Erica Tilley, Speech Pathologist
Problems after a brain injury
People can experience a range of symptoms including:
- Coughing when eating or drinking
- Trouble with reading or writing
- Difficulty understanding other people
- Slurred or unclear speech
- Difficulty finding the right word
- Trouble engaging in conversation with loved ones
- Difficulty with appropriate social skills
This article will be focussing on cognitive communication after a traumatic brain injury. But if your concern is about the other symptoms listed above, a Speech Pathologist at Umbo can also help you with aphasia (language), speech (dysarthria), apraxia of speech, and mealtime management difficulties after a traumatic brain injury. You may like to read more about management of these symptoms on the stroke and degenerative neurological conditions pages as there are similarities in the Speech Pathology approaches used.
Social skills after a brain injury
Many people do not realise that a speech pathologist can help them after a traumatic brain injury. A traumatic brain injury can make it more difficult to think and to concentrate. This can have subtle impacts on the way we listen, speak, read, write, and have conversations. The communication difficulties that arise from the way we think are known as cognitive communication disorder.
You may have difficulties with:
- Starting a conversation
- Staying on topic
- Repeating yourself
- Resisting distractions during conversations
- Interrupting other people talking
- Keeping track of what other people are saying
- Keeping track of what you were saying
- Giving other people a chance to speak
- Understanding sarcasm
- Excessive swearing
- Inappropriate comments
- Reduced eye contact
- Standing too close to other people when talking
Impact of cognitive communication disorders
Loss of friends and social life is a common problem after a traumatic brain injury. Up to 30% of people with severe traumatic brain injury have no social contacts outside of their family.
Therapy for cognitive communication disorders
Research has shown that social skills can improve after a traumatic brain injury, even many years later. In 2014, a group of researchers (INCOG) published best practice guidelines for treating people with cognitive communication problems caused by acquired brain injuries.
Here are the 7 evidence-based rehabilitation principles in lay terms:
1. People may have more difficulty communicating at some times more than others.
This can depend on how well they know the person they are talking to, fatigue, the environment (busy versus quiet), fatigue, and demand (job interview versus catching up with a friend).
2. People with cognitive communication problems should be referred to a speech pathologist.
It is not always obvious that a speech pathologist can help with social communication difficulties such as saying inappropriate things, swearing too much, or not giving conversation partners a chance to speak. However, a speech pathologist can work with you and your conversation partners to find strategies that help.
3. People with cognitive communication difficulties will have different therapy goals depending on the life they led prior to their accident.
For example, we all lead different lives and communicate in different ways depending on our age, what we do for work, our level of education, and our cultural background. A language teacher will have different goals as compared to someone who is working in a very solitary role such as a train driver.
4. People with cognitive communication problems should have opportunities to practice in everyday situations.
At Umbo, we are focussed on how you can transfer communication strategies to your everyday life. We can work with you online to find strategies that can help and set tasks that allow you to put them into practice where it counts most. For example, you might have a go using your new strategy when picking up the milk from the corner store. We can then check in with you to see how it went and to troubleshoot any problems for next time.
5. Therapy should include providing education to your conversation partners.
It can be too easy to place all the pressure on people with cognitive communication disorders to communicate in a different way. Rather, it is a two-way street.
Research has shown that training conversation partners (friends, family, support workers and police officers) also improves conversation quality. Conversations are more effective and rewarding when conversation partners are educated about the consequences of traumatic brain injury, strategies to help keep conversations on track, and monitoring their tone of voice when asking questions. At Umbo, we often work with conversation partners including friends, family, support workers and employers.
6. People with severe communication problems after a brain injury benefit from communication aids.
If you have severe communication difficulties after your injury, we can work with you and your support network to set up communication aids. This might range from something more basic such as communication boards, to using an App on an iPad depending on how much you like technology.
7. People with cognitive communication problems after a traumatic brain injury should be able to choose their own goals.
At Umbo, we are strong believers in person-centred practice, that is working on goals that you feel are the most important to you and your support network. Our practice principles stem from the Umbo values which are Inclusion – Authenticity – Respect – Creativity and Open Mindedness.