|Brain injury rehabilitation involves two essential
processes: restoration of functions that can be restored and learning
how to do things differently when functions cannot be restored to pre-injury
Brain injury rehabilitation is is based on the
nature and scope of neuropsychological
symptoms identified on special batteries of test designed to measure brain
functioning following brain injury.
While practice in various cognitive tasks--doing
arithmetic problems, solving logic puzzles, concentration skills, or reading--may
help brain rehabilitation, this is usually not enough.
Brain injury rehabilitation must be designed taking
into account a broad range of neuro-functional strengths and weaknesses.
Basic skills must be strengthened before more complex skills are added.
Only through comprehensive neuropsychological analysis can the many possible
effects of brain injury be sorted out. This pattern of functional strengths
and weaknesses becomes the foundation for designing a program of brain
Brain recovery follows patterns of brain development.
Gross or large-scale systems must develop (or be retrained) before fine
systems. Attention, focus, and perceptual skills develop (or are retrained)
before complex intellectual activity can be successful.
What Are the Cognitive and Communication Problems
That Result From Traumatic Brain Injury?
What Research Is Being Done for the Cognitive and
Communication Problems Caused by Traumatic Brain Injury?
Cognitive and communication problems that result
from traumatic brain injury vary from person to person. These problems
depend on many factors which include an individual's personality, preinjury
abilities, and the severity of the brain damage.
Cognitive functions refer to what or how much
(e.g., How much does s/he know? What can s/he do?. So long as the executive
functions are intact, a person can sustain considerable cognitive loss
and still continue to be independent, constructively self-serving, and
When executive functions are impaired. the
individual may no longer be capable of satisfactory self-care, of performing
remunerative or useful work on his or her own, or of maintaining normal
social relationships regardless of how well preserved are his or her cognitive
capacities -- or how high his or her scores on tests of skills, knowledge,
Moreover, cognitive deficits usually involve specific
functions or functional areas; impairment in executive functions tend to
show up globally, affecting all aspects of behavior.
Executive functions consist of those capacities
that enable a person to engage in independent, purposive, self-serving
behavior successfully. They differ from cognitive functions in a number
of ways. Questions about executive functions ask how or whether a
person goes about doing something (e.g., Will s/he do it and, if so how?)
(Source: Dr. Muriel Lezak,
The effects of the brain damage are generally
greatest immediately following the injury. However, some effects from traumatic
brain injury may be misleading. The newly injured brain often suffers temporary
damage from swelling and a form of "bruising" called contusions.
These types of damage are usually not permanent and the functions of those
areas of the brain return once the swelling or bruising goes away. Therefore,
it is difficult to predict accurately the extent of long-term problems
in the first weeks following traumatic brain injury.
Focal damage, however, may result in long-term,
permanent difficulties. Improvements can occur as other areas of the
brain learn to take over the function of the damaged areas. Children's
brains are much more capable of this flexibility than are the brains of
adults. For this reason, children who suffer brain trauma might progress
better than adults with similar damage.
In moderate to severe injuries, the swelling
may cause pressure on a lower part of the brain called the brainstem,
which controls consciousness
or wakefulness. Many individuals who suffer these types of injuries are
in an unconscious state called a coma.
A person in a coma may be completely unresponsive to any type of stimulation
such as loud noises, pain, or smells. Others may move, make noise, or respond
to pain but be unaware of their surroundings. These people are unable to
communicate. Some people recover from a coma, becoming alert and able to
In conscious individuals, cognitive impairments
often include having problems concentrating for varying periods of
time, having trouble organizing thoughts, and becoming easily confused
or forgetful. Some individuals will experience difficulty learning new
information. Still others will be unable to interpret the actions of others
and therefore have great problems in social situations. For these individuals,
what they say or what they do is often inappropriate for the situation.
Many will experience difficulty solving problems, making decisions, and
planning. Judgment is often affected.
Language problems also vary. Problems often
poor sentence formation
and lengthy and often faulty descriptions or explanations.
These are to cover for a lack of
understanding or inability to think of a word.
For example, when asking for help finding a belt while
dressing, an individual may ask for "the circular cow thing that I used
yesterday and before."
Many have difficulty understanding multiple meanings
in jokes, sarcasm, and adages or figurative expressions such as, "A rolling
stone gathers no moss" or "Take a flying leap."
Individuals with traumatic brain injuries are often
unaware of their errors and can become frustrated or angry and place
the blame for communication difficulties on the person to whom they are
speaking. Reading and writing abilities are often worse than those for
speaking and understanding spoken words. Simple and complex mathematical
abilities are often affected.
The speech produced by a person who has traumatic
brain injury may be slow, slurred, and difficult or impossible to understand
if the areas of the brain that control the muscles of the speech mechanism
This type of speech problem is called dysarthria.
These individuals may also experience problems swallowing.
This is called dysphagia.
Others may have what is called apraxia
of speech, a condition in which strength and coordination of the speech
muscles are unimpaired but the individual experiences difficulty saying
words correctly in a consistent way.
For example, someone may repeatedly stumble
on the word "tomorrow" when asked to repeat it, but then be able to say
it in a statement such as, "I'll try to say it again tomorrow."
How Are the Cognitive and Communication Problems
The assessment of cognitive and communication problems
is a continual, ongoing process that involves a number of professionals.
Immediately following the injury, a neurologist
(a physician who specializes in nervous system disorders) or another physician
may conduct an informal, bedside evaluation of
and the ability to understand and speak.
Once the person's physical condition has stabilized,
speech-language pathologist may evaluate cognitive
and communication skills, and a
neuropsychologist may evaluate other cognitive
and behavioral abilities.
Occupational therapists also assess cognitive
skills related to the individual's ability to perform "activities of
daily living" (ADL) such as dressing or preparing meals. An audiologist
should assess hearing. All assessments continue at frequent intervals during
the rehabilitative process so that progress can be documented and treatment
plans updated. The rehabilitative process may last for several months to
How Are the Cognitive and Communication Problems
The cognitive and communication problems of traumatic
brain injury are best treated early, often beginning while the individual
is still in the hospital.
This early therapy will frequently center on increasing
skills of alertness and attention. They will focus on improving orientation
to person, place, time, and situation, and stimulating speech understanding.
The therapist will provide oral-motor exercises in
cases where the individual has speech and swallowing problems.
Longer term rehabilitation may be performed
individually, in groups, or both, depending upon the needs of the individual.
This therapy often occurs in a rehabilitation facility designed specifically
for the treatment of individuals with traumatic brain injury.
This type of setting allows for intensive therapy
by speech-language pathologists, physical therapists, occupational therapists,
and neuropsychologists at a time when the individual can best benefit from
such intensive therapy.
Other individuals may receive therapy at home
by visiting therapists or on an outpatient basis at a hospital, medical
center, or rehabilitation facility.
The goal of rehabilitation is to help the individual
progress to the most independent level of functioning possible. For some,
ability to express needs verbally in simple terms may be a goal. For others,
the goal may be to express needs by pointing to pictures. For still others,
the goal of therapy may be to improve the ability to define words or describe
consequences of actions or events.
Therapy will focus on regaining lost skills as
well as learning ways to compensate for abilities that have been permanently
changed because of the brain injury. Most individuals respond best to programs
tailored to their backgrounds and interests. The most effective therapy
programs involve family members who can best provide this information.
Computer-assisted programs have been successful with some individuals.
Researchers are studying many issues related to the
special cognitive and communication problems experienced by individuals
who have traumatic brain injuries.
Scientists are designing new evaluation tools to assess
the special problems that children who have suffered traumatic brain injuries
Because the brain of a child is vastly different from
the brain of an adult, scientists are also examining the effects of various
treatment methods that have been developed specifically for children.
These new strategies include the use of computer programs.
In addition, research is examining the effects of some medications on the
recovery of speech, language, and cognitive abilities following traumatic