Improving communication after a brain injury

September 18, 2025 Acquired Brain Injury Care Neurological Care

Improving communication after a brain injury

Estimated reading time: 8 minutes

Communication problems are a common and often challenging consequence of a brain injury. These difficulties can range from physical speech impairment to issues with understanding,  memory, and social interaction. However, with the right strategies and support, significant improvement is possible.

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Key Takeaways

Communication problems after a brain injury are varied and complex

They can be classified into four categories: physical (speech difficulties), cognitive (issues with thought and memory), emotional (trouble with feelings and social cues), and behavioural (changes in actions). An individual can experience one or more of these challenges, which can significantly affect their ability to socialise, work, and live independently.

Communication strategies must be tailored to the specific stage of recovery

During the initial phase, when a person may be in a coma or have a breathing tube, the focus should be on simple, brief interactions and avoiding overstimulation. As they enter a stage of post-traumatic amnesia, it’s crucial to remain calm, avoid correcting them, and limit new information to prevent agitation and confusion.

Professional support and communication aids are essential tools for long-term improvement

Speech and language therapists (SLTs) play a vital role in assessing communication skills and developing a personalised therapy plan. They may also recommend communication aids, known as Augmentative and Alternative Communication (AAC) devices, which can range from simple picture charts to advanced computer-based systems. The right aid is chosen by considering the person’s physical and cognitive abilities, personal preferences, and lifestyle.

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The four main categories of brain injury effects

1. Physical

Affecting how the body works, which can lead to difficulties with speech production.

2. Cognitive

Impacting how a person thinks, learns, and remembers, which can cause problems with understanding and using language.

3. Emotional

Influencing a person’s feelings, which can affect their ability to express themselves or pick up on social cues.

4. Behavioural

Changing how a person acts, which can alter their communication style and social interactions.

Depending on the area of the brain affected and the severity of the injury, a person may experience one or more of these issues. These difficulties can reduce social contact, make it harder to live independently, and prevent them from returning to activities like work or caring for their family.

Communication during the initial stages of recovery

Initially after a brain injury, a person may be in a coma or sedated to help them heal. During this time, they will not respond to speech, and it’s often unclear how much they can hear or understand. There are no proven methods for communicating with someone in this state. A person with a brain injury may need extensive medical care, which can include a tracheostomy tube to help them breathe. Because this tube is placed below the voice box, the person will not be able to speak out loud, even if they are conscious. If the tube needs to stay in place for an extended period after they are no longer in a coma, doctors may recommend a special valve that reroutes air through the voice box, allowing the person to speak.

Here are some tips for communicating with someone in the early stages of recovery:

  • Talk briefly about things they’re interested in.
  • Keep your language simple and clear, and speak naturally.
  • Use different forms of communication, such as playing their favorite music or recorded messages – always check with staff first, especially in shared rooms.
  • Interact in varied ways like gentle touch, reading aloud, or listening to music, following staff guidance.
  • Avoid over-stimulating them with too much information, loud music, or bright lights.
  • Limit visitors around the bed and have them introduce themselves one at a time.
  • Ensure only one person speaks at a time.

Communication during post-traumatic amnesia

When a person with a brain injury begins to recover, they may experience a period of post-traumatic amnesia (PTA). During this time, they might be agitated, confused, and unsure of their surroundings. This stage will eventually pass. Communication can be difficult; the person may be uncommunicative or their speech may be confused. They might also engage in confabulation, creating believable but incorrect stories to fill in gaps in their memory. For instance, they might genuinely believe they are at work or going to an appointment.

Tips for communicating during post-traumatic amnesia:

  • Stay calm – your distress can increase the person’s agitation and confusion.
  • Limit new information – the person likely won’t remember it, and it can just add to their confusion.
  • Minimise visitors – consider creating a visitor schedule to prevent the person from becoming overwhelmed.
  • Watch for signs of fatigue, such as increased agitation or loss of focus, and allow them to rest.
  • Introduce new topics slowly – pause and give the person time to transition with you.
  • Don’t force a response – allow them to communicate at their own pace.
  • Verify information with staff – if you’re unsure whether they’ve given accurate information, check with staff for clarification; provide accurate feedback without arguing.
  • Don’t correct them when they confabulate – arguing with them about inaccurate information will only increase their agitation.
  • Don’t take aggressive or embarrassing behaviour personally – people have little control over their actions during this time and often won’t remember them later.

 

Find out more about our acquired brain injury at home care services

 

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Speech and language therapy

A speech and language therapist’s (SLT) main job is to help people communicate as effectively as they can. They do this by providing therapy, information, and strategies for both the person with the brain injury and their caregivers. SLTs typically work in hospitals, rehabilitation centers, and community brain injury teams, though some have private practices. Referrals for their services can be made by a hospital or a family doctor (GP). SLTs are experts in treating issues with speech, language, communication, and swallowing. They may work on their own or as part of a team that includes other professionals like physiotherapists, psychologists, and nurses.

To figure out how a brain injury has impacted a person’s communication skills, a speech and language therapist (SLT) will conduct a thorough assessment. This involves meeting with both the individual and their family to get a complete understanding of the person’s life before the injury, including their personality, job, and hobbies. While some people may recover enough to return to all their previous activities, it’s important to understand that this isn’t a realistic goal for everyone.

Communication aids

A speech and language therapist may recommend a communication aid, also known as an Augmentative and Alternative Communication (AAC) device. These aids can be a short-term solution, like an alphabet chart for someone with a tracheostomy, or a long-term tool for those with persistent communication difficulties. In some cases, a person might also learn an alternative form of communication like sign language.

Types of communication aids

Communication aids range from simple to complex:

  • Low-tech options include basic tools like alphabet boards and picture charts.
  • High-tech aids are more advanced and include dedicated communication devices, computer-based systems, and voice amplifiers.

Choosing the most suitable aid

The choice of a communication aid depends on the person’s specific needs. Several factors are considered to find the most suitable option:

  • Physical abilities – the aid must be easy for the person to use, considering any physical difficulties they have.
  • Cognitive skills – the aid should match their ability to learn and remember how to use it.
  • Personal preference and motivation – the person must be willing to use the aid and feel that it helps them communicate more effectively than speech alone.
  • Portability – it’s important to consider if the aid needs to be portable so the person can use it outside the home.
  • Visual abilities – any visual difficulties will influence the size and number of images used on the aid.

The SLT will help determine the best aid by considering all these factors to ensure it fits the individual’s needs and lifestyle.

To effectively improve communication after a brain injury, a person and their loved ones must embrace a combination of professional guidance, patience, and a willingness to adapt communication strategies as recovery progresses.

How can Cavendish Homecare help?

At Cavendish Homecare we are experts in providing acquired brain injury care at home  for clients who want to remain in their own homes. When it comes to your health and well-being, choosing the right homecare package is of utmost importance and navigating this process can be overwhelming. With Cavendish Homecare by your side, you’ll have the support you need to remain safely at home while enjoying elevated health and wellbeing.

If you would like to enquire about our homecare services, contact us on, 02030085210 or email us at info@cavendishhomecare.com.

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About the Author…

Misha Zemkova

Operations Coordinator

Misha plays a key role in ensuring the smooth and efficient running of day-to-day operations across the business. With a background in supported living and a degree in Health and Social Care, she brings both experience and empathy to her role.

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