Many people experience moments when they can’t come up with the exact word, or words, they want to express, and resort to the hackneyed phrase: “It’s on the tip of my tongue.” But for those suffering from a traumatic brain injury, this phrase extends beyond its timeworn use. Word finding, or word retrieval, is one of the most common cognitive difficulties in TBI survivors. The language center of the brain is located in the left hemisphere – the frontal and temporal lobes. Difficulty with word retrieval usually means the damage has occurred in the frontal lobe, the location of most TBIs.

What does this mean for individuals who have suffered a frontal lobe injury? Called dysnomia, or anomia, they tend to have difficulty naming objects, people, and places. They may know what the object is that they are looking at, but cannot identify it.  Sometimes the process is selective, say, to colors. For instance, individuals might know the difference between blue and pink, but cannot name them. In other cases, individuals might be able to identity an object through sound – the ringing of a bell – or touch – a needle – but not sight. Others might use the wrong word. For example, instead of saying, “Can you please pass the salt,” they might say, “Can you please pass the tire?” http://www.speech-therapy-on-video.com/wordfindingdifficulty.html

Circumlocution, a strategy where you “talk around” the name of the object, person, or place you are attempting to identify, often helps. If you’re looking for your cell phone, and you want to ask your husband if he has seen it, you might say, “It’s portable and it rings.” That way he will know what you are talking about. Also, this might prompt you to remember the object. Reciting the alphabet is a strategy that triggers words for me, especially if I can’t recall someone’s name, which happens all the time, even if I just met the person five seconds earlier. So, if I’m trying to recall the name Nancy, I say the alphabet in my head until I get to N. You can also visualize the word written out on a chalkboard, or whiteboard, or even a pad of paper. Similar to circumlocution, if someone cues me by sounding out the beginning of a word I’m struggling to express, my brain synapses suddenly come to life. http://www.speech-therapy-on-video.com/wordfindingdifficulty.html

For writers with a TBI, difficulties with word retrieval interfere with crafting poetic sentences for our readers to chew on. I typically find myself staring at a sentence for several minutes, rubbing my forehead and biting on my pencil. It’s not unusual for me to spend hours working on one paragraph. I usually end up resorting to my pile of notebooks of quotes I’ve collected from some of my favorite authors. For instance, if I’ve used “walk” a hundred times in my manuscript to describe someone entering a room, I flip through the notebooks, scanning the pages for unique ways other authors describe this same action. Of course, I do not steal their phrases, but seeing alternative ways to express “walk” is similar to someone verbally cueing me: My brain lights up with all kinds of options to consider, and I feel as if I just won the lottery.

Give these exercises a try, and feel free to share what works for you.

(FYI: Including research, it took me five hours and twenty-eight minutes to write this bog post).

Traumatic brain injuries are a subset of acquired brain injures, which are not the result of trauma, but occur after birth: hypoxic brain injuries (lack of oxygen to the brain), and anoxic brain injuries (no oxygen to the brain).

In a diffuse axonal brain injury (a type of closed traumatic brain injury) the skull is not broken, but the brain is violently jarred and collides with the skull, causing tissue swelling. Since there is no opening to relieve the swelling, there is increased pressure in the brain, damaging neurons, the core cells of the nervous system. As a result, the communication network between neurons is impaired (think of a downed cable or telephone wire), and basic functions like speech, and  breathing might be affected.

A concussion is caused from direct impact to the head by an object, or sudden movement or momentum from shaking, like in whiplash. Neurons stretch and blood vessels tear, which can cause contusions – bruises on the brain. The individual may or may not lose consciousness. Shaken Baby Syndrome, also known as Abusive Head Trauma and Shaken Impact Syndrome – is a form of whiplash where the aggressor vigorously shakes the baby. Most of these cases occur when babies are between 6 and 8 weeks old, since that is when they cry the most. The trauma may cause them to experience vomiting, seizures, irritability, and poor feeding.

In an open brain injury, the skull is fractured. If it’s pierced, say, from a gunshot or knife, the skull splinters, and fragments can hit brain tissue, causing further tissue damage (a penetrating injury). Even though cell damage can occur in an open injury, there is less chance of brain swelling and therefore increased pressure. That’s why doctors consider them less dangerous than closed head injuries. But, because there is an opening in the skull, bleeding into the brain can occur. And the individual is at high risk for infection, most commonly meningitis – an infection of the membranes surrounding the brain and spinal column.

Frontal lobe injuries affect the front part of the brain. The frontal lobe controls motor skills, thoughts, emotions,and personality. The left side of the lobe controls verbal communication, and the right side controls non-verbal communication – the arty side of our brains. The right lobe also plays a role in negative emotions, while the left lobe involves positive emotions. The area of the frontal lobe that is damaged will dictate how your emotions and personality are affected. Once a cautious person, you may now find yourself to be more impulsive.

So I suppose it shouldn’t come as a surprise that the brain is susceptible to injury. Weighing a slight 3.4 pounds, and encompassing more than 1 billion neurons with an infinite number of connections, the brain is a delicate mass of tissue floating in a fluid environment, much like a fetus in a uterus.

http://www.msktc.org/tbi/factsheets/Understanding-TBI/What-Happens-During-Injury-And-In-Early-Stages-Of-Recovery

http://www.braininjuryinstitute.org/Brain-Injury-Types/Open-Head-Injury.html

http://kidshealth.org/parent/medical/brain/shaken.html