Traumatic Brain Injury (TBI)

What types of TBI are there?

Any injury to the head may cause traumatic brain injury (TBI). There are two major types of TBI:

Penetrating Injuries: In these injuries, a foreign object (e.g., a bullet) enters the brain and causes damage to specific brain parts. This focal, or localized, damage occurs along the route the object has traveled in the brain. Symptoms vary depending on the part of the brain that is damaged.

Closed Head Injuries: Closed head injuries result from a blow to the head as occurs, for example, in a car accident when the head strikes the windshield or dashboard. These injuries cause two types of brain damage:

What communication problems occur after TBI?

People with a brain injury often have cognitive (thinking) and communication problems that significantly impair their ability to live independently. These problems vary depending on how widespread brain damage is and the location of the injury.

Brain injury survivors may have trouble finding the words they need to express an idea or explain themselves through speaking and/or writing. It may be an effort for them to understand both written and spoken messages, as if they were trying to comprehend a foreign language. They may have difficulty with spelling, writing, and reading, as well.

The person may have trouble with social communication, including:

  • taking turns in conversation
  • maintaining a topic of conversation
  • using an appropriate tone of voice
  • interpreting the subtleties of conversation (e.g., the difference between sarcasm and a serious statement)
  • responding to facial expressions and body language
  • keeping up with others in a fast-paced conversation

Individuals may seem overemotional (overreacting) or "flat" (without emotional affect). Most frustrating to families and friends, a person may have little to no awareness of just how inappropriate he or she is acting. In general, communication can be very frustrating and unsuccessful.

In addition to all of the above, muscles of the lips and tongue may be weaker or less coordinated after TBI. The person may have trouble speaking clearly. The person may not be able to speak loudly enough to be heard in conversation. Muscles may be so weak that the person is unable to speak at all. Weak muscles may also limit the ability to chew and swallow effectively.

The SLP completes a formal evaluation of speech and language skills. An oral motor evaluation checks the strength and coordination of the muscles that control speech. Understanding and use of grammar (syntax) and vocabulary (semantics), as well as reading and writing, are evaluated.

Information source: American Speech Language Hearing Association Official Site,