Speech Pathology After Brain Injury – Key to Cognitive Recovery
Speech Pathology After Severe Brain Injury
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Speech pathology for those who survive severe brain injury is far more than relearning how to speak. Speech pathology is a field focused on addressing deficits in a patients ability to communicate. Within the context of a severe brain injury, the interventions of speech pathology begin at the most basic level. Speech pathology starts with the fundamental physical structures from which speech sounds are made. The field goes onward from there to encompass all of the motor, memory and higher thinking processes involved in normal communication.
Speech Pathology Begins with the Physical Processes of Speech
As a result of the injury to either the brain or throat, the physical processes that allow speech sounds to be made and projected may be impaired. Speech pathology does not begin with words but with the throat, as speech is dependent on the integrity of the structures of the throat. A tracheotomy (trach) to intubate a TBI patient, will at a minimum interfere with those functions. A trach may also cause long term physical issues. Particularly after a severe brain injury, the first focus may be on swallowing. Thus, speech pathology may be ongoing when communication is impossible – while someone is in a coma. There is an entire area of specialization of speech pathology focused on treating the severe brain injury patient in the ICU.
Speech Pathology is About Communication
Once the structures that allow speech are protected and rehabilitated, the focus of speech pathology shifts to brain damage that may have effected the use and understanding of words. Language is disrupted in 75% of those who survive a severe closed head injury. As those deficits range from relearning to use the muscles of the throat to form words, to remembering vocabulary, grammar and syntax, the field is at the forefront after coma emergence. Some specific areas of deficits that speech pathology will focus on include:
Speech Pathology will Address Aphasia
Aphasia is an acquired impairment of language processes that deal with the receiving of words and the expressing of communication. The senses of receiving words begins with the ear and expressing begins with the throat and mouth. But aphasia is not caused by damage to either place but to the areas of the brain that are primarily responsible for these functions. Aphasia shows up when the severe brain injury survivor has grammatical difficulties, finding the right word (“word retrieval”), comprehension of what they have heard and in reading and writing. The key to aphasia is that the cognitive processes otherwise seem in the presence of relatively intact. A few more brain injury terms you will hear discussed include anonmia (difficult naming things) and impaired auditory (meaning what you hear) comprehension. In addition, confabulation is a common problem after severe TBI. Confabulation is the telling of completely fantastical stories, which seem believable, but have no relationship whatsoever to reality. Confabulation is not dishonest – it is just the flaw in the process of trying to make sense of holes in what is remember as a result of brain damage. For the poignant confabulated story of what Lethan remembers of waving goodbye to his French teacher before his injury, click here.
Speech Pathology will Address Confused Language
Confused Language – means speech that may be sound right and be used in proper syntax, yet is lacking in meaning because responses are irrelevant or tangential in relation to a specific topic. Confused language is lacking a sequential relationship between thoughts. Such problems are also called a cognitive communication disorder because confused speech is difficult with the elements of communication secondary to cognitive dysfunction, from the other damage to the brain.
Speech Pathology will Address Dysarthria
Dysarthria – (meaning difficulty articulating ‘arthr’) is a motor disorder which impacts speech resulting from neurological injury (a focal neurlogical deficit) of the muscles that help one talk. Those muscles could be in the throat, the mouth, including the tongue. Dysarthria makes it difficult to pronounce words. It is unrelated to any problem with understanding language, just saying it.
All of these specific issues will be addressed if necessary in speech pathology. But the speech pathologist will be far more important than just fixing the speech. As language communication is the ability that separates man from other mammals, it is so related to cognitive functioning, that speech pathologists traditionally have become the specialists in cognitive therapy as well. The speech pathologist will be the key member of the medical team from coma emergence to discharge. The challenge for treatment is to find a way to access speech pathology services long term, not just while an inpatient.