There is an interesting phenomenon often observed in brain injury survivors who were bilingual to the extent of fluency prior to their injuries. In these survivors who have post-injury language deficits the first (native) languages tend to return more quickly and fully than do their second languages. This is true even in survivors who were fully fluent in a second language and used that second language extensively in their everyday lives. As TLC is located in Texas, our staff tends to observe this phenomenon most often in Spanish-English bilingual patients. Many of these patients now contending with language difficulties who learned English later in life find it far easier to name objects or follow directions when Spanish is used, while prior to their injuries they would have been comfortable using either language.
This return of the first language sooner than a second language can have a number of practical consequences. Many survivors understandably become frustrated at an inability to speak that second language with the same skill once demonstrated. Being bilingual is often a point of pride and may have previously allowed the survivor to excel in activities (such as import-export business transactions) that the average person could not. This sudden significant skill gap may even prevent these survivors from returning to jobs in which a second language was utilized as a vital portion of everyday business life. Moreover, if the survivor was previously the primary translator for the family this may cause difficulties in the family’s ability to interact with the outside world. For example, the survivor may have previously served as point person to get information from school regarding a child’s performance as that survivor could easily speak to school officials (and the rest of the family may struggle with casual exchanges in English). If the survivor is now unable to converse fluently in English, the family may now face significant problems interacting with the school.
There are also practical therapy concerns when a survivor struggles with a second language if that second language is the primary language used in the larger community. In America, English is obviously the dominant language. As such, most pre-therapy evaluations are conducted in English. There are a limited number of health care professionals who are comfortable conducting evaluations in another language. However, if a survivor’s first language is not English and that survivor is significantly stronger in his or her first language, that first language will need to be the language used in evaluations so as to get the most accurate measurements of the survivor’s skills. The same is true in therapy. If a survivor understands therapy directions significantly better in a first language, then therapy should be conducted in the survivor’s first language. Additionally, therapists should always inquire as to which language is used in the home. If the survivor’s first language is different than the language used at home (seen when someone who speaks both Spanish and English marries a spouse who only speaks English), then that second language will need extra focus or alternative methods of communication (e.g. pictures or hand signals) may need to be introduced. At TLC, we have a number of Spanish-English bilingual staff and have a contract with a translation service if other help is needed. Overall, rehabilitation professionals must be aware of survivors’ language skills and adjust evaluations and therapy accordingly.
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Posted in Learning about Brain Injury, Working on Skills
Tagged acquired brain injury, aneurysm, aphasia, bilingual, brain, brain injuries, brain injury, evaluation, head injury, injuries, language, rehabilitation, stroke, tbi, testing, therapy, traumatic brain injury, treatment, verbal
One of the primary components of any treatment strategy engaged in the aftermath of a brain injury is neuropsychological testing. It also tends to be the least understood of the various post-injury evaluations. This entry will aim to clarify what is, and is not, neuropsychological testing.
Neuropsychological testing is designed to assess all of the cognitive (thinking) skills that can be impacted by an injury and outside factors (such as fine motor speed) that may influence these cognitive skills. It will be administered by a licensed neuropsychologist or a neuropsychologist’s assistant and tends to last for several hours. It provides a “snap-shot” view of the patient’s current cognitive functioning in order to help guide treatment. Testing will generally include the following domains: memory, attention, executive functioning (reasoning, problem-solving, processing speed and mental flexibility), visual-spatial understanding, language capacity, orientation, basic motor dexterity and mood. Areas such as academic achievement and personality functioning may also be assessed. By attaining familiarity with the patient’s cognitive strengths and weaknesses, the neuropsychologist is able to more effectively direct cognitive rehabilitation and to advise staff tasked with addressing other rehabilitation specialties as to how cognitive skills may impact the patient’s participation in those therapies. For instance, it is important for a physical therapist to know the severity of a patient’s attention deficits as this will effect the patient’s safety when walking in the community.
There are a few misconceptions that patients will often have regarding neuropsychological testing. One misconception that patients commonly face is believing that the way in which results of neuropsychological evaluations are compiled can be considered as roughly equivalent to what they remember of school-based testing. In school-based testing, scoring is used as an entirely objective measure. Getting 90% of answers correct earns an “A”, 80% a “B” and so forth. In a neuropsychological evaluation, scoring is approached from a much more subjective and nuanced perspective. Neuropsychological evaluation scoring is instead based upon how individuals of similar age and gender (and on some tests, race and education) to the patient generally do on the same tests. Patient results are not scored based on a school grade system, but in comparison to how people who are akin to the patient generally score on such tests. As such, the neuropsychologist does not expect a 70 year-old patient to perform at the same level as a 20 year-old. The real question is how does that 70 year-old patient perform in comparison to other 70 year-olds? It is possible that answering 60% of the questions correctly on a particular neuropsychological test is a perfectly normal result for the particular subject being tested. Under the school-based testing method though, such a score could only represent a failure.
Another misconception sometimes held by patients involves believing that the tests will show how smart (or not smart) the patient is. After a severe brain injury, neuropsychologists often use portions of more widely-utilized intellectual evaluations but will tend to look at them very differently than those usually assessing the same results. Rather than being interested in an overall intellectual score, a neuropsychologist is interested in how the patient performs on each of the individual test sections. For instance, how did the patient perform on visual attention assessments as opposed to those for visual reasoning? Furthermore, as more severe brain injuries often effect one part of the brain more than another, a general intellectual score may not provide much useful information. One typical illustration of this dynamic involves a survivor severely injured on the left side of the brain. As a result of this specific injury, he or she may do poorly on those sections assessing verbally-based skills but do perfectly well when required to rely solely on visually-based skills. It would be illogical to simply take the average of the performances on these wholly distinct sections of the test and call that a “true” marker of overall functioning. It is clearly better then to consider the verbal and visual skill levels separately.
Hopefully this post helped somewhat to clarify neuropsychological testing!
Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org
Posted in Learning about Brain Injury, Working on Skills
Tagged abi, acquired brain injury, aneurysm, brain, brain injuries, brain injury, client, concussion, disability, evaluation, exam, galveston, lubbock, misconception, neuropsychological, neuropsychologist, patient, recovery, rehabilitation, stroke, survivor, tbi, test, testing, therapy, tlc, traumatic brain injury, treatment