Often clients with brain injury have problems communicating with others due to a range of problems including cognitive difficulties (i.e. difficulties with thinking skills) and direct damage to the language centres of the brain. See below for the types of problems they may experience and strategies to help them.

The person may not follow what you are saying due to problems with their ability to concentrate.

 What can you do to help?

  • Try not to say anything more than a few sentences at a time and after you have spoken ask the person to relay what you have said to check out they have followed it and understood.
  • Encourage the person to summarise what you have said to check that that they understood you correctly (e.g. ‘Sometimes I do not get my point across. Can you repeat what I have said so I can check you have understood’).
  • If the person has lost track of what you were saying encourage them to pick up on any key points that they have heard and ask you to elaborate on it or explain again (e.g. ‘You were telling me about Katie…. Can you just tell me again what she did?’).
  • Encourage the person to be honest when they have lost track (e.g. ‘Sorry I lost you there…. Can you explain that again?’).

Contributing appropriately and understanding the main ideas in conversations

A client may have difficulty remembering the main points in a conversation, keeping up with what is being said and contributing appropriately. Typical problems include:

  • The person going off on tangents and having verbose speech (saying a lot at once). This can be due to problems organizing speech and self-monitoring.

What can you do to help?:

  • Provide them with feedback if they are going off the track of conversation, providing too much detail or not sticking to the point. Ask them if they mind you saying this and how they would like you to phrase it so they do not get frustrated.
  • Encourage them to summarise what they want to say (e.g. by thinking about the main points of the conversation before they start), slow down their speech and turn take.
  • Encourage them at regular intervals, to check that you are following them (e.g. ‘are you following me? Have I gone off on a tangent?’). Also get them to check out if you are following them by encouraging them to cue into your facial expressions and if there are any signs you are confused or losing interest.
  • You may also provide them summaries of what they have said at intervals to model how to say things succinctly.

Sometimes the person may have difficulty communicating with others when there is lots of distractions or more than one person present

What can you do to help?

  • Practice having conversations with them when there is background noise on (e.g. television).
  • Gradually increase the level of distraction that they feel comfortable with (e.g. building up to having a conversation with them in a noisy pub). Only move onto the next stage one they feel comfortable with previous stage (e.g. rate 0-3 out of 10 difficulty). See table below for how to gradually build this up.


Level of distraction How difficult they think they would find it on a scale of 0-10 How difficult they have found it after practice on a scale of 0-10
At home, with no distractions talking to one person 2
At home with TV on talking to one person 3
In a quiet coffee shop talking to one person 5
In a busy coffee shop talking to one person 7
In a busy coffee shop speaking to more than one person 9

The person may have word finding difficulties

What can you do to help?

  • Encourage them to explain around the word (e.g. if they have forgot the word brush they could say ‘that thing that you use to groom your hair’ and use gestures).
  • If they become anxious about it ‘normalise it’ (e.g. ‘that’s okay everyone sometimes has problems finding their words, when it happens to me I usually try and explain around it’).

They become anxious about speaking in public and think that they appear like a fool if they speak

The following may maintain this problem:

  • The more anxious they are the more likely it is that their communication will get worse because anxiety reduces their ability to process information and depletes their ability to concentrate. Often when individual become anxious about their communication they have a tendency to over-estimate the number of communication slips they make (e.g. word finding difficulties, slurred speech) and they underestimate their skills (e.g. they think that they were incomprehensible). They also may have a tendency to avoid social situations because they find them anxiety provoking which maintains their anxiety.
  • They don’t have opportunity to practice communicating which will improve confidence
  • They don’t have the opportunity to challenge their beliefs that they are very poor at communicating.
  • They don’t learn that they can cope with making mistakes and people won’t generally respond in a negative way.

How can I help?

  1. Fear busting through exposure and challenging beliefs

The best way to overcome your anxiety is to gradually face your fear in a safe and controlled way. During this exposure the person learns to ride out the anxiety until the fear begins to pass. The exposure also gives the person the opportunity to challenge their beliefs. Follow the steps below to facilitate exposure and challenge beliefs.

  1. Create a hierarchy of situations in which the person imagines that their communication will be bad.
  2. Get them to estimate how much anxiety they will experience on a scale of 0-100% during the exposure to these situations. Put them in order (least anxiety provoking first) and address each situation in order.
  3. Get them to estimate in concrete terms how many errors they will make (e.g. they will have word finding problem every two to three words.  A word finding problem is defined by a pause of up to three seconds or getting the wrong word).
Hierarchy of situations in which I imagine my communication will be bad Perceived anxiety on a scale of 0-100% Estimation of errors
  1. Once you have created the hierarchy expose them to each situation starting with the easiest first, only move onto the next stage when their anxiety has reduced to a manageable level.
  2. Feedback to them how many errors they have made either through your observations or through video feedback. Only do this stage if you know that the number of errors that they will make are less than their estimation of errors.
Hierarchy of situations in which I imagine my communication will be bad Anxiety during exposure on a scale of 0-100% Number of errors made