Helping Loved Ones Understand Brain Injury
- Life Beyond Rehab
- Aug 13, 2019
- 5 min read
I recently read a message in one of the groups that I follow on Facebook and I haven’t been able to get it out of my head.
“I am outwardly high functioning since getting my TBI in 2007. I got married in 2014 and he knows under certain circumstances I can have delayed and hesitant speech. He now makes fun of it and calls it annoying. Does anyone have any suggestions to get him to understand?”
In previous posts we have talked about the importance of communication, meaning, the importance of occasionally sitting down and speaking with your loved ones to remind them that despite the amount of time that has passed, your brain injury has not ‘disappeared’.
I would like to preface this by saying something that might not be well accepted: sometimes there are people that will never understand. Maybe they are too scared, maybe they are too selfish, or maybe they just aren’t good people.
That does not mean there is something wrong with YOU.
Now, let’s break down some of the components of speech.
1. Forming your message or identifying a need: understand and process what someone is saying to you or process information coming in that you want to talk about (wanting to make a request or comment):
Example: “I need to let my husband know that we are out of bread.”
Or
Husband: “I really wish we had some bread so I could make a sandwich.”
So many things have to happen: processing/comprehension including, but not limited to: processing speed (how much time it takes for your brain to make sense of the information it is receiving), attention, word finding (connecting meaning to the words that you are hearing or choosing the words you need to have your message make sense), organizing, and immediate memory (holding on to the information long enough to process it or remembering what you want to ask your husband for if they aren’t in your immediate presence).
2. Coming up with a response – once your brain has some understanding of what it just heard or figured out what it wants to say, it has to send the message to your mouth. Some of the responsibilities: word finding (getting all the ‘meaning words’ it wants to respond with like “bread” and “sandwich”), organizing (making sure the words go in an order that makes sense), processing speed (making sure it responds fast enough to the original comment or gets the words out fast enough after getting someone’s attention), and finally, actually producing the words.
This is an EXTREMELY simplified explanation of what happens while we have a conversation with someone, but just think about how fast our brains are able to complete such an amazing task!
What kind of impact can a brain injury have on this process?
Honestly, the possibilities are endless, but here are just a few:
1. Decreased processing speed – you are able to understand what you are hearing but it takes just a little bit of extra time for your brain to take in the information and make sense of it
2. Word-finding deficits – this can be from having a language disorder (aphasia) and can make speaking AND understanding language much more difficult
3. Thought organization deficits – you can know all the things you want to say but you have a hard time putting them in order, mixed with needing some extra time to respond and you can see how speech can QUICKLY become a seriously complex task
4. Motor planning deficits or oral muscle weakness – there are SO many different reasons why someone’s speech is “delayed and hesitant” after a brain injury, including, but not limited to your oral structures (lips, tongue) having a hard time putting all the movements in order (also known as apraxia) or your mouth muscles getting very weak, very quickly during speech (also known as dysarthria).
The main point I am trying to get across is:
Having a brain injury can make something that used to be very easy and automatic (e.g. speaking) and turn it into something much more challenging and effortful.
What can we do to work through it?
1. Give yourself a mental break – everything gets harder when we’re tired and this fact is magnified after a brain injury. We talk every week about the importance of allowing for some “rest” and this means both physical and cognitive. If you are feeling tired or overstimulated, take a break and go into a quiet, dim place and recharge.
2. Speak up – if you feel like your speech is getting ‘worse’, let the person you’re talking to know that maybe you just need an extra second to get your thoughts together or ask them to repeat themselves slower or using fewer words. NEVER be ashamed to ask for what you need.
3. Slow down - the truth is, all of the things we are talking about – organizing your thoughts, finding all the words, trying to get your mouth to make the words correctly – all become even more challenging when you are trying to rush. Take a deep breath and give yourself some slack – the more you try to “push through it” or make yourself “go fast” the harder it will be.
4. Talk about it later – if it gets to be too hard, just ask if you can talk about it at another time when you’ve had a chance to rest or when you feel less overwhelmed by the demands of the conversation. Write it down and let them look at your notes or save it as a reminder that you still need to address it with them at a time that works better for you.
A lot of times people just need a little more understanding of the significant (and often invisible) impact of brain injury. Here are a few places to find some extra information on brain injury basics:
Think about reviewing these resources together. As you read and find things that explain exactly what you’re going through or difficulties that you frequently face, let your loved one or caretaker know. Give them an example of when it was really hard or when you felt particularly frustrated and misunderstood. Often we aren’t able to sympathize with someone else’s challenges because we don’t know how bad it really is for them.
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If you or your caregiver need help navigating life after brain injury through education, support or individualized strategies, don’t hesitate to pick up the phone and give us a call at
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