Being This Bloody Takes Work

Special Effects Designer Lynn Wilcott and director Greg Maraio shared some of details on making the production as full of gore as we’d hoped.

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Brain Injury and Speech Disruptions


Speech problems from brain trauma are common, and vary in severity from mild and temporary to debilitating. Among the possible speech problems from brain trauma, stuttering, slurring, and slow speech are prevalent. A contributing factor to many of the speech problems from brain trauma is the loss of common words or inability to form sentences correctly.

From The National Aphasia Association:

Phil G. was lucky to have survived his auto accident. He recovered nicely from his various physical injuries, but was unprepared for aphasia, the speech and writing difficulties that persisted after the swelling of his brain subsided. As a single young man and a journalist, Phil depended both socially and vocationally on his way with words. Now he found himself continually at a loss for words. His speech was slow and deliberate, often marked by an inability to think of or say the right words. When listening to others he had difficulty keeping up with the speaker, and when trying to take notes he often could not remember how to write certain words. …The speech of a person with aphasia may also become slurred and riddled with mispronounced words, as if the speaker were drunk.

From The Stuttering Foundation:

Neurogenic stuttering is a type of fluency disorder in which a person has difficulty in producing speech in a normal, smooth fashion. Individuals with fluency disorders may have speech that sounds fragmented or halting, with frequent interruptions and difficulty producing words without effort or struggle. Neurogenic stuttering typically appears following some sort of injury or disease to the central nervous system i.e. the brain and spinal cord, including cortex, subcortex, cerebellar, and even the neural pathway regions.

What are the primary symptoms of neurogenic stuttering?

Because it results from a very diverse set of diseases and disorders, the symptoms of neurogenic stuttering may vary widely between different individuals. Neurogenic stuttering might be considered as a possible diagnosis if one or more of the following symptoms are observed:

  • Excessive levels of normal disfluencies or interruptions in the forward flow of speech, such as interjections and revisions;
  • Other types of disfluencies, such as repetitions of phrases, words, and parts of words (sounds or syllables, prolongations of sounds), etc;
  • Hesitations and pauses in unexpected or inappropriate locations in an utterance;
  • Cessation of speech during the production of a word without finishing the word;
  • Intrusive or extraneous additional sounds during speech production;
  • Rapid bursts of speech which may be unintelligible;
  • Extraneous movements of lips, jaw, or tongue while attempting to speak, including posturing.

Many individuals may appear to be unaware of or at least unconcerned about the disruptions in their speech. Others may show awareness, and possibly express anxiety and even depression about the difficulty they encounter in speaking. This may be accompanied by other behaviors, which may include:

  • Secondary or associated behaviors, such as obvious tension and struggle in speech production; movements of head or limbs while speaking; reduced eye contact;
  • Postponement or delay in attempting to say a word or avoidance of words or speaking situations.

Some of the patterns that set the it apart from other types of stuttering:

  • Neurogenic stuttering may occur at any point in the production of a word, rather than primarily at the beginning, as is common with developmental stuttering.
  • Neurogenic stuttering often occurs on any type or class of word anywhere in a sentence rather than being linked to content words such as nouns, verbs, adjectives and adverbs.

Automotive Head Trauma

A medical illustration that shows how traumatic brain injury can result from a car accident.


This medical illustration series depicts a closed head coup and contrecoup injury resulting in traumatic brain injury (TBI). As the drawings show, force from a head-on collision causes the head to move rapidly forward. The brain, within the cranial cavity, suffers a contrecoup injury by striking the inside of the back of the skull, opposite side of the impacting force. Secondarily, the coup (or “blow”) part of the injury, occurs when the brain strikes the interior of front of the skull.

Traumatic Brain Injury / Natasha Richardson

Newsweek ran a pretty clear description of the details of how Natasha Richardson’s minor skiing accident resulted in an unexpectedly dire brain injury. It includes details of symptoms and care. Here are excerpts from that article:


In rare cases, the trauma of hitting your head can have dire consequences, including bleeding and swelling of the brain. In some instances, these injuries aren’t immediately apparent because the patient may initially be lucid and without serious symptoms.

Actress Natasha Richardson’s recent skiing accident appears to be one of these unusual and tragic situations. The Tony Award-winning wife of actor Liam Neeson fell during a ski lesson on a beginner slope at a Canadian resort on March 16. At first, she showed no signs of major injury and was even joking about the incident, according to media accounts. But within hours, her health deteriorated and the 45-year-old mother of two was hospitalized and then subsequently transferred to a New York hospital.

What’s the difference between an ordinary bump on the head, and an injury that may not appear to be serious at first but is potentially critical? The most common thing that happens is that a fall shakes the brain and it then manifests as a concussion. But a concussion by definition is a brief or temporary disruption of the brain. Concussion never lands you in an intensive-care unit. A possibility [in accidents similar to what reportedly happened to Natasha Richardson] is that the fall triggered a syndrome of delayed massive brain swelling.

How can doctors make a diagnosis of a serious brain injury when the patient doesn’t have symptoms immediately? Through a different mechanism than concussions, trauma can rarely trigger a delayed and more sinister reaction or form of injury. These situations occur in two ways: huge swelling of the brain or bleeding on the surface of the brain—both would have an abnormal CAT scan. [After a fall] there is commonly a lucid interval where you may seem fine for an hour or two and then may develop symptoms of a more urgent nature unless something is done to reverse it … like surgery.

What advice would you give to someone who hits their head and may be unsure whether it’s a serious injury? 
What happens a lot of times is that someone is on a ladder and falls off, and they have a concussion. They may pass out, wake up and have a persistent headache and generally don’t feel good. Then, you call 911 and take them to the emergency room right away. We have a saying in neuro:  “Time equals brain.” For these kind of neurological emergencies, the earlier you can figure out what’s going on the better. Literally every minute counts. What happens to you in that first day will often dictate if you’re going to live, die, live with a full recovery or live with some kind of permanent brain injury.