by: Diane Roberts Stoler,
Encoding Storage Sensory Short-Term Long-Term
Speech & Language
Grief & Loss
Loss Of Self
Seven years ago, Valerie writes, she was "still me." At that time, she was concentrating on helping her husband, a native of Italy who was not yet very proficient in English, to set up a business.
Only a quarter-mile from her home in Maryland, Valerie's car was struck by a vehicle whose driver wasn't looking as he pulled out into the road. Valerie was thrown down across the back seat of her car.
She recalls opening her eyes and finding herself on the floor - she was unaware of having struck her head, but remembers experiencing a flash of tremendous rage. Disoriented and shaky, but with no specific complaints, Valerie was driven home.
The next day, Valerie went to the emergency room because she couldn't see straight and felt very confused. The doctor diagnosed a concussion with some muscle strain, but took no x-rays.
Four days later, a general practitioner prescribed Darvocet, a powerful painkiller, and Amitriptyline, an antidepressant used as a painkiller. The medications put Valerie in such a fog that she threw them out a week or two later.
Valerie remembers little about the first year and a half after her accidient, but recalls seeing a neurologist who diagnosed postconcussive syndrome, and told her that her symptoms would disappear in three to six months.
Her MRI and CT scan results were normal. However, for two and a half years after her MTBI, and occasionally even today, people around Valerie can see her eyes glaze over when lights, noise, or too much information causes sensory overload.
Currently, Valerie has trouble remembering what she has just said or done, and she cannot recall the past except in bits and pieces.
Her ability to concentrate and follow through is very limited, as is her ability to organize, prioritize, and initiate activities.
Her depth perception and visual tracking are impaired, which causes all sorts of dyslexic phenomena, and she has problems with eye-hand coordination.
Valerie's MTBI also has a strong emotional component that includes irritability, mood swings, and self-doubt - especially concerning memory and judgement.
The thinking process involves a number of different components, including how you register information through attention and concentration; how you store and retrieve incoming messages; and how you reason, plan, organize, initiate, comprehend, learn new information, and create new ideas.
It also involves your ability to understand language, read and write, and do mathematics.
Many people with MTBI encounter a variety of mental effects in the months and years after injury.
We now consider the many different aspects of your thinking ability and provide information abou mental difficulities frequently associated with MTBI.
Along with information about diagnosis and treatment and practical suggestions that can help minimize the effects of such problems.
After suffering a MTBI, Gail struggled with sensory overload caused by her body's inability to regulate incoming sensations such as sound, light, and touch.
She walked strangly, because she couldn't tolerate the sensation of her feet touching the ground. If someone touched her elbow, she would jump backwards.
Previously, ordinary night sounds had been soothing; now they caused Gail to lie awake at night, listening to cars that sounded as if they were right outside the window, rather than on the highway a half-mile away.
She was disturbed by the sounds of birds moving in the trees and crickets in the grass. Daytime noise wasw completely intolerable, as were bright, blinking, or fluorescent lights.
By the third year after her accident, Gail's regulating ability had improved markedly. Sshe is now able to select which incoming sensation she wants to attend to and thus is better able to concentrate.
She feels that this improvement is probably the result of conditioning herself to her increased awareness of sound and light. However, she still avoids shopping malls and other busy places.
Focusing your attention and concentrating are automatic, spontaneous processes of registering information from sensory and other inputs.
In general, problems in this area go unnoticed until some incident causes you to take notice - for instance, a pot boiling over on the stove. And even these situations are usually chalked up to a faulty memory, rather than to problems with attention.
After a MTBI, attention and concentration problems may occur more frequently than before, and your lack of awareness may disrupt your ability to work, maintain social connections, carry out various tasks, or tend to personal matters.
A problem like Gail's - an inability to select or filter incoming sensations - can cause actual discomfort, as well as difficulty concentrating.
While it can be hard to live with sudden distractibility or over-attentiveness, understanding the nature of your problem and developing a set of management techniques can help tremendously.
Attention is the ability to focus on specific messages; while concentration is the capacity to maintain attention to that message.
These abilities enable you to select which input from bodily sensations and your surrounding environment you wish to respond to, as well as to shift from one activity or thought to another.
It is believed that damage to the upper BrainStem and Frontal Lobes, or diffuse damage to the body's connections to these areas, can cause permanent changes in your ability to attend to and register messages from your body and the outside world.
Like many Brain functions, attention and concentration are dynamic and complex operations. They have three main components: Alertness; Capacity For and Sustained Attention; and Selection. a MTBI can affect any of these.
Alertness is the general readiness that enables you to act upon information from your surroundings, such as sounds, movements, or events.
For example, it is alertness that creates an awareness that the phone is ringing or that a mosquito has bitten you. Sleep problems, which often result from MTBI, frequently cause problems with alertness and awareness.
Fatigue, medications, depression, anxiety, and the consumption of alcohol can also dramatically dimish your alertness level - sometimes to the point that incoming information is never registered.
Capacity For and Sustained Attention is the amount of information you are able to take in and process at a given moment.
For instance, most people can receive and mentally hold on to a seven-digit telephone number long enough to write it down.
Sustained Attention refers to the ability to focus and concentrate on a task or thought for a period of time, while filtering out other information from your body or from the environment.
After a Brain injury, you may find concentrating extremely difficult due to fatigue, distractibility, or the fact that you cannot stop your mind from wandering. You may encounter problems with reading, following directions, or even holding a conversation.
Also, you may find that you can concentrate on certain things - phone calls, for instance - only at particular times of the day.
Selection is the capacity to choose what you wish to concentrate on. This ability includes all of your senses and occurs spontaneously.
Selection has two main parts - filtering, or selecting an experience to focus on, and shifting, or moving your attention from one experience to another.
Filtering is what allows you to concentrate on reading the newspaper despite a fly buzzing around you and the noise of neighberhood children at play.
If your ability to filter has been affected by your MTBI, you can be impervious to things you should notice or overwhelmed by normal background sounds and distractions.
Overfiltering can affect your general alertness and awarness of danger signals or distractions, while underfiltering can disrupt your ability to focus. In either case, the result is difficult completing any task.
Shifting is what allows you to quickly transfer your attention from the magazine article you are reading to a friends calling your name from another the room.
Problems with shifting ability can cause you to repeat thoughts over and over, or to linger on a topic or problem long after others have lost interest. This particular symptom of shifting problems is called Perseveration.
Filtering and shifting problems can combine to create Sensory Overload, which most commonly affects the senses of hearing and sight.
Hearing overload can cause sounds to be magnified or make it difficult to understand conversation in a noisy room.
Visual overload creates sensitivity to light, especially the fluorescent lighting used in many offices, stores, and other public places.
Sensory overload can result in mental fatigue, as your mind tries to make sense of all the incoming information.
Factors that can contribute to sensory overload include medications, caffine, hormonal changes, and attention deficit disorders.
The ability to store and recall information serves as one of the major criteria for determining the severity of Brain injury.
Memory problems are the most common and persistent of all Neurological consequences of MTBI, and symptoms can vary from person to person.
The types of memory problems that can result from MTBI include more than simple forgetfulness. They can involve the inability to recall events or to digest new information and ideas.
The way you remember is also influenced by factors such as attention, organization, motivation, and fatigue, any or all of which may be affected by Brain injury as well.
The processes involved in memory are very complex. Your memory is actually a number of interrelated networks for storing and retrieving information.
This system allows you to store and recall simple sensory information as well as complex knowledge and personal experiences.
Damage to any part of this intricate system can disrupt your ability to categorize, link, and recall thoughts and experiences.
In turn, if you become unable to recall information, it can become extremely difficult to formulate new ideas or even to act upon old ones.
Memory problems are believed to result from injury to the front or rear portions of the Brain's Frontal Lobes, or to special areas within the Temporal Lobes and to internal structrures such as the Hippocampus and Amygdala.
On occasion, the Parietal Lobes may be involved as well. Memory problems resulting from Brain trauma can vary widely in nature and extent, depending on the site, complexity, and severity of the injury.
Registration, also called encoding, involves the perception of environmental information and sensory input. Sensory impairment can affect how - or whether - certain environmental messages are perceived.
Attention problems also can interfree with the amount of information you are able to register, and the accuracy with which you can do so.
Storage is the second phase of memory. How you store information is the key to a keen memory. Relating new material to previously learned information, helps form new pathways between Neurons, for more efficient information storage.
Sensory Memory is the storage of information that lasts only seconds but leaves a lingering sight, smell, sound, or sensation - such as when a fly brushes against your skin. This type of memory works hand in hand with attention.
If you cannot recall the name of someone you were just introduced to, or you cannot recall the phone number just recited by the operator, it is usually InAttention that has prevented the information from being stored.
However, if you have deficits affecting sensory memory, you may be unable to play back in your mind what you have just heard. In the case of visual images, you may be unable to picture a bit of information.
Deficits in sensory memory often go unnoticed. After all, if you don't notice something in the first place, you cannot be aware of not remembering it.
Short-Term Memory, also called Buffer Memory or Working Memory, is the part of the memory process that receives and recalls chunks of information for up to one minute.
Short-term memory is what enables you to integrate previously learned information with new information to form creative or novel thoughts; it is critical to daily living.
It is what makes it possible for you to recall where you placed your car keys or checkbook, whether you locked the door or turned off the stove, and whether you have eaten or bathed.
In the best of circumstances, short-trem memory has a limited storage capacity. This type of memory is the most susceptible to interference from pain, stress, fatigue, attention problems, and sensory overload that can follow MTBI.
For example, if you are interrupted while receiving a bit of information, the thought may be lost.
Long-Term Memory, also called Remote or Secondary Memory, differs from short-term memory in duration, capacity, and manner of storage. Long-term memories are information received and held beyond one minute, becoming learned information.
Research suggests that the capacity of long-term memory is immeasurable, in contrast to short-term memory's limited capacity, and that the reliving or re-experience of memories solidifies their place in long-term storage.
After Brain damage, long-term memories tend to return in fits and starts. Some may never be fully recovered. In some cases, whole areas of information are lost, while related information remains intact.
For instance, you may be able to recall that George Washington was the first president of the USA, but be unable to recall anything about Abraham Lincoln, even with prompting. This type of long-term memory loss is called the *Swiss-cheese effect*.
Usually after Brain damage, long-term memories are the easiest to access, followed by events closer in time to the injury. Verbal memory problems and word-finding deficits can continue for years.
Learning new material - which requires attention, organization, and sensory & short-term memory - is often extremely difficult.
A common sign of long-term memory problems is a vague sense that you are reliving a thought or situation, often called deja vu. This may occur because you are unaware that you are actually recalling a past experience.
It is based on clues that trigger your memory of how the information was first registered. Smells, sights, sounds, and emotions, for example, are linked to memories; this is why hearing an old song can momentarily take you back to the past.
Research shows that information is more easily accessed if you can reproduce the state in which it was registered, either physically or through hypnosis. Any form of stress, fatigue, anxiety, or depression can interfere with this ability.
Memory-retrieval problems can range from *tip-of-the-tongue* struggles, to an inability to describe a missing word or thought, to Amnesia, or complete inability to access information.
Or other thoughts may intrude, information may be recalled incorrectly, or messages may be lost among other information. Forgetting occurs when a particular memory is not accessible.
This can mean the information is no longer stored, or there is some sort of internal or external interference with the memory. Often, forgetting results from poor organization of information to be stored.
For instance, if someone tells you his or her phone number, you need to repeat the number or link it with other information. Such as the year you were born or some other familiar number, in order to remember it. Without this step of practice, the information is more likely to be lost.
Other considerations in the proper storage and retrieval of information include emotions and psychological factors; the use of certain drugs, including a number of prescription medications, as well as alcohol and recreational drugs; and auditory or visual distractions.
Many people experience problems with the registration or storage of messages. However, you may not become aware that you have a memory problem, until you try to retrieve information at some later point and find you are unable to do so.
Problems with Amnesia, or total absence of recall, can also occur following MTBI. There are different types of Amnesia:
Retrograde Amnesia affects the ability to recall events prior to a traumatic event. At times, you may recall bits and pieces of certain events, but other memories remain absent. Specific Brain functions such as sensory and motor abilities can also be affected.
Antergrade Amnesia, sometimes called PostTraumatic Amnesia, affects the ability to remember events following MTBI or other traumatic events.
Neither total Amnesia, the complete loss of memory, nor Psychogenic Amnesia, a dissociative disorder, is commonly associated with MTBI.
Barbara was a sixth-grade teacher in Massachusetts. At school one day, a student dropped a basketball down a stairwell.
Barbara, who was standing on a lower starcase, was hit on the head and knocked unconscious. She then fell down the flight of stairs.
Afterward, Barbara regained consciousness and looked and sounded fine; however, she soon realized that something was very wrong.
For instance, she could no longer take care of bill-paying. Ashamed to admit this, she hid months' worth of bills.
A fact her family discovered only when their power was shut off. Then Barbara was unable to find the bills she had hidden.
Once a highly organized teacher, she found herself similarly unable to function in the classroom, although for a long time she didn't understand why she couldn't work. She simply couldn't judge the extent of her Brain injury.
Aside from organizational memory, and task management problems, Barbara has serious trouble with the concept of time. She no longer understands or relates to the passage of minutes, hours, or days.
Her old routines are currently impossible, though Barbara has learned to set timers all around her house, to help her plan and follow a simple daily itinerary.
Rarely do we stop to consider how it is that we think, for doing so is as automatic as the beating of one's heart. However, after a MTBI, even simple tasks can require a great deal of thought.
This leads people, who are unaware of what has happened to them, to suddenly feel incapable or stupid.
Activities that require Executive Functions - that is, the ability to reason, make sound judgements, and initiate, plan, or organize - may become virtually impossible. This can pose a serious threat to independent living.
Problems with planning, organizing, initiating, making sound judgements, and understanding are linked to injury of the Brain's Frontal Lobes. Research suggests that executive functions are complex processes involving several Brain areas.
Therefore, it is generalized rather than localized Brain trauma that is responsible for post-MTBI problems with executive functions. Fortunately, the complete loss of executive function is very rare.
"The first time I became aware of my reasoning problems was six months after my accident. We were packing for a trip to the mountains, and my husband suggested that I set out the clothing I needed.
A while later, he found me crying, for I had no idea what to do or what to pack. Up to that time, we hadn't truly comprehended the extent of my limitations."
The ability to reason and think is not a single process, but an extremely complex network of related processes. Each of your executive functions, depends upon other mental processes, to enable you to receive, comprehend, and act appropriately upon information.
A problem with any one area can affect your overall thinking ability, just as a problem with one small part of the engine can affect the overall operation of your car.
The following are descriptions of some of the higher-level thinking problems that commonly follow MTBI.
Planning is the capacity for thinking ahead and setting goals, whether for the next hour, the next week, or the next year. The ability to plan is the first step in organizing daily living, you must decide what it is you want to do, before you can determine how to accomplish it.
Impaired planning ability undermines your ability to set goals. If you suffer from this problem, you may need to rely on others, to make plans for you or play it safe by avoiding anything other than a repetetive routine.
"A year and a half after my accidient, my husband, believing that I was much better, invited guests for a Fourth-of-July barbecue.
Prior to my MTBI, such parties were common events at our house. However, now I had no idea what a barbecue was or how to organize one. Happily, this problem has since improved greatly."
Organization is the ability to determine how your daily plans are going to be accompliched. For instance, if you are planning dinner, you must first decide what foods will be included, whether you need to take anything out of the freezer.
Whether a trip to the store is required and when to start preparing each step of the different dishes, included in the meal, so they are all ready at the same time.
Together, planning and organizing require skills in concentration, memory, problem-solving, and sequencing (putting or recalling events in order, or breaking a task into necessary steps).
If you have problems with organization, you may encounter difficulty giving directions or breaking down a task.
If you cannot track and sequence the past, present, and future, it will seem like time has been altered or become nonexistent - as if you have somehow lost time. The emotional result is a general feeling of anxiety, which further impairs your ability to organize, as well as aggravating your symptoms.
Initiation is the ability to carry out the tasks, you set for yourself; the ability to translate thoughts into activity. Even if you ARE able to plan and organize, a MTBI may leave you unable to initiate, the actions you planned.
To family and friends, this may look like a motivational problem; but, an inability to initiate is in fact unrelated, to energy level or ambition.
Rather, the injury may have left your Brain unable to take even the most specific and detailed thought and turn it into activity.
Processing Information is the phase of executive function that is a lightening-quick combination, of a multitude of new pieces of sensory information, with existing knowledge.
A MTBI can affect the speed, duration, and accuracy of the integration, and later interpretation, of such input. Such a processing delay can cost you precious minutes in reaction time, perhaps leading to injury.
For instance, you may not know to immediately remove your finger from a hot stovetop, if there is a delay or other problem in processing the incoming signal of heat.
Or a clear message may lead to an inappropriate response, such as yelling "Fire!" in a crowded theater and then wondering why you are in the middle of a riot.
Comprehension is the ability to make sense out of processed and registered information - for instance, grasping the meaning of subtle humor or a complex story line in a new movie. After MTBI, you may miss these messages.
You may also be unable to understand verbal directions, commands, or questions, and be unable to make sense of maps and signs.
In extreme cases, this problem can take the form of Visual Agnosia - the inability to recognize familiar objects or surroundings - causing the person to get lost inside his or her own home or become unable to recognize family members.
Decision Making - even mild problems making judgements and decisions can affect all aspects of your thinking. Everyday activities such as cooking or driving, may suddenly become impossible, if you ponder at length what used to be split-second decisions.
You may even find yourself, making business decisions, you later regret. Judgement problems stem from four sources: awareness, selection, memory, and emotions.
Obviously, if you have a problem with awareness, or attention, you may overlook informaion that is needed to make a sound decision, such as the cost of an item you are considering purchasing.
If you cannot focus or remember, you will also have problems making choices that are appropriate. If you are upset or anxious, this too will interfere with your ability to make accurate and appropriate decisions.
Judgement difficulities rang from mild to severe, and they affect concrete behavior, such as exercising caution at a stop sign, as well as higher-level problem-solving.
Many people deny their decision-making problems at first, for fear of appearing incompetent or stupid; but colleagues, family members, or friends often provide insight, by pointing out gross errors in judgement.
Learning - you may retain and use many of your old skills, but be unable to acquire and use new information.
You may be extremely proficient at using a computer program, you learned prior to your injury; but despite weeks of training, fail to master, even the basics of a new program.
Even though you may not have any muscular or motor problems, you may also encounter difficulty learning new physical activities, such as a dance step or basketball move.
Creativity is the process of developing new and original thoughts, plans, and solutions to problems.
Researchers believe the creative process begins in the Brain's Right Hemisphere. Of course, it is very difficult to form new ideas, if your executive functions are impaired.
You may misjudge the appropriateness or feasibility of an idea, or simply have trouble focusing on or remembering different facets of your thoughts.
In addition, you may have trouble organizing and following through with the creative process, which means that you cannot act on novel ideas that do occur to you.
"I have lost some of my sense of time. I never know how many minutes elapse when I'm talking to someone. I've learned over the years to watch the clock, when I'm talking and to ask friends to let me know when, they have to hang up the phone.
Also, as the mother of three teenagers, I do a lot of driving. I've learned to clock my trips ahead of time and write a schedule of places to be and the travel time involved. Preparing a schedule also enables me to ask for help recalling things or places I've forgotten. "
Trusting others is the first step towards recovery from the reasoning, planning, and understanding problems, that can surface after MTBI. It is important to allow friends and family members to help you, and to let go of the idea, you alone know what is best.
If you have had a MTBI, you may face much more of a challenge as you go about your work and home life. It helps to take each day as it comes, accepting that your ability to reason, plan, understand, and learn new things may sometimes fluctuate.
The following are some ways to minimize the disruption caused by executive dysfunction:
Problems with your ability to reason, plan, and understand can significantly affect your frustration level and your ability to work and maintain social relationships.
While recovery from executive function problems can be slow and erratic, it helps to know there is a valid reason for your sudden deficits.
It is also reassuring to know professional assistance is available, to supplement the coping strategies that you develop on your own or learn from others.
"John, a 45-year-old car salesman from New Hampshire, was a passenger in a car involved in a rear-end collision.
When the police arrived and saw that no one was injured, they simply asked the questions necessary to complete the accident report.
Responding to their questions, John was more talkative than usual but, to his amazment, he had great difficulty retrieving the words he needed for his answers.
A few weeks later at the car dealership, John's boss took him to task, for his declining sales performance. While they were talking, the boss realized that John's manner of speaking had changed dramatically.
That the once-articulate salesman sounded less sophisticated than before, and was peppering his speech with nonsense words. However, John was only aware of a slight word-finding problem.
As months went by, John's language difficulties increased. He consulted his family physican, who referred him to a Psychiatrist, believing that stress was the culprit.
Meanwhile, John's performance became so poor that he was laid off. His overall anxiety about finances and his now-obvious language problem made matters even worse.
Eventually, John decided to seek another medical opinion. This led to Neurological testing and the discovery that his word-retrieval problem was due to a Mild Brain injury.
John is still unemployed; but he is working with a Speech/Language Therapist at a rehabilitation hospital, to try regaining his former verbal skills."
Speech Problems, or difficulties using the tongue, lips, and larynx to produce sounds, are a common enough occurrence in everyday life. So are deficits in the ability to use abd understand language.
However, problems of this kind rarely appear suddenly, as they can following a MTBI - a circumstance that can easily overwhelm you, if you must suddenly scramble at home and on the job to compensate for mysteriously absent verbal abilities.
Several areas of the Brain help to govern your ability to form words, express yourself, and understand spoken language.
Even microscopic Nerve-Cell damage, in one of these areas, can disrupt your ability to process the Auditory stimuli that precede and accompany verbal communications.
Injury to the lower Left Hemisphere of the Frontal Lobe can damage Broca's Area - one of your Speech Centers - and hamper Articulation (the ability to pronounce Speech sounds) and Fluency (the ability to combine sounds and words smoothly).
If other parts of the Frotal Lobe bear the brunt of the blow, both your ability to concentrate on what you are saying and your attentiveness to the conversation of others may be affected. In general, you may be less able to use or understand verbal or written communication.
Damage to Wernicke's Area, located in the upper Left Hemisphere of the Temporal Lobe, can impair your ability to hear and interpret spoken words.
You may have trouble understanding language and thus speak nonsense words out of contex to the conversation.
Language problems can also result if undetectable tearing or stretching of nerve-cell fibers (Axons) hampers your powers of concentration and your ability to store and retrieve information.
In addition, Right Temporal Lobe damage can cause difficulties with NonVerbal communications, which involves gestures, body posture, facial expression, and eye contact.
Types of communication difficulties can be as different in form and degree as in origin. Whatever your deficit, it is likely to have an impact on every aspect of daily living.
To help you better understand your sudden struggles with speech and language, the most commonly encountered problems are described below.
Verbal Apraxia is characterized by the inability to produce purposeful sounds or words on command, even though there are no muscular problems that would interfere with speech.
This can cause you to sound as if you are stuttering, or as if you are having problems with word-finding.
Dysarthia is often characterized by problems with the muscle movements needed to form, or articulate words. It can also affect pronunciation of spoken sounds.
DysFluency, better known as Stuttering, takes the form of hesitant, stammering pronunciation of the beginning sounds of spoken words.
Usually there are a number of *false starts*, as you repeatedly utter the initial sound or syllable of a word, but the rest of the word fails to follow. Or you may involuntarily draw out single sounds for several seconds, as you attempt to summon the rest of the word.
DysFluency after MTBI is most often seen in people who stuttered as children, though it is not known why such an injury can cause stuttering to resurface.
Aphasia is an impairment in the ability to understand or express words or their NonVerbal equivalents. There are many different types of Aphasia, but most fall into one of three categories: Expressive, Receptive, and Mixed.
Expressive Aphasia involves problems with spelling, sentence structure, Verbal reasoning, and/ or the rate of speech. The most common type of Expressive Aphasia is known as Broca's Aphasia.
With this type of Aphasia, a person is able to understand language but unable to produce speech fluently. Instead, words are spoken in a telegraphic manner, using single words and gestures to convey meaning.
For example, a person with Broca's Aphasia talking about a plane trip might say, "Plane. . . me . . .." and spread his or her arms like wings to make the point. Broca's Aphasia also involves the inability to repeat or write things that are heard.
Another type of Expressive Aphasia is Neologism, a condition marked by grammatical confusion, inappropriate word usage, and the substitution of nonsense words for real words.
Anomia, a third form of Expressive Aphasia, renders a person completely unable to name familiar objects, almost as if he or she were suddenly required to converse in a foreign language.
A lesser form of this problem is Dysnomia, which causes you to grope for words that you know but simply can't think of. "It's on the tip of my tongue", and "You know, the whaddayacallit' are statements characteristic of people with word-retreival problems.
Fluent Aphasia is a type of Expressive Aphasia that results in speech that is properly pronounced, grammatically correct, and effortlessly produced. However, it is often rapid, excessively wordy, and lacking in meaningful content.
Conductive Aphasia is characterized by halting speech with word-finding pauses and concrete rephrasing of words.
Perserverative Speech is remaining overly long on a topic, or the uncontrolled repetition of words, phrases, sentences, or ideas.
Receptive Aphasia is a term that denotes problems with reading, interpreting, and comprehending spoken language. Also called Wernicke's Aphasia, this problem affects the understanding of the meaning of spoken and written words.
Your ability to articulate words may be unaffected, but even though you may be able to recognize the conversation of others, you may be unable to comprehend it, almost as if they were speaking a foreign language.
Or you may be able to comprehend, but find yourself struggling, to process one aspect of what is being said, and missing much of the subsequent conversation. You may also engage in a great deal of meaningless verbalization.
Paraphasia is a type of Receptive Aphasia, characterized by the substitution of parts of words or syllables for words.
Alexia, another form of Receptive Aphasia, is the inability to understand written language.
Mixed Aphasia is a problem with both the comprehension and expression of language.
Sucessful verbal communication requires that several Neurological events occur simultaneously. A malfunction in any facet of the intake or transmission of Nerve Impulses can have a far-reaching effect.
Because the result can be frightening, frustrating, and a significant handicap to job performance and everyday functioning, it is wise to investigate the cause of any speech or language deficits that follow MTBI.
Your primary health-care provider may recommend an MRI or CT scan, though these tests usually yield negative results in MTBI cases. You may wish to ask about an EEG, which can be significant if it shows a slowing of Brain waves in the Temporal Lobe.
You will probably be given a referral to a Neurologist, and you should ask for a NeuroPsychological Assessment as well. This evaluation should be able to pinpoint the underlying source of speech or language difficulties, and provide a starting point for the formulation of a rehabilitation program.
Articulation and stuttering problems that are aftereffects of MTBI, often disappear on their own within three months. Language deficits may fade more slowly and require additional help. What follows is a look at approaches to resolving communication problems that are slow to correct themselves.
Therapy with a Speech/Language Pathologist helps you learn to work around your deficits, stimulate or retrain your Brain's Speech Centers, and moniter the redevelopment of your verbal skills.
EMG biofeedback can also be very effective for improving speech; it teaches you to identify and recognize individual muscle movements in and around your mouth. Psychotherapy may be suggested, to help you cope with the frustration of feeling misunderstood and being unable to express yourself.
It is difficult to accept sudden deficits in speech or language, and very humbling to have to rely on others to help you communicate. It often helps to look at your verbal deficits as a transient symptom, rather than a permanent disability.
By seeking professional assistance and family support, developing strategies that work for you, and being realistic about occasional setbacks, you will pave the way for certain improvements in your speech and language skills.