Case Study:

Team Helps Head Injury Patient Address Hearing and Memory Issues
SIG 6: Hearing and Hearing Disorders: Research and Diagnostics

Summary
An interprofessional practice (IPP) rehabilitation team developed a treatment plan for a
55-year-old man with memory and hearing loss, tinnitus, episodic vertigo, and headaches
following a closed head injury. By working across specialties, the team created and
executed a plan that helped resolve the man’s dizziness and address his hearing and
memory problems.

Patient Info Meet The Team

ROB ROY
55-YEAR OLD
Audiologist Neurologist Occupational Physical
therapist (OT) therapist (PT)

Current Diagnosis:
Closed head injury

Primary care Speech- Patient

physician language
(PCP) pathologist (SLP)

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Background
Mr. Roy, age 55, came to Edgewood Clinic after being diagnosed with a head injury. Mr. Roy fell out of a tree
while boar hunting 2 months prior. He sustained a closed head injury and lost consciousness for 20 minutes.
His symptoms, which he felt had worsened since his injury, included memory loss, word-finding problems, high-
frequency tinnitus, difficulty understanding speech in noise, hearing loss, episodic vertigo, and headaches. He
completed inpatient rehabilitation and was discharged to his home.

How They Collaborated

Each member of the IPP rehabilitation team evaluated Mr. Roy according to their specialty, with the PCP serving
as the team facilitator. After they completed their assessments, the team members met to review the results
together.

The audiologist found that Mr. Roy had hearing loss, moderate difficulty with speech in noise, and benign
paroxysmal positional vertigo (BPPV). The SLP determined that Mr. Roy struggled with word finding and
experienced memory deficits that were consistent with mild traumatic brain injury (mTBI). The neurologist
reported that Mr. Roy’s CT scan was normal and that his MRI was consistent with changes typical of aging. His
EEG was abnormal. The PT found that Mr. Roy had normal functional balance and that he tested positive for
right posterior canalithiasis. The PT recommended a referral to an OT for tree safety education.

After discussing their assessments, the team developed a plan to resolve Mr. Roy’s dizziness, improve his
hearing, address his memory and word-finding issues, and help him avoid future hunting accidents.

As part of the plan’s execution, the audiologist enrolled Mr. Roy in integrated sound therapy for tinnitus
management and fit him for hearing aids. Mr. Roy’s hearing aids were also programmed with a secondary
setting just for hunting. Mr. Roy also attended weekly 45-minute sessions with the SLP for 3 months and focused
on word-finding and memory strategies. The neurologist followed up with Mr. Roy as needed, and the PT
conducted repositioning therapy for right posterior canalithiasis. The OT worked with Mr. Roy on tree safety
education and helped him obtain a harness to prevent future falls.

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Outcome
The team followed up with Mr. Roy 3 months, after the first evaluation, to assess his progress. Mr. Roy
reported satisfaction in using his hearing aids while hunting and playing poker and with his tinnitus
treatment. He showed improved word-finding ability as well as improved quality of life using memory
aides and other strategies.

Ongoing Collaboration
As the team facilitator, the primary care physician follows up as needed and communicates
assessment results and plans with the other team members. The team meets weekly to discuss care
coordination for several patients.

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Case Rubric:
Team Helps Head Injury Patient Address Hearing and Memory Issues
SIG 6: Hearing and Hearing Disorders: Research and Diagnostics

Patient Info Meet The Team

ROB ROY
55-YEAR OLD
Audiologist Neurologist Occupational Physical
therapist (OT) therapist (PT)

Current Diagnosis:
Closed head injury

Primary care Speech- Patient

physician language
(PCP) pathologist (SLP)

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History and Concerns Mr. Roy (DOB: 1/1/63) came to Edgewood Clinic with a
(Share key information diagnosis of closed head injury. Mr. Roy fell out of a tree 2
gathered from team) months ago while boar hunting and sustained a closed head
injury with loss of consciousness for 20 minutes. Symptoms
include memory loss, word-finding problems, high-frequency
tinnitus, difficulty understanding speech in noise, hearing loss
that he feels has become worse since the head injury, dizziness
and episodic vertigo, and headaches. Mr. Roy is a right-handed
firearms user. He completed inpatient rehabilitation and has
been discharged to his home.

The rehabilitation team consists of Mr. Roy’s primary care

physician (PCP), who serves as the team facilitator; an
audiologist; a speech-language pathologist (SLP); a neurologist;
Assessment Plan
and a physical therapist (PT). Within their fields of expertise, the
(Determine roles/
team members develop the following assessment plan:
responsibilities for
evaluation)
PCP – Serves as team facilitator.

Audiologist – Conducts comprehensive hearing

evaluation, tinnitus evaluation, and vestibular evaluation
to include videonystagmography (VNG).

SLP – Conducts standardized speech-language

evaluation and cognitive evaluations after the audiologist
completes the hearing evaluation.

Neurologist – Conducts the CT scan, MRI, and EEG as

well as cognitive and neurologic assessments.

PT – Conducts posturography and balance evaluations.

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After they complete their individual assessments, the team

members review the results. Assessment results were as follows:
Assessment Results
(Summarize key diagnostic
Audiologist – Mr. Roy has high-frequency, mild-to-severe
results)
sensorineural hearing loss with poorer thresholds in the left
ear from 3K Hz to 6K Hz. Speech recognition results agree
with pure-tone thresholds. Patient has moderate difficulty
with speech in noise, which was tested with QuickSIN.
Mr. Roy has bilateral subjective tinnitus pitch matched
at 6K Hz at threshold. He also has right-sided benign
paroxysmal positional vertigo (BPPV) as demonstrated by
VNG testing.

SLP – Mr. Roy demonstrates mild word-finding deficits,

receptive language that is within normal limits, oral/motor
exam that is within normal limits, and no speech deficits.
He has memory deficits that are consistent with mild
traumatic brain injury (mTBI) and that affect quality of life.

Neurologist – CT is normal. MRI is consistent with white-

matter changes typical with aging. EEG is abnormal.

PT – Mr. Roy has normal functional balance and

tests positive for right posterior canalithiasis. The PT
recommends a referral to an

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IPP Treatment Plan Based on the reported findings, the IPP team develops and
(Discuss, reflect, and agrees on a treatment plan, which the team facilitator will
modify recommendations communicate to the family. The plan includes the following
to develop a coordinated actions:
plan)
Audiologist – Conduct hearing aid evaluation, fitting,
verification, and validation. Program Mr. Roy’s hearing
aids with a secondary hunting program that offers reduced
MPO. Enroll Mr. Roy in integrated sound therapy as part of
the tinnitus management program.

SLP – Conduct weekly 45-minute sessions with Mr. Roy

for 3 months, focusing on word-finding and memory
strategies.

Neurologist – Follow up with Mr. Roy, as needed.

PT – Conduct repositioning therapy for right posterior

canalithiasis.

OT – Work with Mr. Roy on tree safety education and have

him obtain a harness in order to prevent and/or safeguard
future falls.

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The team followed up with Mr. Roy three months after the initial
evaluation to assess progress.
Treatment Outcomes
(Discuss results of treatment)
Audiologist – Mr. Roy is hearing better using sound
enrichment successfully for tinnitus, and he reported
satisfaction in using his hearing aids while hunting wild
boars. He also reports hearing better while playing poker
at the Elks Lodge.

SLP – Mr. Roy shows improved word-finding ability, shows

no changes in memory scores, and reports improved
quality of life using memory aides and strategies.

PT – Mr. Roy’s dizziness is resolved.

OT – Mr. Roy’s custom-made harness allows him to climb

up and down trees safely while boar hunting.

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Team Follow-Up The team followed up with Mr. Roy 3 months after the initial
(Determine meetings & evaluation to assess his progress. Team members’ individual
communication plan) conclusions are listed below:

PCP – As the team facilitator, the PCP follows up as needed

and communicates assessment results and treatment
plans/outcomes with team members.

The team communicates via weekly meetings that involve

patient care coordination for several patients whom the team is
following.

Acknowledgement
ASHA extends its gratitude to the subject matter expert(s) who were involved in the
development of the original version of this IPP case:

Keith Wolgemuth, PhD, CCC-A

Ashley Harkrider, PhD, CCC-A
Deb Berndtson, AuD, CCC-A
Anna Meehan, AuD, CCC-A
Erika Shakespeare, AuD, CCC-A
Special Interest Group 6 (SIG 6): Hearing and Hearing Disorders: Research and Diagnostics

Citations
American Speech-Language-Hearing Association. (n.d.). Team helps head injury patient
address hearing and memory issues.
www.asha.org/practice/ipe-ipp/case-studies/case-study-3/

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