152 Chapter 8
Treatment of Communication Disorders in
Traumatic Brain Injury
It has been said that rehabilitation for the patient with traumatic brain injury begins at the
accident site. In rehabilitation, an early start ensures that all that can be done will be done.
Unfortunately, some patients with severe traumatic brain injuries do not survive, and others may
never recover from deep comas. Remarkably, some patients make a complete recovery. Many
patients improve considerably and go on to enjoy functional and in de pen dent lives.
For patients with significantly reduced consciousness, the goal of rehabilitation is to improve
general awareness, orientation, responsiveness, and the ability to learn. In some patients, the use of
psychostimulants may improve attention and reduce distractibility, disorganization, hyperactivity,
impulsiveness, and emotional lability (Petit, 2001).
Coma stimulation is an experimental therapy that provides the patient with multisensory
stimulation to improve responsiveness. There are several coma stimulation techniques. Some
involve reading to the patient, massaging the body, placing dif fer ent odors and fragrances under
the nose, and so forth. The goal is to stimulate the patient to improve arousal, awareness, alert-
ness, and the general ability to benefit from rehabilitation. Some patients, particularly those
with higher levels of awareness, may respond to this type of stimulation. Certain clinicians
believe that coma stimulation, even for patients in deep comas, increases the likelihood that the
patient will make greater gains in rehabilitation after recovering from the coma. Unfortunately,
this therapy has not been carefully researched and proven to benefit comatose patients. It pro-
vides the patient’s family and friends with activities to reduce their sense of helplessness, such
as reading to the patient, talking about current events, and providing nurturing statements.
However, it is impor tant for them to understand that for most patients in a deep coma, little can
be done to improve awareness. Current medi cations, technology, and therapeutic procedures do
not significantly improve consciousness in most of these patients. Desperate families may grasp