Communication Disorders - Fact Sheet

A brain injury can result in impairment of communication abilities by impairing hearing, the muscle movements of speech or even the cognitive processes that put words to thoughts.

Communication problems that result from acquired brain injury vary, and depend on many factors which include 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. Communication problems can be a mixture of both receptive and expressive problems.

Receptive Skills

Receptive skills are the skills involved in receiving and understanding language. Indicators of receptive difficulties may include lack of understanding or attention, problems with quickly given complex information and requests for repetition. It should be remembered that hearing loss can also occur following a brain injury and lead to the same effects. Ideally a hearing test by an audiologist should occur first before assessing receptive skills.

Behaviours that may indicate problems with receptive language include:

Expressive Skills

Expressive skills are the skills required to form coherent sentences, find the right words, and then produce the appropriate sounds.

The ability to use verbal or written skills to express oneself may appear unaffected, but often there are subtle problems that emerge over time. Often communication tests during rehabilitation will not detect problems as these formal testing situations will not trigger many of these subtle issues. Some of these can include:

Anomia – Trouble with Finding Words

Some people with a brain injury will know the word they want to say but just can’t come up with it. This is called “anomia,” which means “can’t name”. Everyone has an occasional anomia; those with a brain injury may have it frequently. It can be particularly frustrating if you are dealing with people all day long, and can lead to poor self esteem.

A variation on this problem is saying the wrong word. Instead of saying, “pass me the spoon”, you might say “pass me the noon.” Or, instead of using a similar sounding word, you may use an entirely wrong word. Instead of “pass me the spoon,” you may say, “pass me the car.”

A speech/language pathologist is a professional who commonly works with this type of problem. This person can teach you techniques to decrease this problem. For example, you can use a technique called “circumlocution.” Basically, you “talk around” the word. If you can’t come up with the word “telephone,” you might say “you dial it, you can call people.” People eventually get what you were trying to say. Another technique that people sometimes use is to go through the alphabet and try to get the first letter of the word. Or you can visualise spelling the word—picture a blackboard and try to “see” someone writing the word on the blackboard. Then read the word off the blackboard.

Dysarthria

Dysarthria results in slow, slurred, and difficult to understand speech as the areas of the brain that control the muscles of the speech mechanism are damaged. A speech pathologist may help with strengthening muscles, increasing movement of mouth and tongue, breathing exercises and slower rate of speech. In extreme cases alternative means of communicating may be looked at.

A person with dysarthria should concentrate on slow clear speech with frequent pauses. It may be an idea to commence a topic with a single word first, and to check frequently that the other person is understanding you. Conversations should be finished as you become tired as speech will deteriorate quickly with fatigue.

Apraxia of Speech

This is a condition in which strength and coordination of the speech muscles are unaffected but the individual experiences difficulty saying words correctly in a consistent way. 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 such as, “I tried to say it yesterday.”

The type of treatment depends on the severity of apraxia. In mild cases, therapy may start by saying individual sounds and contrasting them and thinking about how the lips and tongue should be placed. Sometimes the timing of rhythm of speech to tapping or clapping helps to speak more clearly. Contrastive stress drills use the natural rhythm of speech to increase intelligibility. In this exercise, the same sentence is repeated with a different stress patterns, changing the meaning of the sentence. Individuals with mild apraxia learn strategies they can use to produce words which give them trouble. For very severe apraxia, alternative and augmentative systems, such as physical communication via gestures and facial expressions or written communication using a board, pre-printed cards or a notebook, are often employed.

Confabulation

Confabulation is a memory disorder that may occur in patients who have sustained damage to both the basal forebrain and the frontal lobes. Confabulation is defined as 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. Some may be obviously bizarre, such as a memory of a ride in an alien spaceship; others are quite mundane, such as a memory of having eggs for breakfast, so that only a close family member can confirm that the memory is in fact false.

It is important to stress that confabulators are not lying. They are not deliberately trying to mislead. In fact, the patients are generally quite unaware that their memories are inaccurate, and they may argue strenuously that they have been telling the truth.

Pressure of Speech

Pressure of speech is a tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener. The speech produced, sometimes called pressured speech, is difficult to interrupt and may be too fast or too tangential for the listener to understand--it is an example of cluttered speech.

It is a hallmark of mania and is often seen in bipolar people during manic periods, and is also seen in people suffering from severe anxiety.

Neologisms

Neologisms are newly coined words or phrases that may or may not express a clear idea.

They are most often associated with people suffering a psychotic illness like schizophrenia but are also seen in people with aphasia.

Cognitive Problems

In some cases the person may not appear to have communication difficulties until they are in stressful situations such as returning to work or study. These cognitive problems will usually stem from inability to maintain attention, difficulty with abstract language, poor organisation of language and a slower rate of processing information.

How Professionals Can Help

Following a brain injury, these cognitive issues can make it harder to learn and apply knowledge to specific situations. 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 compensatory strategies and treatment to help the individual be more competent in social situations. Often the individual can learn to compensate for a disability by learning a new and different skill or by using assistive technology such as a hearing aid or augmentative communication device (e.g. speech synthesisers or communication boards).

How Families and Friends can Help

Families, co-workers, teachers and friends can play an important role in helping a person improve communication skills or learn new compensatory strategies, particularly when they work with the speech therapist to provide consistent support in the strategies being taught. Family members should ask questions and expect to be involved in the process of rehabilitation. Not only will this greatly improve the prognosis for the person with the brain injury, by increasing the amount of rehabilitation which will be offered, but can greatly assist the family to understand the injury and reassure the person with the injury that they are being supported.

Approaches to use when communicating with someone with acquired brain injury and a communication disorder.

Approaches to avoid

General considerations for communication

Further information: