VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Speech/Language

QUESTION:
My son sustained a severe brain injury and cannot express himself well. He seems to know what he wants to say, but he cannot actually use the right words. Sometimes the right words do come out but they don’t make a correct sentence. For example, he may ask for his medication by saying: "My pill is time for me." If he wants his coat, he may point to it and say: "Shoes, please." What is the explanation for this? How can we help him improve his communication skills?

ANSWER
Language comprehension and expression are often significantly involved in individuals with traumatic brain injury. The examples you provide are most likely related to dysnomia, or impaired word finding abilities. Dysnomia is a common impairment in individuals with TBI, and involves the ability to select or retrieve a particular word. Errors may be related by meaning (e.g., "shoes" for "coat") or by sound (e.g., "rock" for "sock"). The individual may or may not be aware of his naming errors. He may also pause and struggle to retrieve even a familiar name. This occurs not because he no longer knows the word, but because he cannot access it from his vocabulary quickly. This difficulty can be frustrating for both the individual and the family who want to help but are not sure how to do so.

There are several ways to help individuals who have difficulty retrieving words. A certified speech-language pathologist can evaluate this and many other language-related areas involved in TBI, providing specific recommendations for families. Whenever possible, allow the individual a relaxed, unhurried, supportive communication environment. Avoid conversations in noisy, distracting environments. Whenever possible, avoid completing his sentences for him or making light of his errors. When the individual produces a naming error, but you are aware of what he intended to say, you may choose to ignore it, or calmly ask, "Did you mean (using the word that he used)?" This calls attention to the error and gives the individual a chance to correct it. This is most appropriate in one-to-one conversations but should be avoided if it will embarrass or upset the individual. If you are not sure what the individual is trying to express, calmly tell him this. You may cue him by repeating his initial few words and narrowing down what he was trying to express (e.g., "You said you wanted some new shoes; what shoe store were you thinking of?")

QUESTION:
What is aphasia? How does it manifest in someone with traumatic brain injury?

ANSWER
Aphasia is defined as "the impairment or loss in ability to use language, to communicate or comprehend and exchange thoughts and feelings. Aphasic individuals may also have difficulty reading, writing, using numbers or making appropriate gestures" (Chapey R., 1994, paraphrasing Brody, J., 1992). Aphasia occurs from focal injury to the brain, during stroke or hemorrhage. Individuals with traumatic brain injury often present with language deficits despite the absence of focal injury. Typically, however, these deficits differ from classic aphasia. Holland (1982) notes that patients with TBI have impairments in language use, with deficits including "digressiveness, difficulty in self monitoring that includes impetuousness and disinhibition, difficulty in attending to topic, disorganization, difficulty in initiating speech and its converse problem -- once initiated, speech is difficult to stop -- and difficulty in changing topic." These language impairments reflect the cognitive dysfunction that may occur after TBI, impacting attention recall, organization, sequencing and other areas. In addition, retrieval impairments are frequent. For this reason, language impairments resulting from TBI may be called neurolinguistic impairment rather than aphasia.

References: (1) Brody, J. (1992, June 10). When brain damage disrupts speech. New York Times, p. C13. (2) Holland, A. (1982). When is aphasia aphasia? The problem of closed head injury. In R. Brookshire (Ed.), Clinical Aphasiology Conference proceedings. Minneapolis, MN:BRK. (3) Chapey, R. (Ed.) (1994). Language Intervention Strategies in Adult Aphasia (3rd ed., pp. 3, 90). Baltimore, MD: Williams & Wilkins.

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