Communication disorders after a brain injury
A brain injury can
affect our communication abilities by impairing hearing, the muscle
movements of speech, or the cognitive processes that turn our
thoughts into words.
Communication problems vary, depending on an individual's
personality, pre-injury abilities, and the severity of the brain
damage. Typical effects may include:
- slow or slurred speech
- difficulty swallowing
- drooling or a nasal tone
- problems with finding the right words
- trouble with understanding others.
Communication problems can be a mixture of both receptive and
expressive problems, regardless of whether the cause was
brain tumour, traumatic brain injury, encephalitis or other type
of brain disorder.
Receptive skills involve receiving and understanding language.
Typical signs of this are:
- Poor recognition of vocabulary
- Continually asking for things to be repeated
- Difficulty with the speed, complexity or amount of spoken
- Not paying attention in conversations
- Not understanding what is said
- Difficulty remembering instructions given.
Remember that hearing loss can also occur after a brain injury
and have the same effects. The ideal is a hearing test by an
audiologist before assessing receptive skills.
The ability to form sentences, find the right words, and make
the right sounds may appear unaffected and not be detected
during rehabilitation, but subtle problems can emerge over time.
Possible problems include:
- Non-stop rapid talking
- Rambling explanations and switching to unrelated topics
- Difficulty remembering certain words
- Incorrect use of language
- Interrupting others
- Inappropriate comments and behaviour
- Making up stories
- Minimal responses when a detailed response is needed
- Difficulty with abstract skills e.g. humour, puns,
- Poor spelling and difficulty learning new words
- Saying the same thing over and over (perseveration)
- Trouble with long sentences.
Typical problems & how speech
pathologists can help
Anomia means "can't name". Everyone has an
occasional trouble with remembering a word but it can be a severe
problem after a brain injury. Sometimes the wrong word is chosen
e.g. "Pass me the noon" instead of "Pass me the spoon." A
speech/language pathologist can provide techniques to help, such as
circumlocution e.g. if you can't come up with the word "telephone"
you might say "you dial it to call people" so people will
understand what you are trying to say.
Dysarthria occurs when areas of the brain
controlling our muscles for speech are damaged. A speech
pathologist can help with strengthening muscles, increasing
movement of mouth and tongue and breathing exercises. Common
techniques are focusing on slow clear speech with frequent
pauses, and starting a topic with a single word first then checking
the other person has understood.
Apraxia occurs when the speech muscles can be
unaffected but the brain has trouble sending the signals
to the muscles responsible for speech. For example,
someone may repeatedly stumble on the word "yesterday" when asked
to repeat it, but then be able to say it in a statement. In
mild cases, therapy may involve saying individual sounds and
thinking about how the lips and tongue should be placed, or
speaking while clapping to improve timing. In severe cases,
alternative systems such as gestures, facial expressions, written
communication or pre-printed cards are used.
Confabulation is the spontaneous production of
false memories - either memories for events which never occurred,
or memories of actual events which are displaced in space or time.
These memories may be elaborate and detailed, bizarre or mundane
e.g. memory of having eggs for breakfast. Confabulation is not
lying - the person is unaware their memories are inaccurate, and
will believe they are telling the truth.
How professionals can help
A speech language pathologist can assess and treat communication
problems, and provide advice to rehabilitation teams. They can help
the individual with a brain injury to cope in given social
situations, using therapy to restore lost skills, compensatory
strategies, and assistive technology such as a hearing aid or
augmentative communication devices.
How family & friends can
The speech therapist will involve family to provide consistent
support in any strategies taught. Family and friends should expect
to be involved in rehabilitation after a traumatic brain
injury - it makes a big difference. Some useful tips
- Acknowledge the injury and be supportive
- Listen and allow time for finishing sentences or finding the
- Prompt the person to evaluate their speech and be aware of
- Speak clearly and simply
- Work with the person to see which techniques work well.
Approaches to avoid include:
- False reassurance
- Finishing sentences for the person
- Speaking excessively loudly or slowly
- Using jargon or lengthy explanations.
References and further information