When a traumatic brain injury affects your ability to produce and understand language, then speech therapy can help.
The goal of speech therapy for brain injury patients is to restore communication abilities based on your unique symptoms.
To help you find the best speech therapy intervention that fits your needs, this article will show you what options are out there.
Because brain injury causes unique communication problems as well, we’ll also show you some interventions customized for TBI.
Goals of Speech Therapy for Brain Injury
Communication is a complex cognitive process. Therefore, speech therapy goals for TBI patients involve more than just learning to correctly form words.
A speech therapist will usually include cognitive training in their programs for brain injury patients, since speaking requires mental abilities such as memory and concentration.
Because speaking is fundamentally a social activity, a speech therapist can teach brain injury patients how to follow rapid conversations and interpret nonverbal signals.
Finally, swallowing is crucial to speech production, so SLPs are also trained to help people regain their swallowing abilities.
Communication Disorders after Brain Injury
What type of speech therapy intervention you require will depend on which communication disorder you have.
The following are some of the most common language disorders after brain injury. Most TBI patients will experience more than one.
Aphasia usually occurs after a left-side brain injury. The left hemisphere is where the two regions of the brain in charge of language are found: Wernicke’s area and Broca’s area.
However, aphasia is more of an umbrella term that encompasses several types of impairments. These include:
- Expressive aphasia. This affects a person’s ability to produce words. Speech is usually halting and requires maximal effort. People with expressive aphasia can still read and understand others fine.
- Receptive aphasia. This impairs a person’s understanding of language. They can usually still speak fluently, but their speech is filled with nonsense words. They cannot read or write.
- Anomic aphasia. This type of aphasia affects a person’s ability to find the right words, even though they know what they want to say.
- Global aphasia. The most severe form of aphasia. When a person can neither speak nor understand others, they have global aphasia.
Dysarthria (Slurred speech)
Dysarthria arises when brain injury has impaired your control of the oral-facial muscles. This causes difficulties with producing words, even though the person has no cognitive impairments.
Features of dysarthria include:
- Reduced strength and movement of lips, tongue, and soft palate.
- Problems swallowing (also known as dysphagia)
- Slurred speech
- Difficulty controlling airflow from lungs when speaking
Sometimes, both aphasia and dysarthria are present, which can make diagnosis difficult.
Cognitive and Social Communication Problems
The frontal lobe also plays a role in communication. In particular, it helps you understand the more subtle aspects of a conversation. If it becomes damaged, it could cause you problems such as:
- Not understanding when to let the other person speak
- Only talking about yourself
- Fixating on certain topics, even when others have moved on
- Saying rude or inappropriate things
- Trouble picking up nonverbal cues
- Taking things too literally
In addition, brain injury can cause cognitive fatigue, which will make every part of communication more difficult.
Apraxia of Speech
Apraxia causes problems with coordinated movement. It can affect any muscle, including speech muscles.
People with apraxia of speech do not slur their words. Instead, they might make odd, exaggerated movements with their lips and tongues. They might also pronounce some words strangely.
In some cases, apraxia only appears when the person must think about what they want to say. Otherwise, if they speak spontaneously, there is no issue.
Types of Speech Therapy for Brain Injury
A rigorous speech therapy program can help you recover most of your communication skills.
Below are some of the most common speech therapy methods for brain injury patients. These can also be helpful for concussion patients.
1. Speech Therapy Exercises
For people with mild aphasia or apraxia, practicing TBI speech therapy exercises is the best approach.
The more you practice them, the more you will activate neuroplasticity, which is your brain’s natural healing mechanism.
This mechanism allows healthy portions of the brain to take over function from damaged areas. It is the main way you can learn how to speak again after brain injury.
Some examples of speech therapy drills your therapist might show you include:
- Lip and tongue strengthening exercises
- Coordination exercises
- Articulation exercises
To ensure that you keep making progress, it’s important that you do these activities every day. Mobile apps like the CT Speech & Cognitive Therapy App can walk you through each exercises and help you stay on top of your therapy from the comfort of your own home.
2. Constraint-Induced Language Therapy
Constraint-Induced Language Therapy was designed to help people with more severe language disorder regain speaking skills. It utilizes the same principles as CIMT (Constraint-Induced Movement Therapy)
With movement therapy, the goal is to force the person to use their weak limb by eliminating compensatory tactics.
The idea is, with enough practice, the brain will relearn how to use the affected limb again and the patient will regain function.
For example, if a patient uses their left hand because their right hand is weaker, a physical therapist would tie down the patients left hand while they do exercises with their right hand.
The same principles apply to Constraint-Induced Language Therapy. With this speech therapy method, a patient would have to
- Avoid using compensatory tactics such as gestures, drawings, or writing
- Communicate only by speaking
- Practice heavily for at least one hour per day.
With enough practice, you will activate neuroplasticity and should see improvements in your speech.
3. Music Therapy
For people who have such severe impairments that they can’t even utter a single word, music therapy (or melodic intonation therapy) is a great option.
In fact, there have been cases of people with global aphasia who could not speak, but when asked to sing, they could sing an entire song fluently.
The reason they can do this is because singing engages the right side of the brain, whereas speaking utilizes the left side. If the right hemisphere remains intact, the person will still be able to sing.
It was this discovery that led speech therapists to develop a technique known as melodic intonation therapy.
Melodic intonation therapy involves singing simple words or phrases to the tune of familiar melodies. With enough repetition, patients eventually turn their singing speech into normal speech.
Most patients permanently maintain the improvements that they gain. This makes it a very effective way to re-learn how to speak.
If this method sounds appealing to you, seek out a speech therapist trained in music therapy. You can find a list of certified practitioners here.
4. Oral Reading for Language in Aphasia (ORLA)
This aphasia treatment reading sentences aloud with a speech therapist. The goal is to improve reading comprehension and practice natural sentence rhythm.
Studies show that individuals with expressive aphasia see significant improvement after taking part in this therapy.
This treatment is only suitable for patients who have kept their reading skills.
5. Response Elaboration Training (RET)
Speech therapists designed this treatment approach to help persons with speech disorders increase their elaboration skills.
It’s also sometimes called “loose training” because there are no correct answers. Rather, the goal is to encourage the patient to generate their own responses.
To do RET, the speech therapist will use a set of images depicting an action, such as a man pushing a lawnmower. Then the therapist asks a series of wh- questions (what, where, who, etc…) to help the patient expand on their answer.
A typical RET session would look something like this:
- The therapist shows the patient a photo of a girl walking a dog and asks what the person sees.
- The person with aphasia responds with a short sentence such as “girl…dog”
- Therapist congratulates the patient
- The therapist then asks a question such as “What is the girl doing?”
- Patient answers “girl…walking’’
- The therapist combines the two sentences to say “girl is walking the dog” and asks the patient to repeat the sentence.
- Patient answers with “girl walking dog” and the therapist goes from there.
Depending on how well the patient does, they could go from saying “girl dog” to “girl is walking dog to the park” by the end of the session.
6. Meta-Cognitive Skills Training
Meta-cognitive skills help a person organize and control their own thoughts and actions. They are also critical for conversation.
Some cognitive and meta-cognitive skills that a speech-language pathologist (SLP) will address include:
- Memory and recall
- Planning and organizing
- Attention and concentration
- Self-monitoring and reflection
7. Social Communication Training
Finally, speech therapy for brain injury patients will also involve improving conversation skills.
Most therapists will role-play conversations with their patients, showing them the best responses to make. They also teach them how to take turns speaking, how to stay on topic, and when to change topics, etc.
This allows TBI survivors to learn from their social mistakes in a safe environment free from judgment or embarrassment.
Speech Therapy for Brain Injury Patients
We hope this guide to speech therapy for brain injury patients helps you understand the many options available. Choosing the right approach is crucial to regaining your speech.
You may need a combination of these approaches, depending on how severe your impairments.
But whichever method you use, the key is to practice your exercises daily. If you can do that, your brain will rewire itself and you will make great strides in your communication abilities.