Synapse - reconnecting lives

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 a 

brain tumour, traumatic brain injury, encephalitis or other type of brain disorder.

Receptive skills

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 information
• 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.

Expressive 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, metaphors
• 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 help

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 include:

• Acknowledge the injury and be supportive
• Listen and allow time for finishing sentences or finding the word
• Prompt the person to evaluate their speech and be aware of issues
• 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.