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Communication after Brain Injury: FAQs

 Speech and TBI

By Dr. DeAnna Frye and JoAnn M. Ovnic, M.A.,CCC/SLP

My speech is fine, but after my brain injury my doctor referred me to a speech-language pathologist. Why?

The term speech-language pathologist is deceiving.  Speech-language pathologists (SLP) are skilled in assessment of speech, language, and cognitive functioning.  Following a head injury or other trauma to the brain there are cognitive (thinking skills) problems.  Sometimes these problems will be quite obvious, whereas other times they may be quite subtle.  In addition to speech and language, an SLP will observe and assess swallowing, memory, orientation, problem solving reasoning and attention.  Mathematical skills, planning and organizational skills are also areas in which speech-language pathologists evaluate and treat.  The speech-language pathologist is part of the rehabilitation treatment team.  Once the evaluation period is completed, results of testing and recommendations for treatment are shared with the client, family members, and the clinical treatment team.

What is aphasia?

Aphasia is a language disorder that results from damage to the language centers of the brain.  It can affect a person’s ability to understand language as well as the ability to express thoughts.  Aphasia commonly occurs following a stroke but can occur following traumatic brain injury, brain tumors or an anoxic episode (lack of oxygen to the brain).

Depending on the area of the brain affected, people may experience expressive or receptive aphasia, or a combination of both.  Expressive aphasia is commonly characterized by difficulty with coming up with the right word (“it’s on the tip of my tongue”) writing, and using gestures to communicate thoughts.  Receptive aphasia, on the other hand affects one’s ability to understand what is being said or read.  Even though a person may be able to hear or read words, they may sound or look jumbled.

Several factors may contribute to the severity of difficulties with language.  They include severity of damage to the brain, age, educational level and health prior to injury.  One person might only be able to speak in single words, whereas another may have occasionally have trouble finding the right word in a conversation.  Another person may be able answer simple questions and directions (i.e. “Did you like the movie?” or “Point to the comb.”) while another may have trouble following multiple directions or have difficulty reading more than a simple one or two paragraph article.

A speech-language pathologist assesses and treats people with aphasia with drills and strategies to improve communication.  Exercises vary based on the severity of the problem and take into account a person’s language needs.

My daughter is not able to communicate with us since she had a severe brain injury. Her doctor told us she has receptive and expressive aphasia.  Her arms and hands seem to work fine.  Why doesn’t someone recommend that she learn sign language?

Aphasia occurs as a result of an injury to the language center of the brain.  The degree and type of impairment varies based on the injury.  For example, some individuals may be able to understand what others are saying, but are not able to verbally respond.

When an individual is diagnosed with a language disorder, treatment from a speech therapist is indicated with a focus on regaining speech functions and developing compensatory strategies to help the person develop communication skills, such as through use of gestures or pointing out pictures on a daily communicator.  Learning sign language is a complex task.  While the hands are used as the primary means of communicating, the individual still needs to be able to access language functions in the brain.  Due to injury in the language center, this may not be possible.

What is dysarthria? 

Dysarthria is a speech disorder that results from involvement of the nervous system.  These conditions include stroke, progressive diseases such as Parkinson’s, and less frequently following traumatic head injury.  It affects the quality of speech production and is often characterized by slurred speech and facial weakness.  Symptoms include limited tongue, lip and jaw movements, breathy voice quality, drooling of saliva, chewing and swallowing difficulty, change in voice quality, slow or rapid rate of speech and abnormal intonation (rhythm).

Dr DeAnna Frye has a B.S. in Psychology, M.S. in Counseling Psychology, Ph.D. in Counseling Psychology. She is currently employed by Neurology Neuroscience Associates of Akron. Her special interests are psychotherapy and counseling to patients with neurological disorders with special expertise in brain injury. She is a founding member and the current co-chair of the Summit County Traumatic Brain Injury Collaborative located in Akron, Ohio.

For more information, see:

After a Stroke

By Cleo Hutton

Book on stroke and brain damage for adults and families with practical suggestions and tips for coping with the physical, communicative, cognitive and emotional changes.