American Speech-Language-Hearing Association

Communication Facts: Special Populations: Traumatic Brain Injury—2010 Edition

Traumatic brain injury (TBI), also called acquired brain injury or head injury, occurs when a sudden trauma causes damage to the brain. Communication disorders are common disabilities in TBI patients (1). Professionals from diverse disciplines such as audiology and speech-language pathology provide cognitive rehabilitation services to these individuals (2).



  • The medical and allied health literature indicate that an estimated 1.5 to 2 million individuals each year in the United States sustain a TBI (3, 4, 5, 15).
  • Approximately 270,000 people experience a moderate or severe TBI (1).
  • Approximately 50,000 to 70,000 people die from head injury (1, 4, 15).
  • Research shows that about one third of all injury related deaths in the United States has TBI as a contributing factor (15).
  • Approximately 75% of TBIs that occur each year are concussions (15).
  • The number of children with disabilities, ages 6–21, served in the public schools under the Individuals with Disabilities Education Act (IDEA) Part B in the 2000–2001 school year was 5,775,722 (in 50 states, D.C., and P.R.). Of these children, 14,844 received services for TBI (6).
  • TBI results in an estimated $48 to $60 billion in direct and indirect costs (1, 7, 8, 15).

At-Risk Groups/Causes

  • TBI is a major public health problem, especially among children ages 0 to 4, male adolescents and young adults ages 15 to 19, as well as among elderly people of both sexes 65 years and older (1, 9, 15).
  • Half of all TBIs are due to transportation accidents, and are the major cause of TBI in people under age 75. Among children aged 0 to 4 and adults 75 and older, falls are the cause for the majority of TBIs (1, 15).
  • The leading cause of TBI hospitalizations among persons aged at least 75 years are falls (8, 15).
  • Males are about twice as likely as females to sustain a TBI (10).
  • Domestic violence and TBIs are major societal problems with public health implications. Recent outcome data show that TBI survivors who are victims of assault are more prone to a suboptimal outcome (11).
  • Approximately 20% of TBIs are due to violence (1).
  • Physical abuse is a leading cause of serious head injury and death in children aged 2 years or younger. The incidence of inflicted TBI in U.S. children is unknown (12).

Outcomes of TBI

  • Disabilities resulting from TBI depend upon the severity and location of the injury, and the age and general health of the patient (1).
  • Between 2.5 and 6.5 million Americans alive today have had a TBI (1).
  • Survivors of TBI are often left with significant cognitive, behavioral, and communication disabilities, and some patients develop long-term medical complications such as epilepsy (1, 4).
  • Approximately 5.3 million Americans are currently living with some degree of cognitive-linguistic impairment secondary to TBI (5, 9).
  • Approximately 230,000 to 275,000 people are hospitalized for TBI and survive (1, 3, 15), while approximately 80,000 to 90,000 of these survivors live with significant disabilities as a result of the injury (1, 4).
  • Approximately one-third of adults hospitalized with TBI still need help with daily activities one year after their discharge (3).

Communication Disorders and TBI

  • Some common disabilities include problems with cognition, sensory processing, communication, and behavioral or mental health (1).
  • Some individuals may experience a difficulty in understanding and producing written and spoken language; others may have difficulty with the more subtle aspects of communication, such as body language and emotional, non-verbal signals (1).
  • Sensory deficits may include problems with hearing, smell, taste, or touch. Some TBI patients develop tinnitus, a ringing or roaring in the ears (1).
  • TBI patients may have problems with spoken language if the part of the brain that controls speech muscles is damaged (1). Some may also have problems with intonation or inflection. These language deficits can lead to miscommunication, confusion, and frustration for the patient as well as those interacting with him or her (1).
  • Dysarthria is a common consequence of non-progressive brain damage such as TBI (9,13).
  • Aprosodia, which is the inability to either produce or comprehend the affective components of speech or gesture, is a common occurrence after brain injury (14).
  • One frequent aspect of TBI secondary impairment is disordered attention (5).


  1. National Institute of Neurological Disorders and Stroke. (2002, October 10). Traumatic brain injury: Hope through research . Accessed October 22, 2003,
  2. American Speech-Language-Hearing Association. (1995, March). Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Asha, 37 (Suppl. 4): 23.
  3. Langlois, J.A., Kegler, S.A., Butler, J.A., et. al. (2003, June). Traumatic brain injury-related hospital discharges. MMWR Surveillance Summary, 52(4): 1–20.
  4. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2003, October 8). Traumatic brain injury. Accessed October 15, 2003,
  5. Stierwalt, J.A., & Murray, L.L. (2002, May). Attention impairment following traumatic brain injury. Seminars in Speech and Language, 23(2): 129–138.
  6. U.S. Department of Education. (2002). To assure the free and appropriate public education of all children with disabilities: Twenty-fourth annual report to Congress on the implementation of the Individuals with Disabilities Education Act. Accessed March 3, 2004,
  7. Thurman, D. The epidemiology and economics of head trauma. In L. Miller & R. Hayes (Eds.), Head trauma: Basic, preclinical, and clinical directions (2001). New York: Wiley and Sons.
  8. [No authors listed]. (2003, April 4). Nonfatal fall-related traumatic brain injury among older adults—California, 1996-1999. MMWR, 52(13): 276–278.
  9. Thurman, D., Alverson, C., Dunn, K., et. al. (1999). Traumatic brain injury in the United States: A public health perspective. Journal of Head Trauma and Rehabilitation, 14(6): 602–615.
  10. Centers for Disease Control and Prevention. (1997). Traumatic brain injury—Colorado, Missouri, Oklahoma, and Utah, 1990–1993. MMWR, 46(1): 8–11.
  11. Corrigan, J.D., Wolfe, M., Mysiw, W.J., et. al. (2003, May). Early identification of mild traumatic brain injury in female victims of domestic violence. American Journal of Obstetrics and Gynecology, 188(Suppl 5): S71–S76.
  12. Keenan, H.T., Runyan, D.K., Marshall, S.W., et. al. (2003, August 6). A population-based study of inflicted traumatic brain injury in young children. Journal of the American Medical Association, 290(5): 621–626.
  13. Sellars, C. Hughes, T., & Langhorne, P. (2002). Speech and language therapy for dysarthria due to non-progressive brain damage. Cochrane Database Systematic Reviews, 4: CD002088.
  14. Wymer, J.H., Lindman, L.S., & Booksh, R.L. (2002). A neuropsychological perspective of aprosody: Features, function, assessment, and treatment. Applied Neuropsychology, 9(1): 37–47.
  15. Faul, M., Xu, L., Wald, M.M., Coronado, V.G. (2010). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Accessed March 25, 2010,

Compiled by Andrea Castrogiovanni * American Speech-Language-Hearing Association * 2200 Research Boulevard, Rockville, MD 20850 *

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