Traumatic Brain Injury (TBI)

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A traumatic brain injury, or TBI, can cause speech, language, thinking, and swallowing problems. Speech-language pathologists can help.

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About TBI

A TBI is a brain injury caused by sudden damage to the brain. It can happen when an object goes through the skull and into the brain. An example is a gunshot to the head. Or TBI can happen after a blow to the head. For example, if you hit your head on the floor when you fall.

Some common causes of TBI are

  • falls;
  • car accidents;
  • being hit by or running into an object; and
  • violent assaults.

Sport-related and military combat injuries also cause TBI. You may be more likely to have another TBI if you have had one before. Even a mild TBI can lead to more serious problems if you get hit in the head again.

No matter what type of TBI you have, you will have damage to your brain that happens right away. It may be a skull fracture, bleeding, or blood clots. Later, you may develop pressure inside your skull, seizures, or brain swelling. Doctors will take care of these medical problems.

Signs of TBI

Since your brain controls all that you do, a TBI can cause many problems. A lot will depend on how bad the injury is and where it is in your brain. Some problems may include the following:

  • Physical problems. You may pass out, have seizures, headaches, or dizziness and vomiting. You may not be able to move parts of your body. You may lose your balance and have trouble controlling your arms and legs.
  • Sensory problems. You may be more or less sensitive to lights, sound, and touch.
  • Behavior changes. You may be more emotional, angry, or anxious. You may feel depressed or have mood swings. Events that did not bother you before may upset you after the TBI.
  • Problems with thinking skills. You may have trouble with attention, memory, and problem solving. Higher level skills like setting goals, planning, and being aware of how you behave may be a problem. Learning new skills and information can be hard. But you will probably still remember most things from before the injury.
  • Speech and language problems. Your speech may be hard to understand after the injury. This may be due to weak muscles, called dysarthria. Or, you may have problems controlling your muscles, called apraxia. You may not understand what others say to you or what you read. You may also have a hard time using words to tell others what you want or need. Spelling and writing can also be a problem.
  • Social communication issues. The rules we follow when we talk with others may be hard for you. You may not be able to understand jokes or nonverbal cues. For example, you may not understand what someone means when they shrug their shoulders. You may say the wrong thing at the wrong time or interrupt others.
  • Swallowing problems, called dysphagia. You may have trouble chewing or may cough and choke when you eat.

Testing for TBI

You should see a doctor or go to the emergency room if you have any type of head injury. The doctor may order tests, like a CT scan or MRI, to look at your brain .

You may see other people for testing, depending on the problems you have. You may see other doctors, a psychologist, a physical or occupational therapist, or a social worker. A speech-language pathologist, or SLP, will test your speech, language, and thinking skills. The SLP can also test your social skills and see how aware you are of the problems you have. The SLP will look at how well you chew and swallow, if that is a problem for you.

Treatment for TBI

After testing, the SLP will work with you to improve your skills. What you do in treatment will depend on the problems you have.

In the early stages after a TBI, treatment will focus on:

  • Getting you to respond to sound, touch, or smell. This happens if you are in a coma or not alert.

As you become more aware, treatment may focus on:

  • Being able to pay attention to daily activities.
  • Helping you be less confused.
  • Helping you understand what happened, what day it is, and where you are.

Later on, treatment focuses on:

  • Finding ways to improve your memory. You may start to use memory books or calendars to help you remember.
  • Learning ways to solve problems, make sense of an idea or event, and stay organized.
  • Working on social skills in small groups.
  • Helping you monitor and change your own behavior.

After a while, treatment may include:

  • Going out into the community to plan, organize, and take trips. You may use memory logs, organizers, checklists, and other helpful aids.
  • Working with a vocational counselor to help you get back to work or school.

Some people are not able to speak clearly for a long time after a TBI. Your SLP may suggest that you use other ways to talk, like picture boards or computers that speak for you. This is augmentative or alternative communication, or AAC. Treatment will focus on helping you get better at using your AAC device.

The SLP may suggest that you try different foods if you have trouble chewing or swallowing. You may try different head positions or different ways to swallow so that you will not cough or choke. The goal is to make sure you eat and drink safely.

See ASHA information for professionals on the Practice Portal’s Traumatic Brain Injury page.

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites. 

To find a speech-language pathologist near you, visit ProFind.