Traumatic Brain Injury in Adults

Signs and symptoms of TBI vary, depending on the site and extent of injury to the brain, premorbid abilities, and functional domains affected (e.g., physical, cognitive, language, sensory). The effects of TBI can be temporary or permanent, and no two individuals present with the same pattern.

The clinician considers cultural differences that may lead to differences in presentation of certain cognitive measures (e.g., response time, self-monitoring, executive functioning). See ASHA's Practice Portal page on Cultural Competence for more information.

Signs and Symptoms Related to Traumatic Brain Injury

Physical

  • Changes in bowel and bladder function
  • Changes in level of consciousness, ranging from brief loss of consciousness to coma
  • Dizziness
  • Fatigue
  • Headaches
  • Impaired movement, balance, and/or coordination
  • Motor speed and programing deficits (dyspraxia/apraxia)
  • Nausea
  • Pain
  • Reduced muscle strength (paresis/paralysis)
  • Seizures
  • Vomiting

Sensory–Perceptual

Auditory and Vestibular

  • Auditory dysfunction from injury to the outer ear, middle ear, inner ear, and/or temporal lobe, resulting in

Visual

  • Changes in perception of color, shape, size, depth, and distance
  • Changes in visual acuity
  • Blurred vision
  • Double vision (diplopia)
  • Problems with visual convergence and accommodation
  • Sensitivity to light
  • Visual field deficits/visual neglect

Other Sensory–Perceptual Sequelae

  • Gustatory—loss of taste
  • Olfactory—inability to recognize smells
  • Tactile—sensitivity or defensiveness to touch; changes in perception of pain, pressure, and/or temperature

Cognitive

Attention

  • Deficits in shifting attention between tasks
  • Difficulty with selective attention
  • Impaired sustained attention (e.g., for task completion)
  • Reduced attention span

Executive Functioning

  • Difficulty with the following:

Information Processing

  • Increased response latencies
  • Reduced processing speed (e.g., of rapid speech and/or complex language), resulting in confusion

Memory and Learning

  • Deficits in short-term memory that negatively affect new learning
  • Deficits in working memory that negatively affect following directions and task completion
  • Difficulty remembering to perform a planned action (prospective memory) such as remembering to take medication
  • Difficulty retrieving information from memory
  • Post-traumatic amnesia marked by impaired memory of events that happened shortly before the injury (retrograde)

Metacognition

  • Lack of insight for monitoring one's strengths, weaknesses, functional abilities, problem situations, and so forth
  • Reduced awareness of deficits (anosagnosia)

Other Cognitive Deficits

  • Deficits in orientation to self, situation, location, and/or time
  • Impaired spatial cognition that can affect ability to navigate and ambulate

Language

Pragmatic/Social Communication

  • Conversational turns marked by verbosity
  • Difficulty initiating conversation and maintaining topic
  • Difficulty taking turns in conversation
  • Difficulty inhibiting inappropriate language or behavior
  • Impaired ability to use nonverbal communication effectively (e.g., tone of voice, facial expression, body language)
  • Impaired social cognition skills (e.g., regulating emotion; expressing emotion and perceiving emotion of others; ability to take the perspective of others and to modify language accordingly)
  • Inability to interpret others' nonverbal communication
  • Tendency to be tangential

Spoken Language

  • Anomia or word retrieval deficits
  • Decreased ability to formulate organized discourse or conversation
  • Difficulty following directions
  • Difficulty formulating fluent speech
  • Difficulty making inferences
  • Difficulty understanding abstract language/concepts
  • Difficulty making inferences
  • Tendency to perseverate in verbal responses
  • Tendency to use tangential speech
  • Use of incoherent or confabulatory speech

Written Language

  • Difficulty comprehending written text, particularly with respect to complex syntax and figurative language
  • Difficulty planning, organizing, writing, and editing written products

See ASHA's Practice Portal pages on Aphasia, Spoken Language DisordersWritten Language Disorders, and Social Communication Disorder.

Speech

  • Apraxia of speech (motor programming)
  • Aprosodia/dysposodia, marked by deficits in intonation, pitch, stress, and rate
  • Dysarthria characterized by reduced respiratory support, articulatory imprecision, and/or vowel distortions
  • Hypernasality secondary to paresis or paralysis of velopharyngeal muscles involved in speech

See ASHA's Practice Portal pages on Acquired Apraxia of SpeechDysarthria in Adults, and Resonance Disorders.  

Voice

  • Aphonia/dysphonia resulting from intubation, tracheostomy, or use of mechanical ventilator
  • Laryngeal hyper/hypofunction marked by
  • Neurogenic phonatory abnormalities resulting from injury to sensory or motor innervations to the vocal folds
  • Psychogenic phonatory abnormalities (e.g., related to post-traumatic stress disorder)

See ASHA's Practice Portal page on Voice Disorders.

Dysphagia

  • Swallowing problems secondary to oral and/or pharyngeal sensory disorders and/or motor deficits (e.g., weakness or paralysis of oropharyngeal musculature, oral apraxia)
  • Risk of aspiration while eating related to impact of cognitive impairment (e.g., poor memory, reduced insight, limited attention, impulsivity, and agitation; Logemann, 2006; Morgan, Ward, & Murdoch, 2004)

See ASHA's Practice Portal pages on Adult Dysphagia.

Neurobehavioral

  • Affective changes, including over-emotional or over-reactive affect or flat (i.e., emotionless) affect
  • Agitation and/or combativeness
  • Anxiety disorder
  • Depression
  • Difficulty identifying emotions in others (alexithymia)
  • Emotional lability and mood changes or mood swings
  • Excessive drowsiness and changes in sleep patterns, including difficulty falling or staying asleep (insomnia), excessive sleepiness (hypersomnia)
  • Feeling of disorientation or fogginess
  • Increased state of sensory sensitivity accompanied by exaggerated response to perceived threats (hypervigilance)
  • Impulsivity
  • Irritability and reduced frustration tolerance
  • Lack of initiation (e.g., for making choices, talking, moving)
  • Stress disorders

Considerations for Bilingual and Multilingual Speakers

Cognitive control deficits have a unique impact on the linguistic abilities in bilingual and multilingual speakers (Ansaldo & Marcotte, 2007), especially in individuals with frontal lobe and subcortical lesions (Price, Green, & von Studnitz, 1999). The individual's premorbid proficiency in the languages they speak can influence their ability to maintain the target language.

In addition to language production errors found in monolingual speakers, bilingual and multilingual individuals with acquired brain injury may also demonstrate

  • language-switching errors;
  • semantic/phonological paraphasias produced in the nontarget language; and
  • translation errors.

Speech-language pathologists (SLPs) consider variations in narrative structures secondary to cultural and linguistic factors to ensure that a communication difference is not inaccurately diagnosed as a disorder.

See ASHA's Practice Portal pages on Bilingual Service Delivery and Cultural Competence.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.