A-05 Clinical Considerations for the Management of Post-Concussion Psychogenic Speech Impairments

Abstract The purpose of this case study was to present clinical approaches for psychogenic speech impairments following concussion. Methods Retrospective chart review of a 17-year-old Black male (Patient 1) who sustained a sport-related concussion and a 46-year-old Hispanic female (Patient 2) who sustained a concussion following a motor vehicle accident and exhibited dysfluencies after injury. Both completed a clinical interview, symptom, neurocognitive, vestibular-ocular motor, and mood assessments at each clinical visit. Clinical impressions and management decisions were discussed with treating neuropsychologists. Results At intake, neither patient was attending school/work. Both endorsed significant state anxiety, mild depression, and processing speed impairment. Patient 1 reported dysfluency ~2 hours post-injury, characterized as rapid repetition of sounds followed by full words, which increased under stress. The clinical evaluation required extra time and included psychoeducation regarding atypical speech patterns and stress management. Patient 1 was encouraged to resume school, non-contact cheerleading, and counseling sessions. Speech dysfluencies resolved at 24 days post-injury without speech intervention. Patient 2 reported dysfluency at 32 days post-injury after witnessing an MVA which provoked isolated aphasia followed by a consistent psychogenic speech pattern. Dysfluency was triggered by light/noise sensitivity and some parts of the clinical evaluation were not tolerated following exposure. Vestibular therapy increased dysfluency and was replaced with speech therapy and numerous medication trials (SSRIs, beta-blockers, benzodiazepines) without success. The patient returned to work after 9 months and did not fully resolve speech abnormalities. Conclusions Speech abnormalities following concussion are variable and require the clinician to be flexible with the evaluation and treatment plan.