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6 steps to improve the conversational skills of someone with a TBI


Brain injuries can cause a wide range of challenges, but one that is particularly detrimental to a survivor’s well-being is when communication is affected. I don’t just mean when speech and language skills are impaired, although these are important. I mean when the natural flow of conversation is impacted. This can include interrupting before another person has finished, not following the topic and missing the intended point, or even changing the subject, such as turning the discussion back to themselves and their injury too often. Each of these can be viewed as rude and can make others feel uncomfortable as the situation becomes awkward. Worse still, the other person(s) may lose patience and snap back at the brain injury survivor or avoid social settings with them in the future as they want to dodge further cringe-worthy exchanges.

It’s important that we all help them rebuild the delicate art of conversation

Just as by focusing on particular rehab exercises it’s possible to see improvements in a person’s ability to walk following an accident, it’s possible to relearn how to engage in conversation in a way that makes it easier and more satisfying for everyone involved. Anyone who has raised or worked with children will be able to relate to this. Think back to when they were young and how they would blurt out a thought the moment it popped into their head. It wouldn’t even have to relate to what was happening at the time; children get inspired and curious about things constantly. This could spark an idea or question off, and their impulsive nature can have them declare it in the most inconvenient circumstances. And whilst this can be a little wearing when it goes on for too long, you persevere with teaching them etiquette, like waiting their turn.

I’m not suggesting that a brain injury survivor should be treated like a child, but I am asking people to appreciate that if you give them time, they can get better. The hardest balance to strike is when you give them feedback about what they didn’t get quite right. I had one brain injury survivor come to me saying their family would often tell them to shut up and would disrespect them. This is very sad for everyone involved. I’m sure it comes from the frustration of feeling like the same faux pas keeps happening and that they are exhausted with feeling like they’re stuck in some kind of groundhog day. However, if they haven’t calmly explained to the survivor what they could do better, how are they to know what they did wrong?

How you can boost the conversational skills of the brain injury survivor in your life

  1. Give them eye contact – We are always so busy it’s not unusual for us to be doing chores whilst talking. But to make sure a person knows that we are addressing them, we need to look into their eyes, giving them our attention and making it clear that we need their attention too. This shows that you are interested in them and helps them see when it’s the right time to respond.
  2. Don’t interrupt – Lead by example, and make sure you don’t interrupt them, even if you need to correct a false memory that the brain injury survivor has. Let them finish first and then explain, “I think what xxx was trying to say was……” Otherwise, you are making it look like there is one rule for them, but everyone else can talk over them as much as they like.
  3. Don’t answer for them - If you always answer for them first, you run the risk of damaging their confidence to the point where they don’t feel like they can even try. But also remember that they are not a child, and you shouldn’t just assume you know best. Let them engage in the answer, and then you can help clarify if needed. This allows them to feel respected and supported.
  4. Hold back from immediately answering when they interrupt – Some brain injury survivors will interrupt because they fear they will lose the thought if they wait their turn. Try thanking them for their point, and tell them you’re just going to finish what you were saying and then you’ll come back to that. You are then offering to work as their bookmark and can remind them what they were saying when you are ready.
  5. Ask more questions – Sometimes, people go back to talking about a familiar subject because they don’t know what else to say. Brain injury survivors might feel like they don’t have anything interesting to talk about because they don’t go to work or see as many people anymore. They will have lots of thoughts about the injury and how it has changed their lives, and they might talk about it a lot. There’s nothing wrong with this, but if you are craving a new record for a change, use questions to engage them in the new subject. That way, you’re not just talking at them but drawing them into the conversation. For example, you might be talking about your favourite TV programme. Instead of saying, “Did you see the final of Line of Duty?” which can be answered with one word, yes or no, try, “What did you think of the final episode of Line of Duty?” They might not have seen it which, they’ll tell you, but you can still talk about where they have seen up to. They can recount their opinion, and you can bounce off each other, so you do not feel like you always have to lead the conversation.
  6. Make sure all guests adhere to the same rules – Remind people to be patient and use manners at all times. Naturally, everyone should do this anyway, but it’s worth gentling reminding them. In the world of answering work emails on mobile phones all times of day and night, manners have become diluted, and we don’t always notice how we could be being unintentionally rude and disrespectful. It’s important that no one, especially a brain injury survivor, feels undervalued. Plus, your guests may even thank you later for helping them relax properly for a change and for putting their phone away for a bit.

In time, as the art of conversation starts to return, so will their confidence. And confidence in conversations is a vital ingredient that can suddenly make even the shyest individual a wonderful dinner guest.

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