Share this on:Copied!

If your child suffers a traumatic brain injury (TBI), speech therapy can play an important role in their recovery.

Working with a speech-language pathologist (SLP) can help children improve their speech, express their thoughts more clearly, address cognitive issues, and more. The work often begins in the acute inpatient unit and continues through inpatient rehabilitation and outpatient rehab.

“It is really nice to be able to see their progress from inpatient acute care to inpatient rehab to outpatient,” says Linda Torres, CCC-SLP/L, senior speech-language pathologist, UPMC Children’s Hospital of Pittsburgh-South Fayette.

Learn more about traumatic brain injuries in children and how speech therapy can help.

What Are Traumatic Brain Injuries?

Traumatic brain injuries (TBIs) occur when there’s a jolt, blow, or penetrating injury to the head that affects normal brain function.

TBIs are mild, moderate, or severe. They’re a common cause of injury-related deaths in children. Concussions are a type of TBI.

More than 600,000 children visit emergency departments for TBIs each year. That’s according to the Brain Injury Association of America. Children ages 0 to 4 and 15 to 19 are most at risk of TBIs.

The most common causes of TBIs in children include:

• Accidental blunt trauma to the head.
• Falls.
• Motor vehicle accidents.
• Physical abuse, including shaken baby syndrome.

Speech Problems After Traumatic Brain Injury

A TBI can cause many different symptoms in children. This includes problems with cognition, speech, and communication. They may suffer from one or more speech disorders, including:

• Acquired apraxia of speech — This occurs when damage to the brain affects the pathways for communication. Your brain knows what it wants to say but can’t communicate it to the muscles responsible for speaking. You may struggle to pronounce words correctly, pronounce words inconsistently, or have trouble with speech rhythm or inflection.
• Aphasia — Aphasia occurs when brain damage affects the ability to communicate or understand others’ communication. You may have trouble finding the right word, say the wrong word by mistake, or repeat yourself often. You also may have trouble reading, writing, or understanding what others are saying.
• Dysarthria — Dysarthria occurs when brain damage affects the muscles used to produce speech. A person with dysarthria may struggle to speak or have slurred speech.

Other cognition and communication problems that can occur after a TBI include:

• Attention or concentration issues.
• Breathing problems.
• Memory problems.
• Nonverbal communication problems.
• Slowed processing speed.
• Social communication lapses.
• Swallowing difficulties.

Traumatic Brain Injury and Speech Therapy

Speech-language pathologists (SLPs) can help children overcome a wide range of complications after a TBI. Depending on the severity of the TBI and their symptoms, SLPs can help children:

• Express their thoughts more effectively.
• Improve the clarity of their speech.
• Improve their memory.
• Improve problem-solving, planning, and organization skills.
• Improve their reading comprehension.
• Improve social skills, such as reading social cues and taking turns in conversation.
• Learn how to swallow safely.
• Pay attention better.

“I think when people think of speech therapy, they think of, ‘My child can’t say their Rs, Ls, and S’s,’ as an example,” Linda says. “But there’s a lot more because we do the augmentative communication. If they have trouble communicating, we can use different applications to help them to communicate.”

How Speech-Language Pathologists Help Kids After TBI

SLPs play key roles in children’s recovery after TBI. Speech therapy work typically begins in the inpatient setting and then transitions to inpatient rehabilitation, followed by outpatient.

Inpatient acute care

Speech-language pathologists typically begin working with TBI patients after they get medical clearance.

“We’re involved pretty quickly as long as they’re medically ready to be interacted with,” says Colleen Lyons, CCC-SLP, lead speech-language pathologist, UPMC Children’s.

The specific speech therapy exercises depend on factors like the severity of TBI and the child’s specific symptoms. For someone who has a concussion or mild TBI, the work might involve exercises to improve information processing or memory. The speech therapy team at UPMC Children’s is part of the concussion protocol and will see concussion patients before discharge.

For more severe TBIs, speech therapy exercises could involve working to strengthen swallowing, regain speech, improve cognition, and more.

“As the severity level increases, basically as soon as the child is starting to interact with their environment, we’ll start evaluations to see how much change is happening from this week to that week,” Colleen says. “We’ll work as a multidisciplinary team with occupational and physical therapy to help make sense of what information processing is happening through little things, like response to touch, response to light, response to smells, response to sound.

“And we’re just getting in there and talking to the family as early as possible about what kinds of things we can be doing in the environment to help have a positive impact on change.”

Inpatient rehabilitation

When a child is ready for more targeted work, they’ll often begin inpatient rehabilitation.

“As these kids are kind of waking up and becoming more alert to their environment, typically their care team wants to get them to a rehab floor or a floor where they can participate a little bit more than just the ICU,” says Jared Schuerman, CCC-SLP, speech-language pathologist, Rehabilitation Unit, UPMC Children’s.

“Oftentimes, the more severe cases, we’ll see them as they start to transition to being able to participate a little bit more day in and day out.”

The specific exercises depend on the severity of the TBI and the child’s symptoms. Jared says they often will begin to work on specific, targeted areas for improvement. That can include processing speeds, memory impairments, logic and reasoning, fine language skills, and more.

“We’re working day in and day out with occupational therapy, physical therapy, and caregivers in anticipation of how independent we can have these children leaving the hospital,” Jared says. “And it kind of takes that whole team.”

How long a child stays in inpatient rehab depends on the severity of their situation. It’s as short as a week for mild cases and as long as two to three months for severe cases, Jared says.

Outpatient rehab

Some children get a referral to continue their rehabilitation on an outpatient basis after they get discharged from inpatient rehab. Others may get a referral later if problems emerge at home or school.

In outpatient rehab, SLPs will continue to work with children on their specific targeted areas of improvement from inpatient rehab.

“We work a lot with the families, and we continue the education that inpatient and inpatient rehab has started with the parents,” Linda says. “We try to help educate and transition them back into school for school-age children.

“For the older kids that are in high school, we can home in a lot on their difficulties and get their input, too.  Then, we can look into what difficulties they’re having at school and help them work through those. If they’re not in school, we still work on those goals for the cognitive-linguistic skills that they need.

“If there are some social issues going on, if it’s appropriate, we can put them into a group to work on their social skills as well. So, it’s a nice continuum of care from the acute inpatient to acute inpatient rehab to outpatient.”

Can Children Regain Speech After a TBI?

Speech therapy can help children regain most — if not all — of their prior communication abilities.

“One of the lovely things about working with children is how they have neuroplasticity,” Colleen says. “Since children are supposed to be learning and developing new skills all the time, the brain is a lot more flexible in the ways that it can learn to do things.

“We do see some astounding progress. Especially once you get some momentum, it can be really neat to see how much things will roll along.”

Often, the key to success is strong communication between speech therapy, occupational therapy, physical therapy, and a child’s caregivers.

It’s also important that the therapy is adaptable. What may work for a 4-year-old patient will not necessarily work for a 16-year-old patient, Jared says.

“It keeps you on your toes, in that sense,” he says. “But also, it takes understanding that they have gone through something very difficult, and their family’s gone through something difficult. That adaptability piece comes into play each and every day, which makes it fun.”

Colleen, Jared, and Linda say the most rewarding part of their jobs is seeing children’s personalities emerge as they make progress.

“You can just see this light come up of hope,” Colleen says. “Just watching that happen is rewarding. Because we spend so much of our day trying to make kids shine and trying to find their personalities and what motivates them. It’s really nice to see those moments.”