POSITIVE COMMUNICATION
EXPERIENCES WITH PEOPLE
WITH TBI: A HOW-TO GUIDE
Lyn S. Turkstra, PhD, CCC-SLP, BC-ANCDS
Department of Communicative Disorders
University of Wisconsin-Madison
Overview
 Many individuals with TBI have cognitive
impairments that affect their ability to
communicate in work, social, and family life.
This webinar will present an overview of
communication challenges for adults with
traumatic brain injury (TBI), and offer
strategies and solutions to support effective
communication.
A caveat…
 The problems we will be discussing occur
mostly in individuals with moderate-tosevere injuries and those with milder injuries
who have persistent, measurable cognitive
impairments beyond distractibility and
mental fatigue
Communication Basics
Language
Thoughts
and
feelings
Hearing,
Listening,
Understanding
Speech,
Sign,
Gesture,
Writing,
Voice
Common Problems After TBI
Word-Finding
Problems,
Aphasia
Cognitive and
Emotional
Impairments
Hearing Loss,
Distractibility,
Impaired
Comprehension,
Slow Thinking
Dysarthria,
Dysphonia,
Weakness,
Incoordination
Common Cognitive Impairments
after TBI
 Memory
 Executive function
 Social Cognition
A Common Memory Profile
 Strengths:
 Simple short-term recall: Can repeat back
information immediately after hearing or reading
it
 Implicit memory: Memory for habits or skills
repeated over and over, without conscious
awareness of learning; and memory for emotional
associations – feelings about events and people,
even if the event is forgotten
A Common Memory Profile
 Limitations
 Working Memory: the “computational” aspect of
short-term memory, being able to manipulate
information mentally – e.g., to follow a command
that is out of order
 Transfer of new explicit information (facts and
events) to long-term storage
 Conscious recall of facts and events
Executive Functions
 EFs are the cognitive functions we use for
 Control of thoughts and feelings: starting,
stopping, and shifting thinking and behavior
 Having a sense of time: having a feeling of what
was yesterday vs. last year, sequencing
information, and being able to estimate time
 Abstract thinking: getting out of the moment to
see the big picture, understanding non-literal
language like sarcasm and humor, being
metacognitive (awareness – thinking about your
own thinking)
A Common EF Profile
 Impairments in self-control
 Lack of initiative (e.g., not enough talking) or disinhibition
(e.g., “unfiltered” language, tangents and extra
information), perseveration, lack of flexibility in solving
problems
 Impairments in time estimation and sequencing
 Poor time estimation for completing tasks (e.g., talking for
an hour and thinking it was 5 minutes), confusion about
what happened when, difficulty prioritizing tasks
 Impairments in abstract thinking
 Concrete thinking and lack of “in-the-moment” awareness
of limitations and their effects, impairments in
understanding nonliteral language, lack of transfer of new
learning to a different context
EFs are “Fatigable”
 Self-regulation fatigue is a common problem
in people with EF impairments
 Running out of “thinking energy” part-way
through the day
 Having more behavior problems when tired,
stressed, or multi-tasking
 Consider that we all have SR fatigue at one
time or another: what would it be like if you
already had SR impairments?
Social Cognition
 The cognitive functions we need to function
successfully in social interactions
 Includes Theory of Mind
 Understanding that others have thoughts
different from ours and that their thoughts
influence their behaviors
 Also includes emotion recognition
 “Reading” emotions from others’ facial expression
(affect) and voice
A Common Social Cognition
Profile
 Missing social cues such as disinterest or
discomfort of the conversation partner
 Family comments that the person is
“egocentric,” or “talking at them” vs. “to
them”
 Missing jokes, sarcasm, and implicature
 E.g., “This workplace has a dress code” = “You
should dress according to the workplace dress
code”
What can we do?
 Step #1:
 Understand the person’s strengths and limitations
 Step #2:
 Check the environment
 Step #3:
 Check yourself
Finally…
 Listen to the person with TBI: many people
will tell you exactly what their optimal
workplace communication conditions are if
you ask the right questions
Speaking of which…
 Questions?
Resources
 www.projectlearnet.org/
 A resource originally designed for teachers and
parents, with tutorials and guides for
understanding and addressing behavior problems
after TBI
 http://www.biaw.org/online-library.htm
 Wisconsin Department of Public Instruction
webcast series on Traumatic Brain Injury and
Challenging Behavior
 Beautiful Minds: Guiding Individuals with TBI in
Their Quest to Communicate Work and Learn