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7 Communication and swallowing
7.1 MANAGING CoMMuNICATIoN PRoBlEMS
7.1.1 INTRODUCTION
There is limited evidence describing the efficacy of specific communication interventions post TBI, and the
methodological quality of the studies is generally poor with little replication of relevant studies. Most studies
have not exclusively included patients with TBI. Many have targeted the more general population of ABI, with
frequent reference to stroke. The presence of cognitive impairments in conjunction with communication
impairments in people with TBI means that interventions described as being successful in the stroke
population may not successfully transfer (or be assumed to transfer) to the TBI or non-stroke ABI population.
Research into the effectiveness of interventions in this area is made difficult because of the heterogeneous
nature of the patient group. They present with diverse combinations of communication disorders, generally
with additional cognitive, behavioural and physical deficits. Treatment approaches therefore need to be
individually tailored to each patient’s pattern of disorder, and this reduces the possibilities for carrying out
RCTs. In addition, treatments in ABI are often given as an integrated package, with blurring of professional
roles across the rehabilitation team. Studies of efficacy are further complicated by the difficulty in identifying
the relative contributions of different members of the team.
7.1.2 DEFINITIONS
Traumatic brain injury may result in a variety of communication impairments of varying degrees of severity.
These include:
dysarthria - a group of motor speech impairments affecting clarity of speech, voice quality and volume and
overall speech intelligibility
dysphasia/aphasia - these two terms are now generally used interchangeably to refer to an acquired
multimodal language disorder which can affect someone’s ability to comprehend auditory and written
language and to talk or write. It may or may not coexist with cognitive deficits including visuoperceptual
problems
cognitive-communication disorder, social communication disorder, pragmatic impairments, right
hemisphere language disorder - these terms (which are not interchangeable but denote different disorders)
refer to various impairments of communication affecting language use and discourse, producing a variety
of symptoms, such as reduced use of facial expression, poor eye contact, reduced turn-taking, verbosity/
taciturnity, poor listening skills, reduced relevance, and so on. These impairments may or may not coexist
with aphasic symptoms, and affect the ability to converse successfully.
motor aprosodia - a neurological condition characterized by the inability of a person to properly convey
emotional prosody by means of the pitch, stress and rhythm functions of normal speech production.
7.1.3 PROBLEMS WITH LANGUAGE OR FUNCTIONAL COMMUNICATION
7 • Communication and swallowing
Several systematic reviews and one meta-analysis suggest language deficits and/or functional communication
deficits can be remedied.
One review presents findings which largely apply to patients with stroke (40 studies in total, of which eight
included patients with TBI). The authors summarise that there is substantial evidence to support cognitivelinguistic
therapies for language deficits following left hemisphere stroke. 85 Specifically, group treatment
has been shown to be effective in remediating language deficits, a greater intensity of treatment produces
improved communication skills, interventions for specific language impairments such as acquired dyslexia
are effective (but the nature of the interventions was not described), and computer therapy provides a useful
adjunct to face-to-face (FTF) treatment by a therapist. The authors recognise a compelling need for more
studies to evaluate treatments of pragmatic communication problems in TBI.
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