Communication difficulties following a brain injury can take many forms. But too often, when someone struggles to speak, find words or process language at the usual pace, the people around them – however well-meaning – begin to speak for them.
How do families, carers, therapists and lawyers make sure that what’s heard is truly the person’s own voice – not a well-intentioned interpretation, a filtered version, or someone else’s best guess at what they “probably mean”?
We asked our members: How do we ensure that the voice of someone with communication difficulties following a brain injury is truly heard, not interpreted, filtered or spoken for?
Here’s what they told us.
Steven Akerman, director, Brian Barr Solicitors
Ensuring the voice of someone with communication difficulties after a brain injury is truly heard starts with creating the right environment – one that is calm, supportive and free from pressure.
It is vital to give individuals the time they need to express their wishes in their own way, using appropriate communication and support where required.
At Brian Barr Solicitors we work closely with families, trusted friends and rehabilitation professionals which helps build understanding, confidence and trust.
Most importantly, the individual remains at the centre of every conversation, with their views listened to directly rather than interpreted or spoken for by others.
Askham Rehab MDT
Ensuring the voice of someone with communication difficulties following a brain injury is truly heard starts with recognising that communication is far more than spoken words.
We must assume competence, remain patient, and adapt our approach to the individual’s strengths. This may involve using facial expressions, gestures, body language, writing, pictures, communication aids, AAC technology, or simple yes/no responses.
Creating a calm, supportive environment, reducing distractions, allowing extra time to respond, and discussing one topic at a time can help individuals express themselves more effectively.
Importantly, we should never speak for someone or make assumptions about their wishes.
By actively listening, checking our understanding, and valuing every form of communication, we empower people to share their own views and ensure their voice remains at the centre of decision-making.
Katy James, lead speech and language therapist, Cognivate
Too often people with communication changes are excluded from having their say because others assume they can’t contribute, or they don’t know how to support the person to be involved. Everyone has a role in supporting communication so people can express their views. Communication is a shared responsibility.
First step – ask the person what they find helpful!
Then, good ‘communication habits’ we can all use include:
- Giving people time
- Using simple, everyday language, asking one question at a time.
- Checking the person has understood you, and that you’ve understood them.
- Use all forms of communication e.g. pictures, gestures, writing key words.
National Care Group is one of the UK’s leading adult social care providers. Joanne Colclough, Peripatetic Manager at National Care Group, said:
Understand the person’s cognitive impairment and adapt to their needs; it may take time due to attention and processing skills to ensure they are heard and don’t feel rushed.
Allow enough time for communication and avoid rushing. Be mindful of your body language, as it can cause the person to stop talking if they feel you’re not listening or interested.
Use clear words and avoid jargon. Check the person’s understanding by asking them to repeat what you said, and adapt your communication methods to meet their needs, such as using visual aids, written information, or assistive technology.
Encourage active participation in decisions that affect their life and respect their views, wishes, and preferences, even if you don’t agree.
Listen, ask open questions, and ensure it’s an environment where they feel relaxed.
Advocate, ensuring others recognise their right to be included, listened to, and valued at all times.
Stephanie Potts, clinical adviser and neuro physiotherapist, Lusio Rehab
This is a tricky question as I don’t know that we can ever be sure we have achieved this.
Our level of confidence is going to be related to the severity of the communication difficulty, the skills of the assistant (us) and the complexity of the topic being discussed.
Be resourceful – if the individual works with a speech therapist (chances are they do), make contact with the therapist and pick up helpful tips for your interactions.
For people with dysarthria, time and familiarity with the individual’s voice and personality are helpful. Not assuming you know what the individual is thinking is crucial.
Technology such as lightwriters can be valuable for people with weakness or inco-ordination of the muscles required for speech. Clarifying intent and details is important.
Leaving our ego to one side at the start of the conversation and being prepared to be on the wrong track is essential.
For people with aphasia and dyspraxia prompts such as pictures and question type choice can be helpful.
People communicate in a variety of ways other than verbally so providing a choice of activity/equipment/exercise to help people communicate through action and engagement is useful.
Ensuring we address the individual directly rather than the caregiver is obvious. Time, respect, flexibility, determination, focus and good humour are at the centre of all communication.
Anna Laws, speech and language therapist, Brainkind
At Brainkind we ensure that the ‘voice’ of someone with communication difficulties is heard by first completing in-depth assessment to understand the communication profile of the person we support.
We then adopt a person-centred approach to help them understand a topic area and use a range of resources to enable them to express themselves.
This may include the use of Talking Mats along with high- and low-tech alternative and augmentative communication aids.
The most important element is ensuring that service users can initiate sharing views in areas they want to discuss rather than a model whereby they are always responding to a specific topic raised.
This method of person led interviewing is achieved through customised communication methods, visual tools and adaptive pacing to let the person we support dictate the flow of conversation.
We must acknowledge that communication is much broader than speech.
Individuals can express their thoughts, feelings, preferences, and decisions through a variety of approaches including writing, gestures, facial expressions, communication aids, or technology.
By providing time, encouragement, and accessible communication support we can understand their message directly rather than relying on others to interpret or speak for them. Family members, carers, professionals and advocates should facilitate communication, not replace it, ensuring the individual’s own views, preferences, and decisions guide the conversation.
Caroline Hurst, senior associate lawyer, Court of Protection, Simpson Millar
Where our clients have communication difficulties following a brain injury, they must be given every opportunity to express their own views, rather than having others speak on their behalf.
This means making reasonable adjustments, including allowing extra time, using accessible communication methods and adapting our approach to meet individual needs.
While family members and professionals can provide valuable context, their views should not replace the person’s own wishes.
By listening carefully, checking understanding and recognising all forms of communication, we can ensure the person’s voice remains central to decisions affecting their life, rights and future.
Kian Shelley and Sally Myddelton-Jones, assistant psychologists, Tru Rehab
Ensuring the voice of a person with communication difficulties following brain injury is truly heard begins with recognising that communication difficulties do not equate to an inability to contribute.
Our role is to create conditions that enable the person’s voice to emerge, rather than speaking on their behalf.
This involves adapting communication by allowing time for processing and responses, understanding the individual’s cognitive profile, revisiting conversations where necessary, and accurately recording their views.
Regardless of capacity, the person’s wishes, feelings, and perspectives should remain central, with ongoing collaboration to ensure that their voice continues guiding decisions and care.
Justin Keenan, CEO and co-founder, Lusio Rehab
It starts with taking the time to understand the individual. Recognising that communication is not always about words. It requires patience, observation, trial and adjustment to find the approaches, tools, and environments that allow someone to express themselves.
With the best intentions, people can sometimes step in and unintentionally speak for someone rather than creating the space for their own voice to be heard. The goal should be to support communication, not replace it.
