Headway Essex

Providing Brain Injury Care & Support

Tips for helping people to communicate following brain injury

Speech difficulties

  • Keep the environment as quiet as possible.
  • Make sure that you can see the person’s face when they are talking.
  • Watch their lips as they speak, as this will help you to understand what they are trying to say.
  • Don’t pretend you understand if you don’t, this will leave both of you frustrated.
  • Ask the person to repeat what they have just said. You can help them by repeating the parts that you have understood.
  • Ask the person for a key word. This will help you understand the ‘gist’ of what they are saying.
  • Encourage them to mime or write down what they want to say.
  • Encourage them to use an alphabet chart to spell out key words.


Difficulties in understanding

  • Keep the environment as quiet as possible.
  • Make sure that the person can see your face when you are talking.
  • Speak slowly and clearly, but not as if speaking to a child.
  • Use short, simple sentences.
  • Don’t give too much information at once.
  • Use pointing and gestures.
  • Check that they have understood what you have said.
  • Make sure that you mean exactly what you say.


Expressive Difficulties

  • Be patient, give the person plenty of time to speak.
  • Suggest words or ideas to them which may help them to explain themselves.
  • Encourage them to give you clues as to what they mean.
  • Ask simple questions, such as ‘Where is…?’, ‘Point to…’, ‘Show me…’, ‘Do you mean…?’
  • Encourage them to use gestures or other means (e.g. drawing or using a picture chart) to communicate.
  • Summarise what you understand, so that they don’t need to repeat themselves.
  • If the person is becoming frustrated, reassure them and perhaps move on to another topic for a while. You can always return to the original topic later.


Lack of attempts to communicate

  • Try not to be discouraged because the person is not communicating.
  • Talk to them about matters that interest them.
  • Include the person in conversations when there are two or more people around.
  • Try and make them laugh with jokes. If successful, this will give you a boost, and will help them to hear and feel what it is like to make sounds.
  • Play them music or songs that they know.


Cognitive difficulties

  • Keep the environment as quiet as possible.
  • Remember that the person may get tired quickly.
  • Keep the subject simple.
  • Stick to one topic, or if you change the subject then make sure you tell them.
  • Talk in one-on-one settings or in very small groups.
  • Make sure that only one person speaks at a time.
  • Remind the person regularly of the subject and what has already been said. If they constantly repeat themselves, calmly explain that they have told you this before.
  • Ask them direct questions to help them make a ‘yes’ or ‘no’ response.


Difficulties with non-verbal skills

  • Explain that if they don’t look at you while you are talking, you will feel as if they are not interested in what you are saying.
  • Encourage them to nod or shake their head when agreeing or disagreeing.
  • Remove their hand gently if they repeatedly touch you, and explain that you don’t want them to do this.
  • If they are sitting too close to you, point this out and explain that it makes you feel uncomfortable.



  • Try and include the person in conversations.
  • Give them plenty of time to express themselves.
  • Remind them about the topic of conversation.
  • Regularly ask them if they want to add something to the conversation.



  • Talk in one-to-one settings or in very small groups.
  • Don’t change topic too often.
  • If you see the person becoming agitated, suggest that they do something different for a while.
  • If people come to visit, make sure it is only for half an hour to an hour.


Inappropriate responses

  • Ignore any inappropriate laughing or crying.
  • Distract the person by changing the topic or activity.
  • If they are swearing or being abusive, remain calm and show little reaction.
  • If abusive behaviour persists, explain why you don’t like it and how it makes you feel.
  • Pre-warn friends and relatives about the person’s behaviour so that everyone responds in the same way.


Constant talking

  • Explain to the person that their constant talking is tiring for others.
  • Keep calm, even if you become stressed.
  • Find peace in another room if necessary.


Taking things literally

  • Make sure that you say what you mean.
  • Try not to use ‘catch-phrases’, sarcasm or abstract jokes, as this will confuse them.
  • If you mention a specific time to them, be sure that you stick to it.


Fantasy or ‘confabulation’

  • Don’t go along with things that are made up.
  • If you are not sure what is fact or fiction, check with someone who may know the answer.
  • If they are confused and you can see some truth in what they are saying, try and untangle the confusion and link it to reality.



Exert from “Communications Problems after brain injury”.
By Gillian Kennedy & Kathryn Daniels
Booklet available from www.headway.org.uk



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