Parent's Guide: language, living skills, brain injury & your child
Language and everyday living skills
may need particular attention to ensure that a child with a brain
injury recovers to the fullest extent possible over the years.
Language is one of our most important and complex skills and is
often affected by a brain injury in ways that may be
subtle but nevertheless important. We start to hear, respond to and
learn language from the time we are born. By about five years of
age, most of the basic language structures are in place, but the
process of extending and refining these structures, building
vocabulary and thinking skills, learning to read and write, goes on
throughout childhood and adolescence.
Language & brain injury
A brain injury can interrupt this process. The
younger the child when the brain injury occurs,
the smaller the 'store' of vocabulary and language structures
he/she has built up, and can call on after the injury. In general,
the more severe the brain injury, the more severe the language
problem-although there are exceptions to the rule (as in most areas
of brain injury).
A speech pathologist is the person to help with language
problems-ideally one who is experienced in working with young
people with a brain injury.
Language involves both 'comprehension' - understanding what others
say, and 'expression' - saying things ourselves. And it also
involves the thinking that links these two together, enabling us to
respond appropriately to what someone else says. There are many
skills and resources involved such as a large vocabulary, the rules
of grammar, stringing ideas into a narrative and organising the
mouth, throat and lungs in complex sequences to talk.
Using & understanding language
Children who are very young when they sustain a brain
injury may have difficulty learning the building blocks of
language-words, grammar, and skills such as how to talk about
something that happened yesterday.
Most often, children with a brain injury can talk
quite well. The problems are often less obvious, involving the
processing of language-that is, the way we understand and organize
things in language. Children with a brain injury may,
for example, have difficulty:
- Understanding similarities and differences between things, and
putting things in categories-the differences and similarities, for
example, between a car and a truck
- Being able to link ideas and build associations between
- Sequencing and organising information logically
- Knowing how much to say, or being able to think of what to
- Following instructions.
Children who have problems in these areas may fail to understand
humour, metaphor, innuendo and the 'social rules' in each
situation. If the young person has problems with memory or with
focusing attention, it can be more difficult to understand what's
said and follow a conversation.
A young person with a brain injury may have real
problems developing grammar, sorting out the order of words within
Getting ideas in sequence can also be difficult such as telling
a story. Without strong oral language, it's very hard to develop
good reading and writing skills. Sometimes children can read but
find it hard to understand what they have read, put it into their
own words, or write down their own thinking.
A speech pathologist can often help substantially to develop
these skills. If a child is unable to communicate verbally then a
speech pathologist can also help by providing the child with an
alternative way of communicating - using pictures, words and/or
Slurred and jerky speech - 'dysarthria' - can be a problem after
a brain injury. Usually this clears over the first few days or
weeks, but sometimes, with more severe injuries, speech is more
affected. A child with weak or tight muscles of the face, tongue,
jaw may have slurred or imprecise speech. You will have to pay good
attention to your child's efforts to speak.
Helping your child to listen &
Use language that is concrete and straightforward. If you are
giving instructions, use short, simple sentences and limit yourself
to one or two at a time.
Model or demonstrate what you want, while you say it as well. Ask
your child to restate the information you've just given: "Now tell
me, how are you getting home from school today?" Allow time for
your child to take in what you have said.
Say the same thing twice, in different ways (allowing your child
time to take in each): "We're going to the beach soon. Are you
ready to go to the beach?"
Allow your child time to think of what he/she wants to say. Talk
with your child a lot-just ordinary, everyday conversation. Listen,
don't correct and interrupt, but hear what is said and respond in a
way that shows your interest. Make talking enjoyable and
Help your child to listen as well as talk-for example, explain
that everyone has a turn in conversations, and it's your turn now
(or the turn of another member of the family, etc.). Then encourage
your child to respond e.g. "what do you think about it?"
Organize things so that your child has to ask for things at the
shops such as buying the milk. Make opportunities for talking in
all sorts of everyday situations.
Do things together and talk through the steps together. For
example, packing a bag to go away for a weekend-ask your child what
he/she is going to take, help to write a list - and fill it out,
e.g. "What's going to happen if it rains?"
Find out what games are 'in' at school or in the playground, and
rehearse them at home. Or play other games-cards, checkers, etc.
Take it slowly, talk through the rules step by step, practice each
step, and help your child learn to take turns. Use the
communication aids you and your therapist might make.
Physical & everyday living skills
A brain injury can interrupt and complicate
the development of a young person's physical and everyday living
skills. There are, nevertheless, many positive and constructive
things that can be done to minimize the difficulties, maximize
recovery, and find ways to work around ongoing problems.
Physical and sensory skills
Physical and sensory problems can affect, to a greater or lesser
extent, a person's ability to get about and do simple, everyday
things-from walking, dressing to managing cutlery.
Problems may include weakness and changes in muscle tone,
decreased coordination or balance, fatigue, visual problems and
changes in sensations such as touch, pain and temperature. Often
these problems are coupled with cognitive and behaviour problems,
making it more difficult for the child to compensate for the
physical difficulties. When the brain injury has
been caused by an accident, the situation may be further
complicated by other serious injuries.
The physical, cognitive, sensory and visual realms are all
interwoven. For example visual problems, slow reaction time and
poor coordination can make it very difficult to do something
apparently simple, like throwing and catching a ball against a
Recovery from physical problems is usually more rapid than
recovery from cognitive, thinking and behaviour problems. Much of
the physical recovery happens within the first 6-12 months after
the injury with active rehabilitation.
Growth spurts can disrupt abilities that were previously under
control. This is because a child's musculoskeletal system is often
less adaptable after a brain injury. The long bones
may grow faster than the muscles, so the muscles become tight and
less well controlled.
Physical demands and challenges increase as the child grows older,
and physical problems may show up as the child is increasingly
challenged-even years after the initial injury.
The complexity of games and rules also increases as children
grow older. For example, a lot of sports and games for 4-6 year
olds are about drill training and learning the skills. But when the
child has to take these skills into the context of a competitive
game and respond to lots of other things going on around about, it
can often be much more difficult.
Major transitions can create extra challenges. For example, the
move from primary to secondary school involves a change from having
all lessons and books in the one classroom, to having to walk from
one side of the school to the other between lessons, carrying
books, negotiating stairs, and in a sea of other kids all going
What you can do to help
Break down the skills involved into small components and
practice them with your child. You might, for example, play in a
smaller space, use a bigger ball, practice somewhere where there
aren't lots of other distractions.
Talk to your child's teachers, and any sports coaches, so they
understand your child's special learning needs, are aware of the
challenges that can be expected over time, and can help to
reinforce a structured approach in teaching skills.
Children with a brain injury need lots of
encouragement to take part in physical activities, in order to
maintain their physical ability and a basic level of physical
fitness. You might need to help your child find a sport or activity
that is not competitive, so he/she can experience success in it-for
example, swimming or cycling.
Aids & equipment
Children and young people with a brain injury
may benefit from a range of different equipment and aids,
- Mobility aids-including walkers, crutches, splinting
- Bath equipment, bath chairs, toilet chairs
- Adapted car seats, adapted bicycle seats
- Aids for writing-different work surfaces, adapted pens
- Ways to make eating easier-for example, adapted spoons, cups,
- Computer access-for example, laptops with modified screens to
make print larger
- Splints to maintain range of movement, stretch tight muscles,
or provide stability.
An occupational therapist (OT) and a physiotherapist can both
assist with aids and equipment. The OT can advise on bathroom
equipment and self-care aids for eating, dressing, or managing at
school, the physio can assist with mobility.
A small proportion of children with a brain injury
develop long-standing spasticity which may be helped by splinting,
surgery or medical treatments such as 'botox'.
Self care includes a wide range of everyday activities that we
take for granted - dressing, washing, eating and toileting. Self
care can present problems for someone with a brain
injury, particularly during adolescence when young people
are striving to become independent of parents.
There are various ways to address these problems.
Clothes, utensils and environments can be adapted. Look for
different shaped cutlery or specially adapted cutlery. Experiment
with different types of clothing and fastenings-for example,
T-shirts or tops that don't require buttoning, clothes with larger
buttons, slip-on shoes rather than laces or small buckles.
Break down tasks into small steps, and start by getting the
young person to do only the easiest step, or maybe the last step.
And provide lots of opportunities for practice.
Use cues to remind the young person of a daily routine. For
example, list what has to be done to get ready for school-it might
include, Get dressed, Brush teeth, Brush hair, Pack bag. Put the
list on the fridge door, or your child's wardrobe door.
Set priorities and do the important things first, so fatigue and
stress don't interrupt them. If necessary, help with the less
important tasks so you've time and energy to focus on the skill
currently being learnt.
Arrange with the school and/or other agencies involved to use a
daily diary system, to keep track of what has been learned.
References and further information
Many thanks to Brain Foundation Victoria for permission to adapt
their material for this fact sheet.