Speech and Language Therapy After a Brain Injury

Brain injury symptoms and functional outcomes after speech and language therapy are unique to each individual. Our goal is to maximize cognitive-communication and/or swallowing function during rehabilitation at Gillette. We customize your child’s therapy to you and your family’s needs by working as a team. The following information is meant to provide you with general information on what speech and language therapy may address after a brain injury.

Speech and language pathologists evaluate and treat communication, cognition, and swallowing skills.

A brain injury can affect the ability to use language to express thoughts, ideas and feelings (expressive language) as well as the ability to understand what others are saying (receptive language).  Furthermore, certain physical injuries can affect hearing, voice and breath support for speech.

Everyday activities such as playing a board or computer game, completing a worksheet, reading, writing or engaging in social conversation are used to help facilitate improvements in expressive and receptive language function. 

Children may need more help from an adult to complete activities in the beginning following injury or they may need to be taught strategies to compensate for their language difficulties.  Over time the goal is to help the child recover as many skills as possible and/or be able to use compensatory strategies to complete language tasks on their own.

If hearing, voice, and breath support for speech is affected by brain injury:

• The child may be referred to audiology for further assessment
• A child requiring a tracheostomy may need to use a special valve called a "Passy Muir valve" to achieve voice for speech
• The child may be taught respiratory muscle training exercises to strengthen breath support for speech
• Speech production exercises may be taught to improve speech
• The child may be taught to use signs, pictures, buttons or computers known as augmentative communication to speak

A brain injury can affect a variety of cognitive skills including being aware of one’s surroundings, paying attention, processing, remembering, and learning new information, initiating, and following through on activities, planning, organizing, solving problems, and using good judgment.

Cognitive functioning is related to the child’s level of consciousness which is a measurement of a child’s responsiveness to what is going on around them. 

The Rancho Levels of Cognitive Functioning is a tool used to assess and describe a child’s level of consciousness.  This tool is used to monitor a child’s progress as well as help design an appropriate treatment program.  Children progress through the levels of consciousness at their own rates with some passing through each of the 8 levels while others will not.

A brain injury can affect the ability to safely eat and drink.  This can be due to several reasons including decreased alertness and awareness of the environment or an injury to the part of the brain that controls chewing and swallowing. 

If a child is unable to safely eat and drink by mouth, then a tube placed through the nose (NG) or inserted surgically through the abdomen (G-tube) to the stomach is used to deliver nutrition and hydration while a child is recovering.

Speech language pathologists will help to determine when a child is safe to start eating by mouth.  This is done gradually by:

• Providing the child with small amounts of food starting with purees and gradually increasing to chewable solids and liquids as the child demonstrates the ability to safely manage and swallow the food or liquid
• A test called a videofluoroscopy (x-ray picture of the swallow in real time) or FEES (scope with camera inserted through the nose) may need to be completed.  These tests help to determine if the child is swallowing safely, what muscles are affecting the swallow, and what accommodations for safety may need to be made
• A therapy called Neuromuscular Electrical Stimulation (NMES), Respiratory Muscle Training (RMT), or Surface Electromyograpy (sEMG) may be used to help strengthen the muscles for swallowing.