Communication problems after brain injury are very common. Although most of us take it for granted, the ability to communicate requires extremely complex skills and many different parts of the brain are involved.
There are four main categories of the effects of brain injury. Any of these can cause communication problems:
- Physical – affecting how the body works
- Cognitive – affecting how the person thinks, learns and remembers
- Emotional – affecting how the person feels
- Behavioural – affecting how a person acts
Many people will experience more than one form of communication problem after brain injury, depending on the areas of the brain affected and the severity of the injury. It is also important to recognise that such problems may occur alongside other changes in physical, cognitive, emotional and behavioural functions.
The diagram below shows the cerebral cortex. The cortex is the outer part of the brain, which is responsible for our more sophisticated thinking skills. Many of the functions listed are important for communication and injury to any of these areas can impair communication skills.
This section explains some of the ways brain injury can affect communication.
- Language impairment – aphasia (often called dysphasia)
Covers problems with understanding language and expressing thoughts through language. Also covers problems with reading and writing.
- Speech difficulties
Discusses disorders of speech that can occur after brain injury.
- Cognitive communication difficulties
Covers some of the problems with communication caused by cognitive difficulties, such as memory impairment, attention difficulties, poor social skills and fatigue.
Our booklet Coping with communication problems after brain injury provides more in-depth information about the issues covered here, and you can contact the Headway helpline if you have any further questions.
via Communication problems | Headway
OBJECTIVE:This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals.
METHODS:Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms “VR,” “rehabilitation,” and “stroke.”
RESULTS:Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training.
CONCLUSIONS:Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.
via Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview. – Abstract – Europe PMC
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly used to modulate neural activity in the living brain. In order to establish the neurophysiological, cognitive or clinical effects of tDCS,tDCS most studies compare the effects of active tDCS to those observed with a sham tDCS intervention. In most cases, sham tDCS consists in delivering an active stimulation for a few seconds to mimic the sensations observed with active tDCS and keep participants blind to the intervention. However, to date, sham-controlled tDCS studies yield inconsistent results, which might arise in part from sham inconsistencies. Indeed, a multiplicity of sham stimulation protocols is being used in the tDCS research field and might have different biological effects beyond the intended transient sensations. Here, we seek to enlighten the scientific community to this possible confounding factor in order to increase reproducibility of neurophysiological, cognitive and clinical tDCS studies.
via Sham tDCS: A hidden source of variability? Reflections for further blinded, controlled trials – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation
This article outlines key principles and considerations in the rehabilitation of cognitive challenges following mild, moderate, and severe traumatic brain injuries, with a focus on the needs of the service member and veteran population. The authors highlight specific evidence-based strategies and interventions and provide functional examples to support implementation. By emphasizing the array of tools and resources that have been designed to address cognitive challenges in the service member and veteran population, they focus on optimizing cognition to support successful community reintegration and the resumption of a full and meaningful life.
via Rehabilitation of Cognitive Dysfunction Following Traumatic Brain Injury – Physical Medicine and Rehabilitation Clinics
Multiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework.
A systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training.
Thirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode.
The multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player’s skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players’ game conditions.
Robotic assistance and virtual reality in neuromuscular therapy
Neurological deficits can result in impaired motor function that affect a person’s quality of life. Researchers have been working to restore the nervous system and reduce the neurological deficits of people suffering from stroke, spinal cord injury, or traumatic brain injury . For people with neurological deficits, impaired motor function is among the most prominent factors limiting the quality of life . Motor neurorehabilitation can lead to permanent improvements in motor function . Robotic assistance and virtual reality have the potential to enhance rehabilitation of neuromuscular deficits beyond the levels possible with conventional training strategies [4, 5].
Game experience and task performance in multiplayer games
Robot- and virtual reality-assisted single-player games are well integrated in neurorehabilitation schedules. Recently, multiplayer games have been tested to complement neuromuscular therapy. Multiplayer games are expected to motivate the patients and increase the potential of robot- and virtual reality-assisted neuromuscular therapy.
Multiplayer games incorporate social interaction to promote the enjoyment of the involved players. The additional player adds new possibilities to the game environment, generally missed in single-player gaming against preprogrammed challenges or artificially controlled opponents. The multiplayer environment and related game mechanics can facilitate social interaction, ranging from conversation to haptic interaction. Due to the this added social interaction, the game experience is thought to be better in multiplayer compared to single-player gaming .
The mode of the game specifies whether the players compete or cooperate with one another . In line with the flow theory, a competitive mode requires opponents of similar skill level to achieve enjoyment as the task difficulty experienced by one opponent . Comparable skill levels prevent boredom or stress and result in a meaningful challenge level that leads to a flow state when training . In such training conditions the players have a positive game experience.
In positive game experience players increase their game performance [9, 10]. Increased game performance facilitates the general idea of serious games, i.e., playing for a primary purpose other than pure entertainment . If enhanced game performance is achieved by increased physical activity, training intensity is also increased. In neuromuscular therapy, training intensity – alongside early treatment, user-centered, and task-oriented training – is one of the key factors in neurorehabilitation [12, 13]. Therefore, multiplayer gaming has great potential to further increase the benefits of robot-assisted neuromuscular and virtual reality-assisted therapy [14, 15].
Continue —> Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games | Journal of NeuroEngineering and Rehabilitation | Full Text
Fig. 4Difficulty adaptation based on individual condition setting in multiplayer games. Game experience (left) can be optimized by balancing the game performance (right). – Left: The initial game experience under nominal conditions relates to the skill level of the opponent and is non-optimal for differently skilled players (squares). Optimal game experience is perceived by the players when the condition adapts the difficulty towards the players’ skill level (circles). – Right: A common initial game performance state consists of a conditional task difficulty and its corresponding player specific game performance (square). Player specific difficulty adaptation can balance the game performances of the two players (circles)