Communication Problems after Head Trauma

Head Trauma Affects Normal Communication Pathways

Diffuse brain injuries happen when a shock travels throughout the brain, damaging tissues, nerve cells and blood vessels. This shock can come from a blow to the head, or sudden dramatic pressure changes in the environment from a blast.

After head trauma, many suffer from difficulties with both speech and complex mental tasks. In medical terms these brain functions are called “cognitive-linguistic function and executive process”.

Some observable cognitive changes include:

  • Taking a longer time to make a decision
  • Taking a longer time to interpret information and respond appropriately
  • Not knowing how to interpret certain social situations, expressions or reactions from others
  • Having difficulty remembering things learned, and events from the past
  • Difficulty focusing, and maintaining attention

Researchers are trying to better understand the language related changes that come from head trauma and diffuse brain injury. For the most part, head injury victims recognize common words with the same skill as the rest of the population. If a person who experienced mild to moderate brain trauma takes a standardized word recognition and language test, they usually perform pretty much the same as everyone else.

The problem occurs when they have to connect words and concepts correctly to explain situations, react appropriately and processes that information to take action.

What this tells scientists is that the problems with language are a result of how the brain performs mental tasks, and not simply how it remembers words.

Some common language processing challenges after head trauma include

  • Understanding sarcasm and irony
  • Interpreting jokes or non-literal language correctly
  • If several people are talking at once, understanding what is being said to whom
  • Recognizing when words are not used correctly, and identifying grammar or language structure errors

These are all challenges that go beyond basic word recognition, and require a more complex thought process where situation, environment and intent are all required to understand meaning.

Physical Injury and Language Processing

Several parts of the brain are responsible for managing language. The temporal lobes of the brain, which are on the sides of the head by the temples and the ears, are involved in learning words and languages. The front of the brain, called the frontal lobe, helps interpret proper communication and word use. Other parts of the brain relay messages and guide correct responses.

When there is head trauma, parts of the brain responsible for cognitive-linguistic function and executive process may be injured and bleed or swell. In addition, generalized swelling of the brain and damage to nerve cells that run throughout the brain further contribute to communication challenges.

Nerve Pathways and Communication

Here is a real- world example:

When someone says "Thanksgiving Dinner" several things happen.

  1. The sound enters the ear and stimulates nerve impulses which one specific area of the brain interprets as words.
  2. Memories of Thanksgiving pop up and images of a Thanksgiving dinner table, stuffing and gravy emerge from a different part of the brain.
  3. Associated emotions come forward. Thanksgiving may be connected to feelings of warmth, family, and enjoyment. Or, if Thanksgivings are stressful, more anxious emotions emerge.

In a few seconds the entire brain becomes involved in interpreting and understanding the words that were stated, and then formulates a response, based on the words, images, memories and emotions.

After head trauma, the words can enter the ear and be recognized, but the pathways that connect to memories and emotions may be damaged. Pathways that allow the brain to initiate a correct response may also be damaged.

This disconnect is part of the reason why individuals with head trauma may have reactions that do not seem appropriate, or appear to be disconnected from the broader experience.


Time can help repair some of the connections in the brain. Therapy may be needed to help an individual re-learn how to process information correctly and react appropriately to different words and concepts.


Barwood, C. H., & Murdoch, B. E. (2013). Unravelling the influence of mild traumatic brain injury (MTBI) on cognitive-linguistic processing: A comparative group analysis. Brain Injury, 27(6), 671-676. doi:10.3109/02699052.2013.775500

Borgaro SR, Prigatano GP, Kwasnica C, Rexer JL. Cognitive and affective sequelae in complicated and uncomplicated mild traumatic brain injury. Brain Injury 2003;17:189–198.

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