Acquired Brain Injury

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Acquired Brain Injury
Improving Communication Skills

Thinking and communication (i.e. "cognitive-communication") difficulties are the most common consequences of acquired brain injury (ABI). They have a profound impact upon social reintegration, school and work return success and almost every other key area of adjustment after an injury.

Family, friends, teachers and employers play an important role in helping survivors of ABI to cope. This article outlines basic communication strategies that can be used immediately after an injury. It is also important that you consult a speech-language pathologist, with expertise in ABI rehabilitation, for assessment and programming advise as soon as possible about an injury.

1. Keep Conversations Focused:
People with ABIs often have trouble identifying topics and following topic shifts in conversation. Inappropriate focus on detail points can derail them or they can wander off topic when distracted by background noise or activity. To help them refocus:

Remind them of the topic
Redirect discussion, e.g. by asking, "What were we talking about?" or "Can we get back to (topic)?"
Use a pencil and paper to make topics explicit

2. Eliminate Distractions:

Avoid having important or stressful conversations at low energy times, e.g. just before bed. Fatigue can be a significant distracter. Background noise is often poorly tolerated by individuals with ABIs. Reduce or eliminate it by turning off the radio or TV, or moving to a quiet room to have important conversations. Turning away from windows or closing blinds during important discussions can eliminate visual distractions.

3. Decrease Listening Demands:
Memory and attention impairments often make listening a challenge. Never assume that the individual with ABI understands or remembers what you say. They may be nodding their heads in agreement while struggling to understand the point of your message. On the other hand, they may understand well at the time, but completely forget the conversation later that day! Verify understanding by asking them to repeat what they have heard in their own words. Then record discussion points (e.g. in a journal) for future reference. To further simplify demands:

Slow your speech rate and chunk important information
Emphasize important words and repeat important ideas
Augment verbal with nonverbal information (e.g. pictures, facial expression, gestures)
Use concrete and familiar terms
Focus the discussion on one topic at a time.

4. Simplify Questions:
Memory problems can make it difficult to respond to open- ended questions like "‘what did you do today?’ Avoid questions that appear to test their recall skills, and instead use more supported and closed-ended questions like "You saw Joe this morning at physio. Did you have a good session?" Yes/no questions are usually easiest to answer. Forced- choice questions (e.g. Who did you see at physio today? Joe or Bill?) are also a good way to compensate for word naming problems.

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London Speech and Language Centre
1589 Fanshawe Park Road East
London ON N5X 3Z9

This article may be reprinted with our permission.