4 a lesser extent over the next three years regardless of severity of the injury [14–16]. Dahlberg et al. identiﬁed a volunteer sample of 52 people with closed head injury who were at least 1 year post injury [17]. They had received rehabilitation and had persistent social communication deﬁcits one year post injury. Patients were randomised to receive treatment or not. Subjects who received social communication skills training had improved communication skills that were maintained on follow-up. Overall life satisfaction for participants was improved. In fact, it has been suggested that recovery can continue up to 10 years [18]. Few cases recover their pre- morbid status. Alajouanine et al. report a more favourable outcome with posttraumatic aphasias than with aphasias related to cerebrovascular disease. Even mild brain injury (GCS > 12) can result in subtle long-term impairment of speech. Whelan et al. compared a detailed language proﬁle of a 19-year-old woman, 2 years following a mild brain injury with a matched normative cohort of 10 participants with no neurological impairment. Deﬁcits in attention, lexical access, complex lexical-semantic manipulation, response monitoring, and organization were revealed. Thus lending support for the hypotheses pertaining to neuronal fallout mechanisms within the frontal lobes as a consequence of mild neurological insult [19]. Others have proposed that long-term speech deﬁcits and other functional deﬁcits have therapeutic potential other than speech therapy. It has been hypothesised that “idle” or “recoverable” injured neurons may be evaluated with SPECT imaging prior to administration of hyperbaric oxygen. These were subse- quently evaluated with SPECT imaging post therapy, demon- strating perfusion. This hypothesis has not gained popularity despite initial enthusiasm. Early goal directed therapy in the treatment of the trauma patients with adequate cerebral oxygenation and prevention of hypotension is paramount to ensure a patient reaches a stage, where rehabilitation is possible [20]. Future work is essential to optimise outcome from this socially debilitating deﬁcit as the incidence of blunt trauma due to motor vehicle injuries continues to rise. 5. Conclusion Patients who sustain closed head injuries are susceptible to a variety of functional and psychological impairments. Speech is one of the cardinal factors that determine the outcome of a prolonged illness and intensive rehabilitation. It determines whether one can integrate into daily life at home and at work. These cases highlight that despite signiﬁcant initial deﬁcits in speech and language following closed head injuries favourable long-term outcomes can be achieved with prolonged and intensive rehabilitation. References [1] S. Nishio, N. Takemura, Y. Ikai, and T. Baba, “Sensory aphasia after closed head injury,” Journal of Clinical Neuroscience, vol. 11, no. 4, pp. 442–444, 2004. [2] M. J. T. Fitzgerald, Neuroanatomy, Basic and Clinical, WB Saunders, 3rd edition, 1996. Case Reports in Medicine [3] S. O. Dell, R. Batson, D. L. Kasdon, and T. Peterson, “Aphasia in subdural hematoma,” Archives of Neurology, vol. 40, no. 3, pp. 177–179, 1983. [4] J. L. Stone, J. R. Lopes, and R. A. Moody, “Fluent aphasia after closed head injury,” Surgical Neurology, vol. 9, no. 1, pp. 27–29, 1978. [5] M. Vukovic, J. Vuksanovic, and I. Vukovic, “Comparison of the recovery patterns of language and cognitive functions in patients with post-traumatic language processing deﬁcits and in patients with aphasia following a stroke,” Journal of Communication Disorders, vol. 41, no. 6, pp. 531–552, 2008. [6] S. W. Hoﬀman and C. Harrison, “The interaction between psychological health and traumatic brain injury: a neuro- science perspective,” Clinical Neuropsychologist, vol. 23, no. 8, pp. 1400–1415, 2009. [7] R. D. Vanderploeg, H. G. Belanger, and G. Curtiss, “Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 7, pp. 1084–1093, 2009. [8] D. L. Warden, L. A. Labbate, A. M. Salazar, et al., “Posttrau- matic stress disorder in patients with traumatic brain injury and amnesia for the event?” The Journal of Neuropsychiatry & Clinical Neurosciences, vol. 9, no. 1, pp. 18–22, 1997. [9] R. Mayou, B. Bryant, and R. Duthie, “Psychiatric conse- quences of road traﬃc accidents,” British Medical Journal, vol. 307, no. 6905, pp. 647–651, 1993. [10] A. Feinstein, S. Hershkop, D. Ouchterlony, A. Jardine, and S. McCullagh, “Posttraumatic amnesia and recall of a traumatic event following traumatic brain injury,” The Journal of Neu- ropsychiatry & Clinical Neurosciences, vol. 14, no. 1, pp. 25–30, 2002. [11] W. A. Lishman, “Psychiatric disability after head injury: the signiﬁcance of brain damage,” Proceedings of the Royal Society of Medicine, vol. 59, no. 3, pp. 261–266, 1966. [12] M. Groher, “Language and memory disorders following closed head trauma,” Journal of Speech and Hearing Research, vol. 20, no. 2, pp. 212–223, 1977. [13] E. B. Menon, S. Ravichandran, and E. S. Tan, “Speech disorders in closed head injury patients,” Singapore Medical Journal, vol. 34, no. 1, pp. 45–48, 1993. [14] K. M. Heilman, A. Safran, and N. Geschwind, “Closed head trauma and aphasia,” Journal of Neurology Neurosurgery and Psychiatry, vol. 34, no. 3, pp. 265–269, 1971. [15] M. R. Bond and D. N. Brooks, “Understanding the process of recovery as a basis for the investigation of rehabilitation for the brain injured,” Scandinavian Journal of Rehabilitation Medicine, vol. 8, no. 3-4, pp. 127–133, 1976. [16] T. Najenson, L. Mendelson, I. Schechter, C. David, N. Mintz, and Z. Groswasser, “Rehabilitation after severe head injury,” Scandinavian Journal of Rehabilitation Medicine, vol. 6, no. 1, pp. 5–14, 1974. [17] C. A. Dahlberg, C. P. Cusick, L. A. Hawley, et al., “Treatment eﬃcacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial,” Archives of Physical Medicine and Rehabilita- tion, vol. 88, no. 12, pp. 1561–1573, 2007. [18] T. Alajouanine, P. Castaigne, F. Lhermitte, R. Escourolle, and B. De Ribaucourt, “43 cases of post traumatic apha- sia: anatomical and clinical data and evolutionary aspects,” L’Enc´ephale, vol. 46, no. 1, pp. 1–45, 1957.