Traumatic Brain Injury

Because communication skills and their cognitive correlates are critical to one’s vocational, academic, and social success, the speech-language pathologist’s (SLP) involvement in the rehabilitation process is important. The American Speech-Language Hearing Association (ASHA)(1987) delineates the role of the SLP:

  • Cognitive processes that directly or indirectly impair the individual's ability to effectively communicate
  • Elements of speech production, language, and nonspoken communication

In regards to treatment, the ASHA report (1987) states:

SLPs have traditionally provided intervention for cognitively based communication impairments. In recent years this has been referred to as cognitive retraining, cognitive rehabilitation, cognitive therapy, cognitive remediation, or neurotraining.

The standards of care approved by the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) provide guidelines for the clinician who provides services to the cognitive-communicative disordered population. These standards indicate that the speech-language pathologist’s evaluation should include, among other things, and analysis of the following skills:

Foundation skill (attention, concentration, memory), organizing processes, convergent and divergent thinking, deductive and inductive reasoning, problem solving and judgement, executive functions, insight and social behaviours.
(Ontario Association of Speech-Language Pathologists and Audiologists, 1987).

Normally, in the rehabilitation course of treatment, the SLP will work closely with an interdisciplinary team, which includes doctors, rehabilitation aids, physiotherapists, occupational therapists, social workers, teachers, and family members.


More Information on SLP’s Role in Rehabilitation of TBI

Speech-Language Pathologists are trained to detect communication disorders associated with right-hemisphere brain damage;

For example:

  • Distinguishing between significant and irrelevant contextual cues.
  • Integrating pictures and verbal story elements into a theme.
  • Interpreting implicit or intended meanings grasping the figurative meaning of metaphors and idiomatic expressions over-personalizing external events.
  • Organizing information into an appropriate hierarchy.
  • Maintaining topics of conversation.
  • Demonstrating sensitivity to the communicative situation.
  • Showing response impulsiveness.
  • Interpreting and producing affective facial expressions.
  • Interpreting and producing the prosodic features of verbal messages.

(Myers & Mackisack, 1990, p.17)

Treatment efficacy summary on right hemisphere brain damage (PDF)

Diagram of the Brain

Many communicative impairments identified in TBI are also associated with language learning disabilities, and therefore will affect an individual’s ability to comprehend, express, recall, read, write, and interact successfully. Difficulty in communicating will often have cognitive underpinnings and consequently affect:

  • Word retrieval
  • Words having multiple meanings
  • Figurative language such as metaphors, humor, and idioms
  • Analogous thinking

(Wiig & Semel, 1990; Ylvisaker & Szekeres, 1986)


Defining Acquired Brain Injury and Traumatic Brain Injury

(adapted from Ontario Brain Injury Association, 2008)

What is Acquired Brain Injury?

Damage to the brain, which occurs after birth, as a result of a traumatic or non-traumatic event and is not related to a congenital or a degenerative disease and can result in temporary, prolonged or permanent impairments in cognitive, emotional, behavioural or physical functioning.

Acquired Brain Injury is not:

A degenerative condition like Parkinson's Disease, Alzheimer's Disease, Huntington's Disease or Multiple Sclerosis (MS) or a congenital condition like Fetal Alcohol Syndrome (FAS), prenatal illness, perinatal hypoxia.

Traumatic Brain Injury

Damage to the brain, which occurs after birth, as a result of an external force (i.e. fall, motor vehicle crash, assault).

Non Traumatic Brain Injury

Damage to the brain as a result of:

  • metabolic disruption (i.e. hypoglycemia);
  • hypoxia and anoxia (i.e. oxygen loss due to near-drowning, strangulation, cardiac arrest, stroke);
  • occupying lesion (i.e. tumour, cyst, abscess, haematoma);
  • toxins (i.e. lead, mercury, solvents, carbon monoxide);
  • illness (i.e. meningitis, encephalitis);

Resources for caregivers and survivors: