Brain injury and communication

Also called Acquired brain injury and communication, ABI, TBI and communication, Head injury and communication

After a head injury the speech may be perfect and the conversation still go wrong: cognitive communication difficulties, and why families notice them before clinicians do.

What it is

A brain injury is damage to the brain from an accident, assault, fall, infection, tumour, lack of oxygen or similar, and the Health A-Z covers it as brain injury. Communication after brain injury can involve aphasia or dysarthria, but the commonest and least recognised change is different: the person's language works and their conversation doesn't.

That's cognitive communication disorder, and it comes from the thinking skills a conversation runs on: attention, memory, speed, planning, reading the other person, holding back. Families describe someone who talks too much or too little, loses the thread, says the unsayable, can't follow a group, or is "not the same person to talk to". Clinical tests of language often come back normal, which is why it gets missed.

Who it can help

People at any stage after a brain injury, from the rehabilitation unit to a decade on, and especially their families and employers, who carry the daily consequences. Younger adults are over-represented, because the causes are.

It's not the right entry for the injury's first days, when the medical picture dominates and communication may be absent; intensive care covers that. Nor for dementia, which is progressive where brain injury is not.

How it works

Different injuries give different pictures. Frontal lobe damage affects self-monitoring, so the person may interrupt, over-share, lose tact, and not notice. Attention problems mean a group conversation is lost within a minute. Memory problems mean the same story three times and appointments forgotten. Slowed processing means the reply arrives after the topic has moved on. Fatigue makes all of it worse by afternoon.

Rehabilitation is about strategies and environment more than drill: agreed signals for "you've gone off topic", a notebook or phone for everything, one-to-one conversations rather than groups, quiet rooms, rest before anything that matters. Communication partner training, where the family learn to structure conversations, has good evidence. Insight often returns slowly and can't be forced.

Personality and behaviour changes can strain relationships to breaking, and support for the family is part of the treatment, not an extra.

Getting started

Name the pattern, kindly, and agree one strategy for it: a hand signal for "let me finish", a rule of one topic per conversation, a notebook that goes everywhere. Review it weekly rather than daily.

Ask the GP or the neurorehabilitation team for a speech and language therapy assessment that specifically looks at cognitive communication, and for neuropsychology if it hasn't happened. For work, Access to Work funds coaching and equipment, and written instructions and a quiet desk are reasonable adjustments.

Get the family a helpline number and a group. This is a long road and they'll need it.

Where to get help

Headway is the brain injury charity, with a helpline, local groups and detailed guidance on communication and behaviour after injury. NHS neurorehabilitation and speech and language therapy are via the hospital team or GP; the RCSLT explains what a therapist does. Carers UK supports the people doing the caring.