Communicating following brain injury

Information from our factsheet Communicating following brain injury

Communication means the passing of information between people. When we communicate, we both give and receive information. We do this, both by speaking and also in non-verbal ways, through our facial expressions and hand movements.

Common things that people have difficulties with

After a brain injury, many people have difficulties with speaking, listening or being aware of other people's non-verbal communication. These difficulties can include problems with talking and writing; or with understanding what they are reading, or what someone is saying. Some people also find it difficult to have a conversation in a group and may get restless, or not realise that they are interrupting other people. Of course, this can lead to problems and means that their family, work colleagues, and friends may need to show them patience and understanding.

People with a brain injury, may have some of the following difficulties:

  • Not being able to recognise words that they used to know
  • Needing things to be repeated several times
  • Having difficulty when someone speaks quickly or tells them a lot of information in one go.
  • Not paying attention in conversations
  • Not understanding fully what someone is saying
  • Not being able to follow instructions
  • Misunderstanding jokes, sarcasm, or taking what someone says literally.

People with a brain injury, may also have some of the following difficulties in expressing themselves:

  • Difficulty "finding" the word they want to say, or using the wrong word altogether.
  • Getting the order of the words in a sentence mixed up.
  • Repeating the same thing over and over (this is known as "perseveration").
  • Answering only "yes" or "no" when someone asks them a question.
  • Poor spelling and difficulty in learning new words.
  • Trouble with writing full sentences.

A Speech and Language Therapist may be able to assist by helping to strengthen muscles, to increase movement of the mouth and tongue, with breathing exercises, and by slowing down speech. Some people find that equipment, such as a voice synthesizer, may be a way for them to communicate when they are not able to use their own voice.

Some tips if you have a brain injury

  • Don't rush - it is fine to speak a bit slower if that suits you better.
  • Try to stay calm.
  • Tell your family and friends what you have difficulty with so that they can be more aware of it.
  • If you can't find the word you want to use, try to use another one that is nearly the same, or explain what the word means.
  • If you are going to a meeting, for example, try to plan what you are going to say before you get there.
  • Use gestures, photographs, or other non-verbal communication.

Remember - getting the message across is what's important, not having the words exactly right. So do try to relax.

Top Tip - turn off distractions like the TV or radio to make it easier to talk and hear.

Tips if you don't understand what someone has said:

  • Ask the person to talk more slowly.
  • Repeat what the person has said to check that you have understood them correctly.
  • You could ask them to explain what they have said: "I'm sorry but I didn't understand what you said. Could you explain it to me?"
  • You could ask them to repeat what they have said: "I'm sorry but I couldn't hear what you said. Could you say it again?"

For carers or partners

  • Give the person time to finish what they are saying (try not to finish their sentences for them).
  • Also, try not to speak for them.
  • Always try to establish eye contact with the person you are talking to.
  • Watch the person's lips carefully as it may help you to understand what they are saying.
  • Don't be afraid to say if you have not understood what someone has said.
  • If you understand part of what the person said, repeat that bit so the person does not have to say it again.
  • Remember to check that the other person has understood you
  • Include the person in the conversation as much as you can
  • Avoid speaking loudly
  • Try to avoid being shocked by swearing as some people with an ABI lose their inhibitions about using bad language.
  • Remember that just because someone has a difficulty talking, it doesn't mean that he, or she, can't understand you.
  • Use hand gestures to help show the person what you mean.
  • Try to be as encouraging as possible when the person with the brain injury tries to communicate.
  • Alert the person to changes in the topic of conversation
  • Try to use specific questions, such as, "What did you watch on TV?" instead of
  • Don't force the person to speak
  • Turn off the television or radio.
  • If you have something important to talk about, try to pick a time when the person with the brain injury is refreshed and relaxed.

Here are some terms that you may hear

Dysarthria is a condition where someone slurs their words when they speak. After a brain injury, this happens due to weakness of the muscles of the face, tongue, larynx (voice box) and muscles used for breathing. It may cause a person to speak quickly, slowly or quietly, as well as slurred. Aphasia refers to any impairment of speech, and can be divided into Receptive Aphasiaand Expressive Aphasia:

  • Receptive Aphasia - this is when someone has difficulties in understanding written language and what people are saying.
  • Expressive Aphasia - this is when someone has difficulty talking and expressing ideas. They may also find writing difficult.

Global Aphasia - this when someone has both Receptive and Expressive Aphasia.
Dyspraxia of Speech - when someone has a brain injury they may not be able to link together sounds and syllables to make coherent words, consistently.
Dysnomia is when the person's speech flows normally but they cannot find the right word.