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Communication Problems After Traumatic Brain Injuries

Traumatic brain injury (TBI) is a complex injury with variety of symptoms and disabilities. TBI has a huge impact on the individuals involved and their family members. TBI is a form of brain injury caused by sudden damage to the brain. Depending on the source of the trauma, head injuries caused by TBI can be either open or closed injury.

Type of traumatic brain injury

There are two types of traumatic brain injury.

  • Open head injury : It is also called “punctured injury“, in which injury occurs when an object (e.g. a bullet or a sharp object) punctured into the brain and cause damage to certain parts of the brain. Symptoms shown are varied depending on which part of the brain that is damaged.
  • Closed head injury : Injury is caused by a blow to the head (for example, when the head hitting the windshield or dashboard during a car accident). As a result, problems such as skull fractures, bleeding and blood clots in the brain may occur.

Regardless of the cause of trauma, TBI also can be caused by two types of damage to the brain: early stage brain damage, in which the damage occurred give immediate results (e.g. skull fractures, bleeding, blood clots), and second stage brain damage, which is damage constant brain from time to time after the trauma (e.g. increased blood pressure in the skull, seizures and swelling of the brain).

The causes of traumatic brain injury

TBI causes are as follows:

  1. Fall
  2. Accidents involving motor vehicles (e.g. cars and motorbikes) and pedestrians
  3. As a result of an impact or collision (e.g. banging on the surface)
  4. Violent attacks (e.g. being hit by a blunt object)

Injuries in sports and explosion/injury during the war are also one of the main causes TBI.

Cognitive and communication of individuals as a result of traumatic brain injury

A cognitive and communication problem caused by traumatic brain injury varies from one individual to another. These problems depend on many factors, including individual personalities, abilities of the person before the injury and severity of brain injury.

  1. The effect of traumatic brain injury on the recovery process

    Effects of brain damage usually occur after the injury. However, some of the effects of TBI may be misleading. The new brain injuries often suffered from temporary damage as a result of swelling and bruising called contusion. These types of damage are not permanent and functions of the brain will recover when swelling or bruising is gone. Therefore, it is difficult to accurately predict the extent to which long-term problems at early stages after TBI.

    If the brain injury is more concentrated in one area it will cause long-term problems and permanent disability. The recovery process can occur when the area of non-injured brain began to take over the functions of the affected brain. A child’s brain is more capable to recover quickly than in the adult brain. Therefore, a child who suffered a brain injury progressed better than adults with brain damaged of the same severity.

    The swelling of the brain of moderate to very severe brain injury can cause pressure on the bottom of the brain called the brainstem. The brainstem controls conscious function of an individual. Many individuals who suffer this type of injury is in a state of unconsciousness called a coma. A person in a coma can really react to any kind of stimuli such as loud noise, pain, or odour. In other cases, some can move, make noise, or respond when pain but they are not aware of the situation around. They are also not able to communicate. Some who managed to recover from a coma, they become aware and able to communicate.

  2. Cognitive problems

    For individuals who are conscious, cognitive deficits often associated as a result of traumatic brain injury include having trouble focusing for a specific period, organizing thought, and easily confused or forgot. Some individuals will have difficulty learning new information. There also are not able to interpret the actions of others and cause them to have problems with socializing. What they say or what they do is often not appropriate to the circumstances. Some are having difficulty solving problems, making decisions, and planning. Consideration of a matter is also affected.

  3. The issue of language

    Language problems also vary. The main problem is the difficulty finding words, unable to make sentences and frequently gives wrong explanations and different complexities of clarifications. This is caused by problem of understanding or difficulty finding the words to be delivered. For example, when asking for help in finding the shoes when going out of the house, the individual will say, “That thing I use to run in the field”. They also have problems with understanding jokes, metaphors and figurative language such as “Time is money” or “The world is my oyster “.

    Individuals who have a traumatic brain injury often do not realize their mistakes and can become frustrated or angry and blaming others for their communication problems, especially to the people they are talking to. Ability to read and write can also be affected than those who only have speaking and understanding problems. Mathematic abilities either to solve simple or complex problems can also be affected.

  4. Speech problems

    Speech produced by individuals with traumatic brain injury may be slow, unintelligible and difficult or impossible to understand if the parts of the brain that controls muscle movement for speech production is damaged. This speech disorder is called dysarthria. These individuals may also experience problems with swallowing called dysphagia. Some individuals may also have had apraxia, in which the strength and coordination of the speech muscles are not affected, but difficulty in programming oral muscles for speech production. For example, someone can have difficulty producing the word “ball” when asked to repeat it, but then able to say “I will be able to play football this evening” out of sudden and spontaneously.

How to improve the ability to communicate of individuals after traumatic brain injury

Here are some approaches used to assist individual’s communication due to traumatic brain injury.

Feedback structured : it is very useful to get information from someone you can trust about aspects of fluent communication. This can be helpful if feedback is given immediately after the conversation occurred. Feedback should emphasize on communication abilities of the individual and areas that can be improved.

The use of video footage during a conversation : resume a video recording of the conversation was very helpful in identifying the strengths and weaknesses while communicating.

Model : Speech therapist or conversation partner can demonstrate and give examples of ways to communicate in different situations.

Shaping, signalling, and reduce signal : shaping refers to reinforce positive behaviour change until the target communication behaviour has achieved, signalling refers to giving instructions or guidelines to help in improving the ability to communicate, and reduction refers to the decreases of giving signal gradually.

Acting and training : acting and communication training in different situations help in improving the ability to communicate.

Positive feedback : give praise and encouragement for positive behaviour can help in improving communication skills. For example, individuals can earn reward points for every time he showed a positive behaviour (e.g. initiate a conversation) or do not do negative behaviours (e.g. to disturb others).

Homework : practising to communicate in everyday life is very important. The more training to communicate made outside the therapy sessions, the faster the positive changes can occur.

Alternative Communication : For individuals who suffer from severe communication problems, using alternative communication such as body gestures, the use of picture communication book and applications through telecommunication and media devices such as mobile phones and tablets can be used as a tool to communicate so that individuals can express their feelings and desires and avoid disappointment and depression as a result of unable to speak.


  1. Social Communication and Traumatic Brain Injury: A Guide for Professionals, retrieved from http://www.tbicommunity.org/resources/publications/professional_education_social_comm.pdf September 10, 2015.
  2. Traumatic Brain Injury (TBI), retrieved from http://www.asha.org/public/speech/disorders/TBI/, September 10, 2015.
  3. Traumatic Injury Resource Guide: The Bridge to a Meaningful Recovery, retrieved from http://www.neuroskills.com/brain-injury/cognitive-and-communication-disorders.php, September 10, 2015.


Last Reviewed : 28 August 2020
Writer / Translator : Mohd Azmarul bin A Aziz
Accreditor : Fairus bt. Mukhtar
Reviewer : Nadwah bt. Onwi