Arguments in favour of Traumatic
Brain Injury (TBI)
and Degenerative Diseases.
Traumatic Brain Injury (TBI)
 TBI can occur as a consequence of a focal impact
upon the head, by a sudden acceleration or
deceleration within the cranium, or by a complex
combination of both movement and sudden impact.
 In addition to this primary injury, secondary injuries
may occur minutes, even days following the injury.
 TBI can be categorised as mild, moderate or severe
by the Glasgow Coma Scale.
Prevalence
 1 million- minimum estimate of people in the UK living
with long-term effects of TBI
 558- UK residents per 100,000 sustaining a brain injury
(1/200)
 Every 90 seconds- someone is admitted to hospital in the
UK with TBI
 353,059- UK admissions to hospital with acquired brain
injury between 2011-2012
Risk Factors
TBI is a condition that any of you could experience, at any time, without any
predisposition.
On top of this, the highest incidence of TBI is 15-24.
Males are twice as likely to have TBI, however, when matched for severity the
prognosis of females is worse.
Although categories of mild, moderate and severe are derived from the
Glasgow Coma scale, alone, these cannot predict the long term effect of TBI.
Instances of TBI is greater in lower socioeconomic groups.
Thinking more globally, the prevalence of TBI in developing countries is
increasing significantly. This is due to the rate of automobile use increasing
much faster than safe infrastructure on which to drive.
Symptoms
 Aside from the communication and social aspects we
have touched on, such as impaired executive functioning,
there are many more consequences.
 Physical impairments, such as loss of co-ordination.
 Sensory impairments, such as loss of smell, taste or sight.
 Mood and personality changes which may lead to a loss
of self for both the individual and their friends and
family.
Degenerative Diseases
 Degenerative diseases are a result of a continuous process
based on the degeneration of cells, affected tissues or organs
deteriorate over time.
 Strongly linked with age. Currently 16% of the European
population is 65+ and expected to each 25% by 2030.
 Therefore, the prevalence of degenerative disorders will
increase.
 Degenerative diseases may be genetic, or a result of medical
conditions such as alcoholism, a tumor or stroke. Others may
be a result of viruses and often the cause is unknown.
Commonly cited diseases and prevalence
 Alzheimer's- 850,000 people living with dementia in
the UK alone. Expected to rise to £2 million by 2051.
One person diagnosed every 3 minutes. That is 325
so far today….. Majority of cases not inherited, but
family history of the condition is a risk factor.
 Parkinson's- 127,000 people in the UK. A suspected
genetic element.
 Huntington's- 10,000 people in the UK. Inherited
faulty gene.
Quality of Life
Some examples:
TBI, Parkinson’s Disease and Dementia
TBI (1)
 Work implications (returning to normal life)
 Tested a number of areas including
speaking under time pressure
 Production of oral language
 Verbal reasoning


Result – 85% of time successfully predicted whether someone
was in employment.
Isaki, E. and Turkstra, L. (2000) Communication abilities and work reentry following TBI. Brain Injury 14 (5) 441-453.
TBI (2)
 Living with cognitive communicative difficulty
following TBI
 Concluded that

communication difficulties plus memory problems, fatigue and
irritability = “unsatisfactory interpersonal relationships”.
O’flaherty, C. and Douglas, J. (1997) Living with cognitive-communicative
difficulties following traumatic brain injury: using a model of interpersonal
communication to characterize the subjective experience. Aphasiology 11 (9)
889-911.
TBI (3)
 Carer impact…
 Study assessed impact of 5 different disabilities
arising from head injury (1 of which was speech and
language)
 Looked at 2 measures:


caregivers’ ‘perceived stress’
‘strain’
 Results for – Speech and language link for both
stress and strain (statistically significant for ‘strain’)
Connolly, D. and O’Dowd, T. (2001) The impact of the different
disabilities arising from head injury on the primary caregiver.
British Journal of Occupational Therapy. 64 (1) 41-46.
Parkinson’s Disease
 NICE guidance – CG35
 SLT “should be available”
In particular LSVT (or similar)
 Speech intelligibility
 Effective communication (e.g. AAC)
 Swallowing

Dementia
 RCSLT position paper on dementia
 Key area relating to QoL:
Specific assessment of dysphagia
 Reduce stress on caregivers – by providing management strategies
 Assessment of consent to treatment
 Reduced social exclusion

• RCSLT (2005) Speech and Language Therapy for people with
dementia. London, RCSLT.
Current provision/ initiatives for TBI
 Inpatient rehabilitation-
- A prospective study looked at 3 inpatient centres between 1989
and 1996. Patients received a MDT approach with physical,
occupational, psychological, and speech therapy. It found that
increased therapy intensity potentially
enhances outcomes (Cifu et al, 2003).
- Another study looked at patients with aphasia after TBI who were
admitted in the post-acute phase for a late inpatient rehabilitation
programme. They found all functional, cognitive and language
scores increased significantly, suggesting inpatient rehabilitation
may even be beneficial at later stages (Demir et al, 2006).
Current provision / initiatives for TBI
 Community based SLT:
- 52 people with TBI who were at least 1 year post injury,
received 12 weekly group sessions (1.5h each) working on
social communication skills. All patients had improved
social communication compared to controls, which was
maintained at 6 months post treatment (Dahlberg et al,
2007).
Current provision / initiatives for degenerative
diseases
 Dementia
Asking every hospital to appoint a ‘dementia champion’- It
has been found there is now a shift towards more positive
and person-centred approach and participants’ perceptions
about dementia being challenged and altered (Alzheimer
Scotland, 2014).
Providing online dementia training resources- over 377,000
NHS staff have already received Tier 1 dementia training
(Department of Health, 2015).
Current provision / initiatives for degenerative
diseases
 Parkinson's disease-LSVT has the most evidence of effectiveness (Ramig et al,
2007). 90% of people with hypokinetic dysarthria will show
improve in speech and voice after LSTV (Theodoros et al,
2006).
- Noble et al (2006) found that 80% of patients with Parkinson's
disease felt SLT had helped them, but around 43% of patients
have no contact with SLT services (Miller et al, 2011)
- This shows that although there is effective treatment, there
needs to be better access to this provision.
References
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Alzheimer Scotland, (2014). Evaluating the impact of the Alzheimer Scotland Dementia Nurse
Consultants/Specialists & Dementia Champions in bringing about improvements to dementia care in acute
general hospitals http://www.nes.scot.nhs.uk/media/2711490/impact_evaluation_-_executive_summary.pdf
Cifu,D.X., Kreutzer,J.S., Kolakowsky-Hayner,S.A., Marwitz,J.H. and Englander,J., (2003). The relationship
between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis. Archives
of Physical Medicine & Rehabilitation, 84, 1441-1448
Dahlberg,C.C., Cusick,B.A., Hawley,M.S.W., Newman,J.K., Morey,C.E., HarrisonFelix,C.L. and Whiteneck,G.G.,
(2007). Treatment efficacy of social communication skills training after traumatic brain injury : a randomized
treatment and deferred treatment controlled trial. Archives of Physical Medicine & Rehabilitation, 88, 1561-1573
Demir, S.O., Altinok,N., Aydin,G. and KÃseoglu,F., (2006). 'Functional and cognitive progress in aphasic patients
with traumatic brain injury during post-acute phase. Brain Injury, 20, 1383-1390.
Department of Health, (2015). Dementia. https://www.gov.uk/government/policies/improving-care-for-peoplewith-dementia
Noble, E., Jones, D., Miller, N., and Burn, D., (2006). Speech and Language therapy provision for people with
Parkinson's disease. International Journal of Therapy and Rehabilitation , 13 (7) 323-327.
Miller, N., Noble, E., Jones, D., Deane, K., and and Gibb, C., (2011). Survey of speech and language therapy
provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives.
International Journal of Language & Communication Disorders., 46 (2). 179-188
Ramig et al, (2007). Intensive voice treatment (LSVT®) for patients with Parkinson’s disease: a 2 year follow up.
Journal of Neurology & Neurosurgical Psychiatry, 71, 493–498
Theodoros et al, (2006). Treating the speech disorder in Parkinson’s disease online. Journal of Telemedicine and
Telecare, 12, 3, 88–91
Speech and language therapy:
a long-term investment
UK – NHS – we all contribute to it.
Cost to the NHS: TBI - £4.9 bill; Dementia
- £19.1 bill; Multiple sclerosis - £2.3 bill;
Parkinson’s disease - £2 bill (Imperial
College London, 2013).
Speech and language therapy – prevent
later, potentially avoidable expenditure.
Malcolm’s story
Idiopathic Parkinson’s disease.
Speech deterioration due to lack of speech
therapy.
Issues with self-esteem -> social isolation > depression -> unemployment.
Costs on different levels
Financial implications for Malcolm and his
wife.
Relationship problems.
NHS paying for clinical psychology,
counselling, medication.
State benefits an additional cost.
Preventable?
Early speech and language therapy input.
Benefits of speech therapy to Malcolm:
improved breathing, clearer, louder speech
-> more confident -> improved relationship
-> independence.
Financial benefits on micro and macro
level.
Pre-emptive
Local health services can save £20,000
yearly with coordinated approach to
Parkinson’s disease – includes speech
therapy (National Institute of Clinical
Excellence, 2006).
Therefore – pre-emptive approach with
these types of illnesses -> avoid later costs.
Long-term investment that pays off.
Conclusion
A broader picture of Traumatic Brain Injury
 Thomson et al’s (2000) Cochrane review reported that cycling
helmets redcued the risk of brain injury by 88%
 Vehicle safety laws have significantly reduced rates of TBI in high-
income countries
 In the US, firearms are the leading cause of TBI with a survival rate
of 9%
 Contrast this with the UK, where fall-related incidences are the
leading cause, and survival rates are 89%
 This may not be a case for funding, or relevant to speech therapy,
however, it may be an interesting point to raise to the NRA.
Traumatic Brain Injury
As mentioned the costs of TBI are vast and long-term
and have both a micro and macro affect.
Speech and language therapy has proven to better
equip individuals post-TBI for autonomy. In turn this
reduces the cost to society, increases their contribution
to the economy and in doing so, reducing the
likelihood of depression.
Degenerative Diseases
 In terms of Parkinson’s, speech therapy has proven
able to increase the volume and clarity of individuals
speech. This has a significant impact on their ability
to communicate effectively and enable socialisation.
 Speech therapy can enhance the QOL of those with
degenerative diseases. Equally, if confidence is
maintained the likelihood of them staying in work is
increased.
REMEMBER
Any one of you, at any point, particularly if you are
between 15-24 could get TBI. So think of this not only
as an investment into healthcare but as an investment
in yourself.
Wear your helmet (hair-met)