Traumatic Brain Injury (TBI)

What types of TBI are there?

Traumatic brain injury (TBI) is caused by injury to head. There are two major types:

Penetrating Injuries: These are injuries in which a foreign object such as a bullet enters the brain and damages specific parts of the brain. The major damage is done in the specific area in which the object penetrated. Symptoms vary depending on which part of the brain is damaged.

Closed Head Injuries: These are injuries caused by blows to the head such as the head striking the dashboard in a car accident. These can cause two types of brain damage:

Primary brain damage, the damage that is limited to the time of the impact, such as:

  • skull fracture: breaking of the bony skull
  • contusions/bruises: often occur right under the location of impact or at points where the force of the blow has driven the brain against the bony ridges inside the skull
  • hematomas/blood clots: occur between the skull and the brain or inside the brain itself
  • lacerations: tearing of the frontal (front) and temporal (on the side) lobes or blood vessels of the brain (the force of the blow causes the brain to rotate across the hard ridges of the skull, causing the tears)
  • nerve damage (diffuse axonal injury): arises from a cutting, or shearing, force from the blow that damages nerve cells in the brain’s connecting nerve fibers

Secondary brain damage, damage that can progress past the point of trauma, and includes:

  • brain swelling (edema)
  • increased pressure inside of the skull (intracranial pressure)
  • epilepsy
  • intracranial infection
  • fever
  • hematoma
  • low or high blood pressure
  • low sodium
  • anemia
  • too much or too little carbon dioxide
  • abnormal blood coagulation
  • cardiac changes
  • lung changes
  • nutritional changes

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What physical problems occur after TBI?

Physical problems may include hearing loss, tinnitus (ringing or buzzing in the ears), headaches, seizures, dizziness, nausea, vomiting, blurred vision, decreased smell or taste, and reduced strength and coordination in the body, arms, and legs.

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What communication problems occur after TBI?

Those with brain injury often have issues with their cognition (thinking) and communications. They become less independent due to these difficulties. Issues vary depending on the location and severity of the damage.

Survivors of brain injury may have difficulty in communication as they may not be able to find the words to express themselves through speaking and/or writing. It may be difficult for them to comprehend both written and spoken messages as well as spelling, writing, and reading.

A brain injury patient may have difficulties with social communication, including:

  • taking turns in conversation
  • maintaining a topic of conversation
  • using an appropriate tone of voice
  • interpreting the subtleties of conversation (e.g., the difference between sarcasm and a serious statement)
  • responding to facial expressions and body language
  • keeping up with others in a fast-paced conversation

Brain injury patients may seem overemotional or emotionless, act inappropriately, and have a difficult time communicating effectively, which can be frustrating to friends and family.

The muscles in the lips and tongue may also be weaker or less coordinated which can cause more difficulty in speaking clearly. The individual may not be able to speak up or be heard in conversation. Muscles may be too weak to allow the individual to speak at all. This can also limit their ability to effectively chew and swallow.

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What cognitive problems occur after TBI?

Cognition, or thinking skills, is commonly damaged after traumatic brain injury and can result in the loss of awareness of the individual’s surroundings, lack of attention to tasks, and poor memory, reasoning, problem solving, and executive functioning (e.g., setting goals, planning, self-awareness). Difficulties vary depending on where the injury occurred and how severe it is. These difficulties may include the following:

  • Trouble concentrating when there are distractions (e.g., carrying on a conversation in a noisy restaurant or working on a few tasks at once).
  • Slower processing or “taking in” of new information. Longer messages may have to be “chunked,” or broken down into smaller pieces. The person may have to repeat/rehearse messages to make sure he or she has processed the crucial information. Communication partners may have to slow down their rate of speech.
  • Problems with recent memory. New learning can be difficult. Long-term memory for events and things that occurred before the injury, however, is generally unaffected (e.g., the person will remember names of friends and family).
  • Executive functioning problems. The person may have trouble starting tasks and setting goals to complete them. Planning and organizing a task is an effort, and it is difficult to self-evaluate work. Individuals often seem disorganized and need the assistance of families and friends. They also may have difficulty solving problems, and they may react impulsively (without thinking first) to situations.

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How is TBI diagnosed?

The speech-language pathologist (SLP) works with the person and his or her family/caregivers as part of a team that may also include:

  • doctors
  • nurses
  • neuropsychologists
  • occupational therapists
  • physical therapists
  • social workers
  • employers
  • teachers

The team works together to assess the patient and construct a treatment plan.

The speech language pathologist conducts an oral motor evaluation check to assess the strength and coordination of the muscles that control speech. The SLP also evaluates the patient’s comprehension and skills in grammar (syntax) and vocabulary (semantics) as well as reading and writing.

Pragmatic (or social communication) language are assessed through tests and role-playing scenarios in communication. The SLP may ask the patient to discuss stories and the points of view of various characters in a story.

The patients cognitive-communication skills are evaluated to determine whether the patient is aware of their surroundings, whether they know important self-information, (their birthday, name, where they are) their recent memory skills, and executive functioning skills. Their ability to plan and organized and attention to detail will also be evaluated.

If the SLP notices any issues, they will evaluate the patient’s swallowing and make recommendation in regards to management and treatment. This will ensure that the patient can swallow safely and receive the nutrition they need. The SLP may also recommend addition swallowing tests.

If necessary, the SLP may also evaluate the benefit of a communication aid or device to express basic needs and ideas.

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What other organizations have information about TBI?

Please be aware that the following list is not comprehensive, and does not necessarily imply endorsement from Premier Therapy Associates as to its content.

See also:

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