After a Head Injury: Understanding Speech-Language Challenges

By

Gina Garippo

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If your loved one has suffered a head injury, it’s likely that his or her ability to understand or express language has changed in some way—possibly dramatically. Although many head injuries stem from common causes such as car or bicycle accidents, falls, or violence, each and every injury is different. As a family member or caregiver, you have the ability to help your loved one overcome unique communication challenges as much as possible.

“Family members of those who have suffered a head injury want to know when and how much their loved one will recover. Unfortunately, there are no rules with head injury,” explains Dana Read, MS, CCC/SLP, CBIST, regional speech pathology clinical manager and brain injury specialist for SSM Rehabilitation Hospital in St. Louis, Mo. “Depending on what area of the brain was affected and to what degree, brain-injured patients can have a wide variety of communication problems. They can also recover at very different rates.”





Speech-Language Problems

Many brain-injured patients do regain the ability to talk. However, some have problems that can make communication more challenging, including:

  • Aphasia: A disorder that occurs when the language portion of the brain has been damaged. Some patients with aphasia may unknowingly use made-up words or language. Often, they have problems understanding the sentences spoken to them. Others may know exactly what they want to say but have trouble finding the words. Some can only use one-word sentences or short phrases. Patients with extensive aphasia are unable to form sentences or understand words spoken to them.

  • Dysarthria: A condition that occurs when the body’s speech muscles have been weakened or damaged. People with dysarthria  know exactly what they want to say but they may be difficult to understand because they have slurred speech or talk in a whisper.

Many patients may be frustrated because they are aware of their speech limitations. It’s common for family members to be frustrated by the inability to have rich conversations with their loved one, too. Both sides will need to make some adjustments.
“Don’t expect your loved one to be able to communicate exactly like he or she did before the injury,” advises Read. “Learn how to adapt your communication style—such as speaking more slowly or giving your loved one time to respond. It can greatly improve your interaction.”

Cognitive-Communication Problems

Being able to speak allows your loved one to be connected to the world. But speech alone does not mean he or she is able to express meaningful ideas. Many head-injury patients also suffer from cognitive problems that can limit communication. Symptoms may include:

  • Rude or inappropriate language

  • Rapid, non-stop talking

  • Repeating the same story over and over

  • Rambling conversations

  • Talking about unrelated topics

  • Difficulty maintaining attention to conversation

  • Problems understanding abstract language such as humor or sarcasm

Therapy to Improve Communication Skills

The greatest improvements in speech and language tend to occur in the first six months after a head injury. But progress can be made for years. A speech-language pathologist (SLP) can help. SLPs work with brain-injured patients to help regain communication function whenever possible. They also teach strategies to compensate for communication problems, such as asking someone to repeat a question, only conversing in face-to-face situations, or using a communication device.

SLPs also work with physical and occupational therapists to implement therapies that can adapt to a patient’s motor problems. Motor problems can affect communication in several ways. For example, patients may not be able to use gestures or body language to communicate. They may have problems writing sentences when they hold a pen or use a keyboard. They may also have difficulty using some communication devices that require typing or pointing to express the words or phrases they want to convey.


Physical and occupational therapists can help patients learn to use special communication devices that are adapted to fit their motor abilities. For example, for patients who are unable to use their arms or legs, some communication devices can be operated by head movements or eye gaze.

It can be difficult to accept that your loved one is different. Head injuries most often occur without warning and leave family and friends in search of what to do next. Rest assured. You don’t need to have all the answers—only a willingness to accept this new reality and show some compassion. Working with your loved one’s medical and rehabilitation team can provide enormous help and inspiration.


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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 14, 2017

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