Brain damage can lead to a variety of "deficiencies" that characterize the different clinical pictures. They are described by short incisive words: we are speaking of terms such as aphasia, amnesia, agnosia and apraxia. This terminology derives from classicism and has now become acquired language in all areas of neurology.
A recent study based on the qualitative research methodology, has analyzed the question of how people create the sense of Self after a serious brain injury. The study highlights the construction of the comparison between the concept of the pre-lesional self and the post-lesional one.
Following a brain injury, people construct the sense of their Self based on the meanings they attribute to their lived experiences and through social and practical activities. Emotional impact that follows a brain injury can further dramatically affect functioning in daily life.
In this regard, according to Erikson’s theory of identity formation, a person’s identity is formed in eight stages from birth into adulthood, and one of these stages related to the formation of identity during adolescence, is known as Identity vs. Role Confusion.
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Along with the most obvious physical and cognitive deficits that can lead to significant changes in the contexts of daily lives, Self-knowledge disorders can make the self-assessment of a person more complex regarding possible changes that invest one’s concept of Self.
The concept of personality change resulting from a brain injury refers to an alteration or a discontinuity in the condition of being a unique and unrepeatable human being - what the Americans call personhood.
3.1 From neurolinguistic to neuropragmatic
The main manifestation of Self-disorders occurs in the communication sphere.
The inappropriate management of communication exchange, due to the impairment of skills in communicating effectively with others, is the major barrier to the brain-damaged person’s reintegration in the community. It is not only the linguistic modality that sustains the severe deficits following brain damage, but also the extra-linguistic mode, that is the ability to communicate through gestures.
During communication exchange, people normally integrate linguistic and extra-linguistic acts with appropriate para-extra-linguistic aspects.
A brain injury causes impaired paralinguistic processing, with the inability to recognize emotions, through voice and facial expressions. Thereby, these communication difficulties undermine social skills because they make a person unable to create and maintain stable and lasting personal relationships.
Furthermore, even context shapes language and communication in terms of
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motivational, intentional, conversational and linguistic dimensions. People who live in an environment that lacks stimulation and social contact, gradually become isolated and depressed. They can manifest poor communication of gestures and words, which precludes the possibility of implementing more effective communication skills. The interpretative nature of communication constitutes the essential strength that can determine the construction as well as the breaking up of interpersonal relationships. An interruption in communication exchange occurs when there is a huge discrepancy between the perceived message and the intended message. The communication level is inadequate due to a lack of insight.
The current challenge is represented by the neuropsychological research applied to communication, such as non-verbal systems and gestural communication.
To the traditional phonological, morphological, lexical, syntactic, and grammatical aspects of language, the study of pragmatics that concerns the communication processes through which a person conveys intentions, aims, thoughts and emotions must be added. Pragmatics also includes idiomatic, metaphorical and ironic communication as well as discursive and conversational functions and social cognition skills. By mediating the relationship of a person with the surrounding environment, these aspects configure language and communication as dynamic processes because they take place within progressive negotiations and synchronization.
The paralinguistic component par excellence is the prosodic system, consisting of vocal parameters such as intonation and timbre, and temporal ones including rhythm of speech, articulation and pauses. The prosodic function, moreover, is distinguished in intrinsic prosody, which relates to the intonation profile
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(affirmative, negative, vocative); intellectual prosody, which concerns the non-literal meanings of communication; and emotional prosody, which allows us to decode emotions like happiness, anger, and sadness. According to some surveys, emotional prosody involves the right hemisphere, while it plays a secondary role in intrinsic and intellectual prosody.
3.2 Communication disorders and levels of speech analysis
At all levels of communication, it is necessary that the person be aware of the meanings he or she intends to communicate, plan them intentionally and implement the strategies to put this intent into practice.
The overwhelming majority of deficits affecting the pragmatics of communication concern the propositional aspects of the message related to the formulation, relevance and clarity of the linguistic message.
Pragmatic deficits can be classified in two macro-categories. The first concerns the cognitive deficits that are responsible for the qualitative and quantitative disorganization of the speech content, while the second category is of an emotional nature and contains deficits in terms of expression and emotional regulation. In this regard, the researcher Bloom (1994) stated that the linguistic structure of patients with damage to the left hemisphere of the brain is generally fragmented at sentence and word level, while the interruption of speech in patients with lesions to the right hemisphere is the elaboration of broader linguistic units.
It was also found that people with left lesions encounter problems within the
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sentence while patients with right lesions have problems in the unity of speech.
Pragmatic disorders, however, cannot be interpreted as formal linguistic deficits, but the possible explanations are to be found in broader communication skills that refer to the complex relationship between language and the overall situation in which it is required. Communication is therefore a complex cognitive process based on the integration of various cognitive functions and an intricate network of neural circuits. Furthermore, it is as complex a cognitive process as it is delicate, and the presence of a communication deficit compromises its functioning, so that communication acts, even relatively simple, become difficult to manage.