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).

Neuropsychologists are not medical physicians; they are psychologists who study the relationship between behavior and the brain. They first interview the individual: work and medical history, family dynamics, and school performance. The neuropsychologist gathers this information in order to compare level of functioning prior to a traumatic brain injury with post-injury functioning. The testing covers a broad range of areas: concentration, attention span, basic and abstract thinking, memory, mathematical reasoning, motor skills, problem-solving skills, judgment, and emotional character.

In May 2006, when I believed there had to be more than PTSD to blame for my difficulties in the workplace, I saw a neuropsychologist. I spent eight hours filling out self-evaluation forms and undergoing testing. Separately, my husband and I scored (one being the best, ten the worst) my level of irritability and depression, and my ability to remember things, concentrate, multitask, recall words, and think quickly. Our scores were nearly identical, with most of them ranging between five and eight. I spent the remainder of the day filling in dots on questionnaires, naming faces in photos, sticking pegs in tiny holes in less than fifty seconds, drawing figures from memory, naming as many items as I could think of that started with the letter T in less than one minute.

A few weeks later, the results came in the mail: the tests suggested I had sustained a traumatic brain injury when I was hit by a car three years earlier.

Finally, I had answers as to why I had trouble following conversations, learning new information, or performing most tasks in a timely manner. Finally, I had a reason as to why I could not retrieve the word from my brain when the neuropsychologist asked me to name the photo of two vertically connected glass bulbs with sand trickling from the top bulb to the bottom bulb.

Hourglass.

Emblematic of the passage of time, the hourglass also marks new beginnings.