Following Acquired Brain Injury (ABI), the person’s communication can be affected by the environments in which they live, socialise and work. These settings can be referred to as ‘communication environments’.
There can be significant psychosocial implications for the person and their family following ABI. Therefore, the consequences of brain injury may include significant changes to the communication environments in which the person can participate, resulting in reduced opportunities for communication. The person may no longer be able to participate in previously valued communicative experiences (e.g. with work colleagues, social events). Additionally, because of communicative and cognitive impairments, they may no longer be able to manage the communication demands presented by a range of environments (e.g. busy hospital ward, family gatherings).
The environments in which the person spends time can have either a positive or detrimental impact upon communication. It is helpful to be aware of the factors which can best facilitate effective communication within the person’s day-to-day environments and what may hinder communication.
Living at home or in a hospital/care setting following ABI may have a significant detrimental impact on the person’s ability and motivation to communicate if the person’s environment is:
- Busy, distracting and noisy.
- Confusing and disorientating for the person (especially if they are living in a new environment with care staff with whom they are unfamiliar).
- Frightening for the person.
- Lacking privacy and comfort.
- Supported by people who do not have sufficient information about the person’s communication abilities and how to facilitate communication.
Providing an environment which is supportive of communication will facilitate the person with ABI to participate in communication and enjoy opportunities for social interaction.
The person with brain injury may enjoy the social benefits provided by interaction with others who also have ABI. The person may find this a fun, relaxing, supportive and understanding communicative environment. However, for some people with ABI, sharing an environment (their place of residence, social events etc) with other people who may be significantly communicatively and cognitively impaired can sometimes present significant challenges:
- Those with brain injury who have to share accommodation and social environments (ward, care home, group setting) may lack awareness of each other’s difficulties with communication and cognition. They may be unable to:
- Understand each others’ communication and why other people’s communication may be different or difficult to understand.
- Provide each other with the necessary time and support required for successful communication.
- Tolerate each others’ interpersonal interactions, especially if behavioural difficulties are prominent.
- It may be confusing, distressing and anxiety provoking to share an environment with others who may be noisy, confused and/or behave in an unpredictable, even aggressive manner at times. This may result in avoidance of opportunities to interact and socially withdrawal.
- A noisy and overwhelming communication environment, shared with other people who may behave in an unpredictable manner, can be a trigger for challenging behaviour.
Communication with family, friends and staff (who do not have communication/cognitive impairments) may be more successful, enjoyable and rewarding for the person with ABI. It may be easier for the person with ABI to interact with those who have no communication impairments, who behave in a consistent and predictable manner, who understand their difficulties and can support them appropriately.
Following brain injury the person may no longer have the communication opportunities previously presented by normal family, social, occupational/educational routines. They may have reduced:
- Opportunities to communicate about normal everyday things. The person with a brain injury may no longer regularly see family, friends and work colleagues etc to fulfil their normal social communication needs.
- Topics of conversation to communicate about. The person may no longer be able to engage in work, family events, holidays, day trips, social nights out etc. They may no longer be able to access a range of normal social and leisure opportunities. This results in significantly reduced life experiences about which to converse.
- Opportunities for normal levels of social interaction. The person may be dependent on support/care staff to fulfil their social communication needs. If living in an institutional setting (e.g. hospital, care home) the realities of life in such settings means that it can be difficult for busy staff to set aside the time to chat when they may have other responsibilities.
The person with significant communication problems following brain injury is likely to need more opportunities for supported interaction, rather than less. Impaired memory and other cognitive problems, communicative problems and elevated levels of anxiety/distress result in the need for the person to be provided with more opportunities for social interaction, orientation and reassurance. It is likely that the person’s changes in social, occupational, educational and/or living circumstances will reduce their opportunities for communication when they may actually require more.
The person with reduced ability to initiate interaction and self directed activity (arising from confusion and executive functioning impairment) results in an increased dependence on family/carers to provide opportunities for interaction and activity. If these opportunities are not facilitated, the person’s attempts to seek interaction may be perceived as demanding, attention seeking or challenging behaviour. Describing attempts to seek normal communicative opportunities as attention seeking is unhelpful. Family/carers should attempt to understand the reason for the person’s behaviour and provide the levels of support/interaction which the person needs. Reduced opportunities for interaction may have a detrimental impact upon the person’s mental wellbeing and behaviour, quality of life and interpersonal relationships.
Communication difficulties arising from the environments in which the person with brain injury spends their time can contribute to increased levels of fatigue, experience of overwhelm etc, which in turn may further exacerbate communication difficulties. Occasionally, the experience of social isolation and reduced opportunities to communicate may lead to challenging behaviour, especially if the person experiences significant levels of anxiety in the context of significant cognitive impairment.