Communicating with someone close who has a brain injury

Communicating with someone close who has a brain injury may require slower exchanges, fewer distractions and checking important information together. Communication difficulties involve more than words: attention, working memory, processing time, emotions or understanding implied meanings may also contribute.

The aim is not to address an adult as a child, but make exchanges accessible while preserving participation and choices. These are general suggestions; persistent language problems warrant appropriate assessment, particularly by a speech and language therapist.

This article provides general information. It cannot diagnose a brain injury or assess the seriousness of an individual situation remotely, and it does not replace an examination or advice from a qualified healthcare professional.

Hearing a sentence does not always mean immediately processing it

Someone may hear a speaker perfectly yet need longer to understand a complex instruction. With three pieces of information in one sentence, working memory may lose the first while listening to the third. Television noise, simultaneous speakers or fatigue can amplify this difficulty.

This sometimes produces a misunderstood scene: someone has just explained and wonders why there is no answer. Yet silence may be processing time rather than indifference. Louder repetition does not always resolve attention or comprehension-speed difficulties.

First choose quieter surroundings, express one idea at a time and pause. If no answer comes, offer another wording rather than several consecutive questions.

Five practical changes for a difficult conversation

MSKTC strategies can translate into very simple actions.

1. One speaker at a time: avoid simultaneous instructions from several people.

2. One main item: say tomorrow’s appointment is at 10 am before adding travel details.

3. Time to answer: do not routinely finish the person’s sentences.

4. A chosen aid: record a decision, use a diagram or show an object if helpful.

5. Respectful checking: restate decisions together rather than require word-for-word repetition.

These adjustments should not remove all complexity. Find conditions enabling participation, then increase demands when possible.

Checking understanding without making it an examination

Asking whether someone understands readily prompts an automatic yes even when details are unclear. Conversely, constantly demanding repetition can feel like a school test. Prefer an action-focused question: how would they like to organise tomorrow morning, or what is still needed before leaving?

For example, after consultation, someone close summarises decisions in two written lines with consent. Together they check the next appointment and question to ask. Both can consult the same cue rather than depend on the other’s memory.

When language itself is affected, adapt the strategy to comprehension abilities. Gestures, pictures or alternative supports may be useful; a speech and language therapist can guide selection.

When words, tone and intentions no longer align

Some people after traumatic brain injury struggle to find words, follow a story, understand irony, interpret tone or stay on topic. An abruptly worded reaction does not necessarily reflect the intention others assume.

Avoid the opposite extreme too: explaining every disagreement through brain injury deprives the person of their opinion. People retain the right to disagree. Asking what was understood differently often helps more than asking who has a problem.

Someone close can separate the concrete fact, such as different information about a time, from the emotion, such as fear of a missed appointment. This may make discussion less accusatory.

Choosing the time and planning a way to pause

Treatment, budget or organisational discussions differ in difficulty between a quiet morning and late evening after a tiring day. Advance notice, less stimulation and permission to pause may improve conditions for agreement.

Agree a break signal, such as stopping for ten minutes then returning only to that point. Do not make it a punishment or assume discussion is cancelled forever.

For important conversations, recording decisions is particularly useful. The person can choose a notebook, shared message, consensual recording or calendar. Recording must not be imposed as a formality; participants’ agreement and confidentiality must be respected.

Preserving independence in decisions

Sometimes a slow answer leads others to talk directly among themselves. This shortcut can exclude the person from decisions about them. Allowing time, asking them directly and offering expressive supports helps avoid exclusion.

Speech or memory difficulty does not automatically mean inability to decide. Where needed, capacity assessment for a particular act belongs within an appropriate framework, not an improvised judgement by family or friends.

For example, to organise a family meal, someone close presents two written time options and asks which suits. The decision remains the person’s where possible; others support expression and implementation.

When should speech and language therapy or other support be sought?

Discuss with the doctor or rehabilitation team if conversations remain difficult despite simple adjustments, language access changes or misunderstandings compromise care, administration or relationships.

A speech and language therapist can assess language and communication, offer individual tools and support those close. A neuropsychologist may clarify attention, memory or executive contributions. Roles complement one another; each professional’s involvement depends on assessment.

Take sudden changes seriously: new difficulty speaking or understanding, especially with limb weakness, facial changes, acute confusion or impaired consciousness, is not an ordinary existing communication problem. Call emergency services immediately.

Emergency numbers
United States: 911
United Kingdom: 999 or 112
European Union: 112
Elsewhere: your local emergency number

A common question: should you always speak more slowly?

No. A slower pace helps some people, but the priority is matching this person in this situation. Ask what helps; artificially slow speech or simplifying every sentence may be unnecessary and infantilising.