Speech disorders in closed head injury patients

Head injuries vary in type and degree of severity and clinicians agree that most individuals who suffer head injury have cognitive, speech injury, behavioural and sensory motor problems immediately after and during their rehabilitative phase.

The hospital courses of thirty-one closed head injury (CHI) patients admitted to our Rehabilitation Department from January 1990 to April 1991 were studied with particular reference to their speech disorders.

Severity of the initial brain injury, best measured by length of coma using the Glasgow Coma Scale (GCS) was the most significant predictor of outcome, defined by the Glasgow Outcome Scale (GOS). Eighty-one percent of our patients were unconscious immediately following their injury. Upon admission into our neurosurgical department, thirty-nine percent were comatose with a Glasgow Coma Scale score of eight or less. Fifty-two percent had a score of twelve or more and the rest were in between. Twenty-six percent had skull fractures, while seventy-four percent had one or more extracranial injuries. Neurologically eighty-one percent of our patients had either a left or right hemiplegia/paresis. In the assessment of speech, thirty percent were aphasic, twenty-five percent had motor speech disorders, thirty-two percent had mixed speech deficits and thirteen percent did not have any significant speech problems. Average stay in the Rehabilitation Department was ten weeks.

Although most patients showed an overall trend of speech improvement across time, the severely injured (Glasgow Coma Scale less than eight) continued to manifest permanent residual deficits especially those with expressive, mixed or global aphasia. The mild to moderately injured (Glasgow Coma Scale more than eight) seem to have anomia and word retrieval difficulty with little receptive language impairment, and these persisted months after discharge.