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

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.

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.

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.

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.