Redefining communication after brain injury: A “new normal”?

One of the major challenges that can accompany a brain injury like a stroke or TBI is difficulty with communication. The person affected often knows exactly what they want to say but has trouble getting the proper words and/or sounds out. Understandably, this change can create feelings of frustration and anxiety. 

However, there is good news for those looking to improve their communication skills! We often see some degree of spontaneous recovery of brain function after a stroke or brain injury, and the brain has amazing abilities to heal and compensate for damage over time. This means that some communication abilities may improve on their own, with speech-language therapy, and with consistent at-home practice. Further, just like your speech and language abilities can change over time, so can the way you communicate. With this in mind, it is important to remain patient, open-minded, and flexible to different communication approaches that may work for you. In fact, consider redefining what “normal” communication means.

Redefining “normal” communication

When it is still difficult to get the words out, remember that the main goal of communication is to get your message across. Fortunately, speaking is not the only way to do this. In fact, most people use a range of communication approaches every day—we talk, change our tone of voice, point, wave, and use facial expressions. Practicing with different communication tools and techniques can allow you to adapt and actively participate in conversations throughout different stages of your recovery. Consider some of the following options. While changing your means of communication can be frustrating, there are strategies and tools that you can put into action to overcome the communication challenges that may come after stroke or brain injury.

4 alternative communication strategies

• Writing. For some people, writing can be easier than speaking. When having a conversation, consider using a notebook, whiteboard, or phone to write down key letters, words, and phrases. Sometimes, this can provide your brain with enough information to help you say a specific word. However, if you still have trouble, this gives your conversation partner an additional way to understand what you are communicating to them.
• Drawing. Drawing images can help you portray and enhance the messages you are trying to express. This can range from simple drawings (e.g., stick figures, shapes) all the way to complex scenes and actions. You do not have to be an artist to benefit from this approach! There are specific therapeutic programs designed to help improve communicative drawing skills. Ask your speech-language pathologist for more information about using drawing as a communication tool.
• Augmentative and Alternative Communication Devices (AAC). There are a range of tools available that can either take the place of speech or serve as a backup when others cannot understand you. This can be in the form of communication boards with helpful symbols, speech-generating applications on mobile devices and tablets, devices dedicated to speech generation, and more. These options provide flexibility for those who cannot rely on speech, though they should not be viewed as a “last resort” for when therapy gains have plateaued. With the use of images, words, sounds, and videos, AAC can stimulate different parts of the brain in ways that actually improve spoken language ability.
• Other Non-Verbal Communication (gestures, signs, facial expression, intonation). Countless research studies show that nonverbal communication such as gestures, facial expressions, body language, and intonation impacts how others interpret the message we are expressing. Sometimes, this type of communication can replace speech (e.g., shaking your head for ‘no’), other times it can help support it (e.g., holding up an empty glass, or pointing to a pitcher of water when you would like a drink refill). While the use of nonverbal communication comes naturally to some people, others require more support. Fortunately, a range of evidence-based therapy techniques has been developed to facilitate effective nonverbal communication. Ask your speech-language pathologist for ways that they can help.

Being a flexible communicator can be the key to maintaining relationships and an active social life after a stroke or brain injury. Once you have found strategies and tools that work for you, it may be helpful to educate your loved ones on how they can best help you implement this new means of communication.  Check out our communication strategies handout to learn more!  For even more information, explore the resources below.

Additional Resources

• American Speech-Language-Hearing Association. Aphasia. https://www.asha.org/public/speech/disorders/Aphasia/
• American Speech-Language-Hearing Association. Information for AAC Users. https://www.asha.org/public/speech/disorders/information-for-aac-users/#finding
• Aphasia Communication Tips. (2019, October 30). National Aphasia Association. https://www.aphasia.org/aphasia-resources/communication-tips/
• Ford, M. (2019, April 28). Visual Art and Aphasia. National Aphasia Association. https://www.aphasia.org/stories/visual-art-and-aphasia/

Marissa Russell is a practicing speech-language pathologist clinical fellow serving English and Spanish-speaking patients at Northeast Rehabilitation Hospital. She is also a Clinical and Scientific Consultant for Constant Therapy Health, where she is involved in content development, advisement on product features, and other app-related clinical support.