Note: The iLs Case Study Series typically features cases which are being presented for the first time; this case is an exception in that it continues a previously reported case after the client’s second iLs program.  Those with brain injuries often require ongoing therapy, and this case illustrates the improvement which can occur as a result of multiple iLs programs.

Date:
July 2013

iLs Associate:
Amy Dubey, OTR, CBIS

Client:
“J”, male, age 52

Presenting Problem:
Traumatic Brain Injury

Date of Injury:
March 2001 and July 2008

Background:
“J” is a 52 year-old male who had been involved in two different auto accidents and is diagnosed with a Mild Traumatic Brain Injury (MTBI). The first auto accident was in 2001 and the second was in 2008. He had received skilled therapies in 2001: Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (SLP).He was the owner of a construction company for many years and has not returned to work since his last accident. J has been in rehabilitation for several years with hopes of returning to work; however, his cognitive deficits prevent him from doing so. There are no significant physical limitations that prevent him from working. Currently, he is 11 years post his first accident.

Initial Presenting Problems:

  • Not staying on task
  • Unable to recall information
  • Unable to write simple letters/emails concisely
  • Distracted by visual and auditory information while performing tasks
  • Poor visual motor skills (tracking, scanning, VOR)
  • Poor organizational skills at home and in workshop
  • Poor physical, visual and auditory endurance (fatigues quickly and easily throughout the day)

iLs Program Used:
Between August and November of 2012 he completed the iLs Concentration/Attention Program (40 sessions). Some of the iLs sessions were completed in the clinic (2x per week) and others were completed at home.

In February 2013 he began a second iLs program, Reading & Auditory Processing (40 sessions), as a home program. He completed the program in April of 2013.

Other Interventions:
J received OT, PT and speech therapy weekly after both of his accidents. Primary OT goals were to increase his endurance with visual processing, auditory processing, and multi-sensory processing. As of February 2013 his insurance company would not approve any further skilled therapy sessions; however, they did approve the purchase of the iLs Total Focus unit for J to use at home.

Summary of Results:
J made significant, and sustained, improvements in his cognitive performance after both iLs programs, the first of which began 11 years post-injury. Following is a summary of his pre- and post-program scores for each of two standardized assessments (complete data may be found in the unabridged report).

TAPS Test of Auditory Processing

The following scores are pre-iLs and post-second iLs program:

–         Sentence Memory: 25% to 84%

–         Phonological Blending: 9% to 75%

–         Auditory Reasoning: 9% to 75%

–         Auditory comprehension: 50% to 75%

SCAN-3 for Adolescents & Adults – Test for Auditory Processing Disorder
During initial testing (pre-iLs) J fell asleep during the 4th subtest of the SCAN-3 test and had to be woken up. After his first iLs program, he completed the entire SCAN-3 test without fatigue setting in and showed significant improvement Auditory Figure Ground, Competing Words and Time Compressed Sentences.

After his 2nd iLs program, J scored in the normal range on all sub-tests. Most significant improvement was made with the sub-test Competing Words Direct Ear, a diagnostic test that assesses the ability to process competing speech signals by presenting monosyllabic word to each ear simultaneously. His pre-iLs score was in the 5th %. Post-iLs program one was 16th %, post-iLs program two was 75th %. The functional significance of this improvement is important as it means he is now able to carry on a conversation in a restaurant, listen to a TV with others in the room talking, attend a work meeting with multiple conversations going on, etc.

Client Comments:
After completing his first iLs program, wife and client note:

* Improvement in temper at home

* Recognizing others are around and being more considerate of others

* Feels his brain is getting clearer – not overwhelmed as much

* Can prioritize what is important to do now and what can wait

* “I know when to ask for help now, and when to stop”

After completing his second iLs program, client says:

* My head is clear most of the time

* I enjoy reading again (and recalls what he has read)

* I can hear and process conversations better in public places

* I am learning how to play the guitar

* I feel more considerate about others and what I say

* I can multi-task; carrying on multiple tasks without forgetting one of them

* My family relationships are improving

Recommendations:
This therapist recommends J continue on with the iLs Optimal Performance I program which is designed to increase attention, energy, and focus. This therapist also recommends J work with the iLs Interactive Language Program to further improve his monotone voice, facial expressions, non-verbal communication, prosody, intonation and verbal communication skills.

Assessments:

Test of Auditory Processing Skills:

The Test of Auditory Processing Skills (TAPS-3) is an individually administered assessment of auditory skills necessary for the development, use, and understanding of language mostly use in academic and everyday activities. Norms are provided for ages 4 years – 0 months through 18 years -11 months. Since J is older than 18 years, he should have scored 18+ years on all initial testing.

Pre and Post iLs TAPS-3 Scores. Scores in ( ) are Pre iLs. The 3rd set of scores are post the 2nd iLs program.

Subtests Raw Score Age Equivalent Percentile
Word Discrimination (32 / 32)
32 / 32
(18+ years)
18+ years
(75%)
75%
Phonological Segmentation (34 / 35)
35 / 35
(18+ years)
18+ years
(50%)
75%
Phonological Blending (18 / 35)
31 / 35
(7 years 6 months)
18+ years
(9%)
75%
Number Memory Forward (13 / 32)
17 / 32
20 / 32
(6 years)
9 years 2 months
13 years
(1%)
9%
25%
Number Memory Reverse (10 / 32)
18 / 32
(9 years 2 months)
18+ years
(9%)
63%
Word Memory (21 / 30)
21 / 30
20 / 30
(15 years)
15 years
13 years
(25%)
25%
25%
Sentence Memory (28 / 56)
29 / 56
39 / 56
(12 years 7 months)
13 years 5 months
18 years
(25%)
25%
84%
Auditory Comprehension (26 / 32)
30 / 32
(12 years 7 months)
18+ years
(50%)
75%
Auditory Reasoning (15 / 34)
32 / 34
(10 years 9 months)
18+ years
(9%)
75%

“The SCAN-3 is an individually administered battery of tests designed to identify auditory processing disorders. The American Speech-Language Hearing Association defines Auditory Processing Disorder as a deficiency in the perceptual processing of auditory information in the central nervous system as demonstrated by poor performance in one or more of the following skills:” (R.W. Keith, SCAN-3 manual, 2009. Pearson, Inc.)

*Sound localization and lateralization

*Auditory pattern recognition

*Auditory performance with competing acoustic signals

*Auditory performance with degraded acoustic signals

*Auditory discrimination

*Temporal aspects of audition, including: temporal resolution, masking, integration and ordering

Pre and Post iLs scores. The ( ) scores are Pre iLs scores. Third score is post Reading and Auditory Processing Program (His second iLs program). The ** indicates that he performed the testing with some background noise in the room from other people talking and walking into the room during testing. (This is a good thing, as his scored did not significantly diminish.)

Test Description % Ranking Scaled Score Ranking
Gap Detection This screening test measures the ability to detect brief gaps of variable durations (measured in ms) between tone pairs. (Pass)
Pass
Pass
Auditory Figure Ground 0 dB This test is used to assess the ability to process speech in the presence of background noise at the 0 dB signal-to-noise ratio. This is used as a screening test and as a diagnosis test. (9%)
37%
63%
(6 / 19)
9 / 19
11 / 19
(Borderline)
Normal
Normal
Competing Words-Free Recall This test is used to assess the ability to process competing speech signals presenting a monosyllabic word to each ear simultaneously. The examinee is instructed to repeat both words in any order. This test is used for screening and supplementary assessment. (16%)
84%
75%
(7 / 19)
17 / 19
12 /19**
(Normal)
Normal
Normal
Filtered Words This diagnostic test is used to assess the ability to process distorted speech by presenting monosyllabic words low-pass filtered at 750 Hz. (37%)
95%
91%
(9 / 19)
15 / 19
14 /19**
(Normal)
Normal
Normal
Competing Words – Direct Ear This diagnostic test is used to assess the ability to process competing speech signals by presenting monosyllabic word to each ear simultaneously. The examinee is instructed to repeat both words in a prescribed order and scoring reflects the prescribed order. (5%)
16%
75%
(5 / 19)
7 / 19
12 / 19
(Borderline)
Normal
Normal
Competing Sentences This diagnostic test is used to assess the ability to process competing speech signals by presenting pairs of unrelated sentences in the right and left ears. The examinee is instructed to repeat the sentence heard in one ear. (1%)
75%
75%
(3 / 19)
12 / 19
12 / 19
(Disordered)
Normal
Normal
Auditory Figure Ground +8 dB & 12 dB These supplementary tests are used to assess the ability to process speech in the presence of background noise at+8 dB and +12 dB signal-to-noise ratios. (9% & 16%)
63% & 37%
91% & 84%
(6 / 19 & 7 / 19)
11 / 19 & 9 / 19
14/ 19 & 13 / 19
(Normal)
Normal
Normal
Time Compressed Sentences This supplementary test us used to assess the ability to process degraded speech by presenting sentences that have been time compresses at 60% (.1%)
37%
75%
(1 / 19)
9 / 19
12 / 19
(Disordered)
Normal
Normal

Ear Advantage Summary Pre iLs program scores:

Test RE Score LE Score = EA Typical CumulativePrevalence
Auditory Figure Ground 0 9 12 = -3 No 10%
Competing Words – Free Recall 13 11 = 2 Yes 0%
Filtered Words 17 14 = 3 No 15%
Competing Words – Direct Ear RE 9 4 = 5 No 5%
Competing Words – Direct Ear LE 12 10 = 2 Yes 0%
Competing Sentences 27 22 = 5 No 5%
Auditory Figure Ground +8 dB 18 18 = 0 Yes 0%
Auditory Figure Ground +12 dB 18 19 = -1 No 15%
Time Compressed Sentences 21 24 = 3 No 5%

Ear Advantage Summary Post iLs program scores (1st score is after Concentration & Attention program and the 2nd  score is after the Reading and Auditory Processing program):

Test RE Score LE Score = EA Typical CumulativePrevalence
Auditory Figure Ground 0 13
16
14
14
= -1
2
Yes
Yes
0%
0%
Competing Words – Free Recall 17
14
16
17
= 1
-3
Yes
No
0%
15%
Filtered Words 20
19
19
19
= 1
0
Yes
Yes
0%
0%
Competing Words – Direct Ear RE 11
11
10
9
= 1
2
Yes
Yes
0%
0%
Competing Words – Direct Ear LE 14
15
13
14
= 1
1
Yes
Yes
0%
0%
Competing Sentences 35
35
35
35
= 0
0
Yes
Yes
0%
0%
Auditory Figure Ground +8 dB 20
20
19
20
= 1
0
No
Yes
15%
0%
Auditory Figure Ground +12 dB 19
20
19
20
= 0
0
Yes
Yes
0%
0%
Time Compressed Sentences 28
30
30
30
= -2
0
No
Yes
5%
0%

 

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