Social Communication after Brain Injury

What is social communication? How is it affected by a brain injury? What can people and their family, friends, and other communication partners do to help support social communication after brain injury? Keep reading this month’s blog post to find out. Or, if you’d rather listen to learn: I was recently invited back on the “Hope Survives: Brain Injury Podcast” to talk about social communication after brain injury with Cristabelle Braden. You can listen to the episode HERE or by clicking “Play” below:

What is social communication?

When I think about the term “social communication”, it sometimes seems redundant to me. If communication is the verbal and nonverbal ways that we express our ideas and feelings and understand others, when is it NOT social? 🤔

We use social communication skills throughout the day when we interact with family, with friends, at work, at school, or in the community. Written language often also falls under social communication: for instance, when we send an email or read a text message.

Social communication skills, often also referred to as social pragmatic skills, include:

Turn taking and length of turn
Topic maintenance and relevance
Body language (e.g., facial expression, eye contact, gesture, etc)
Intelligibility
Verbal organization
Cognitive-communication skills (e.g., attention, memory, executive function)

It’s important to remember that social communication implies that there are two or more people involved. Therefore, we must keep all communication partners, as well as the environment/context, in mind.

How might a brain injury impact social communication?

Because a brain injury can impact both verbal and nonverbal communication, it can have an effect on social communication in many, but not all, cases. Areas of difficulty might include:

Understanding, following, or remembering what others are saying
Organizing or clearly expressing their thoughts
Verbosity (talking too much)
Matching facial expression and body language to the situation
Understanding sarcasm or other indirect language
Appropriateness or politeness (e.g., lack of a “filter”, not thinking before they speak)
Repairing breakdowns in communication

These changes can impact personal relationships, as well as one’s ability to communicate at work or participate in school.

Tips for social communication after brain injury

Tips for Brain Injury Survivors

First, give yourself some grace. Recovering from a brain injury is no easy feat, and can take time. Find a trusted family member, friend, or other communication partner who can support you. Advocate for yourself – share your communication challenges with others, and let them know how they can support you. For example: “I might ask you to repeat what you said if I miss it the first time, or don’t quite understand what you mean.” or “If you notice I seem withdrawn when we’re with our friends, could you try to include me in the conversation?“. Maybe you even feel comfortable asking for feedback for how you did in a certain social situation. For example, “How do you think that went?” or “Did I stay on topic?” You may also want to consider working with a speech-language pathologist (SLP) in your area who specializes in neuro rehab to learn strategies to support social communication. An SLP may recommend individual and/or group therapy, incorporating specific strategies, role play, and/or video feedback to help you reach your goals. And finally, you may benefit from participating in a support group with other brain injury survivors.

Tips for Communication Partners

Because communication is inherently social, communication partners have an important role in brain injury rehabilitation. First, it is important to recognize that the person with a brain injury may or may not be aware that they are having communication breakdowns. Regardless of whether they are aware, it can feel awkward or uncomfortable to talk about social communication. However, with patience, compassion, and empathy, you will be an important resource and can help your partner have the most successful interactions. Ask what you can do (if anything) to help make communication easier. For instance, this might mean simply giving them extra processing time to formulate their thoughts, or asking follow up questions in a supportive way. And if your family member is participating in speech therapy, ask if they’d like you to join one of their sessions to learn about what they’re working on and how to best support them.

Tips for Speech-Language Pathologists (SLPs)

It is within our Scope of Practice to evaluate and treat people with social communication deficits after a brain injury. Be sure to consider contextual/environmental factors such as the person’s communication partners and the daily situations in which each person communicates. This means that we should not only provide individual and/or group speech therapy, but also provide training/consultation to our client’s communication partners. ASHA’s practice portal includes information about social communication, although this resource is not specifically about brain injury. My friend and colleague Danielle Hyde of NeuroConnections in Toronto shared some wonderful brain-injury specific resources that are worth checking out: the University of Sydney Acquired Brain Injury Communication Lab and the University of Kentucky Social Communication and Cognitive Abilities Laboratory led by Professor Peter Meulenbroek. SLPs: please feel free to comment below or email me at katherine@lotusslp.com if you have other helpful resources for SLPs related to social communication after brain injury!

Tips for Other Healthcare Providers

Please consider referring your patients with brain injury for a speech-language pathology evaluation. This is especially important if your patient reports changes in their communication or cognitive skills after their injury, or changes in relationships. SLPs are experts in communication and cognition, and will use formal and informal measures to assess social communication skills and the impact they might be having on your patient’s daily life. If appropriate, the SLP can provide skilled therapy to support your patient, which is usually covered by their health insurance. One resource to find an SLP in your area is to search the American Speech Language Hearing Association’s (ASHA) directory, and filter by “state” and “areas of expertise”.