Speech and Communication After Brain Injury FAQs
by Roberta DePompei and Yvonne Gillette
I often hear the term cognitive communication. What does that really mean?
Communication is much more than words. It involves listening, speaking, and reading, writing and gesturing. Cognitive communication is the combination of thinking skills and language. It is the ability to use language and all the underlying skills for communication, including attention, memory, self-awareness, organization, problem solving and reasoning. When these thinking skills are combined with language, the result is communication.
Our son was doing pretty well in school until he went to junior high school. Now he has a lot more reading assignments and homework. Even though he spends much more time on his homework, he can't seem to keep up and is falling behind.
As a child grows up, new difficulties in learning or language can appear as reading, writing and thinking become more complex in school. It is important to monitor a student's language development and learning skills through adolescence.
As students enter middle, junior high and high school, the nature of school work changes. Much of school work now requires abstract reasoning and problem solving that places new demands on different parts of the brain than were used in earlier grades. Multiple classes and teachers mean different teaching styles and homework assignments. Any difficulty with these changes is an indication that a student's cognitive communication abilities need to be reevaluated.
Our child is non-verbal. I hear a lot about augmentative communication and technology, but it sounds complicated. Could this help and how expensive is it?
Augmentative communication doesn't always require technology, such as computers, and it doesn't have to be expensive. An augmentative communication system means that devices or methods help existing communication skills. Sign language, picture notebooks, word boards, and tape recorders can be part of an augmentative communication system. Even when computers are involved, prices vary. Choosing the level of technology depends on how and where the device will be used, costs, maintenance, and repairs. The personal choice of the user is a major factor in the decision. There are so many options that they are often described under three categories of "no, low or high" technology.
Who pays for communication systems?
There are many possible sources but getting approval can be complicated, especially for more costly systems. If the system is needed for learning, then funding through special education is possible. A doctor's prescription may help with payment under insurance plans. Funding through the Medicaid program of Bureau for Children with Medical Handicaps is possible, but regulations vary from state to state. Vendors can provide advice on funding options.
Because funding is complicated, it is important to try out or rent a system before purchasing it. Many companies have loaners for trial use. Renting a system may be preferable if the child's needs are rapidly changing. Advocacy by parents and professionals, and even appealing denials for payment, can lead to approval.
Our son's speech was really slow and difficult to understand for several months after his brain injury. As he made physical progress, his speech also improved. Is there any reason to have him followed by a speech pathologist now he is back in school?
The ability to speak and hold conversations can be misleading. Language skills often return after a brain injury, but communication can still be affected. While conversation may seem "normal" in non-stressful situations, this can change when the child or adolescent is tired or under stress.
Changes in communication in youths are mostly likely to show up in school under the pressures of time, being graded, completing assignments and keeping up with classmates. A speech and language pathologist can evaluate ongoing progress, identify problems and help the student develop compensatory strategies. As part of the educational team, the speech pathologist can help others recognize and respond to changes in cognitive communication.
How do we find a speech and language pathologist who has experience with students with brain injury?
Speech and language pathologists may be licensed in their state and may also be certified by the American Speech-Language-Hearing Association. When choosing any professional, it is important to ask questions to make the right fit between a specialist, your child and your family. Look for a speech and language pathologist who has experience with brain injury and who has worked with clients of similar age. If your child is in school, look for a speech and language pathologist who regularly works with schools and is familiar with special education.
What are some of the changes or warning signs that parents and educators can watch for?
Too often it is failing or lowered grades that signal difficulty. It is important not to wait until the student is in trouble to get help. Early warning signs that an evaluation by a speech and language pathologist is needed are: speaking or writing that is disorganized, difficulty concentrating and paying attention, confusion when new ideas are introduced, a slower rate of handling information, and difficulty learning new vocabulary or grasping ideas. By evaluating these areas every three months during the two years following a brain injury, difficulties can be spotted early and help provided before the student fails.
If technology is needed for communication, what should we look for?
Hardware (the machine or equipment) and software (the program that run the computer) can be standard "off-the shelf" items found in most computer stores or can be customized for the individual's needs. Look for what methods are used to select messages (pointing, typing or pressing a switch). Voice output produces sounds so that messages are stored in a device and retrieved by choosing a key or picture on the board (digitized output). A device can even speak once messages are typed in or stored (synthesized output). There are many choices for keyboard design such as pictures, bigger or smaller keys, and keys with guides to help position fingers. Some screens speak when touched or have menus that lead to message screens. The size and weight of a devices is another consideration as if affects how portable it is. The point is that there is no one answer for everyone. Technology must be carefully matched to the needs and preferences of the user.
This material is provided by:
Lash & Associates Publishing Training Inc.
708 Young Forest Drive, Wake Forest NC 27587
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