Following a brain injury, some individuals will have difficulty understanding what is said to them. is has been described by patients as feeling as if they have woken up in a foreign country. They may be able to get the gist of what is said but suddenly interpreting precise messages is beyond them. Others will have difficulty remembering the names of things or people, even those of loved ones and close friends. Frequently, individuals will experience both challenges. 

Frustration builds 

This difficulty in understanding or finding words – known as ‘aphasia’ – is often mirrored in reading and writing. Whether communicating verbally, or via text message, email or letter, brain injuries can cause major challenges.

Everybody has difficulty on occasions remembering the name of an individual or expressing a view and we all find that frustrating.

Imagine the overwhelming frustration of not being able to understand or express oneself reasonably ALL of the time and thus it is easy to understand why so many people with this difficulty get frustrated and give up trying. 

Other problems mount 

Damage to the brain can cause other difficulties with communication alongside aphasia or separately.

For example, there may be a problem with controlling the muscles of speech resulting in voice and articulation being different to what it was previously.

It may be that it is hard for the person to make themselves understood because of imprecise articulation and slurring.

They may become unintelligible or their voice may be too quiet or loud. Unsurprisingly, this can, again, cause embarrassment and frustration.

This speech difficulty is often termed dysarthria. It requires great effort on the part of the person to produce speech as clearly as they would like and they may reduce their attempts to converse because of this effort. 

Personality perceptions change 
These difficulties in speaking can lead to family members feeling that the individual has had a change in personality – when this may not be the case.

If previously they had been quick at repartee, humorous responses or coming forward with their opinion, they may now have difficulty summoning up the energy, words or the control to do this.

Furthermore, frustration can result in outbursts of temper, particularly initially. 

Sticking points 

It is not uncommon following brain injury for an individual to get stuck on saying the same word or phrase when attempting to speak and this phrase will get in the way of what they are trying to say.

This is called perseveration. It is not only irritating to the listener but also to the individual. 

They may repeat a swear word, nonsense word or meaningless phrase. It is just hard to stop it popping out! It can be particularly di cult if the person perseverates on important words such as ‘yes’ because this could be interpreted as assent when the opposite may have been intended on occasions. 

Where to seek help? 

Speech and language therapists are familiar with the broad range of speech, language and communication difficulties associated with brain damage.

They will be able to assess and diagnose the features of an individual’s difficulties and develop strategies to assist them to communicate more effectively and to improve these features.

Sometimes, the use of technology, such as assistive communication devices, will help the individual get their message across and regain some control over their lives through communicating more effectively. 

No two cases are the same 
Every person who has a speech and language difficulty following trauma to the brain will be different. The nature and severity of the damage will result in different types and severities of difficulty along with retrained abilities.

These will be modified by their previous personality and personal characteristics. Additionally, it is important to remember that communication always takes two and thus the communication partners will need to learn different ways of supporting and encouraging conversation.

Cheat sheet: How to help people with communication problems after brain injury and stroke: 

  • Reduce distractions when having
a conversation to help the individual concentrate and focus.
  • Keep your voice at normal volume if the individual does not have a hearing problem.
  • Talk slightly slower if you find that this helps the individual understand more easily. But do not talk too slowly as this can be humiliating. Find the best speed
for that person.
  • Use gesture and facial expression
if you find this helps. For example, you may wish to point to the things you are talking about.
  • Encourage all e orts at speaking and/or communicating and focus on what is successful.
  • Check that you have understood what the individual is saying by rephrasing and asking whether you got it right.
  • If you can’t understand the
person don’t pretend to do so. Apologise for not understanding them and, if the situation does not improve with your guesses, then leave it and say you will come back to it later – but don’t forget to do so!
  • If the person can use gesture, writing, drawing or anything else which will help them get their message across, encourage them to do so.
  • Individuals with communication difficulties may sit back in a group. Encourage participation
particularly in anything that will
affect them directly.
  • Don’t ignore any efforts to speak.
  • With time you will modify your way of communicating with the individual who has a speech/ language problem and they will learn ways of getting their message across. Remember,
this process takes time!

Communications problems at a glance 


  • Loss of neuromuscular control of the structures involved in articulation results in speech slurring, or dysarthric speech.
  • Tone and quality are affected by damage to the tongue, lips, vocal cords and palate.
  • Articulation can be affected by stroke or brain injury.
  • Complete loss of speech due to impairment of neuromuscular control is known as anarthria.


  • Dysphasia – communication disorder as a result of
brain damage – can be broken down into problems with expression, comprehension, reading and writing.
  • It is caused by a lesion affecting the dominant
hemisphere in the parietal and temporal areas.
  • Receptive involvement suggests a more extensive lesion.
  • Global dysphasia suggests all aspects of language may
be impaired, with the patient limited to unintelligible grunting sounds.


  • Chronic neurological diseases such as MS or spinal
cord injury can lead to intercostal and diaphragmatic muscle weakness. These can impair breath control and therefore fluency.


  • Dysphonia refers to speech problems as a result of physical disorders of the mouth, tongue, throat or vocal chords.
  • Polyps (small growths), nodules and oedema (fluid build-up in tissue) in vocal cords can cause abnormal stresses and tension which result problems commonly experienced by singers