Ir a Posters Electrónicos     Ir a Conferencias



The role of the Speech-Pathologist on Traumatic

Brain Injury Rehabilitation


Authors: Alexa Sennyey, Andreza Maciel dos Santos, Cibele Ricardi;
                    Luciana Alves Abdulmassih

Country: São Paulo, Brazil.


Send Comments


  1. Explain how TBI can impact on communication
  2. Identify common communication errors on TBI patients
  3. State functional treatment strategies
  4. Conclusion


Communication Disorders on TBI

Effective communication is the capacity that includes not only expressive language and comprehension, but also several other cognitive behaviors that are controlled on different parts of the brain. Following the definition of the American Speech and Hearing Association (ASHA), cognitive-communication are the processes that include executive function, attention, processing of information, memory, visual and space perception, problem solving ability and psychosocial behavior (ASHA, 1991).


Common Cognitive-Communication Disorders on TBI

Communication disorders on TBI patients are very heterogeneous. The lesions are usually difuse, caused by different types of impact, speed of impact and results of the injury also depend on pre-morbid aspects of the patient, age, cerebral dominance, education, socioeconomic status (Ruff and Camenzuli, 1991). Frontal and temporal lobe damage is the most common to happen. Frontal lobe has an important role in the organization and appropriatness of communication. Pre-frontal cortex damage results on cognitive-communication impairments such as attention, memory, perception, personality changes, apathy, lack of initiative, hyperactivity, inappropriate social behavior, impulsivity (Stuss and Benson, 1983, 1984; Blumer and Benson, 1975; Fuster, 1980; Gazzaniga, 1979). Left frontal and temporal lobe lesion on patients with left hemisphere dominance, can cause aphasia, although not so common and mostly transient (Sarno, 1980, 1984). Language disturbances associated with TBI includes word fluency, naming ability, comprehension, paraphasia and impairments of reading and writing (Heilman, Safran and Geschwind, 1971; Levin, 1981; Levin, Grossman and Kelly, 1976; Sarno, 1980). Right hemisphere damage can impact on communication regarding speech intonation, facial expression, attention, memory, pragmatic ability, orientation and perception (Burns, et al, 1985). Dysarthria is also a common symptom related to TBI patients (Groher, 1977; Najanson et al, 1978; Hagen, et al, 1979; Sarno, 1980).

Study done in the Hospital Arthur Ribeiro de Saboya, in São Paulo, will discuss common symptoms found in the population of TBI patients. This study was done during the years of 1998-1999 on Head Injury (HI) resulted from gun shot, and TBI. On the group of TBI, 37,7% presented some kind of aphasia (reception, emission, anomia); 14,3% dysarthria and 46,8% cognitive disturbances (memory, attention, orientation, etc). On the group of HI from gun shot, 62% presented some kind of aphasia (receptive, emission, anomia); 12,5% dysarthria and 62,5% cognitive disturbances (memory, attention, orientation, etc).


Functional Treatment

Functional treatment should have as goal the effectiveness communication, where language, cognition and psychosocial factors are considered. Discurse and social interaction ability should be evaluated, and therapy goals are based on the results. Therapy environment should take into account real-life needs and activities of daily-living. Strategies are based on residual capacities and compensatory abilities of the patient. Family members and friends should be active part of the rehabilitation process. Goals should be clearly defined with interdisciplinary participation. Patient should be included as much as possible to participate on treatment goals, evolution and needs of modification (Barco, et al, 1991; Adamovich, et al, 1985; Hartley, 1995). Cognitive rehabilitation is a difficult and sometimes a long process that involves overcoming a number of difficult obstacles (Sbordone, 1991) that have as the ideal and long-term goal the return to most of the pre-morbid responsibilities and activities.



Preliminary results of this research shows that a head injury, from severe to mild level, can leave the patient with cognitive communication disorders that will in some way will bring dificulties to his or her life when trying to achieve the maximum possible of the pre-morbid responsibilities. One of the professionals that has a very important role on the rehabilitation of this population is the Speech Language Pathologist, who has the expertise on the cognitive-communication abilities and rehabilitation.



  1. Adamovich, B; Henderson, J.A. & Auerbach S. Cognitive Rehabilitation of Closed Head Injured Patients, Pro-Ed, Austin, Texas, 1985.
  2. Barco, P.P; Crosson, B.; Bolesta, M.M.; Werts, D. & Stout, R. Training awareness and compensation in postacute head injury rehabilitation. In: Kreutzer, J.S. & Wehman, P.H. Cognitive rehabilitation for persons with traumatic brain injury. Imaginart Press, Bisbee, Arizona, 1991.
  3. Blumer, D. & Benson, D.F. Personality changes with frontal and temporal lobe lesions. In Benson and Blumer (Eds.), Psychiatric aspects of neurologic disease. New York, Grune & Stratton, 1975.
  4. Burns, MS; Halper, AS; Mogil, SI. Diagnosis of communication problems in right hemisphere damage. In Burns, MS, Halper, AS, Mogil, SI. Clinical Management of Right Hemisphere, 1985.
  5. Burns, MS Language without communication: the pragmatics of right hemisphere damage. In Burns MS; Halper, AS, Mogil, SI. Clinical Management of Right Hemisphere Dysfunction. Gaithersburg, Md: Aspen Publishers Inc.: 17-28, 1985.
  6. Fuster, J. M. The prefrontal cortex. Anatomy, Physiology and Neuropsychology. New York, Raven Press, 1980.
  7. Gazzaniga, M. S. The frontal lobes. Handbook of behavioral neurobiology: neuropsychology (Vol. 2). New York, Plenum Press, 1979.
  8. Groher, M. Language and memory disorders following closed head trauma. Journal of Speech and Hearing Research, 20; 212-223, 1977.
  9. Hagen, C.; Malkmus, D.; Burditt, G. Intervention Strategies for Language Disorders Secondary to Head Trauma. Short course. American Speech Language and Hearing Association, Atlanta, 1979.
  10. Hartley, L. Cognitive-Communicative Abilities Following Brain Injury. A Functional Approach. Singular Publishing, San Diego, CA, 1995
  11. Heilman, K.M.; Safran, A. & Geschwind, N. Closed head trauma and aphasia. Journal of Neurology, Neurosurgery and Psychiatry, 34: 265-269, 1971.
  12. Levin, H.S., Grossman, R.G. & Kelly, P. Short-term recognition memory in relation to severity of head injury. Cortex, 12:175-185, 1976
  13. Levin, H.S. Aphasia in closed head injury. In M.T. Sarno (Ed.), Acquired Aphasia. New York, Oxford University Press, 1981.
  14. Murdoch, B.E. Desenvolvimento da Fala e Distúrbios da Linguagem. Revinter, Rio de Janeiro, 1997.
  15. Najenson, T.; Sazbon, L., Fiselzon, J.; Becker, E.; Schechter, I. Recovery of Communicative functions after prolonged traumatic coma. Scandinavian Journal of Rehabilitation Medicine, 10, 15-21, 1978.
  16. Ruff, R.M. & Camenzuli, L. F. Research challenges for behavioral rehabilitation. Searching for solutions. In: Kreutzer, J.S. & Wehman, P.H. Cognitive rehabilitation for persons with traumatic brain injury. Imaginart Press, Bisbee, Arizona, 1991.
  17. Sarno, MT. The nature of verbal impairment after closed head injury. Journal of Nervous Mental Disorder, 168: 685-692, 1980.
  18. Sarno, MT. Verbal impairment after closed head injury: report of a replication study. Journal of Nervous and Mental Disorder, 172: 475-479, 1984.
  19. Sbordone, R. J. Overcoming obstacles in cognitive rehabilitation of persons with severe traumatic brain injury. In: Kreutzer, J.S. & Wehman, P.H. Cognitive rehabilitation for persons with traumatic brain injury. Imaginart Press, Bisbee, Arizona, 1991.
  20. Stuss, D.T. & Benson, D.F. Frontal lobe lesions and behavior. In A. Kertesz (Ed.), Localization in Neuropsychology. New York, Academic Press, 1983.
  21. Stuss, D.T. & Benson, D.F. Neuropsychological studies of the frontal lobes. Psychological Bulletin, 95:3-28, 1984.


You may send the comments about this article to 
Discussion Neurosurgery'99 List

To contact Authors personally:



     Ir a Posters Electrónicos     Ir a Conferencias


Go Top