Traumatic brain injuries are most common amongst young people and can have long term consequences. The authors of this article provide an approach to management of cognitive and communication difficulties which starts with a detailed assessment using the model of cognitive communication competence which takes account of a range of domains including day-to-day communication, and support for communication partners across multiple settings. The most common cause of communication difficulties in TBI arise from underlying cognitive difficulties in areas such as attention, social cognition and memory. The latter in particular impacts on development of vocabulary. Additionally, it is important to consider individual factors such as age of onset and contextual factors incuding family support. Traditionally, interventions fall into categories of restorative, compensatory, habilitative, and functional/contextual. Interventions can also be categorised based on their level - whether they work on bottom up (fundamental processes) or top down (higher order processes). Bottom up approaches predominantly use drill-based approaches, or errorless learning. Higher order processes use metacognitive skills training or strategic learning interventions. Both approaches benefit from support in the immediate environment, and communication training for families and teachers is considered a vital component of either approach. Given the complexity of cognitive communication difficulties, it is important to plan interventions carefully and in collaboration with the MDT. This includes the person themselves, who can often prioritise their own needs better than professionals around them, even when they are a younger person with a TBI.
Planning for the long term when working with young people with TBI
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