Exploring Person-Centered Goals in Speech-Language Pathology Services for Mild Traumatic Brain Injury.

Abstract

Purpose: Person-centered goals represent meaningful and motivating aspirations of patients and help rehabilitation professionals shape treatment plans to meet individual needs. The purpose of this research note is to describe person-centered goals identified among individuals receiving speech-language pathology services after mild traumatic brain injury (mTBI) and to consider how goals might be informed by existing self-report measures and guide treatment planning.

Method: Using a retrospective chart review approach, we extracted person-centered goals of patients between the ages of 14 and 65 years who received care from a speech-language pathologist at an outpatient specialty concussion clinic between August 2019 and March 2020. Goals were coded according to impairment, activity, and participation domains; environmental setting; treatment domain; rehabilitative expectation (restorative or compensatory); as well as by alignment with items in a concussion symptom scale. Three reviewers independently coded goals, with discrepancies in ratings resolved through consensus. Data were analyzed descriptively.

Results: In total, 59 patient charts met inclusion criteria. Mean patient age was 31.85 (SD = 17.31). Most goals were at the activity level (46%), followed by participation (32%), and impairment (22%). Return to productivity was central to patient goals, with almost half addressing return to school (49%) and 21% specifying return to work. By domain, goals were primarily cognitive in nature (62%), followed by communication (13%), emotional regulation (13%), or unspecified (12%). Almost all goals were restorative (86%). Just 37% of goals were represented on the symptom scale, as expected, those that were reflected cognitive needs.

Conclusion: Person-centered goals are not well captured by standard mTBI symptom scales, thus emphasizing a need for rehabilitation providers to use problem-focused interviewing, motivational interviewing, or other person-centered methods to identify personally relevant and meaningful goals in this population.