Brain injury can disrupt a person’s ability to communicate and lead to problems with:
Language deficits appear in a variety of forms, and can be directly related to the location of the injury to the brain. Certain language problems, called aphasia, are the result of the injury location to very specific parts of the brain. An injury affecting a broad area of the brain can result in general language problems or language of confusion (this type of deficit is more common).
Receptive aphasia (sometimes called dysphasia) refers to difficulty listening to or understanding verbal information. It also includes difficulties with comprehension of written information. Some patients with receptive aphasia appear to understand more than they actually do. This is seen when the patient gives incorrect answers to simple yes and no questions or has difficulty following simple directions.
Expressive aphasia refers to the difficulty some patients have formulating and verbalizing their thoughts, finding appropriate words, or initiating communication. This difficulty appears in various forms:
Word Finding Problems: The inability to think of a specific word or difficulty naming familiar objects
Perseveration: The uncontrollable repetition of words and the inability to change this action
Circumlocution: Talking around a point, but not getting to the point, or eventually getting there after much description
Paraphasias: The frequent use of word substitutions such as “mother” for “father” or “spork” for “fork”.
These behaviors may appear in combination or alone. Patients' ability to express themselves verbally varies greatly with each individual.
General Language Deficits
General language deficits are more common following a brain injury, including problems with receiving information and also expressing ideas and thoughts (receptive and expressive language skills). Disorganization and confusion in the area of language can occur as a result of cognitive deficits. This is called language of confusion. Sometimes, cognitive deficits can actually hide or camouflage a language problem. At other times, they can make language appear more severely impaired than it really is. Generally, language skills improve substantially with improvement in cognitive functioning.
As receptive and expressive language skills improve, other communication problems may emerge, these are called pragmatic deficits. Pragmatic skills involve how we communicate rather than what we say. For example, you may see:
Changes in communication style
Difficulty in initiating conversation
Lack of knowledge about what is or is not an appropriate topic of discussion
Poor eye contact
Difficulty staying with one topic
As the patient’s awareness of strengths and weaknesses in these areas increases, the ability to communicate more effectively improves.
Motor Speech Deficits
A brain injury may result in difficulty in coordinating the muscles needed to produce speech. Voice sound is made by air moving past the vocal cords in a controlled way. Speech production requires muscles in the abdomen, chest, and throat to work together. Muscles of the mouth and face are also used. Articulation refers to the movement of the jaw, lips, tongue, and soft palate to produce speech sounds. Following are some of the motor speech problems you might observe:
Dysphonia: Difficulty producing and maintaining voice; problems in voice production can indicate vocal cord paralysis or weakness
Dysarthria: Slurred speech that occurs as a result of muscle weakness or in coordination of breathing, voice production, and articulation (forming words in the mouth)
Apraxia: The inability to perform coordinated movements of the muscles needed for speech, automatic sequences, such as reciting the alphabet, are easier, but, verbalizing needs and ideas are more difficult.
When motor speech skills are severely impaired, the therapy staff may recommend a non-verbal means of communication. This might be a simple alphabet or picture board or a more elaborate electronic device.
These items are referred to as augmentative communication devices. The device suggested by the staff will depend on the patient’s cognition, receptive and expressive language skills, visual and perceptual abilities, motor skills, and daily communication needs.
The Healing Process
The healing process continues for two years or more after a brain injury. At first, the patient may be confused and disorganized, which disrupts normal communication and behavior. As the confusion clears and awareness improves, communication with familiar people also improves.
Early communication efforts may include verbalizations; facial and body gestures, such as smiling and pointing; or perhaps writing. An effective technique of using “yes” and “no” to carry on a conversation may evolve naturally or with the aid of a therapist or family member.
Cognition and communication are intertwined; cognition serves as the basis for communication and communication allows us to receive and express our thoughts. As cognitive skills improve, communication will also improve. The rehabilitation process focuses on improving cognitive functioning, which then provides a foundation for relearning language skills.