1. Speaking and/or swallowing because of weakness or incoordination of muscles.

2. Hearing/understanding due to hearing loss.

3. Language skills related to understanding or making sense of what one hears or reads.

4. Language skills involving organization of thoughts, finding appropriate words and/or putting words in the appropriate order to express one's ideas in speech or writing.

5. Cognitive areas such as those described previously, causing confusion in understanding and expressing messages and/or functioning well in one's home and work environment.

6. Memory, particularly in regard to short-term memory (recall of recent past).

What does the Speech Pathologist do to help?

The speech pathologist is a specialist in evaluation and treatment of speech, language, voice, swallowing, and higher level language and cognitive problems. Once patients with head trauma are alert and interacting with their surroundings, testing and observation will occur to determine their ability to benefit from a therapy program. If a program is indicated, it will be designed to increase communicative abilities within the limitation of the type and severity of the disorders they demonstrate. Results of the evaluation are shared by team members so that they may be able to incorporate this information into their treatment programs.

Communication/Cognitive problems associated with Head Trauma

If testing indicates a language disorder and the patient demonstrates ability to participate adequately, work occurs specific to that deficit area. Swallowing difficulties, which decrease the patient's ability to eat safely or maintain adequate nutrition, may be present. Treatment will then also occur in this area, with dietary adjustments or tube feedings initiated as necessary. Some patients may demonstrate weakness and incoordination which interfere with speech and voice production. Therapy may then include speech and voice production work, as well. All patients receive a hearing screening and those with detected problems are referred to a specialist for more thorough evaluation.

As discussed earlier, patients may demonstrate difficulties with cognitive functioning. For those individuals, work occurs to improve attention, memory, thought organization, reasoning and problem-solving. Improvement in these skills is facilitated by presenting structured cognitive tasks in a developmental sequence of easiest to more difficult learning tasks. Structure is introduced into all tasks. This involves decreasing the amount, complexity, rate and duration of information presented at any given time, and providing the patient with repetition and predictability. As each of the patients progress, the program will change in accordance with their abilities.

What Can I do to Help?

Strong emotional support, with provision of a calm and predictable environment, is necessary. Patience and understanding, in the face of physical and/or verbal behavior previously uncommon to your family member or friend, is a key element. Becoming more familiar with the common stages of recovery in head trauma will help prepare you with the sometimes upsetting and surprising behaviors present. The more you understand about the progression of stages and what can be expected at each level, the better you will be able to provide a calm response. Remember that the patient has difficulty recalling information over periods of time, sometimes as short as minutes. Confusion will be present because of this, and matter-of-fact correction versus direct challenge will help keep the situation low key. Keeping the amount of information given, at any one time, to low levels and doing so in a repetitive manner will assist in helping the patient to absorb it more easily.

Should you have questions about how to handle certain types of situations or how to help with specific language or swallowing problems, please do not hesitate to contact the speech pathologist working with the patient. Since each individual will perhaps have difficulties in different areas, more specific and meaningful information can be presented in this way. Family meetings will also be held to discuss current status and goals for patients during their hospitalization and course of treatment. Attendance at therapy sessions is encouraged, however, please understand that there will be times when additional individuals in the therapy session would be distracting for the patient. In these cases, such as during evaluation or when the patient is highly distractible, you may be asked to wait outside the therapy room during the session.

Communication/Cognitive Problems Associated with Head Trauma Follow-up:

Some patients will require therapy following the hospital stay. It is important that you follow-up with recommendations for ongoing therapy. Encouragement and support that you provide as a family member will go a long way in helping individuals overcome their problems.

What is aphasia?

Aphasia is a language processing disorder. It is a loss of the ability to formulate, express or understand the meaning of spoken or written words. It affects oral expression, reading, writing, and the use of gestures. It is not the same as confusion or dementia, which are characterized by a more generalized decrease in intellectual functioning.

What causes aphasia?

Aphasia is a direct result of damage to the "language areas" of the brain - usually in the left hemisphere. The most common causes of aphasia are:

1. Disruption in the brain's blood supply (stroke, hemorrhage, heart attack, etc.).

2. Head injury.

3. Tumors.

4. Infections, inflammations, etc.

What are the symptoms of aphasia?

There are different aphasia types and levels of severity which depend on the site and extent of damage. Although a receptive or expressive deficit may dominate, usually there are elements of both. Aphasia is frequently classified as "non-fluent" or "fluent".

Non-fluent aphasia is usually characterized by relatively good understanding and marked difficulty forming words. The patient often understands conversation well, although not perfectly. At severe levels the patient may be unable to speak at all. At less severe levels, speech may sound "telegraphic" with many of the smaller words omitted. Inappropriate repetition of the same word or phrase may occur as if the patient is "stuck" in a pattern that they cannot break.

In fluent aphasia, the patient's speech production is more rapid. Rhythm and articulation are often normal. Word and sound substitution often result in imprecise and empty speech. In severe cases, no real words can be recognized, and the patient's speech may consist totally of meaningless jargon. There are subtypes of fluent aphasia in which patients' ability to understand, repeat what they hear, "find" words, and recognize their own errors will vary.

Global aphasia is characterized by severe impairment in both the production and the understanding of language. Talking may be limited to a single word or phrase. Understanding simple questions or statements is difficult. Reading and writing skills are usually more affected than talking or understanding.

What can a speech pathologist do to help?

The only direct help for aphasia is speech and language therapy. A speech pathologist is highly trained in speech, language and thought processes. The first task of the speech pathologist is to accurately assess all aspects of the patient's communication ability. It is extremely important that the patient be evaluated to differentiate levels of severity and aphasia types. Communication with the patient on a daily basis and the type of therapy provided will differ markedly, depending on the patient's communication profile. Once evaluated, the speech pathologist reports results to the patient's physician and family. Following evaluation, treatment goals are determined and, if appropriate, therapy is initiated. Therapy usually will continue until the patient has made maximum measurable improvement. With some patients this may occur in a few weeks; other patients may benefit from therapy for several months.

Will the patient get better?

The amount of recovery from aphasia depends on numerous factors. Although recovery is different in each particular patient, the following are the chief influencing factors:

1. The site and extent of the lesion.

2. The cause of the lesion (e.g., the recovery from aphasia acquired through head injury may be different from that acquired through stroke).

3. Whether medical treatment of the cause is possible.

4. If the patient receives speech treatment and when speech treatment is started.

5. The severity and type of aphasia.

6. Associated non-language deficits such as: paralysis, memory deficits, confusion, decreased ability to learn new information, decreased control of emotions, and difficulty with thought organization.

7. Language and intellectual ability prior to the episode.

8. Personality, temperament and motivation.

What can family and friends do to help the patient with aphasia?

The first thing friends and family should do is to increase their knowledge about the patient's specific problems. This should be done through discussion with the patient's physician and with the patient's speech pathologist. Initially, the family should simply provide a supportive, noncritical environment. Continue to treat the patient as an adult with respect an adult deserves. Ask the patient's speech pathologist for a list of do's and don'ts specific to your family member.

Follow-up:

Some patients will require therapy following their hospital stay. It is important that you follow-up with recommendations for ongoing therapy. The encouragement and support you provide will go a long way towards helping individuals overcome their problems.

Right Hemisphere Brain Injury The right hemisphere of our brain has been called the non-verbal and the non-dominant brain hemisphere. It is true that, in most persons, the right hemisphere does not control speech and language, but it still contributes to communication and behavior. In addition to controlling the left side of the body, the right hemisphere helps us perceive our world visually; it helps us to respond to emotions, feelings and humor; it brings together ideas; it solves problems creatively, and uses images to help us remember. When something goes wrong in the right brain, a person may show a few or many of the following problems, depending on the extent and area of brain damage:

1. Impaired Attention and Awareness: