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Old 02-07-2013, 12:48 PM   #1
meowzbark
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TBI + Retraining Speech

I've tried to do research on traumatic brain injuries, but not working in the medical field, I'm having difficulty understanding some of the terminolgy and procedures. I'd like to know how plausible my character's situation is and if there is anything I should add or take away:

One of my main characters (17 year old girl) is in a boating accident and suffers a traumatic brain injury. Scene is told from different POV so we only see the after effects of the injury.

This wound on her head requires stitching. I assume that they will shave her head, but I'm not sure if it's partial or full. Does it matter the location of the wound? I'd prefer for her to keep enough hair to cover up the injury location.

At some point, she goes into a coma. Would it be plausible for the doctors to self-induce the coma to repair damaged tissue and bone in her skull? I read that sometimes they do because the brain requires less oxygen in a coma situation and sometimes it helps survivability.

When she wakes from the coma (within 24 hours of arriving at hospital), she remembers things but not faces. She also forgot how to speak and needs to retrain herself how to talk. How long does it this process take? I was thinking about having her use one or two sylable words in dialogue and make the sentances as basic as possible. Are there certain vowels or constinents that she might avoid because they are harder to say?

Also, what medications or required therapy might she have to do after leaving the hospital. I currently have her in the hospital for 3 weeks. If everything is progressing well, how long until she can return to school?
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Old 02-07-2013, 01:30 PM   #2
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I don't know if this helps but I recently read an article about a person who can't talk after a brain injury but who can communicate by singing. Apparently a different part of the brain is used for singing than what is used by talking.
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Old 02-07-2013, 02:15 PM   #3
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There are two areas on the left side of the brain that control language. If her injury was to this side of her head, then different aspects of language would be affected. Broca's and Wernicke's areas. Broca's area is towards the front (not very front) has more to do with syntax, grammar, and sentence structure - putting her thoughts together coherently. Wenicke's area (in the back half, but not very back) has more to do with comprehension. There are other areas (still on the left) that seem to be involved as well, but I believe these are still considered the top two. A lot of your questions really hinge on the location and extent of her injury. However, most readers won't know this much.

Coma can be induced for a variety of reasons, one of which is when there is swelling in the brain. I'm not a doctor, so I really am at the max of my knowledge on this. Having made this disclaimer, three weeks seems short to me for someone who had part of her skull reconstructed.
School would depend on recovery of speech & understanding.

You're from Arizona - Gabby Giffords, your own state Congress person, was shot in the head a year ago. I heard part of her testimony before congress last week. Her speech was halting, she was having difficulty getting her well scripted thoughts out, and she has had access to some of the best medical care and speech therapy available. Granted, she was shot, your MC was 'just' hit in the head.

Perhaps if your character's injury isn't too grievous your time frame would work better? Hopefully someone with more medical background will weigh in for you!
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Old 02-07-2013, 02:48 PM   #4
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Quote:
Originally Posted by Nekko View Post
There are two areas on the left side of the brain that control language. If her injury was to this side of her head, then different aspects of language would be affected. Broca's and Wernicke's areas. Broca's area is towards the front (not very front) has more to do with syntax, grammar, and sentence structure - putting her thoughts together coherently. Wenicke's area (in the back half, but not very back) has more to do with comprehension. There are other areas (still on the left) that seem to be involved as well, but I believe these are still considered the top two. A lot of your questions really hinge on the location and extent of her injury. However, most readers won't know this much.

Coma can be induced for a variety of reasons, one of which is when there is swelling in the brain. I'm not a doctor, so I really am at the max of my knowledge on this. Having made this disclaimer, three weeks seems short to me for someone who had part of her skull reconstructed.
School would depend on recovery of speech & understanding.

You're from Arizona - Gabby Giffords, your own state Congress person, was shot in the head a year ago. I heard part of her testimony before congress last week. Her speech was halting, she was having difficulty getting her well scripted thoughts out, and she has had access to some of the best medical care and speech therapy available. Granted, she was shot, your MC was 'just' hit in the head.

Perhaps if your character's injury isn't too grievous your time frame would work better? Hopefully someone with more medical background will weigh in for you!
Thanks for the input. I don't want her comprehension to be impaired, since then the narrative will be affected. Just her ability to communicate. So you're information is definitely helpful. I don't plan on including too much specifics in the story, but I don't want to turn off readers by being inaccurate.

The time frame is one thing that I'm concerned with. There are supernatural influences that could account for a speedy recovery, however I don't want it to be too fast that it wouldn't seem possible without these supernatural influences. I read that the average time in the hospital for TBI was 21 days, so that's how I came up with my current time frame. Again, I know it all depends on the specifics.

Quote:
I don't know if this helps but I recently read an article about a person who can't talk after a brain injury but who can communicate by singing. Apparently a different part of the brain is used for singing than what is used by talking.
I will definitely incorporate this. Thank you.
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Old 02-07-2013, 04:20 PM   #5
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There are two aspects to memory: procedural memory and autobiographical memory. Procedural is how to do things, like writing, using the phone, driving a car. Autobiographical is who you are and who other people are and what's happened in your life so far. It's possible for either or both to be affected following a head injury.

There's lots of information about there about people who've suffered strokes and the effects on their memory, and it's worth looking into that because it is, after all, just another form of brain damage. The most famous injury case is however Phineas Gage, who suffered a personality change. There are also cases of people who've started speaking with a different accent or even in a different language.

It's certainly possible to lose the ability to recognise objects but retain the ability to recognise faces, or vice versa, as these seem to be 'kept' or 'processed' or whathaveyou in different parts of the brain.
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Old 02-07-2013, 06:01 PM   #6
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Quote:
Originally Posted by meowzbark View Post
When she wakes from the coma (within 24 hours of arriving at hospital), she remembers things but not faces. She also forgot how to speak and needs to retrain herself how to talk. How long does it this process take? I was thinking about having her use one or two sylable words in dialogue and make the sentances as basic as possible. Are there certain vowels or constinents that she might avoid because they are harder to say?

Also, what medications or required therapy might she have to do after leaving the hospital. I currently have her in the hospital for 3 weeks. If everything is progressing well, how long until she can return to school?
From my experience with a friend of the family who suffered a stroke in her 40's, speech therapy and its early start is absolutely vital to regaining the ability to speak. The problem for her was that she knew what she wanted to say, but she couldn't remember how to actually say it - and the more frustrated she got, the worse her ability to communicate became.

The term for that sort of speech impediment is 'aphasia', or if that's not quite right then it'll be a good place to start your research on this.

Either way, she'll be looking at months if not years of speech therapy.
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Old 02-08-2013, 12:22 AM   #7
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I'm not a medical doctor but I am a TBI survivor. (Incidentally, I was also 17 y/o at the time.) Feel free to PM me if you have any more questions.

Quote:
Originally Posted by meowzbark View Post
This wound on her head requires stitching. I assume that they will shave her head, but I'm not sure if it's partial or full. Does it matter the location of the wound? I'd prefer for her to keep enough hair to cover up the injury location.
Does the wound go all the way through the skull? Injuries that pierce the skull are classified as "open TBI" (a good example would be a gunshot wound) whereas injuries that don't are classified as "closed TBI".
http://en.wikipedia.org/wiki/Open_head_injury
(Mine was a closed TBI due to a car accident, btw.)

Quote:
Originally Posted by meowzbark View Post
At some point, she goes into a coma. Would it be plausible for the doctors to self-induce the coma to repair damaged tissue and bone in her skull? I read that sometimes they do because the brain requires less oxygen in a coma situation and sometimes it helps survivability.
Yes, but remember that depending on the type of brain injury, it's not uncommon for the brain to go into a coma all by itself. That's what mine did.

Quote:
Originally Posted by meowzbark View Post
When she wakes from the coma (within 24 hours of arriving at hospital), she remembers things but not faces. She also forgot how to speak and needs to retrain herself how to talk. How long does it this process take? I was thinking about having her use one or two sylable words in dialogue and make the sentances as basic as possible. Are there certain vowels or constinents that she might avoid because they are harder to say?

Also, what medications or required therapy might she have to do after leaving the hospital. I currently have her in the hospital for 3 weeks. If everything is progressing well, how long until she can return to school?
First, you definitely need to read up on the experiences of Gabby Giffords. My TBI was right frontal lobe, so I had no trouble with talking, but I had other physical and mental challenges. Gabby's was left. That's probably what you're looking for.

To me, 21 days in the hospital is believable - I was only in the hospital 23 days - BUT then I was in rehab for many more weeks. When I was released from the hospital, I was medically stable but still far from recovered. I was barely able to walk (with a cane) and could not navigate stairs at all. Also, in the 6 months immediately following a TBI, you're at extremely high risk of a repeat TBI, so my neurosurgeon would not allow me to do anything that could potentially result in another TBI. No sports, no driving, and I had to have someone with me EVERY time I went up or down stairs.

Oh, as far as school - if she has a good ally in the school principal/counselor, she should be allowed to return on at least a part-time basis reasonably soon. I was completely blessed with a great principal and counselor who really fought for me. My challenge was a bunch of therapists from the rehab center who felt that, due to a bunch of irrelevant statistics, I would be unable to graduate high school and shouldn't be allowed to try. Mr. Jeffers and Ms. Alvested argued that I be given a chance, and I did manage to graduated on time.

A couple of other thoughts:
Don't forget the ventilator. When you are in a coma (regardless of whether it is "natural" or induced), respiration is depressed and you are put on a ventilator. Period.

Also, Hollywood has done you a favor in that, you will be able to get away with a lot of "stretching reality". You know those movie scenes where a person wakes up from a coma, stretches, and says, "oh my, I feel like I've just had the most marvelous nap"? Yea, not even realistic. I honestly do not remember waking up from my coma. Thanks to a little amnesia, I barely even remember the hospital, and I don't remember the accident. Since then I've learned that most of what people think they know about brain injuries is generally wrong, but they'll believe just about anything.

Can't think of anything else right now. Like I said, PM me if you have any other questions.
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Old 02-08-2013, 12:59 AM   #8
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I, too, am a car accident survivor with TBI. I was 21, my injury was in the left temporal lobe.

I was in a coma for a week or so (not induced, it was a result of my injury). I did not require stitches, so they did not cut my hair at all. I was in the hospital for 3 weeks total.

I could not walk, talk or see, even after they sent me home. I had to re-learn English, little by little over a period of a couple of months. First, my ability to walk came back, then my language, then my vision. I never did re-learn Spanish.

I still have intermittent aphasia. It has been 40 years since my accident. PM me if you would like more detail. Good luck with your project!
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Old 02-09-2013, 02:20 PM   #9
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Sorry about the delay in responding. I forgot about this thread. *embarrassed* Thank you for sharing your experiences. This entire thread has really helped polish off this aspect of my story.

Quote:
From my experience with a friend of the family who suffered a stroke in her 40's, speech therapy and its early start is absolutely vital to regaining the ability to speak. The problem for her was that she knew what she wanted to say, but she couldn't remember how to actually say it - and the more frustrated she got, the worse her ability to communicate became.

The term for that sort of speech impediment is 'aphasia', or if that's not quite right then it'll be a good place to start your research on this.

Either way, she'll be looking at months if not years of speech therapy
Aphasia. It's good to have a name for it. Thanks!

Quote:
First, you definitely need to read up on the experiences of Gabby Giffords.
I followed Gabby Giffords's story when it originally happened. I will definitely look her recovery process. I'm glad that the time frame is on track. She won't be back to normal by the end of the book, as the entire book only spans a couple months.

You make an interesting point about not driving. I'm going to have to figure out an alternative way to get her from Point A to B, since she won't be able to drive and her love interest lost his license, since he was operating the boat impaired. An unforeseen road bump that I must figure out. Thank you!

Quote:
I could not walk, talk or see, even after they sent me home. I had to re-learn English, little by little over a period of a couple of months. First, my ability to walk came back, then my language, then my vision. I never did re-learn Spanish.
Hm. This is interesting. My character originally is bi-lingual. So, I could have her lose all knowledge of Spanish as well.
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Old 02-09-2013, 10:40 PM   #10
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Something to keep in mind is that TBI recovery is measured in years, not days or weeks. I remember seeing something on the news recently about Gabby Giffords testifying before Congress about gun control, and she still was not speaking "fluently". She had written out her testimony, and you could tell she was choosing each word very carefully. If you didn't know her story and ran into her in a restaurant or store, you'd probably assume she was "mentally challenged". (Definitely a wrong assumption, of course!)

All this talk of languages reminds me - one time I read about a woman who woke up from a brain injury coma with a French accent. She was 100% American, never took French classes, had never even been to France!
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