Communication Effects After Brain Injury

In this article:

Common effects:

• Does not speak clearly
• Problems starting conversation
• Word finding problems
• Problems following a conversation
• Reading comprehension problems

Less common effects:

• Dysarthria
• Interrupting/hard time taking turns in coversation
• Topic selection problems
• Writing problems
• Nonverbal communication issues

A TBI can cause changes in a person’s communication skills. These changes vary from person to person.

How severe the injury is and its location affect these changes.

Factors that play a role in communication problems include:

• behavior
• memory, attention, and other thinking skills
• judgment
• social skills
• self-awareness.

Communication skills are very important in everyday life. Your family member may not be able to use words to express him or herself well. This can be very frustrating. Many people with TBI do well speaking in non-stressful situations. But your service member/veteran may not be able to use these speaking skills during a stressful situation at school, work, home, or in the community.

Language problems can lead to miscommunication and confusion. This may make it harder than it used to be to make new friends and maintain old relationships. A positive note: Most people with a TBI do, in fact, speak again. Most make notable progress in the other areas of communication over time.

A speech language pathologist (SLP) is the team member who treats communication problems. Your service member/veteran may be able to speak, but may need training to:

• understand and remember what is being said
• express needs, wants, and ideas clearly to others.

The SLP treats problems with speech, voice, and memory.

What are Common Communication Effects?

Language and thinking are linked. Language involves understanding, talking, reading, and writing.

In this chapter, you will read about some common communication effects from a TBI. You will also learn about ways that you can help your family member with these effects.

Each person with a TBI will have different communication problems. Some are more severe than others.

Communication problems occur when the frontal and temporal lobes of the brain are injured.

Hearing or vision loss make it harder to communicate well. If your family member is having communication problems, his or her hearing and vision should be checked.

Use this article as a guide. Talk to the speech language pathologist, neuropsychologist, and doctor about the specific areas that are hardest for your family member.

Feedback is important to help improve your family member’s communication.

Does Not Speak Clearly

What you might see:

• Slurred speech
• Speaking too loudly or softly
• Speaking too rapidly.

How you can help:

• Tell your family member that you did not understand what he or she said. Ask him or her to say it again more slowly.
• Use a consistent cue or gesture to let him or her know you did not understand. For example, cup your hand over your ear as a reminder to speak louder.
• Allow time for your service member/veteran to express him or herself.

Problems Starting a Conversation

What you might see:

• Unable to start or is slow to start conversations
• Long pauses
• Problems explaining what he or she means
• Does not respond to another’s questions or comments.

How you can help:

• Help your service member/veteran start a conversation by asking a leading question such as, “What do you think about …?”
• Encourage your service member/veteran to talk about topics of interest or familiar topics.
• Ask open-ended questions (e.g., questions that cannot be answered with a “yes” or “no”), such as, “Tell me more about your day.”
• Give your service member/veteran with TBI your full attention.
• Give your service member/veteran time to organize his or her thoughts.
• Use redirection, if necessary (e.g., “So what do you think about….?”)
• Reinforce all efforts to start a conversation. Show that you value what your service member/veteran has to contribute to conversations.

Word Finding Problems

What you might see:

• Problems finding the right word to describe what he or she is trying to say.

How you can help:

• Give your family member time to locate the word he or she is looking for.
• If he or she still cannot locate the word after some time, guess at what he or she might mean. Or ask him or her to write it down.
• Try to be patient. It can be very frustrating for your service member/ veteran when he or she knows what he or she wants to say but cannot locate the right word or phrase.
• Encourage him or her to use another word that is close in meaning.
• Suggest that he or she use many words (or a description) instead of using a single word. (This is called circumlocution, a strategy speech language pathologists will often teach.)

Problems Following a Conversation

What you might see:

• Difficulty paying attention to what is said
• Misinterpreting what is said
• Being “off topic” compared to the rest of the people in the conversation.

How you can help:

• Get your service member/veteran’s attention before speaking.
• Be clear and to the point. Keep it simple.
• Reduce distractions.
• Every so often, stop and ask your family member to restate what he or she heard to ensure understanding.
• Reduce your rate of speech and pause frequently to allow the person time to process and respond.
• Avoid abrupt topic changes.
• In group conversations, help set a slower pace of conversation.

Reading Comprehension Problems

What you might see:

• Problems understanding what is read
• Trouble stating the main idea or main point.

How you can help:

• Read with your service member/veteran.
• Review the reading material, using the 5W strategy – Who, What, Where, When, Why:
  • Who are the characters?
  • What happened to the characters in the book? What did they do about it?
  • Where did it happen?
  • When did it happen?
  • Why did it happen?
• The 5W’s should be related, that is, they should refer to the same characters or portion of the story.
• Your service member/veteran can write out important information or say it out loud; this uses other senses to increase comprehension.
• Emphasize important information in the text.

What Communication Effects Are Less Common?

Dysarthria

Dysarthia means having a hard time using the muscles needed to form words and produce sounds.

What you might see:

• Speech is often slow, slurred, and garbled
• Problems with intonation or inflection.

How you can help:

• The speech language pathologist will prescribe exercises to improve the muscles used in speaking. Over time, these exercises will make your family member’s speech more clear. Help him or her to do these exercises properly and regularly.
• Allow ample time for your service member/veteran to express him or herself.
• Encourage him or her to take time to speak.
• Inform those around your service member/veteran about the diagnosis so they too allow the person time to express him or herself.

Interrupting or Having a Hard Time Taking Turns in Conversation

What you might see:

• Talking non-stop
• Not allowing the listener a turn to speak
• Frequent interruptions
• Inability to adjust communication style for the situation
• Bringing up the same topic over and over again (perseveration).

How you can help:

• Politely interrupt and ask for a chance to speak. Tell your service member/veteran you would like to say something.
• Ask your service member/veteran to please make it brief.
• Develop a hand signal which indicates to the service member/veteran that he or she may be monopolizing the conversation.
• Gently alert him or her to the fact that the topic change was too abrupt or that he or she has interrupted and will be given a chance to say his or her piece in a moment.
• Use positive reinforcement for all attempts at listening rather than talking.
• Your service member/veteran may be interrupting because he or she is “lost” in the conversation. Encourage him or her to let you know if he or she doesn’t understand what is being said.

Topic Selection Problems

What you might see:

• Problems finding good topics for conversation
• Problems keeping up when topics change
• Introducing a new topic abruptly
• Problems staying on topic.

How you can help:

• Pick topics that your service member/veteran enjoys. Ask about his or her interests and opinions.
• Clarify new topics as they come up.
• Ask how his or her comment relates to the topic: “How does the price of gas relate to what you ate for lunch?”
• Tell your service member/veteran you are confused or getting lost in the conversation.
• Gently but firmly alert your service member/veteran if he or she is bringing up a topic that may be offensive to others.

Writing Problems

What you might see:

• Problems expressing thoughts in writing
• Problems getting started writing
• Writing the same words or phrase over and over (perseveration).

How you can help:

• Practice writing with your service member/veteran. For example, write letters to friends or relatives.
• Make a list of openings (i.e., Dear, Hello, Hi, etc.) and closings (i.e., Thank You, Sincerely, Yours Truly) and the reasons for selecting them.
• Suggest saying words out loud before writing them.
• Suggest reading what is written to make sure it makes sense.

Nonverbal Communication Issues

What you might see:

• Having a hard time understanding common nonverbal cues (e.g., facial expressions, hand gestures)
• Standing too close or too far from those he or she is speaking to
• Uncomfortable number/type of physical contacts
• Body language that doesn’t “match” what is said
• Facial expressions that don’t “match” what is said
• Poor eye contact
• Staring at others during conversation.

How you can help:

• Politely ask your service member/veteran to stand closer or further away.
• Explain the behavior is making you feel uncomfortable.
• Tell your service member/veteran you are confused by the difference in body language and spoken message. Briefly explain what you saw and heard.
• Ask him or her to stop any distracting motions.
• Role play the right way to behave in a particular setting. Work with the health care team to practice appropriate behavior. This will help decrease behavior that causes problems.
• Talk to your family member about how to act in certain situations, before he or she is in those situations.
• Give feedback on the right amount of eye contact to keep with another person. Praise all improvements.
• Decide on a signal to indicate problematic behavior.

Journal

The questions below can help you reflect on your experience as a caregiver. You can write your thoughts here, copy this page and add it to your journal if you keep one, or reflect on these questions in your journal.

• What communication effects have you observed in your service member/ veteran? How severe is the effect?
• Is there one particular instance that stands out for you? Describe what happened and how you reacted.
• What impact have these communication effects had on you? On other members of the family?
• What strategies have you tried to use to help your service member/veteran cope with communication effects? How well have they worked?
• What strategies do you plan to try in the future?