Traumatic Brain Injury, Speech-Language Therapy Activities

After a traumatic brain injury speech is often disrupted or impaired. The injury may be from blunt trauma, a lesion or a stroke, among other things. The trauma could have impacted the speech areas of the brain--Wernicke's or Broca's--causing a cognitive problem, or it could be in the motor areas of the brain creating a production problem. Treatment depends to some extent on where the injury is, but there are therapies with varying degrees of success depending on the extent of the injury.

Naming the Disorders

• Motor problems include dysarthria, problems with the muscles of the tongue or lips, and
  apraxia, a lack of coordination of the muscles of the tongue or lips.

  Cognitive problems include dysphasia, some impairment of the language modality (speaking, writing), aphasia, a total impairment of the language modality, and dysprosody, dysfunction of the quality or expression of speech. Dysprosody is a neurological problem that has not been localized within the brain.

Speech Motor Problems

• Immediately after an injury the goal is just communication--using eye blinks, nods or "yes" and "no" in response to questions is a first step. Then therapy starts to concentrate on strengthening and coordinating the muscles for creating speech. Therapy includes the following exercises:
  * Move the tongue from side to side and up and down, breathing after each step.
  * For strength and "elevation," create "chipmunk cheeks," blow air into the mouth while holding the lips tight so as to puff out the cheeks. "Lemon sucks" are just to opposite, forming a seal with the lips, suck in air so the cheeks are recessed.
  * Take a deep breath, hold for five seconds while using internal muscles to push down the diaphragm.
  * Take a deep breath, hold for five seconds while using the internal muscles to pull up the diaphragm.
  * Blow into a straw while blocking the end with a finger, hold for five seconds.
  * Say "ah, ah, ah" in a deep voice.
  * Say "ee, ee, ee" in a high voice. Alternate five times with the above exercise.
  * Carefully progress to control in activities such as gargling exercises

  As the area is integrated in function, stretches for neck, shoulders and back and flexing the arms, all might be included as well as breathing exercises.

  Biofeedback can be used to encourage controlled breathing and a relaxed diaphragm.

Cognitive Speech Problems

• There are a number of therapies for recovery of speech after a stroke, such as:
  * Cognitive linguistic therapy seeks to re-associate feelings with words;
  * Programmed simulation uses a multisensory approach;
  * Group therapy that creates a safe environment for the brain injury victim to practice speech in and other exercises.

  Again, the first step is just basic communication, communicating "yes" or "no" goes a long way to getting the patient's needs met. As therapy continues, the patient is encouraged to verbally connect with his surroundings and memories. Additionally he should try:
  • Identify objects in the room.
  • String together simple sentences such as "boy go."
  • As speech progresses, move on to speech.
  • Neurologically progress to things such as tongue twisters
  • Make lists of synonyms.
  • Make a list of homonyms.
  • Make a neural net/mind map.
  • Make plans and value judgments.