Lea Treworgy
Lea is a clinical speech-language pathologist at Kindred Hospital Los Angeles, a long-term acute care facility that treats a high volume of Spanish-English bilingual patients. She has also worked at the California Rehab Institute, and has years of experience treating patients suffering from TBI. After working with bilingual individuals for many years, she has developed a valuable skillset, one that eases the pain of and begins the healing for people with traumatic brain injury.
Q: How do you begin an initial assessment with a bilingual patient with TBI?
A: I always like to get a thorough medical history, including interviewing the family. This way I can get information on level of education, occupation, and how long they've been speaking English. Stuff like education and occupation could give me a good idea of their proficiency in English or if I should decide to asses them in Spanish instead. Another piece of information from medical history I look for is where the site of lesion is in the brain and its severity. Depending of the area of injury we could expect what language disorders they my present with:
*Frontal cortex- deficits in cognitive skills such as emotional expression, problem solving, memory, language, judgment.
Brain stem- slurred speech (dysarthria), double vision.
Left hemisphere - aphasia and apraxia of speech.
*Right hemisphere-attention, perception, learning, memory, recognition and expression of emotion, and neglect.
*frontal cortex and right hemisphere are the two site of lesions that are most common in my experience with TBI patients.
What language do you conduct the assessment in? Is there a benefit to conducting the interview in one language over the other?
In my experience I usually always end up assessing in their native language. At the acute rehab hospital sometimes we will do both languages for those who are higher level to see if the language disorder presents in both (often times it does).
What does a typical treatment look like?
For treatment plan I start with native language, especially in the long term acute setting. For initial treatment for TBI I work on very basic stuff like orientation, short term memory, basic attention and safety. I also do a ton of family education at this point. Often times family and friends do not understand brain injury so I provide them with extensive education and recommendations (e.g. decrease over stimulation, provide quiet time, no TV/iPhone use, limit people visiting, provide time for ample sleep, keep lights dim, provide a calm and quiet environment, etc). I am fairly proficient in Spanish to provide this type of speech therapy.
At the acute rehab hospital the patient is starting to improve and is working on more complex cognitive linguistic skills like executive functioning, safety awareness around the house, money management, complex problem solving, social interaction, preparing to go back home/school/work etc. This is where we are required to offer professional translators (we have a service that has a video screen and the translator interprets the entire session in real time). Using a family member is not valid interpretation.
What type of evaluation and treatment methods do you use with bilingual patients?
Specific therapy methods that I use for bilinguals are the same for English speakers. I do admit it is very challenging, despite the use of a translator, when you are not familiar with the language. For me the second most common language I run into is Farsi. Sometimes patients do not always find a video translator helpful or find it too distracting, which is not uncommon with our TBI patients.
Evaluations I use for my bilingual patients (they are all easy to find the Spanish version online)
St. Louis University Mental Status Exam
Montreal Cognitive Assessment
Brief Interview of Mental Status
A: I always like to get a thorough medical history, including interviewing the family. This way I can get information on level of education, occupation, and how long they've been speaking English. Stuff like education and occupation could give me a good idea of their proficiency in English or if I should decide to asses them in Spanish instead. Another piece of information from medical history I look for is where the site of lesion is in the brain and its severity. Depending of the area of injury we could expect what language disorders they my present with:
*Frontal cortex- deficits in cognitive skills such as emotional expression, problem solving, memory, language, judgment.
Brain stem- slurred speech (dysarthria), double vision.
Left hemisphere - aphasia and apraxia of speech.
*Right hemisphere-attention, perception, learning, memory, recognition and expression of emotion, and neglect.
*frontal cortex and right hemisphere are the two site of lesions that are most common in my experience with TBI patients.
What language do you conduct the assessment in? Is there a benefit to conducting the interview in one language over the other?
In my experience I usually always end up assessing in their native language. At the acute rehab hospital sometimes we will do both languages for those who are higher level to see if the language disorder presents in both (often times it does).
What does a typical treatment look like?
For treatment plan I start with native language, especially in the long term acute setting. For initial treatment for TBI I work on very basic stuff like orientation, short term memory, basic attention and safety. I also do a ton of family education at this point. Often times family and friends do not understand brain injury so I provide them with extensive education and recommendations (e.g. decrease over stimulation, provide quiet time, no TV/iPhone use, limit people visiting, provide time for ample sleep, keep lights dim, provide a calm and quiet environment, etc). I am fairly proficient in Spanish to provide this type of speech therapy.
At the acute rehab hospital the patient is starting to improve and is working on more complex cognitive linguistic skills like executive functioning, safety awareness around the house, money management, complex problem solving, social interaction, preparing to go back home/school/work etc. This is where we are required to offer professional translators (we have a service that has a video screen and the translator interprets the entire session in real time). Using a family member is not valid interpretation.
What type of evaluation and treatment methods do you use with bilingual patients?
Specific therapy methods that I use for bilinguals are the same for English speakers. I do admit it is very challenging, despite the use of a translator, when you are not familiar with the language. For me the second most common language I run into is Farsi. Sometimes patients do not always find a video translator helpful or find it too distracting, which is not uncommon with our TBI patients.
Evaluations I use for my bilingual patients (they are all easy to find the Spanish version online)
St. Louis University Mental Status Exam
Montreal Cognitive Assessment
Brief Interview of Mental Status