Consequences of Moderate to Severe TBI
Speech/Language Problems
Motor-Speech Disorders
Following an injury to the brain, individuals may experience difficulty with articulation, fluency and dysarthrias of speech. Articulation problems are generally more noticeable early in recovery and tend to normalize as recovery proceeds. If the specific areas of the brain that affect muscle control for speech are damaged, persistent speech impairments such as imprecise articulation, ataxia of speech and dysfuency will be apparent. The prosody (stress, intonation and emphasis) of a person's speech may also be affected, resulting in changes in tone and meaning in their speech. This is a most challenging problem to treat.
Voice
Often during the early stages of hospitalization following TBI, an individual may require that tubes be inserted through the vocal cords to assist with breathing. The intubation may result in irritation to the cords and a temporary hoarse/breathy voice or permanent damage. Persistent hoarseness would require an evaluation by an otolaryngologist. A voice that is low in volume or too loud may be the result of poor self-monitoring.
Tangential Speech
Some individuals have difficulty staying on a topic and will tend to wander off in the content of their speech. For example, you may ask the child what he had for lunch. He will start to tell you about the carrots on his tray, then start to talk about the rabbits he has at home and how they live in a hutch, how he has to clean the hutch or his mother will get mad at him, how last night his mother made him spend time in his room because he did not clear the table, etc. An inability to self-monitor, trouble organizing information and word-retrieval problems can all contribute to this problem.
Hyperverbal Speech
This refers to an excessive amount of speaking on the part of the injured child. He shows a lack of awareness of his communication partner and an inability to read signals as to when to stop talking. It can also be a sign of impaired frontal lobe functioning and a poorly functioning "braking" system.
Confabulation
The child may offer information that is unrelated to reality or appears false. Usually, the information comes in response to orientation questions. The answer may sound very plausible and at times reflect information that was once experienced by the child, but not recently or relevant to the situation at hand.
Anomia (Word Finding)
An inability to find the right word when speaking or trouble naming things or thinking of people's names is not uncommon following a brain injury. The severity of this problem is generally much greater early in the recovery process, but may persist depending on whether a focal injury to the speech center of the brain occurred.
Language
Difficulties understanding what is said and verbalizing in coherent, semantically and syntactically correct speech is common following a brain injury. The extend of this problem may vary depending on the severity of the injury and its location (i.e., whether there was a focal injury).
Abstraction
Older children who have developed the ability to understand and use abstract language often have significant problems with figurative language following a brain injury. Often, they are unable to interpret proverbs and idiomatic expressions, and have difficulty with implied meanings and jokes from their peers. Such children tend to take things literally, resulting in misunderstandings and social problems with their peers.
Reading Comprehension
Children with brain injuries often have difficulty understanding what they are reading, particularly if they have had trouble comprehending speech. Generally, problems understanding what is read parallel auditory comprehension troubles but may persist, particularly when visual impairments are present.
Writing
In terms of the mechanics of writing, the child may experience difficulties writing with a weak or non-dominant hand. As for content, the child may have problems with spelling, grammar, word retrieval, thought organization or concept formation, any of which could affect his ability to put things in writing.