Challenges with communication after TBI

“ [It was] horrible in hospital, I could not talk, it was hard to speak. I couldn’t count to 10, I didn’t have enough breath and my breathing would stop in the middle. [The staff asked] “What’s your name?” I couldn’t pronounce my own name. Give me pen and paper. Pen and paper helped. ”

Person with TBI

After a brain injury, many people wake up to find themselves having trouble communicating their thoughts, feelings and needs (24). It can be very scary and lonely losing your ability to communicate.

To communicate with other people, several skills are involved which use different areas of the brain (25), including:

  • Listening to others,
  • Reading written communication,
  • Taking in visual communication or cues (non-verbal),
  • Processing the information,
  • Remembering the right words,
  • Coordinating and controlling your facial muscles to make sounds.

Depending on which area of your brain is injured, you may have trouble with one or more of the following skills.

Understanding speech

There is so much information around you in the hospital. Many different people will come to speak to you. You might not be able to understand what is said to you. You may see mouths moving, but not make sense of what they are saying.

Sometimes people with TBI who have spoken multiple languages before injury, might find they can only understand one language after injury (25).

Understanding written words

You may find that reading and comprehending written words might be difficult too. Words you previously could read and understand, may look like nonsense to you. Let staff know if you experience this. In this instance, it can be helpful to use pictures when communicating.

Finding the right words

“ I cannot explain myself sometimes … Just difficult for me to speak the words I’m used to speaking you know. Even with English, Afrikaans, it’s the same. ”

Person with TBI (26)

You might have trouble using the right words in sentences. Or sometimes, you might be using words in the wrong places in the sentences. You may also find that you can’t remember the names of objects you use frequently, and need to describe them to get your meaning across.

Sometimes reading and writing might be easier than talking. You might be able to write or type some words out to be understood. Using emojis and pictures to help with expression can also be helpful.

Finding the right sounds for words

Sometimes difficulties arise when you have the right words, in the right order but when you speak them out loud, they are jumbled up or you find yourself using the incorrect sound for the word. E.g.: caterpillar – taterpillar.

In some cases, you will be aware that there are errors in your speech. In some cases, you might not be aware of the difficulties and those around you will be aware.

Slurred speech

Sometimes you might know the right words and the right sounds of those words. However, your facial muscles cannot work properly together, and your speech sounds like you are slurring.

Other communication difficulties

  • You also might find it difficult to keep to a conversation topic (talking about one thing at a time),
  • Talking too much,
  • Understanding things literally,
  • not understanding humour,
  • Using inappropriate language with unfamiliar people (or saying the wrong thing to the wrong person),
  • Difficulties understanding when to start and stop speaking in a group conversation,
  • Taking time to respond to questions,
  • Emotional outbursts (suddenly cry or laugh uncontrollably) during conversations.

What should I do if I’m experiencing communication difficulties?

Not being able to understand others can be a very frustrating and emotional experience.

If you have trouble understanding what is said to you, try using non-verbal communication. For example, you can gesture STOP and shake your head to indicate that you do not understand. This will help staff to find different ways to communicate with you.

If you have trouble with your speech after injury, using communication devices can help you get your meaning across. Hospital staff might also suggest working with a healthcare professional called a Speech Pathologist to help you to understand your areas of difficulties, and to work with you to improve your communication skills. With ongoing practice and rehabilitation, many people with TBI are able to communicate meaningfully after injury.


  1. Finch E, Copley A, Cornwell P, Kelly C. Systematic review of behavioral interventions targeting social communication difficulties after traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 2016;97(8):1352-65.
  2. McDonald S, Code C, Togher L. Communication disorders following traumatic brain injury: Psychology press; 2016.
  3. Talbot KJ, Krüger E, Pillay BS. Experiences of acquired brain injury one-month post-discharge from acute hospitalisation. African journal of disability. 2023;12:1037.