unintelligible speech following traumatic brain injury. Brain Injury, 8(4), 363-375.
Type of
Study
Case study
Subjects 1 male; age 34; 9 years post-injury
Diagnoses Severe TBI with drug addiction pre-injury and psychotic issues post-injury
Speech
Condition
Moderate-severe communication impairment with severe auditory comprehension and intelligibility deficits, moderate expressive language and pragmatic deficits
Purpose To determine treatment strategies given the premorbid characteristics, physiological and cognitive deficits, and psychosocial variables for a single subject
Methods Speech production therapy 1 hour a day 4 days a week for 8 months
Optimized physiological system-bilabials, palatal lift

Behavioral management-rate reduction with pacing board

Function therapy-hierarchy in 5 levels from initiation of function phrases and multisyllabic words to unstructured conversation with an unfamiliar listener

Self-monitoring
Results Pacing board helped intelligibility and speaking rate
Refused wearing palatal lift

Subject ended therapy
Treatment
Implications
Consider pre-morbid personality, physiological status, cognitive deficits, and psychosocial history.
Sequence of treatment: optimize physiological system to maximize behavior therapy, use functional contexts and not meaningless drills, allow patient to make decisions about therapy participation and use of strategies.
 
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