Cognitive communication difficulties
Communication is a complex process, which involves many aspects of thinking and social skills. If brain injury impairs any of these skills then it can affect the ability to communicate successfully. 'Cognitive communication difficulties' is the term most often used for the resulting problems.
The frontal lobes are particularly important for cognitive communication skills because of their role in the brain's 'executive functions', including planning, organisation, flexible thinking and social behaviour. However, many other parts of the brain interact to perform the skills and are also important, such as areas of the temporal and parietal lobes.
This type of communication difficulty reflects a range of potential cognitive changes, such as:
- Attention and concentration difficulties
- Memory problems
- Literal interpretation
- Reduced reasoning and problem-solving skills
- Cognitive fatigue
- Slowed speed of information processing
- Impaired social communication skills
- Reduced insight
Attention and concentration difficulties
Problems in this area can contribute to a range of communication difficulties. For example:
- The person may not be able to concentrate to watch a TV programme that they used to enjoy. They may begin to chat, thus affecting other people's enjoyment of the programme.
- They may have difficulty concentrating on conversations. This could cause them to end conversations abruptly or
avoid them altogether.
- Failure to pay attention can lead to the person missing important information. This can cause them to say inappropriate and embarrassing things. For example, you may have told them that a friend's pet has died but if they were unable to pay full attention, they might still ask the friend how their pet is.
- Dividing attention between two or more activities may be difficult. For example, the person may ignore what someone says when carrying out another activity at the same time. This may appear rude to people who do not understand.
A person with memory problems may find it hard to access information that they 'know'. This can affect skills such as word recall and remembering people's names, which are very important when communicating socially. The failure to remember names or faces at a party, or information relevant to a conversation, can cause embarrassment and can lead to people avoiding social situations altogether.
Damage to the right side of the brain may lead to the person interpreting verbal information very concretely and taking things literally. They may have a reduced ability to grasp humour or sarcasm and may miss the subtle nuances of conversation. This type of difficulty can result in the person taking things the wrong way. For example, a joking "What time do you call this to come home at night?!" could be taken seriously and lead to an argument.
Similarly, it can make it hard for the person to understand common expressions. For example, if you use an expression such as "I'll just be a minute" they may take it literally and get upset if you take longer than one minute.
Reduced reasoning and problem-solving skills
Altered problem-solving ability can result in the person being unable to use language to think through and resolve a problem (e.g. how to get home having missed the last bus). This can cause them to make poor judgments or decisions (e.g. setting out to walk home alone in the dark, rather than a wiser alternative such as ringing home for a lift).
Impaired reasoning and problem-solving skills can also lead to people experiencing difficulties in their conversational style. They may fail to understand the logic of someone's point of view, and be inflexible in their own opinions.
Cognitive fatigue is a common long-term consequence of brain injury. Once fatigued, the person will often manage less well with their cognitive communication skills. Attention and concentration will be reduced, they will be less able to think clearly and they may become irritable and agitated. Fatigue can also make other communication impairments worse, e.g. aphasia, dysarthria and dyspraxia of speech.
Slowed speed of information processing
This is again a common consequence of brain injury, and may mean that the person cannot keep up with a rapidly flowing conversation. Often the person will comment that this is most difficult in busy settings, or when talking with more than one person. This can result in them becoming 'overloaded' with information. They may then become overwhelmed and 'switch off', or get frustrated and angry.
Impaired social communication skills
Social communication difficulties are particularly associated with injury to the frontal lobes of the brain. Difficulties in this area can mean the person does not recognise everyday social cues, both verbal and non-verbal. For example, they may not realise that someone is uncomfortable with the topic of conversation or that they are in a hurry to leave.
There are a number of widely accepted 'norms' of social behaviour within any culture. Brain injury may affect a person's ability to recognise and adhere to these norms effectively. They may say the wrong thing at the wrong time and come across as rude or aggressive, e.g. saying "Look at her! Isn't that coat horrible!" in a loud voice on the bus.
Other potential problems with social communication may include:
- Altered turn-taking skills (e.g. the person either being overly talkative and 'hogging' the conversation or not realising that it is their turn to speak)
- Interrupting someone else because they are afraid that otherwise they will forget what they want to say
- Altered ability to talk around a shared topic (e.g. flitting from topic to topic, or having a reduced range of topics)
- Speaking only about themselves and fixating on certain subjects
- Talking in a sexually explicit way or swearing at inappropriate times
- Perseverating (getting stuck) on a favoured topic (e.g. wishing to leave hospital)
- Altered ability to give information in an orderly and organised way (e.g. assuming the other person shares knowledge about the topic when they don't, or vice versa)
- Not using or 'reading' non-verbal cues accurately, such as facial expressions and body language
The person may lack or have limited insight into any or all of these problems. They may believe they are acting 'normally' and exactly as they would have done before. This can be hard for those interacting with them. If the person lacks insight, it makes changing the problematic behaviours extremely difficult because it is hard for them to deal with a problem if they don't know there is one.