Communication can be a difficult thing to unravel. As Speech and Language Therapists, we look at many different aspects of communication, and try to understand how each aspect affects another.
This is particularly relevant when working with acquired brain injury. By ëacquiredí, we mean a brain injury that was not present from birth. Acquired brain injuries can be traumatic, where an external force injures the brain, such as the impact of a car crash, assault, or even falling down the stairs. By contrast, non-traumatic brain injuries do not involve external trauma, and occur ëinsideí the skull ñ such as stroke, infection, or haemorrhage. For these reasons, no two brain injuries are the same; they all vary according to their severity and the location(s) within the brain.
From a speech and language perspective however, brain injuries do have something in common: the concept of cognitive-linguistic function. Cognition refers to a personís ëthinkingí skills ñ such as memory, learning, and executive functions (e.g. planning, organising, decision-making and problem-solving; the management of cognitive processes that helps us get through a typical day). Linguistic function refers to many aspects of language, such as grammar, word meaning and sound awareness.
In brain injury, it is not easily possible to separate cognition from linguistics. For example, if a personís brain injury has left them with memory difficulties, this will impact on their ability to remember and understand long sentences. If a personís injury has left them with attention difficulties, they may have difficulty concentrating in conversations, classrooms or at work.
In particular, a personís cognitive difficulties resulting from brain injury can impact on their social communication. Some people with brain injuries find that they lose their drive, or motivation. For example, they have difficulty initiating getting out of bed, or getting dressed. This will therefore impact on their communication; if they are unable to initiate getting dressed, they are also often unable to initiate conversation, which can be very socially isolating.
Similarly, many people with brain injuries find that their cognitive ability to inhibit their behaviour is reduced. This often presents itself through communication; particularly through inappropriate language and/or behaviour. For example, a non-brain-injured person may have a thought that would be inappropriate if spoken aloud (such as a sexual, aggressive or racist comment). In this situation they are able to inhibit their behaviour without difficulty, and refrain from speaking aloud. A brain-injured person may be unable to inhibit their behaviour, and would typically verbalise their thoughts. This can be embarrassing for the individual, and can place them at risk of social vulnerability, particularly if they are among members of the public who may take offence at their comments.
Speech and language therapists working in this field help to manage any communication difficulties arising as a result of cognitive deficits, as well as working with speech and language impairments arising from direct damage to the brain structures. This can be particularly challenging as many individuals with brain injury present with anosognosia ñ a lack of insight into the difficulties that they are experiencing.
Sarah Bennington January 2011
Written on behalf of Integrated Treatment Services. ITS is a private Speech and Language Therapy service based in Leicestershire and the East Midlands. It specialises in providing highly-skilled Speech and Language Therapists, but also associates with other therapeutic professionals, including Occupational Therapists, Physiotherapists, Psychologists and Arts Therapists.
