Difficulties with communication can be caused by many factors, including changes in behaviour and thinking skills, problem solving, judgment, reasoning, awareness, memory loss and lack of self-awareness. Language ability and speech also may be affected by brain injury.
People with a brain injury may have changes in one or many of these areas. The severity and combination of problems vary among people.
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PROBLEM & SIGNS
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WHAT TO DO
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Problem: Initiating conversation
Signs:
- Does not respond to another person’s conversation, questions or comments
- Does not start, or is slow to start conversations, ask questions, or make comments
- Leaves long pauses
- Has difficulty with explanations
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What to do:
- Encourage the individual to participate. For example ask, “What do you think about that?”
- Ask open-ended questions such as, “Tell me about...”
- Give the person time to organize thoughts. Extra time may be necessary to respond to any request or question.
- Give the individual your full attention until the thought is completed.
- Rephrase what he or she has said such as, “Do you mean…?”
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Problem: Following conversation
Signs:
- Has difficulty paying attention to what is said
- Misinterprets what is said
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What to do:
- Get the person’s attention before speaking.
- Be clear and concise.
- Reduce distractions.
- Emphasize important information.
- Offer to repeat what was said.
- Ask the person to look at you when speaking. Invite the person to ask questions or request clarification.
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Problem: Taking turns in conversation
Signs:
- Talks non-stop, does not give the listener a turn to speak
- Does not appear to adjust communication style
- or behaviour for the situation
- Has a hard time selecting topics for conversation
- Has a hard time keeping up when topics change Introduces a new topic abruptly
- Does not always stay on topic
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What to do:
- Politely interrupt and ask for a chance to speak.
- Ask the person to, “Please make it brief,” or announce that you would like to speak.
- Ask about the person’s interests and opinions.
- Clarify new topics as they arise.
- Ask how the person’s comment relates to the topic, for example, “Do you mean… ?”
- Tell the person you are confused or “getting lost” in the conversation.
- Tell the person you did not understand and ask to hear it again.
- Establish and use consistent gestures or cues (for example, cup your hand to your ear as a reminder to speak louder).
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Problem: Problem with intelligibility
Signs:
- Slurred speech
- Speaks too loudly or softly, making the message hard to understand
- Speaks too rapidly
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What to do:
- Tell the person you did not understand and ask to hear it again.
- Establish and use consistent gestures or cues (for example, cup your hand to your ear as a reminder to speak louder).
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Problem: Nonverbal communication
Signs:
- Does not seem to understand common non-verbal cues
- Stands too close or too far from conversational partner(s)
- Uncomfortable number or type of physical contacts
- Body language that does not seem to “match” what is said
- Facial expressions that do not seem to “match” what is said
- Distracting, repetitive or excessive body movements
- Poor eye contact
- Staring at others during conversation
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What to do:
- Ask the person to maintain a comfortable distance.
- Politely ask the person to modify his or her physical contacts because you feel uncomfortable; offer an explanation if necessary.
- Tell the person you are confused by the difference in body language and spoken message.
- Ask what the person is feeling.
- Politely ask the individual to stop distracting movements.
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