Volume 5, Issue 1, Winter 2023
Ask the Specialist: Six Tips for Communication After a Brain Injury
by Jessica Lynn Danley
Clinical Education Coordinator
University of Arkansas Speech and Hearing Clinic
Ordering food from a drive-thru restaurant, chatting with friends in a noisy lobby, and talking to family over the phone. These are all common social routines that rely on good communication skills. A brain injury can cause speech challenges that make communication and socializing harder. After a brain injury, it is common to have speech struggles like “slurred” speech, low volume, speech that is too fast or too slow, and mumbling.
Learning to use speaking tools and changing the environment can lead to easier conversations. If you are having trouble with clear speech after a brain injury, here are some tips that may help:
- Slow Down. Slow down your speaking rate and place longer pauses between words.
- Pace Yourself. Talking for long periods of time can lead to voice strain and use more effort or energy. This extra effort can also cause fatigue, which can in turn affect the clearness of speech. Take breaks to recharge.
- Over-Articulate and Break It Down. Practice over-articulating the sounds of each word. This means that you will practice exaggerating each sound in a word. You can also break down longer words into smaller pieces. Words can even be broken down syllable-by-syllable to make them easier to understand.
- Consider Your Environment. How loud or distracting is the current environment? Try to reduce the noise or move your conversation to a quieter location. Is the room well-lit? Check to see if your listener can see your face as you speak because visual clues can be helpful.
- Practice With Others. Join a local community support group for a chance to practice new speaking habits in a supportive environment. Share your goals and ask for feedback from others.
- See a Speech Therapist. Some people need special strategies to help them overcome speech issues. Speech-language pathologists (SLPs) are health care professionals who can listen to your speech and offer helpful treatment options for your speech troubles. Ask your primary care physician (PCP) for more information.
Resources
https://www.asha.org/public/speech/disorders/dysarthria/
https://www.brainline.org/article/communication-effects-after-brain-injury
FAMILY STORY: LAWSON HETHER
As Told to Kristen Alexander
In November 2020, Lawson Hether was a senior in high school and a car fanatic. At only 17 years old, he had rebuilt the engine on his Mazda Miata and he loved to drive like a racecar driver. According to his mom, Kristin Hether, Lawson was an arrogant teen with a need for speed. Still, he had a big heart and a great work ethic. He loved missions, learning, his Miata, and fish tanks.
The day after Thanksgiving, after leaving a friend’s house, Lawson took a curve too fast, ran off the road, flipped his car and hit a tree. The car was upside down and so was Lawson, secured in the driver’s seat by his seat belt. In a Caring Bridge journal entry to family and friends, Kristin wrote, “The accident occurred in front of a house where the homeowner was sitting outside and ran to the scene. He and another neighbor cut Lawson’s seat belt and gently lowered him to the ground.” That man turned out to be an old friend of Lawson’s grandparents.
Lawson was taken to Arkansas Children’s Hospital, where he was found to have a diffuse axonal injury (DAI), meaning that the impact had caused little tears throughout his brain tissue. Despite being in a coma, his body was very active, pulling at his tubes and wiggling around to get comfortable. Because of the COVID-19 virus, only one parent was allowed to visit Lawson, so Kristin and her husband Aaron took shifts with him at the hospital.
In only a matter of days, Lawson progressed to semi-comatose and started short therapy sessions. Despite being paralyzed on one side, he took 10 assisted steps just one week after the accident. By two weeks out, he was nodding and shaking his head yes and no, and showing new signs of awareness. Kristin’s journal entries showed her excitement and gratitude.
Then on December 14, after two and a half weeks of progress, Lawson had a stroke in his room after physical therapy, right in front of his mom and a nurse. He was rushed to surgery to remove a clot in his brain. For the next few days, the family could only wait. Lawson was in another coma — medically-induced this time, with drains in his brain to keep the swelling down. However, his brain was swelling to critical levels, and the family started preparing for the possibility that they might have to let him go. On December 18, Kristin’s journal entry seemed prepared to say goodbye. With little hope for Lawson’s survival, she wrote about Lawson’s faith and knowing that “Lawson will be made whole in the life to come.”
Later the same day, her tone shifted as she reported that a CT scan had shown improvement. She wrote, “this has put us back into the game for now!!”. The waiting was back on as the swelling decreased, and Lawson was gradually weaned off supports. For the next few weeks, scans and reports kept coming back “better than expected,” and Lawson moved back to a regular hospital room and then to Baptist Health Rehabilitation Institute (BHRI), for further rehab.
Looking back, Kristin said her time in the hospital with Lawson was really fueled by adrenaline. “I felt like his watchdog,” she says. She asked lots of questions, sometimes pushing back on the care team’s medicine or diet choices. As his mother, Kristin could tell when something was not right. When a medicine made him sick to his stomach, she noticed and talked to the doctors, who changed the plan. After that, Lawson was able to feel better and work harder in his therapies. Lawson’s dad Aaron would take shifts at the hospital when he could, although he had to spend more time at work. Kristin cherished those moments because she got to spend time with their youngest son, Luke. Aaron had a special way with Lawson that helped motivate him in his recovery. He always brought speakers to listen to their favorite music together.
After 1 month at BHRI, Lawson went to “brain camp” (as the family calls it) at NeuroRestorative Timber Ridge in Benton, where he stayed for 9 months. He was nonverbal, which made staying in the cabins difficult, because he could not ask for what he needed. He remembers being really depressed. Some of the other residents were loud, so it was hard to rest. Despite these challenges, Lawson adjusted and continued to get better. He even started coming home on the weekends and was able to walk unassisted at graduation.
After Timber Ridge, “Lawson returned to Little Rock Catholic High, taking a full schedule of courses, even though he didn’t need many credits to graduate. He pushed the other students in P.E. class with his performance. He could run a mile and do 50 push ups. Once he finished school, Lawson knew he needed to do more work on his recovery. He asked to go back to “brain camp”, and to the Hethers’ surprise, they were able to work it out with insurance. Because of the progress he had made, he was able to enter Phase 2 this time, which he really likes.
Lawson works really hard in therapy. Kristin says he has always had a great work ethic, and that shines in his therapies. He is still working very hard on his speaking. His voice is not at full strength, so he often uses his phone to communicate with others. He also has trouble with impulse control at times.
The accident caused big changes to Lawson’s personality. He is not shy to tell others that he was “a huge jerk” before his accident. Kristin describes him before the accident as arrogant and really mean to his younger brother. In many ways, the family likes the “new” Lawson better. If you meet him today, it would be hard to believe who he was before. He has a sweet smile and seems kind, with a great sense of humor. Lawson said, “I have totally changed my outlook on life for the better. I am nicer, believe it or not, and I am closer to God. I still have a lot of work to do, though, just as anyone else.”
Lawson has lots of dreams for his future. Before his accident, he was really into math and science, but now he struggles more with that. He is interested in occupational therapy, welding, and working on cars again. He can still remember many parts of the car, but not how to fix them. As a caregiver, Kristin is still wrestling with the future. She knows Lawson could be in her care permanently, and that is a future she had not planned for. She said, “I know when he comes home from Timber Ridge, it is going to rock my world because we are very different people. He is very driven and needs lots of activity and routine. I am a slow mover, less structured and I’m scared because I feel selfish. I don’t want to have to do that, but I will.” She also has fears about his behaviors being misunderstood by people in the world if he is independent one day.
Despite all the trials of the brain injury, Lawson says it has been a blessing because he doesn’t cut others down like he used to. He has a lot of trust to build back with his brother. It was all a big strain on Luke, the youngest, who was home alone for much of the pandemic, while the family was in the hospital. Kristin expressed that it was really hard to divide time between her sons when Lawson needed so much support.
Lawson’s advice to other people with brain injuries is simple: Stick it out. You can do it!
Kristin’s advice:
- Advocate. Speak up when something seems off.
- Don’t be afraid to ask questions. Do your best to keep up with what is going on in your loved one’s care.
- You can’t answer the question, “why”. You have to look at what you can do from here, and realize that your life is changed forever. It’s just one day at a time.
- Don’t compare your recovery to someone else’s.
Social Security Pointers: SOCIAL SECURITY BENEFITS INCREASE IN 2023
By Tonya Cater, Social Security Public Affairs Specialist
Approximately 70 million Americans will see an 8.7% increase in their Social Security benefits and Supplemental Security Income (SSI) payments in 2023. On average, Social Security benefits will increase by more than $140 per month starting in January. Federal benefit rates increase when the cost of living rises, as measured by the Department of Labor’s Consumer Price Index (CPI-W). The CPI-W rises when inflation increases, leading to a higher cost of living.
This change means prices for goods and services, on average, are higher. The cost-of-living adjustment (COLA) helps to offset these costs. We mailed COLA notices throughout the month of December to retirement, survivors, and disability beneficiaries, SSI recipients, and representative payees. If you misplaced your notice, you can securely obtain your Social Security COLA notice online using the Message Center in your personal my_Social Security account.
If you prefer to access these types of notices online and not receive the mailed notices, you can log in to your personal my_Social Security account to opt out by changing your preferences in the Message Center. You can update your preferences to opt out of the mailed COLA notice, and any other notices that are available online.
Did you know you can receive a text or email alert when there is a new message waiting for you? That way, you always know when we have something important for you — like your COLA notice. “Medicare premiums are going down and Social Security benefits are going up in 2023, which will give seniors more peace of mind and breathing room,” said Kilolo Kijazaki, Social Security acting commissioner. “This year’s substantial Social Security cost-of-living adjustment is the first time in over a decade that Medicare premiums are not rising and shows that we can provide more support to older Americans who count on the benefits they have earned.”
January 2023 marks when other changes will happen based on the increase in the national average wage index. For example, the maximum amount of earnings subject to Social Security payroll tax in 2023 will be higher. The retirement earnings test exempt amount will also change in 2023. Visit this fact sheet for more info: https://www.ssa.gov/news/press/factsheets/colafacts2023.pdf
Be among the first to know! Sign up for or log in to your personal my_Social Security account today. Choose email or text under “Message Center Preferences” to receive courtesy notifications. You can find more information about the 2023 COLA at https://www.ssa.gov/cola/.