Another sensible piece of advice from Winnie The Pooh.

As part of Brain Injury Week and the theme of “See The Hidden Me”, the brain injury support charity Headway have helpfully put descriptions of some of the symptoms and injuries brain damage can cause and how they can “hide” the person behind the brain injury due to communication problems.

Communication problems after brain injury are very common. The ability to communicate requires extremely complex skills and many different parts of the brain are involved.

We thought it might be useful to give them an airing here to assist with understanding of brain injuries.

Injury to language centres of the brain leads to a condition called “aphasia”. There are different levels of impairment. The term “dysphasia” refers to partial loss of language.  But the two are often used interchangeably.

The regions of the brain used for understanding and language are in the dominant side of the brain and so for most people, particularly right-handers, they are in the left hemisphere.

There are two main forms of aphasia: receptive aphasia, which is an impairment of the understanding of language and expressive aphasia, which is an impairment of the understanding of language.  However, it is common for there to be a combination of both as brain injuries can occur in several areas of the brain at once.

With receptive aphasia, the content of speech is often jumbled or lacking meaning. The person may not recognise spoken and/or written words. They will not be able to understand sentences or follow conversations. They may however retain some non-verbal skills and recognise, say, gestures or pictures, so non- verbal forms of communication may help.

Remember that the person may be unaware of their errors and expect you as the listener to respond.

It can also affect reading and writing skills. But one thing to be careful of here is to check sight, as brain damage can affect this and is sometimes forgotten.

Useful adaptations for both reading and writing include enlarging print size, selecting a clear font, using a line guide to support looking at the full line of print, and increasing contrast between paper and print, e.g. black type on yellow paper.

Expressive aphasia is an impairment of the ability to use and express language. In its most severe form, the affected person may be unable to produce any meaningful speech, but more commonly, speech may lack fluency with relatively few words used. The speaker will use short, simple sentences, broken up by frequent pauses.

So a sentence such as ‘Tomorrow I’m going to the pub with my partner for our anniversary’, may be expressed as ‘tomorrow…pub… partner… anniversary’. This requires the listener to accurately piece the message together. This may just require patience and resisting the temptation to jump in with possible interpretations, which can be frustrating for the injured person!

Remember, the brain injured person may be able to understand language normally and be aware of their own difficulties.

There is a condition called “dysarthria”. It occurs when there is damage to parts of the nervous system involved in the control of muscles used for speech and results  in reduced control and clarity of speech.

When dysarthria occurs in isolation, a person’s ability to speak will be impaired, but their ability to understand language and construct sentences will be intact. It is important to establish whether this is the case and not just make the assumption that because someone cannot speak, they cannot understand either.

“Dyspraxia” is a disorder of planned and co-ordinated movement. It occurs because of injury to areas of the brain responsible for conscious movement, mainly situated in the frontal lobes.

Dyspraxia of speech can also cause people to have difficulty saying what they are consciously thinking about saying. They may be able to speak perfectly normally when not thinking about it, for example, if someone asks them a question and they have to respond spontaneously.  Thus they can seem not to have this problem and therefore listeners don’t realise. Long words can tend to be more difficult to say then short words with dyspraxia, so their speech can sometimes appear a little “stilted”.

There can also be slurring, sometimes mistaken for drunkenness or drug abuse if the brain injury is not known about.  Brain injured people can sometimes carry small cards or lanyards explaining that they have a brain injury to avoid this.

A Speech and Language Therapist will be able to assess individual patterns of aphasia. Treatment may then involve a mixture of therapy, advice and strategies.  The cost of this is one the “Heads”, or types of claim we will make in a claim for a head/brain injury.

To speak to a member of our team call 01522 561020 or email

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